The Veterinary Industrial Complex

[4X4Dodger]

My Big Dog Nigel became seriously ill recently and in the end and after more than 15 days of not eating and many vet visits to two different vets, multiple medications and innumerable tests (all inconclusive) I had to make the terrible decision to put him to sleep.

But in all that process some things struck me about Vet Care in today's world:

Veterinary Practices are far larger than ever before. Two of the vets we visited had 11 or more employees.

Veterinary Medicine is following Human medical services delivery in form and function. Putting you in small rooms waiting for the doctor, meanwhile a "Nurse" or Vets Asst comes to hear your story and enters it on a large patient computer program. If you are lucky you will get a few minutes with the doctor before he decides on 8 tests to be done.

In a study done by, I believe, Johns Hopkins the average Human patient gets to say seven words before being interrupted by the doctor...They concluded that this means that doctors really know very little about their patients before deciding on a battery of tests and possibly a prelim diagnosis that often turns out to be misguided.

I found the Vets practicing in much the same way.

Having a large building with 11 employees, debt servicing on all of that medical technology from Ultrasound to x ray machines, computers and testing equipment plus building overhead means by my calculations that vet needs to generate more than one million dollars a year in income...and probably closer to one and a half million to be able to make a decent return on his/her investment.

What does this mean for the dog or cat owner?

It means that vets, despite their protestations that they don't get involved in financial details, such as what certain things cost, know well that they must push testing of every conceivable type and sell lots of drugs to make that income level.

Think of what even middling salaries cost for 11 people...plus insurance, employer paid benefits, Workmens comp, and employers Social Security taxes.

My experience is that all of this growth in the size of vet practices isn't necessarily serving the best interests of the Pet or it's owner.

The BEST care my dog Nigel got was finally at a small vet practice with three employees, dedicated to the health and well being of the animals and not the necessity of generating 1.5 million dollars a year.

I think our Veterinary care is suffering due to this "industrialization"

Nigel was 11 years old and the consensus was he had cancer. But not a single test we were urged to have done not a single result aided in that diagnosis. Almost $1,000 dollars in vet bills later we were left with nothing.

I dont expect perfection or easy answers. I have had cancer myself so I know. But I do know that the system is out of whack.

[WandaLust2]

4X4Dodger wrote:


(Respectful brevity snip)

I dont expect perfection or easy answers. I have had cancer myself so I know. But I do know that the system is out of whack.

I know exactly what you're talking about. My vet was once like the 3 person operation you mentioned. His prices were also affordable for all but the poorest people. But then he went wild with expansion - a huge new Animal Hosp with all the goodies, then added a boarding facility plus grooming! He now has several times the number of employees and his prices go up constantly. CONSTANTLY! And they're all young graduates. They only stay a year or two and move on. So we're paying a premium price for inexperienced novices. His clients, both working and retired sure aren't getting raises as quickly. He is now only affordable to the upper income people of this county. And this in only 5 years. He does no charity work (low-cost) for Rescues or Fosters.

I wont go into the waste of money on tests they did on one of our cats that started using throw rugs or anything cloth she found on the floor to urinate on. Nothing they suggested worked - and they were evasive when asked for more information on the "bladder infection" evidence they found. They did run several tests and they were expensive. I don't like that they now take your pet in the "back room" and leave you standing there in the exam room staring at the wall. You have no clue what, if anything, they are actually doing in the back room. What did we pay all the money for? Months later, she is still doing it but we are not going to keep filling his coffers with one useless med and/or test after another. She has no bladder infection.

And vaccines! The veterinarians I worked for in NYC knew that yearly boosters are no more necessary for cats and dogs than they are for our children and ourselves. They were only recommended for show dogs and cats plus hunting dogs with high exposure to other animals. But they want you to bring them all in for these boosters anyway, plus the new money maker, the so-called "wellness exam" = to the tune of $75 or more per pet. I almost popped a button when I demanded I stay there and watch this exam. It was a joke. It took no more than 5 minutes and the cost was something like $40. Those of us not in the higher income bracket, the retired with more than one pet, simply cannot afford these prices and super-speedy "wellness exams." Where will this all end, with only the wealthy able to get care for their cats and dogs? That's the direction it's heading.

