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.

[DownTheAvenue]

I think Dr. Doug's perspective and 4x4Dodger's are interesting- one from the practitioner and one from the recipient. What is telling is the divide between the two and breaks down to this: are the decisions based on need or revenue. The recipient has walked away from an ongoing experience that did not end well with the feeling he received unneeded procedures just to generate revenue probably to pay for equipment used for those procedures. The practitioner asserts any decision about needed tests or procedures are solely for the benefit of the patient, not the practice.

I will tell one point that 4X4Dodger made that is almost universally false and that is many veterinarians perform tests to mitigate liability. In most states, a pet is considered personal property, and its emotional value is of no consequence. Therefore, a "wrongful death" of a 10 year old spayed or neutered mixed breed would be very little and liability would be determined how much a similar animal would cost in the "open market," or the cost to adopt such an animal at the local rescue groups or humane societies. Very little. You probably pay more for your automobile insurance than a vet pays for his malpractice insurance.

[WandaLust2]

rockhillmanor wrote:
Yes I hope Doc you don't personally take offense. Certainly not intended to offend.

I hope he don't take offense at what I post either.

IMHO it's NOT the majority of 'vets', it's the new 'trend' of corp owned veterinarian clinics that are cropping up all over that stock them chuck full of 1st year vets, vet techs treating pets and pet owners becoming nothing more than an assembly line of consumers.

This is how we feel about the place we've been going to the past 5 or 6 years. All recent grads and it is indeed like an assembly line. First you wait in the waiting room as long as 30 minutes with an appt. Why? because they OVERBOOK! Then it's off to the exam room. What's with sitting people in the exam room and having to explain what's going on to a tech? She's not treating the pet, a vet is - send a Vet in. Then the vet comes in after anywhere from 15 minutes to 20 minutes, barely talks to you and runs your pet into the backroom for another 10 minutes or more. Then he/she is back, has no interest in what you have to say, and tells you what tests are needed or meds or vaccinations or whatever....

Just like shopping malls and Wally world drove out the mom and pop stores IMHO, I think these new 'corporate owned' 'assembly line type' vet clinics just might be driving out the old time small personally owned vets offices. The local vet just can't compete with the corporation owned type vet clinics that have ample finances and that have a lower over head.

That may be regional. They are competing very well with the overpriced Corp owned assembly-line type Animal Hosps where I live and in FL.

AND they immediately shut down their emergency service also.
Leaving clients to have to go to one of those 24 hr ER Vet Clinics way across town in an emergency where it costs $800.00 to just walk in the door.Just try and find one of these corporate owned assembly line vet clinics that offers emergency service. Sadly you won't.

They will gouge you after hours. They're staffed with recent grads who are not being paid high-five figures to staff the place at night. So why the outrageous charges?

Now I'm looking for a new clinic too after having two of the new vets there working for the corporation, that suggested euthanasia for 2 different dogs I own simply because they were not capable of diagnosing the problem. Even after I told them what was wrong with each one. :R

Because they don't have the time to really LISTEN anymore. They overbook and so the new grads have to get through their appointments quickly. So many clients per day must be seen. If an emergency comes in it's a disaster for those with appts. (Been there - done that) You can leave and make another appt or sit and wait several hours. This I never understood since both places I worked in NYC had Vets who worked in the back doing the x-rays, surgeries etc. They handled the emergencies so the vets up front were not required to handle them, leaving their appts sitting for, in some cases, more than an hour, hour in the half.

[WandaLust2]

winnietrey wrote:
Yep, you nailed it Rockhill. To quote Oscar Wilde (people know the price of everything, and the value of nothing)
What that means to me is, when you find a good vet, chiro, md, dentist, mechanic, who ever. who gives you great service, but maybe charges a bit more, spend the little extra money. Send in your friends. Keep the guy in business. To much price shopping, not enough thought on value for money spent

I think you're using the wrong words "a bit more." No one minds spending "a bit more" for a vet they like, a good vet. The ones we're talking about charge a lot more! Sometimes almost double the price of another local Vet/Animal Hosp. We're talking about those pushing these "packages" someone else mentioned, pushing yearly vaccines, demanding blood work ($25+) for dogs on anti-heartworm meds year round, on and on.

No one would mind "a bit more." My vet's prices almost doubled on most things and more than doubled on others in only 5 years! This is why unless it's an emergency while we're here in TN for the summer we will not go there anymore.

Also, the vet in FL has been practicing for many years. The cats are examined in front of us, not whisked off to the backroom. The vets we get to see here in TN are recent graduates and we don't get to see the same one all the time. The turnover is large, even at the desk. Why pay top dollar for newbies? Top dollar because the owner is deeply in debt? I wish him luck with his business adventures but we're retired and can no longer afford his prices.

[WandaLust2]

qtla9111 wrote:


Old-fashioned doctoring practices still exist. Not everything has to be a mega-business.

Yes it does. They are out there. I found the FL vet by asking everyone I met in FL who they took their cats and dogs to, and about pricing, taking pets to the "back room" etc.

