You walked into my clinic - not an established client with a relationship - but someone who rarely sought any care at all for your pet. You told me your pet was "up to date" with vaccines but you couldn't provide any proof. (I have to take this information at face value even though it can potentially put my entire staff at risk)
You told my receptionist you could pay for the exam. We believed you. So I stopped what I was doing with my established, paying client and ran to your emergency. Just like I always do.
Your little dog was bitten by a bigger dog. And it was badly, badly injured. I informed you that its injuries were SO bad, that she needed to see a specialist or be euthanized. I would get her stabilized and then send you to the surgeon.
You immediately said you had no money for extensive treatment. Thank you for being honest. You asked me to just put her to sleep because you couldn't afford treatment. I thanked you again for not telling me I should treat for free and arguing with me.
But.
You lied when you said you could pay for the exam. Your truth was that you had a pack of cigarettes in your purse and a look of crystal meth on your face. I know that look. I see it a lot.
So I had to pay for the exam, the euthanasia of your badly injured pet and the cost of disposing of her body because you had no money. Zero. None. Because, yes, I do love animals. And I hate to see them suffer.
I don't fault you for not having any money.
But if you realized that this scenario plays out every single day in my practice, you'd realize how much money it costs me. Actually, though, you probably wouldn't. You have no idea and you don't get it. You've made personal choices that don't allow you to take care of your pet.
You expect someone else to do it for you. And I did, because I care more for your dog than you did. I could have said No and sent you to the shelter where they would have euthanized her for $25. You wouldn't have been with her, holding her while she went to sleep. You wouldn't have been able to sit in my exam room for an hour sobbing and grieving, making us all cry.
No, instead, I sucked it up like I always do and I did what I could. We humanely euthanized her and ended her suffering.
And you didn't pay me one dime. That bill for the disposal of the body will be here next week, and the staff who took care of her and eased her anxiety still got paid, and my good paying established client had to wait for a long time while I dealt with you.
I'm the one who didn't get paid. I incurred 100% of the costs.
So the next time someone tells me I'm greedy or that I charge too much or that I don't care about animals.... Screw you. You are misinformed, uneducated or downright ignorant.
This scenario plays out every day in every veterinary clinic in every state of this country. So articles like the one written below - are fantastic. Keep pissing us off by making one of the most humane, caring, underpaid professions in the country look bad. We are starting to congregate and realize that you are doing this to us and we are starting to fight back.
Wednesday, May 2, 2012
Monday, April 30, 2012
Corking Fee
Speaking of PETA....
Looks like we're not the only ones pondering PETA today! Check out this gem The Bloggess put up over the weekend. I can't agree with her characterization of PETA as "fine," but I sure can appreciate the humorous correspondence she shares in this post. Dr VBB [heart] The Bloggess!
Sunday, April 29, 2012
PETA drops a dooce.
I hate peta. I love animals, but PETA is over the top and would like to bomb innocents, including those animals caught in the research facilities. Fuck you PETA. I don't wear fur, but I do eat meat. Because the meat industry uses more of the carcass than the Native Americans did. Ride on an air plane? Like those breaks. Thank the bovines. And if you ride in a plane, you should wear leather and eat meat. And be ok with "cat gut suture" which is bovine tendon. So PETA, laid a big old dooce. Divorce your ideals, embrace treating other creatures with dignity.
The Loss of Dentistry
So I wrote that last post because of a scenario I experienced a few months ago....
Owner brings her dog in for a swelling under the eye. As soon as I look at the dog's mouth, I realize it's most likely a carnassial tooth root abscess. I discussed this with the owner, and also informed her that the rest of the dog's mouth is in really bad shape and he needs multiple tooth extractions. I also told her that the dog needs to have the mouth radiographed (xrays) because sometimes what we think is a simple abscess can actually be something a lot worse, like cancer. (two of my most recent carnassial tooth extractions actually ended up being sarcoma in the mouth, not just an abscessed tooth - had I not done xrays before pulling the teeth, we would not have known that)
Owner said this to me: "Oh no, I only brought him here for you to diagnose him. I'll be taking him to the low cost facility because they are soooo much cheaper than you. We will only come here for the real problems."
WTF?
I was flabbergasted, insulted and angry.