Price health Ins for your pets if you're a multi-pet household. Who can afford it? The prices keep going up as the vets raise their fees.

I understand they too have to make a living and have many expenses but they seem to be more and more out of wack with the cost of everything else.

I now take them to a vet in FL we found (we're snowbirds) who is a 4 person Animal Hosp. They don't take your pet in the back room. They don't sell you wellness-exams if the pet needs to be vaccinated. It's included in the visit. They don't have you spend 10+ minutes waiting in the exam room to see the vet after some tech comes in for the info. It's vet medicine as it was and should be and it's affordable.

[4X4Dodger]

Pawz4me wrote:

4X4Dodger wrote:

Secondly my main point about large vet practices and the amount of money they MUST bring in to pay the salaries, overhead, service debt et. al are real world and there is no denying that there HAS to be tremendous pressure to increase income at every opportunity to meet those costs, to say nothing of profit or a decent living for the Vet.

It depends on what the extra employees are doing. Are they really unneeded, a product of poor management? Then sure prices will have to be raised to meet the extra cost. Or are they productive employees who are bringing in money to the practice--are they groomers and boarding kennel attendants and things like that? If so they're making money for the clinic. In most clinics nowadays the vets aren't the only ones who generate income.

It really does not matter from a business standpoint if employees help bring in income. It is the Practice that the income belongs to. The VET still must meet the Salaries of ALL employees. And as any business person knows Labor is often the biggest expense of almost any type of business. Regardless of what the employees do the practice still must bring in a very considerable cash flow to keep the doors open. In the vet practices that I visited I'd bet my new truck that that figure is close to 1.5 million/year

Thats $125,000 PER MONTH and $4,166.66 EVERY SINGLE DAY OF THE YEAR.

You dont do that with boarding and grooming. The vast majority of that income MUST come from visits and tests and surgeries, selling drugs, expensive dog foods et al.

These are just the facts of what kind of cash flow you must have. You cannot convince me as a business man that the VET(s) don't feel a tremendous amount of pressure to meet those income goals every month.

And even IF you cut my estimate in HALF it is still a formidable amount to have to bring in.

[BCSnob]

We have a good friend who is a vet and certified chiro vet. I am amazed how many people want to get diagnostic advise for free or chiro diagnosis for free.

"Can you look at my pet and tell me what's wrong; it's not doing well"

It's probably no different for auto mechanics being asked to look at someone's car for free and tell the owner why it's not running right.

It's a two way street.

[Tvov]

I lean towards agreeing with 4x4Dodger and rockhillmanor.

I just deleted a long post about Vet costs these days. It is a tough thing. People today seem to want much more to do almost anything for their pets - which I can understand many times. From a cold, financial point of view it doesn't make sense, but people choose what they want to do, and pets so many times are a loved part of the family.

So Vet offices get bigger to handle all the work, they sell products directly to customers, they do more and more testing because many people insist on it.

I don't know what the answer is, except to become an informed customer, and if needed, stop the Vet from walking out of the room and talk with him/her about options.

[qtla9111]

Marketing and sales.

[rockhillmanor]

4X4Dodger wrote:
.....But in all that process some things struck me about Vet Care in today's world:

Veterinary Practices are far larger than ever before. Two of the vets we visited had 11 or more employees.

Veterinary Medicine is following Human medical services delivery in form and function. Putting you in small rooms waiting for the doctor, meanwhile a "Nurse" or Vets Asst comes to hear your story and enters it on a large patient computer program. If you are lucky you will get a few minutes with the doctor before he decides on 8 tests to be done.