[xteacher]

I left my vet several years ago after the practice went corporate. They started pushing expensive care packages, most of which I wasn't interested in. They also replaced the front desk personnel, who then had no clue who I was EVERY time I went in. asking me what my name was EVERY time. The previous lady always greeted me with a smile, knew who I was, and knew my dog's name.

I changed to a much smaller practice a few years ago with a good vet, but now this practice is starting down the same path - so disheartening. I find myself fending off services/packages I know I don't need. At least the front office staff hasn't changed and knows who I am. The vet is still very caring and good, so I stay.

[winnietrey]

Yep, you nailed it Rockhill. To quote Oscar Wilde (people know the price of everything, and the value of nothing)
What that means to me is, when you find a good vet, chiro, md, dentist, mechanic, who ever. who gives you great service, but maybe charges a bit more, spend the little extra money. Send in your friends. Keep the guy in business. To much price shopping, not enough thought on value for money spent

[rockhillmanor]

Yes I hope Doc you don't personally take offense. Certainly not intended to offend.

IMHO it's NOT the majority of 'vets', it's the new 'trend' of corp owned veterinarian clinics that are cropping up all over that stock them chuck full of 1st year vets, vet techs treating pets and pet owners becoming nothing more than an assembly line of consumers.

THE HARDEST thing I had to do when I choose to go Full Time RV'ing was leaving my vet behind. IMHO 'THE' BEST in the whole wide world vet! :C

Yes he started out real small in a small town and over the years his business grew. I had friends from 150 miles away bring their pets out to his clinic to be diagnosed and treated. He was good and more importantly he really 'cared'.

No matter how big his clinic grew, the new building he had built, or how much more new equipment he purchased he NEVER lost the real reason he wanted to become a vet and his deep ingrained purpose of really wanting to help all animals.

Just like shopping malls and Wally world drove out the mom and pop stores IMHO, I think these new 'corporate owned' 'assembly line type' vet clinics just might be driving out the old time small personally owned vets offices. The local vet just can't compete with the corporation owned type vet clinics that have ample finances and that have a lower over head.

The vet I did find locally here that I liked just got bought out by a corporation last month. 😞

75% of the good vets working there left the following day refusing to go that route.

AND they immediately shut down their emergency service also.
Leaving clients to have to go to one of those 24 hr ER Vet Clinics way across town in an emergency where it costs $800.00 to just walk in the door.

Just try and find one of these corporate owned assembly line vet clinics that offers emergency service. Sadly you won't.

Now I'm looking for a new clinic too after having two of the new vets there working for the corporation, that suggested euthanasia for 2 different dogs I own simply because they were not capable of diagnosing the problem. Even after I told them what was wrong with each one. :R

[Deb_and_Ed_M]

BCSnob wrote:
These folks never think about the massive loans she needs to pay off which she took out in order to learn how to provide the free care they are wanting to receive.

As a kid, I wanted to be a Vet. As I grew older (and wiser) - I began to see just what a Vet DOES for a living, and the inherent risks. A former Vet of mine had his femur shattered by a horse's kick that put him out of commission for a long time. My small-animal Vet has been broken into several times, which has necessitated turning her facility into a Veterinary Ft Knox....

[4X4Dodger]

dturm wrote:

BCSnob wrote:
Our friend goes to homes and dog events to provide vet care in addition to working in a small clinic in a small town. She talks about some people (even those she knows personally) wanting/expecting free care both at dog events and in the clinic. These folks never think about the massive loans she needs to pay off which she took out in order to learn how to provide the free care they are wanting to receive.

I'm not saying there are not vets/vet clinics that are more about the money than the care. I'm saying that clients attitudes may have help create the attitude some vets/vet clinics take with their clients.

I know it's hard to cover the costs of animal care in many cases. The flip side is that if remuneration for the vet is not consistent with the years of education many of the most qualified will opt for other professions. This leaves the people selected for vet school picked from a much smaller pool, thus lessening the talent pool.

My comments were not so much disputing that vet medicine has changed, become more technical, equipment intensive. It undisputedly has.

I have issue with the assertion that the quality of animal care has diminished. If it has, it's not the knowledge base available or the testing or equipment that is utilized, or the cost. It's the way medicine is practiced. That is by no means universal in the profession.

I find the blanket assertion that vets routinely order needless tests or procedures in the name of money, offensive. In fact, rarely are new pieces of equipment purchased unless there is an underlying need to improve patient care AND it already makes sense financially. It doesn't make sense from a business standpoint to purchase an expensive piece of equipment in the hopes of pushing the use of it unnecessarily in hopes of making money. Doing that is just stupid.

Doug

Doug, I think with all due respect to you and your profession no one, including myself in this discussion has claimed any blanket assertion that all vets are operating the same.

What I am claiming is that when a vet practice becomes large there are undeniable financial pressures that must be acknowledged. Vets and Doctors don't like to think of themselves as businessmen, but the fact is...they are if they are in their own practice.

Further that this trend is not in the overall best interests of the animals or their owners. As costs rise, some vets are MORE expensive than a human GP charges for a visit, many people just cannot afford the cost of Vet care. For some people a visit to the vet may mean they don't get treated for something they might badly need treatment for. Or have to forego that treatment.