I told her the reason it was so cheap there was because I did such a better job than they do. It didn't matter. She just wanted "cheap." Okay, I get that. You have 3 kids and 5 dogs. Maybe you should look at that. However, I digress....
But let me do a comparison for the difference between what would occur at my place vs. what will occur at the low cost place.
The removal of a carnassial tooth involves splitting the tooth and pulling out 3 roots. It involves equipment that can cost $5000. We also do what's called a mucosal flap with the gum tissue so that we can then close the open socket/defect. The animal is much more comfortable after surgery and heals so much better. We also do nerve blocks so that when the pet wakes up, they aren't feeling the pain of that extraction.
We would take dental xrays of the mouth so that we can see the roots of the rest of the teeth, and make recommendations on what else might be abscessing and needing removal. We also look for things like... cancer.
All of our anesthesia patients, especially those having dental work, are intubated (have a breathing tube) and have an IV catheter in place and are on IV fluids. This is for safety and their comfort.
The only ones who do dentistry in my hospital are myself and my registered, licensed techs. And let me add - that is per my state's LAW. Unlicensed techs are NOT supposed to be doing dentals. Period.
Now let me tell you what will happen at the low cost place: they don't even have RVTs. They don't have dental xray. They do not intubate the dentals (there is no breathing tube inserted into the trachea) and they definitely do not place IV catheters or administer IV fluids. They yank teeth without splitting them, they do NOT do mucosal flapping and I'm pretty sure that local nerve blocks aren't even in their vocabulary. I can only imagine how many tooth roots are left in those sockets. How would they know? They don't use dental xray.
I know of a low cost vet who doesn't use a high speed drill. He used a pair of pliers to "break" a tooth so he could get it out. I wish I was making this up, but I am not.
That's not how I do things.
So what is this client getting? A very, very poor service, yet she thinks that I'm ripping her off because I charge more for what I do at my practice. Hmmpf.
She then had the nerve to ask me for an estimate, so she could compare it to the low cost place. I refused. I mean, why should I bother wasting my tech's time working up an estimate for this woman? I politely asked her to leave.
She deserves the medical care she gets. And when she does come back to me for something like... a major abdominal surgery, it's gonna cost twice as much because I now have to make up for the loss of my dentistry services - another bread and butter income - to the low cost facility.
It is a vicious cycle, American Public. Please hear our cries and believe us when we say we aren't doing it because we want to gouge you; most of us really do want to provide quality care. But if you can't support us on the little stuff, then don't expect us to be around when the big stuff comes up.
You will get what you pay for, in the end.
Owner brings her dog in for a swelling under the eye. As soon as I look at the dog's mouth, I realize it's most likely a carnassial tooth root abscess. I discussed this with the owner, and also informed her that the rest of the dog's mouth is in really bad shape and he needs multiple tooth extractions. I also told her that the dog needs to have the mouth radiographed (xrays) because sometimes what we think is a simple abscess can actually be something a lot worse, like cancer. (two of my most recent carnassial tooth extractions actually ended up being sarcoma in the mouth, not just an abscessed tooth - had I not done xrays before pulling the teeth, we would not have known that)
Owner said this to me: "Oh no, I only brought him here for you to diagnose him. I'll be taking him to the low cost facility because they are soooo much cheaper than you. We will only come here for the real problems."
WTF?
I was flabbergasted, insulted and angry.
I told her the reason it was so cheap there was because I did such a better job than they do. It didn't matter. She just wanted "cheap." Okay, I get that. You have 3 kids and 5 dogs. Maybe you should look at that. However, I digress....
But let me do a comparison for the difference between what would occur at my place vs. what will occur at the low cost place.
The removal of a carnassial tooth involves splitting the tooth and pulling out 3 roots. It involves equipment that can cost $5000. We also do what's called a mucosal flap with the gum tissue so that we can then close the open socket/defect. The animal is much more comfortable after surgery and heals so much better. We also do nerve blocks so that when the pet wakes up, they aren't feeling the pain of that extraction.
We would take dental xrays of the mouth so that we can see the roots of the rest of the teeth, and make recommendations on what else might be abscessing and needing removal. We also look for things like... cancer.