What does this mean for the dog or cat owner?

My experience is that all of this growth in the size of vet practices isn't necessarily serving the best interests of the Pet or it's owner.

The BEST care my dog Nigel got was finally at a small vet practice with three employees, dedicated to the health and well being of the animals and not the necessity of generating 1.5 million dollars a year.

I think our Veterinary care is suffering due to this "industrialization" ....

Boy have you got that right. I have to TOTALLY agree with you.

When I went full time the HARDEST thing about it was leaving my local vet. 2 vets on staff and I had 110% of their attention when it came to caring and diagnosing my pets. If they did not have an answer they were immediately personally on the phone to the University asking for more information/ongoing studies etc to help my pet.

The vets LISTENED to me the owner, who is the only one that can speak on behalf of an ill pet. The vet tech did nothing more than take down a simple sentence of why I was there prior to the vet coming in.

Fast forward to where I have moved to.
Same scenario you speak of numerous vets in one clinic. You are herded like cattle to a waiting room. Only to be seen by a 'vet tech' who diagnoses your pet and they all seem to NOT want to listen to the owner. AND many times never seeing the same vet twice.

Vet techs who do NOT have any where's near the education a vet does, yet they are 'given the responsibility' of diagnosing your pet. The vet coming in at the last minute to ok any meds.

If it were not for the fact that I have been in dogs for a very long time and have been involved in many diseases, diagnosis and treatments and by osmosis know more than some vets, 2 of my dogs just this past year would have been unnecessarily euthanized at the vet I am using now.:(

I feel very sorry for the inexperienced pet owner who is left in the hands of the 'now' factory line vet clinics.

I am also shocked just how many of these clinics with multiple vets that the 'majority' of the vets are first year veterinarians! AND that the majority of the vets are NOT board certified. I'm guessing because they are less expensive to hire.

Not to knock a first year vet but if you have something wrong with your pet that is hard to diagnose, not common place, etc the first year vet is NOT going to be able to help you simply by not having the experience.

At my home vet their certificates were all posted on the wall in the office. I do NOT see this practice anymore, I thought it was required.

As a pet owner you NEED to ask these questions BEFORE you put your pets health in their hands. And don't be afraid to ask either.

How long have you been a vet?
Are you board certified.

[Pawz4me]

4X4Dodger wrote:

Secondly my main point about large vet practices and the amount of money they MUST bring in to pay the salaries, overhead, service debt et. al are real world and there is no denying that there HAS to be tremendous pressure to increase income at every opportunity to meet those costs, to say nothing of profit or a decent living for the Vet.

It depends on what the extra employees are doing. Are they really unneeded, a product of poor management? Then sure prices will have to be raised to meet the extra cost. Or are they productive employees who are bringing in money to the practice--are they groomers and boarding kennel attendants and things like that? If so they're making money for the clinic. In most clinics nowadays the vets aren't the only ones who generate income.

[ForestRiverTeac]

Dr. Doug, I appreciate your thoughtful words. Thanks for taking the time to share them.

I used a vet for many years that was small -- it still is a relatively small practice. What changed for me wasn't the care I received, but the way the office was run. For some reason the front office became impersonal and pretty unwilling to talk with me, especially when I was traveling & needed support. Used to be I could call, talk things through with some of the techs, and they would in turn talk with the vet and get back to me. That changed, and after close to 15 years I moved my pets to another practice.

Veterinary care is definitely an art. And I like being able to have a thoughtful dialogue with the vet when it comes to working out what's best for my pets. When a practice's front office prevents that from happening I feel like I have no other choice but to find a practice that will give me the kind of support I want.

Laura

[4X4Dodger]

dturm wrote:
I have avoided commenting on this topic. While I believe 4X$Dodger’s observations may be accurate, I don’t feel all of the conclusions are warranted.

