Oh, Cable Guy!

So, this isn't meant as a "poor me" post, or a husband bashing post, or anything other than a "take a minute and think about this" post. 

I'm a full-time small animal veterinarian. My husband works for a large cable company as an installer. We both work our butts off to be good at our jobs.  

I was paying bills the other day and realized: 

• I spent 4 years in graduate school to be able to do what I do. My husband was on the job trained. 
• I graduated with ~$115K in loans (all from grad school). My husband has none. 
• I paid for my school. My husband's company paid him to attend school. 
• I pay for my health insurance, have my own retirement plan since my clinic does not offer one, and get no money for continuing education, uniforms, dues for professional organizations, etc. My husband gets full medical, dental, vision, retirement plan, weekly paid training sessions, a work vehicle, and paid for uniform shirts. 
• I work, on average, about 60-65 hours per week. If there are emergencies, I have a patient in hospital that needs care, or we are busy, it's significantly more than that. My husband works about 50 hours a week. 
• I do not get any paid time off for sick days or vacation. He accrues paid time off every week, and is guaranteed sick days. 

So, all of this adds up to a significant difference in the bottom line, right?

Well, I suppose it does.....the past few months, he's made more than I do. 

In essence: with less training, less debt, fewer hours, better pay, and better benefits, it makes more sense for me to go work for a cable company than it does for me to a be a practicing doctor. Kinda makes me stop and think - next time I have a bright eyed young person look up at me and tell me they want to be a vet, too... It's sad.

"I've already spent SO MUCH MONEY..." - guest post

Today, a guest post from Emily, who writes:

I have been working in ER/Critical Care for more than 10 years.  And wow, today I read in the news that the owner/trainer of "Uggie" who was in Artist and Water For Elephants was suffering from some mysterious shaking disease and had spent thousands of dollars on trying to figure out what it was, I got a little miffed.  Now you might think that I would be happy that they were spending money on the dog that they earn money off of, but no.  Why does the amount spent have to be at the forefront of the conversation?  Do parents always preface their quest for diagnosis on a illness in a child with a dollar amount that they are spending after insurance?  No, not really!!!!
Does spending money on your pets make the owners saints?  Some owners think so, but really come on people.  Having a pet is a responsibility wether or not the pets are for companionship, breeding, show or other.  It is very frustrating to go into a room and the first words from the client are "I've already spent 200 dollars on Fluffy and I she is not better and I really do not want to spend much more."
Well, had the owner got their pet vaccinated appropriately, you would not be here with the dreaded Parvo virus!!!  Had the owner spayed or neutered their pet they would not be here with ulcerated mammary tumors, or a testicular torsion.  Had the owner properly provided flea, tick and heart worm preventative, they would not be here for flea anemia, immune mediated joint disease or right sided heart enlargement.  Had the owner actually paid for regular grooming, or bathed and brushed their pet regularly, they would not be here for skin laceration from trying to cut matts off their pet.
I have known clients to obtain a second mortgage to pay their vet bills. Their pets were family.  I have had clients call family and friends to collect money to treat appropriately.  It can be done!!!
So, when people brag on how much they have spent on their pets for sympathy or attention, I find it repulsive and insulting.  We are doctors, we studies hard, we love medicine and prefer treating those who do not have a voice!!  Veterinarians are here to provide a voice for the patients.
The owner/trainer of Uggie certainly have it in their budget for pet health insurance as well as most others. It saves in the long run just like it does in people.  Imagine if you had to pay for your annual physical exam and blood work, mammogram or colonoscopy, or any ER visit or UTI or sinus infection.
We are doctors and not taking advantage of people or their pets.  We want to practice excellent medicine and improve quality of life for pets.  It is not amount the money. 

I tend to agree - investing in preventive care up front can save a lot down the road. Too many owners are penny-wise and pound-foolish. But then, that's not a behavior limited to pet-owners. Emily, I feel your pain. I hope the economy turns around and fewer people are put into the position of making healthcare decisions with their wallets.

Family pets

It's funny. There's that saying, "Physician, heal thyself," yet, I'm sure most physicians agree that if there is anything seriously wrong, it's not a good idea to try to treat yourself. Similarly, it's generally considered unethical and inappropriate for physicians to treat family members for serious conditions. Percival's Medical Ethics (pub 1803) addresses the matter, proposing separation of personal and professional identities with respect to caring for family members. There are many reasons for this, loss of professional objectivity probably being the most important. So, anyway, what does this mean to me as a veterinarian? Well, there are no formal rules regarding treatment of one's own pets. It's not frowned upon by any professional societies that I know of. In the absence of a third-party payer system, in fact, most veterinarians I know do choose to either treat their own pets, or simply have an arrangement with a close colleague in their own practice in which they treat each other's pets. For me personally, it's a problem not so much with my own pets (whom I do have a colleague treat, because I find that my own loss of objectivity is so great as to interfere with providing quality care - my own pet once went apneic under my care, and while I did successfully resuscitate her, I will NEVER AGAIN put myself in that position!), as it is with family pets.