All of our anesthesia patients, especially those having dental work, are intubated (have a breathing tube) and have an IV catheter in place and are on IV fluids. This is for safety and their comfort.
The only ones who do dentistry in my hospital are myself and my registered, licensed techs. And let me add - that is per my state's LAW. Unlicensed techs are NOT supposed to be doing dentals. Period.
Now let me tell you what will happen at the low cost place: they don't even have RVTs. They don't have dental xray. They do not intubate the dentals (there is no breathing tube inserted into the trachea) and they definitely do not place IV catheters or administer IV fluids. They yank teeth without splitting them, they do NOT do mucosal flapping and I'm pretty sure that local nerve blocks aren't even in their vocabulary. I can only imagine how many tooth roots are left in those sockets. How would they know? They don't use dental xray.
I know of a low cost vet who doesn't use a high speed drill. He used a pair of pliers to "break" a tooth so he could get it out. I wish I was making this up, but I am not.
That's not how I do things.
So what is this client getting? A very, very poor service, yet she thinks that I'm ripping her off because I charge more for what I do at my practice. Hmmpf.
She then had the nerve to ask me for an estimate, so she could compare it to the low cost place. I refused. I mean, why should I bother wasting my tech's time working up an estimate for this woman? I politely asked her to leave.
She deserves the medical care she gets. And when she does come back to me for something like... a major abdominal surgery, it's gonna cost twice as much because I now have to make up for the loss of my dentistry services - another bread and butter income - to the low cost facility.
It is a vicious cycle, American Public. Please hear our cries and believe us when we say we aren't doing it because we want to gouge you; most of us really do want to provide quality care. But if you can't support us on the little stuff, then don't expect us to be around when the big stuff comes up.
You will get what you pay for, in the end.
We Are Small Business
I know this topic has been mentioned before, but I feel so strongly about it and I am so worried about it, that I think it deserves yet another post.
The majority of veterinary practices are privately owned entities and are considered "small businesses". We are some of the remaining few (sadly, few) professions who are still dominated by the small business model. Yes it is changing - corporations like VCA, Banfield, etc. are moving in and trying to buy us up and take over. There is talk about forcing the small guys out of circulation and moving towards a model more like human medicine, where there are small satellite clinics where you go to get your wellness done, but you have to go to the bigger central hospital if you need more in-depth care. The satellite clinics won't have the equipment, staff or abilities to handle things that we do now.
This means you can't get your bloodwork, xrays or other tests done immediately (one of those things people love about vet med) because it wouldn't be done at a satellite clinic. It would be more like a human model, which to me means "pain in the ass" model.
In a lot of ways, it makes business sense. Owning (and yes I am an owner) a veterinary hospital is becoming less and less worth it on many levels. Our "rewards" for owning are diminishing at a rapid rate - and by "rewards" I don't really mean fancy things; I mean things like... taking home a salary and funding my retirement. When simply earning a living becomes so difficult that it's no longer worth it, well, you'll start to see the disappearance of the small mom-and-pop veterinary clinics, just like you are seeing a loss of those types of businesses in other realms as well.
So what does this mean for the public and why am I writing this blog?
Let me put this into real, every day terms.
Small animal hospitals help fund their day to day operations through spays, neuters, vaccines, and in some cases, the sale of medications and supplies for pets. Things like, Frontline Plus, dewormers, heartworm preventatives, etc.
Selling these things - what some call "the bread and butter" of a practice, helps us keep other costs down so that people can still afford things like dentistry for their pets, or when their dog eats rocks, we can do an abdominal exploratory surgery without bankrupting our client.
But what is happening? Well, many of our "bread and butter" sales are disappearing. To non-profits who now do spays and neuters for so cheap (because they get donations and tax breaks that we private businesses DO NOT GET) that we can't compete, so we've lost that business. To low cost, high volume places that do shoddy work and basically lie to the public about the quality of care their pets receive. Products like Frontline Plus and others, have either gone over-the-counter (sold by Target, Wal-Mart, PetSmart, etc) And now, Big Box Pharmacies are going to start selling veterinary drugs, which will take yet another bite out of income for these small clinics who are merely trying to survive to begin with. I am writing more and more prescriptions for clients who can get their Rimadyl or Clavamox at a regular ol' human pharmacy now, for cheaper than I can sell it to them. I don't blame them, they need to save money. But it's a loss of income for my hospital, which translates to making it harder and harder to pay MY bills, pay MY payroll, and simply keep my doors open.