It is true that with the technological improvements and increase in knowledge have changed the field of veterinary medicine. This offers a much wider understanding of animals and their diseases and so many more options to deal with them. This does come at a cost, but the benefits are real. To say that this is “harming pet care overall” just isn’t warranted.

Another aspect to what has happened may be a misconception that many have about medicine. There is a reason it’s call “the ART of medicine.” So many think all you have to do is run a test, take a blood sample, do a radiograph/mri/ultrasound and you have an answer. That’s just NOT the way it is. Diagnosis is hard and many conditions/diseases don’t follow the book or multiple diseases are present at the same time and complicates our job. It’s sad to admit how many times we guess about what’s going on – with some pretty good evidence and reasoning – but still a guess.

You can end up spending $$$$ and still not have an answer or the answer you want. This situation can result in frustration and anger aimed at your vet. This situation is more often unreasonable expectations compounded by poor communication.

I hope the profession has not gotten to the point where needless tests or procedures are done in the name of $$$ or CYA.

I know after running a 4-5 doctor practice with 15 employees, the decisions about equipment purchasing can be difficult. It has always been about patient care, not income generation. Business decisions were never about the equipment purchase then pushing utilization to justify cost. It's always about the need for utilization for patient care to justify the cost.

There is no doubt that veterinary care costs have risen. It is also true that there are some veterinarians who push the best care/technology/medicine available.

You always have a choice and I still believe that veterinary care in this country is a bargain.

Doug, DVM

I think that first off you must admit that as a Vet you come to this discussion with a built in bias. Regardless of your good intentions and however you may operate your practice you cannot extrapolate your actions to most or even many vets.

My Biological Father was a Doctor and head of a hospital, My nephew is a head and neck surgeon (Otolarangologist) My sister in Law has been an OR and ER nurse for her entire career. As a former Cancer patient with stage four Squamous cell carcinoma of the head and neck I am not naive about medicine or the challenges of Diagnosis OR the financial issues involved in private practice.

I do agree that medicine is partly an art and intuition and my point is that is exactly what is lacking at so many vets now.

And while the decision to purchase a particular piece of equipment may indeed pivot on a patient care analysis you still must be able to pay for that machine. Which means it MUST be used. It must carry it's own weight, financially speaking.

The vets that own their own businesses are essentially businessmen. You absolutely must make payroll and all the rest of the expenses and turn a profit if you are to survive. Now we all know that most Vets and Doctors try to keep out of money discussions with patients. This is simply smoke and mirrors. Of course you know what it all costs, otherwise you wouldnt be in business long.

I know it makes Vets and Doctors uncomfortable to talk about business and money but the reality is that it is part of what you must do.

As for poor communication and out of line expectations, I agree these can complicate things, however in my direct experience it is the Vets that are not listening or questioning nearly enough. Despite telling one Vet repeatedly that Nigel WANTED to eat But could not bring himself to do it, he continued to use the phrase in conversation and in writing that Nigel had no appetite. This was clearly not true. He did have an appetite and wanted to eat but no matter how he tried he just couldnt bring himself to do it. The second vet we went to got this point.

And lastly I am afraid that Vets have long since been ordering tests to up income AND to mitigate liability.

And no I did not have unreasonable expectations nor am I not able to communicate clearly and precisely with the Vet or any other doctor for that matter. But what I saw and experienced were real and when put together with many other Vet visits all across this country I can say with surety that in many cases Vet/Pet care in this country is needlessly expensive, (sometimes more than a human doctors visit)and less about what is actually needed for the patient than generating income to support overly large practices.

Happily the Vet that put Nigel out of his misery we found in a small town in Oregon. He was by far the most concerned, compassionate vet we had seen. He was a one man practice with about two or three employees. His goal was CLEARLY centered on Nigel and his well being.

Technology is a tool only a tool and it can often give misleading or outright false results. (my cancer was misdiagnosed twice) but too often it seems that it has become a crutch in diagnosis rather than one of many tools including intuition, experience and that elusive "ART" that also needs to be brought to bear in patient care.