Vet costs, with it's technological intensiveness is inherently more expensive.

Lastly There is a book that I believe every medical professional should be required to read it is; THE LAWS OF MEDICINE by Siddartha Mukerjee. Dr. Mukerjee was educated at The University of Oxford and is the author of THE EMPEROR OF ALL MALADIES A Biography of Cancer which was the basis of the eponymous PBS series by Ken Burns. This book is about doctor patient interaction and how doctors at all levels know less and less about the people (and pets) that they are treating. It's a very good book and I highly recommend it. And if you get a chance also listen to Dr. Mukerjees TED Talks.

I am now 63 years old, I have had dogs the overwhelming majority of my life, I have been to countless vets all over America and in several other countries. One thing I have noticed is that nowhere is veterinary medicine practiced more like human medicine or more expensive than in the United States. And when I ask myself are we ACTUALLY getting BETTER care than those vets I have been to in places like Cambodia, Switzerland, England and several other countries where it is not the Big Business it is here, or as technologically intensive, my answer has to be a resounding no.

[winnietrey]

Perhaps these are just the rantings of an old guy. But I have been a Chiro for some 37 years, To me the world has changed. These youngsters coming out of school now, be a Chiro or vet. Would face some pretty stiff challenges in my opinion. Easy to have probably 150k in student loan debt, Another 100k to build out and equip a office (which probably way to low an estimate). Plus rent, Front desk people, and on and on.

They will have an overhead that would choke a horse right out of the gate. As a vet they have to compete against the big boys like Petco, and start from ground zero with no patients.

If you go to work for a big clinic, they are going to want to see production, they are going to want to make a profit on your work. otherwise why would they want another Doc.

So yeah, I think the world probably has changed. But in my experience what people want more than anything is your time. But that is hard to do if you have a big overhead to meet.

But I would say this, the vast majority of folks in health care be it human or animal, want to do the best they can for the patient. They don't like the assembly line thing anymore than the patients do.

I am fortunate, bldg. and equipment paid for long ago, wife runs the front desk. So we have the time, to take our time. Really don't want to see any more patients in a day. just want to take care of our people, spend some time with them and do the best we can. Some folks like that, others I think want the younger Doc's with the newer and fancier offices.

[dturm]

BCSnob wrote:
Our friend goes to homes and dog events to provide vet care in addition to working in a small clinic in a small town. She talks about some people (even those she knows personally) wanting/expecting free care both at dog events and in the clinic. These folks never think about the massive loans she needs to pay off which she took out in order to learn how to provide the free care they are wanting to receive.

I'm not saying there are not vets/vet clinics that are more about the money than the care. I'm saying that clients attitudes may have help create the attitude some vets/vet clinics take with their clients.

I know it's hard to cover the costs of animal care in many cases. The flip side is that if remuneration for the vet is not consistent with the years of education many of the most qualified will opt for other professions. This leaves the people selected for vet school picked from a much smaller pool, thus lessening the talent pool.

My comments were not so much disputing that vet medicine has changed, become more technical, equipment intensive. It undisputedly has.

I have issue with the assertion that the quality of animal care has diminished. If it has, it's not the knowledge base available or the testing or equipment that is utilized, or the cost. It's the way medicine is practiced. That is by no means universal in the profession.

I find the blanket assertion that vets routinely order needless tests or procedures in the name of money, offensive. In fact, rarely are new pieces of equipment purchased unless there is an underlying need to improve patient care AND it already makes sense financially. It doesn't make sense from a business standpoint to purchase an expensive piece of equipment in the hopes of pushing the use of it unnecessarily in hopes of making money. Doing that is just stupid.

Doug

[BCSnob]

Our friend goes to homes and dog events to provide vet care in addition to working in a small clinic in a small town. She talks about some people (even those she knows personally) wanting/expecting free care both at dog events and in the clinic. These folks never think about the massive loans she needs to pay off which she took out in order to learn how to provide the free care they are wanting to receive.

I'm not saying there are not vets/vet clinics that are more about the money than the care. I'm saying that clients attitudes may have help create the attitude some vets/vet clinics take with their clients.

[Pawz4me]

qtla9111 wrote:

BCSnob wrote:
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.

I think that depends if the vet, like a doctor, is a family vet with a long term relationship with the patient.

Old-fashioned doctoring practices still exist. Not everything has to be a mega-business.

Yes. I've been with the owner vet of the group I use since I was 16 years old. I'm 53 now. He started out as a one-man show (not even a receptionist) in a single wide trailer that grew into a four vet practice in a large brick facility that also offers grooming and boarding and now has many employees (including three full time receptionists/front office staff). But I still get very personal attention. If I shopped around from vet to vet I wouldn't expect to get treated quite the same as I am where they know me so well. But over all those years and all the changes I can't say that the pricing has ever jumped more than the usual keeping-up-with-the-COL amounts.

[qtla9111]

BCSnob wrote:
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.

I think that depends if the vet, like a doctor, is a family vet with a long term relationship with the patient.

Old-fashioned doctoring practices still exist. Not everything has to be a mega-business.