And it makes those emergency situations when your goofy lab ate a rock and I have to perform an abdominal surgery to remove it - all that much more expensive. Because I've lost other income that would normally cushion the costs of a surgery like that.
Now, let me say that I get it. I get that people want and need cheaper alternatives. I get that vet care can be expensive and I get that sometimes it's all you can do just to pay for vaccines. People do need alternatives.
Unfortunately, though, what they are doing to themselves is.... shooting themselves in the foot. Veterinary practices are actually bankrupting at an alarming rate, something that has NEVER happened in this history of this profession. We simply cannot compete any more with the loss of our "bread and butter" sales that subsidize the rest of the care we provide because, well, now we have to actually charge the actual amount it costs to provide real quality medical care. Without the "subsidy" of the income from the sales of products and medications and spays, neuters and vaccines.... well, when your pet really gets sick and needs major abdominal surgery, now we have to charge more for that to make up for the lost income.
Or we close our doors.
And that is what is happening. Slowly but surely, small practices are going out of business. The beloved model that evokes comments like, "Wow I sure wish you were MY doctor, because the care I get at my vet is SO much better than anything I can get in human medicine" is slowly but surely dying and becoming extinct.
So what am I asking of the public? Don't bitch and moan so much about the cost of things. Buy your drugs FROM YOUR VET, even if it costs $20 more. Price shop if you must, but if it's only a difference of $50, then go to your regular vet instead of the low cost place. Ask questions. Tour your vet's hospital. MAKE AN INFORMED DECISION.
Because the reality is that if you continue to go to low cost facilities for the "bread and butter" things, then when you really need good care, you won't get it... because you didn't support the real hospital and they went out of business.
But most of all, know that you are supporting A SMALL BUSINESS. Not just a vet. Not just a clinic. But A SMALL BUSINESS. America was built upon and sustains itself on small business. When the public insists on buying everything from Big Box stores or online for cheaper, they are hurting a small business, and ultimately, hurting themselves.
I don't expect this post to change anything. But I want to warn the American public that if they don't start supporting their veterinarians more, then the face of vet medicine is going to change rapidly and I suspect the American public isn't going to be very happy with what they get.
Shop local, stay local and spend your money at your vet even if it costs you a little more. Otherwise, don't complain down the road when we disappear. And yes, we are disappearing.
The majority of veterinary practices are privately owned entities and are considered "small businesses". We are some of the remaining few (sadly, few) professions who are still dominated by the small business model. Yes it is changing - corporations like VCA, Banfield, etc. are moving in and trying to buy us up and take over. There is talk about forcing the small guys out of circulation and moving towards a model more like human medicine, where there are small satellite clinics where you go to get your wellness done, but you have to go to the bigger central hospital if you need more in-depth care. The satellite clinics won't have the equipment, staff or abilities to handle things that we do now.
This means you can't get your bloodwork, xrays or other tests done immediately (one of those things people love about vet med) because it wouldn't be done at a satellite clinic. It would be more like a human model, which to me means "pain in the ass" model.
In a lot of ways, it makes business sense. Owning (and yes I am an owner) a veterinary hospital is becoming less and less worth it on many levels. Our "rewards" for owning are diminishing at a rapid rate - and by "rewards" I don't really mean fancy things; I mean things like... taking home a salary and funding my retirement. When simply earning a living becomes so difficult that it's no longer worth it, well, you'll start to see the disappearance of the small mom-and-pop veterinary clinics, just like you are seeing a loss of those types of businesses in other realms as well.
So what does this mean for the public and why am I writing this blog?
Let me put this into real, every day terms.
Small animal hospitals help fund their day to day operations through spays, neuters, vaccines, and in some cases, the sale of medications and supplies for pets. Things like, Frontline Plus, dewormers, heartworm preventatives, etc.
Selling these things - what some call "the bread and butter" of a practice, helps us keep other costs down so that people can still afford things like dentistry for their pets, or when their dog eats rocks, we can do an abdominal exploratory surgery without bankrupting our client.