[dturm]

I have avoided commenting on this topic. While I believe 4X$Dodger’s observations may be accurate, I don’t feel all of the conclusions are warranted.

It is true that with the technological improvements and increase in knowledge have changed the field of veterinary medicine. This offers a much wider understanding of animals and their diseases and so many more options to deal with them. This does come at a cost, but the benefits are real. To say that this is “harming pet care overall” just isn’t warranted.

Another aspect to what has happened may be a misconception that many have about medicine. There is a reason it’s call “the ART of medicine.” So many think all you have to do is run a test, take a blood sample, do a radiograph/mri/ultrasound and you have an answer. That’s just NOT the way it is. Diagnosis is hard and many conditions/diseases don’t follow the book or multiple diseases are present at the same time and complicates our job. It’s sad to admit how many times we guess about what’s going on – with some pretty good evidence and reasoning – but still a guess.

You can end up spending $$$$ and still not have an answer or the answer you want. This situation can result in frustration and anger aimed at your vet. This situation is more often unreasonable expectations compounded by poor communication.

I hope the profession has not gotten to the point where needless tests or procedures are done in the name of $$$ or CYA.

I know after running a 4-5 doctor practice with 15 employees, the decisions about equipment purchasing can be difficult. It has always been about patient care, not income generation. Business decisions were never about the equipment purchase then pushing utilization to justify cost. It's always about the need for utilization for patient care to justify the cost.

There is no doubt that veterinary care costs have risen. It is also true that there are some veterinarians who push the best care/technology/medicine available.

You always have a choice and I still believe that veterinary care in this country is a bargain.

Doug, DVM

[4X4Dodger]

Thanks to all who conveyed your condolences. Nigel was a great pooch who came as a a puppy from a shelter and he is sorely missed for sure.

[4X4Dodger]

Pawz4me wrote:
I'm sorry about Nigel.

But . . . your experience isn't universal, and thus your observations very likely aren't entirely accurate. The vet group I use employs way more than eleven people. And yet I've never felt rushed or pressured to have testing done until I had time to think it over.

Well to say that what I observe is not accurate may not be what you meant but I can assure you it is accurate. As someone who has owned and operated large and medium sized businesses and came from a family who did the same I can pretty much look at a business and tell you how much it's costing to run it. I also must point out that I didnt say or imply that it was universal. But it is a growing trend for sure already entrenched in many practices.

Secondly my main point about large vet practices and the amount of money they MUST bring in to pay the salaries, overhead, service debt et. al are real world and there is no denying that there HAS to be tremendous pressure to increase income at every opportunity to meet those costs, to say nothing of profit or a decent living for the Vet.

This is just plain business sense. And in my view this is raising vet costs out of all proportion to other costs and resulting in an overall skewing of what is truly important and harming pet care overall.

[Deb_and_Ed_M]

I agree with Colliehauler - I wish I could get medical care from people who are as caring as my Vet. And this past December, when Jimmy developed an allergy to flea bites and I had to find a Vet in Florida, I again found someone who was caring, and offered me several approaches to his treatment. But I guess I've been lucky that my dogs have not required more specialized treatment.

My sympathies on the loss of your Nigel (((HUG)))

[colliehauler]

Sorry about Nigel its hard losing a good friend.

My experience with my local vet could not be more different. Compared to human health care I consider my vet a bargain. Same with the vet I use at my seasonal site.

Now with that said when I took Collies to K-State cost were higher and not near as personal. I lost Bud this year to what the vet's and I thought was a brain tumor. To do a MRI at K-State to confirm was $2000. dollars which I opted not to do.

[Pawz4me]

I'm sorry about Nigel.

But . . . your experience isn't universal, and thus your observations very likely aren't entirely accurate. The vet group I use employs way more than eleven people. And yet I've never felt rushed or pressured to have testing done until I had time to think it over.