Friday, January 23, 2009

A Vet Writes About the Veterinary Business Model

Sara B., a veterinarian writes about the veterinary business model, and why she finally left the profession.



I am a consistent reader of your blog and I have a fondness for terriers having grown up with sundry specimens. I currently own some Russo-European Laiki, a breed of hunting spitz. These guys are a general-purpose hunting dog with equal enthusiasm for large and small game. They could be categorized as a bay-barker and they are closed mouth on trail. To date, the numbers in the US are quite low, and the breed is far from AKC ruination ;) Mine haven't had much opportunity to hunt since we moved to Alexandria, VA from WI, but we spend a great deal of time in the woods hiking and biking and as such, their exercise requirements are satisfied and they keep me well informed of local wildlife.

Another affliction is a terrible horse habit (just because one does not smoke or drink to excess, does not mean that one is free of vices). VA has proven to be a boon location for any equestrian if they can afford it, and most of us horse nuts find a way to incorporate it into the most meager of budgets. I was invited on a few foxhunts as a guest and it was spectacular. I mean really a gas! What could be better? Dogs hunting, riding cross country, spotting a fox, libations in flasks??? Oh, and by the way, the silly horse haircuts are necessary unless you want an overheated field hunter and to spend the entirety of the afternoon cooling him out. Those are called 'trace clips' and the horse just wears a blanket when he is stabled and pastured.

But, this email is not to extol the many virtues of the Russo-European Laika or foxhunting. Instead, I wanted to comment on the Veterinary Profession (cue foreboding music). I happen to be a veterinarian. (For many, my choice of profession seems puzzling given my thorough enjoyment of foxhunting or watching my dogs bay boars. But, they lack imagination.) Before you cease reading and deliver this directly to your trash barrel to avoid what you might think is surely criticism, I will tell you it is not. I don't disagree with your health care articles one bit.

But here's the thing: Because I didn't subscribe to the whole "make money, make money, make money" gig, I no longer work in private practice. About five years ago, I was a young enthusiastic new grad and I was looking forward to serving my patients and clients. Instead I was constantly reprimanded for not adhering to 'protocol'. I was chastised in front of the staff for scripting out medications to local human pharmacies where I knew my clients would get a financial break for drugs that were exactly the same as those on our shelves. I didn't always want to use the laser for surgeries. I told people to purchase bottles of goat Panacur at the local farm & barn store instead of selling them pricey Drontal Plus tablets. I didn't recommend the Lyme vaccine. I didn't vaccinate everyone every year for distemper. I will surely burn in hell for mentioning the use of ivermectin rather than selling boxes of HWP to my beagle & coonhound kennel clients. I constantly spent too much time talking with the clients in each appointment. I would "give away" recheck exams. I didn't really care what brand of food people fed their pets (Most of the time they were being fed too much anyway!) And, most egregiously, I was forever giving away nail trims. (Do you know, I was supposed to charge for nail trims even if the animal was under general anesthesia!?!?!?!) The baffling list goes on and on...Ironically I was never fired for these offenses - just lambasted by the clinic owner and practice manager until I quit of my own volition.

You see, I believed that a little good will would go a long way. I also viewed my job as one of education. My job was to educate the pet owner about problems I detected and present them with OPTIONS. My job was not to make them feel guilty about which option they selected. They might rightfully opt to do nothing! My job was not to threaten them or bully them into tests and procedures. What I did want, was compliance. If they were educated and understood what was wrong and what I was trying to accomplish with a particular diagnostic path or treatment regimen, compliance would be better.

I didn't care what people spent. Wouldn't hazard to guess anyway - any preconceived notions I had about pet owners were regularly refuted. If they wanted to dump $3500 diuresing an 18 year old cat with renal failure so they could have more time with her, that was their decision. If they said it was time for pink juice, that was fine too. I did strongly believe that each client deserved my time, and that $90 should buy them far more than a physical exam and a heartworm test (The 4DX test, you know, so we can be certain that a tick has been on the dog. Big surprise.) I wanted them to feel comfortable enough around me to inquire about giving slippery elm to a dog with megaesophagus, or admitting that they couldn't afford something. If I didn't know the intimate details of lagenidium off the top of my head, they knew I would do my homework and get some answers for them. I wasn't advocating lesser care...I was simply looking to save them some money WHERE I could.

The veterinary clinic is a terrible business model. Medicine and diagnostics have advanced, this is undeniable. On the positive side, disease detection is better, treatment is often instituted earlier, and many patients benefit and have improved quality of life. I am thrilled with recent advances and focus on pain management. But despite all this, the business model has not changed for decades. Veterinarians are still expected to be James Herriot. NOWHERE else in the health care industry can one go and get 'wellness' care, soft tissue surgery, orthopedic surgery, physical therapy, neurology, dentistry, radiology, oncology, and emergency services under the SAME roof. It is ridiculous and it becomes its own downfall. There is this belief that the clientele expect and demand the latest and greatest, that you are doing them a disservice if you don't have all the bells and whistles. But then when you get the bells and whistles you have to jack up costs to meet your absurd overhead demands. I find it loathsome.

I think most pet owners desire to be proactive about their pets' health and even do many things on their own such as you advocate. What they lack is a basic grasp of animal husbandry. Just as people are further and further removed from the food on their plates, they are removed from animal care basics. I grew up caring for horses, cattle and dogs in a rural community in Illinois. I was aware of normal behaviors, appetite, attitudes, feed intake, water consumption and stool characteristics. Body condition scoring was something that was done frequently and adjustments to rations were made accordingly. We had animals that lived long productive lives with few visits from the veterinarian. Now, taking a history is often (not always) like having a conversation with a wall. The owners aren't comfortable administering medications and treatments.

Though it is always easier to dwell on the cases that didn't go well versus the successes, the clients and patients are not what convinced me to leave. I found working with many of them rewarding. I liked seeing familiar faces (canine and human) come through the door. I didn't mind putting parts of my own paycheck towards clients' accounts. But I don't miss it enough to go back and I certainly don't have the capital to open my own practice.

If you echo these sentiments in your blog, kindly use my first name and last initial (Sarah B.)

Enjoy the inauguration tomorrow. Seems you are looking forward to it. Write back if the mood strikes you.

Until then, keep lookin' up! Here's my Laika bitch, Tuli, treeing squirrels.



Anyone else here think the veterinary profession lost a really good one?

And what does it say about that profession that such a vet decided to leave private practice rather than succumb to the notion that the economic bottom line was the only bottom line that mattered?

Could Sarah B. have stuck it out? Sure. You can walk 20 miles with a thorn in your foot too, if you really want to.

But life is supposed to be enjoyed, and a hostile work environment that is in conflict with your ethos and ethics is not a prescription for happiness. I get it. And I salute the tough choice made. But I am saddened that it was a choice that had to be made at all.

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