But what is happening? Well, many of our "bread and butter" sales are disappearing. To non-profits who now do spays and neuters for so cheap (because they get donations and tax breaks that we private businesses DO NOT GET) that we can't compete, so we've lost that business. To low cost, high volume places that do shoddy work and basically lie to the public about the quality of care their pets receive. Products like Frontline Plus and others, have either gone over-the-counter (sold by Target, Wal-Mart, PetSmart, etc) And now, Big Box Pharmacies are going to start selling veterinary drugs, which will take yet another bite out of income for these small clinics who are merely trying to survive to begin with. I am writing more and more prescriptions for clients who can get their Rimadyl or Clavamox at a regular ol' human pharmacy now, for cheaper than I can sell it to them. I don't blame them, they need to save money. But it's a loss of income for my hospital, which translates to making it harder and harder to pay MY bills, pay MY payroll, and simply keep my doors open.
And it makes those emergency situations when your goofy lab ate a rock and I have to perform an abdominal surgery to remove it - all that much more expensive. Because I've lost other income that would normally cushion the costs of a surgery like that.
Now, let me say that I get it. I get that people want and need cheaper alternatives. I get that vet care can be expensive and I get that sometimes it's all you can do just to pay for vaccines. People do need alternatives.
Unfortunately, though, what they are doing to themselves is.... shooting themselves in the foot. Veterinary practices are actually bankrupting at an alarming rate, something that has NEVER happened in this history of this profession. We simply cannot compete any more with the loss of our "bread and butter" sales that subsidize the rest of the care we provide because, well, now we have to actually charge the actual amount it costs to provide real quality medical care. Without the "subsidy" of the income from the sales of products and medications and spays, neuters and vaccines.... well, when your pet really gets sick and needs major abdominal surgery, now we have to charge more for that to make up for the lost income.
Or we close our doors.
And that is what is happening. Slowly but surely, small practices are going out of business. The beloved model that evokes comments like, "Wow I sure wish you were MY doctor, because the care I get at my vet is SO much better than anything I can get in human medicine" is slowly but surely dying and becoming extinct.
So what am I asking of the public? Don't bitch and moan so much about the cost of things. Buy your drugs FROM YOUR VET, even if it costs $20 more. Price shop if you must, but if it's only a difference of $50, then go to your regular vet instead of the low cost place. Ask questions. Tour your vet's hospital. MAKE AN INFORMED DECISION.
Because the reality is that if you continue to go to low cost facilities for the "bread and butter" things, then when you really need good care, you won't get it... because you didn't support the real hospital and they went out of business.
But most of all, know that you are supporting A SMALL BUSINESS. Not just a vet. Not just a clinic. But A SMALL BUSINESS. America was built upon and sustains itself on small business. When the public insists on buying everything from Big Box stores or online for cheaper, they are hurting a small business, and ultimately, hurting themselves.
I don't expect this post to change anything. But I want to warn the American public that if they don't start supporting their veterinarians more, then the face of vet medicine is going to change rapidly and I suspect the American public isn't going to be very happy with what they get.
Shop local, stay local and spend your money at your vet even if it costs you a little more. Otherwise, don't complain down the road when we disappear. And yes, we are disappearing.
Thursday, April 26, 2012
Spring, death, and no vet med
Every time of year, I find myself in an incredible depression. Spring should be a happy time, full of parvo puppies, unwanted litters of kittens dumped on your door step, and equine dystocias. The night before last, I had a dream about a spring festival that my high school has every year. Since 1904, my school has had a May Day festival. The sophomores pray for fertility by dancing around a may pole (why the FUCK does the school want the sophomores to be fertile anyway???) and the seniors wear ball gowns and are presented to society. Yes, it was a girls' school, though the thought of 18 year old boys in ball gowns makes me laugh.
I started the school as a sophomore, meaning that I was on tap to practice the fertility rite of dancing around the may pole (the obligatory orgy usually associated with this type of festival is frowned upon by the school and the parents). Well, back to the dream. I dreamed about the very sweet girl that was the May Queen in our senior class. She was dressed in a t-shirt and jeans and this year's seniors were insisting that she could not participate without the ball gown. I was arguing that of course she could, she was Mary Smith. Unlike many schools whose elected fall queens, prom queens, etc, our class chose someone that was unfailingly sweet rather than the obligatory cheer leader. Oddly enough, at an all girls' school, there was a distinct lack of the "mean girls" phenomenon.