Ahhh, family. Gotta love'em, right? I am lucky enough to be surrounded by lots of loving family members, and honestly in the grand scheme of things, I have very few complaints about them. I would love to provide them all with free veterinary care, but - well - first of all, I'm not a practice-owner. There are limits to what I can give away. Information, sure. After all, information wants to be free. Medications, diagnostic tests, other sorts of things, well - those I can sometimes get at cost or cost plus something, sometimes I can't. And while some family members are really understanding about that, others I know think I'm just being mean. Sorry about that, guys. It's especially hard when I know certain family members simply don't have the money to provide the gold standard of care, as much as we would all love them to. On occasion, I've been lucky enough to have a local specialist colleague offer a family member of mine a professional discount. My profession is full of caring individuals like that, who will offer highest quality care at a deep discount, when THEY feel it is appropriate (not when Jane Random Client wants it, which is a whole separate issue). I hope that they can karmically balance out the scummy, corner-cutting Dr. Pols of the world. [And let me just take a moment here to go off on a tangent and add: Dr. Pol does NOT practice high-quality medicine. In one episode, he left a severely dehydrated puppy with hemorrhagic gastroenteritis alone in a cage dying, without even giving it any fluids. Seriously? he also doesn't seem to gown/glove up for surgery, or do any other 'standard of care' type things. OK, moving on...]

So anyway, all of this is really a lead-in to a story I wanted to tell. Details have been changed but the heart of the matter is completely true.


One day at 5 AM, my spouse's cell phone rings. It's a close relative on my spouse's side of the family. She found one of their cats on the floor near a "pool of dark liquid." The cat was "gasping" and when she touched it, "nothing happened." "What should we do?" she wanted to know.

It was one of those moments for me. I have them all the time. Moments when I feel like the person I'm talking to is going to be grossly unsatisfied with my response, no matter what my response is. Moments when I feel like no matter what I say, the person I'm talking to is going to come away with the idea that I'm an imposter, because surely a "real doctor" could do better than THAT.

I was in bed. It was 5 AM. The baby was nursing and I was just noticing that she was in fact running a fever again (the fever had not been present at bedtime). What was I supposed to do, get up and go over there and see that the cat was in fact agonal? Is this what they expected of me? I'd have no access to any diagnostic tools save my eyes, ears, and fingers; nor would I have what was probably the most important thing - Euthasol. Better to send them to a hospital. But which one? They won't go to the local university teaching hospital. They claim the vets there killed one of their cats. We always disagree on that, but it was a long time ago and besides, the cat is dead (ha ha)(sorry) so I can't suggest that. But the local ER sucks. The one my boss refers to - I wouldn't direct them to if they paid me. That leaves the one I almost went to work for, the one with the unreasonable non-compete clause in the contract. So I tell them:

It doesn't sound good. I can't tell what's going on, but you can't do anything at home to help him and you can't do anything at home to end his suffering. He needs to go to the hospital.

Later, I call my spouse to find out what happened. The vet said that the cat was agonal (duh) and she didn't know why. She offered supportive care and diagnostics, with the caveat that whatever they found was probably incurable, or humane euthanasia. The owner elected euthanasia, which is what I would have hoped for. But they declined a post-mortem exam, which was a total let-down for me.

We got together with this part of the family about a week after this event. They told me the whole story, in their own words. I'm sure they didn't mean to make me feel guilty, but when they said "since you couldn't come over, we went to that place you suggested," I heard "since you didn't love us enough to get out of bed, we went to that inconvenient and expensive place you suggested, which couldn't even help us anyway."

It's hard to be a veterinarian in an extended family of pet-owners, is the bottom line. Just wanted to put that out there. Thanks for listening.

It's dog-eat-dog.

Yesterday I sat on my ass. In the middle of the afternoon, got a call from someone we hadn't seen since 2006... cat vomiting for "last two or three months," now urinating on floor of kitchen. Time to put the cat to sleep.

Nope, hasn't been anywhere else. I told my OM "Well, at the very least I'll probably end up keeping it since it was a great cat, fixing it, and finding it a home."

"Oh, no you won't. She demands to be present. She wants to witness it when you kill it. She's calling around for prices and going to the cheapest one. I'm afraid she might call back."

So here I sit... no money. Shitbag wants to kill her nice cat that is, in all likelihood, treatable. For the past ten years I would have told her to get bent... but I was prepared to do a convenience euthanasia because it was the only way I could keep the lights on.

She never called back. There's competition for convenience euthanasias now.