Well, back to the dream. It turns out that yesterday was indeed the May Day celebration at the school. It also coincided with the 20th anniversary of the sudden death of my father. My father was on his way back from a golf tournament. His plane hit a sudden snow storm in the mountains of North Carolina. It was missing for several days before it was finally found. While some people held out hope that he and the pilot would be found alive, I was pretty sure that it was not going to end happily.
The last time I saw my dad, I was a spoiled 16 year old. I passed him on the road, him in his work truck and me in my car. I honked and waved and sped up because I didn't want him to give me flack about going out with my friends that day. I purposely avoided him.
The next day, while he was playing in the golf tournament, I was very distraught. I told my mother that something huge was about to change. I asked her, "What if I told you that tomorrow, the most important thing in your life would be gone? What would you do? Everything is about to change."
That night, my dad was not back on time. About 4 AM in the morning, I heard my mother scream and start wailing. She had learned that the plane had gone down. For several days, they searched for the plane. During this time, I continued to go to school and practice the may day dance. The plane was found and both my dad and the pilot were dead. A family friend went to ID the bodies so we didn't have to. But after practically predicting the event, my family looked at me differently.
So yesterday was the 20th anniversary and my subconscious knew it. The only good thing that really came out of that situation was that my inheritance allowed me to finally buy a horse. And that horse was a better incentive for good grades than any other possession. That horse got me into a college with a riding scholarship. And that school got me into vet school. My dad always wanted me to be a brain surgeon. And while I have poked on some brains when examining a skull fracture, I am not a neurosurgeon.
Sorry for the downer post. And sorry for the minimal tie in to veterinary medicine. But I am just writing about what is going on in my life.
I started the school as a sophomore, meaning that I was on tap to practice the fertility rite of dancing around the may pole (the obligatory orgy usually associated with this type of festival is frowned upon by the school and the parents). Well, back to the dream. I dreamed about the very sweet girl that was the May Queen in our senior class. She was dressed in a t-shirt and jeans and this year's seniors were insisting that she could not participate without the ball gown. I was arguing that of course she could, she was Mary Smith. Unlike many schools whose elected fall queens, prom queens, etc, our class chose someone that was unfailingly sweet rather than the obligatory cheer leader. Oddly enough, at an all girls' school, there was a distinct lack of the "mean girls" phenomenon.
Well, back to the dream. It turns out that yesterday was indeed the May Day celebration at the school. It also coincided with the 20th anniversary of the sudden death of my father. My father was on his way back from a golf tournament. His plane hit a sudden snow storm in the mountains of North Carolina. It was missing for several days before it was finally found. While some people held out hope that he and the pilot would be found alive, I was pretty sure that it was not going to end happily.
The last time I saw my dad, I was a spoiled 16 year old. I passed him on the road, him in his work truck and me in my car. I honked and waved and sped up because I didn't want him to give me flack about going out with my friends that day. I purposely avoided him.
The next day, while he was playing in the golf tournament, I was very distraught. I told my mother that something huge was about to change. I asked her, "What if I told you that tomorrow, the most important thing in your life would be gone? What would you do? Everything is about to change."
That night, my dad was not back on time. About 4 AM in the morning, I heard my mother scream and start wailing. She had learned that the plane had gone down. For several days, they searched for the plane. During this time, I continued to go to school and practice the may day dance. The plane was found and both my dad and the pilot were dead. A family friend went to ID the bodies so we didn't have to. But after practically predicting the event, my family looked at me differently.
So yesterday was the 20th anniversary and my subconscious knew it. The only good thing that really came out of that situation was that my inheritance allowed me to finally buy a horse. And that horse was a better incentive for good grades than any other possession. That horse got me into a college with a riding scholarship. And that school got me into vet school. My dad always wanted me to be a brain surgeon. And while I have poked on some brains when examining a skull fracture, I am not a neurosurgeon.
Sorry for the downer post. And sorry for the minimal tie in to veterinary medicine. But I am just writing about what is going on in my life.
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