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No More Blaming and Shaming: What Vets & Pet Parents Need to Understand About Each Other

When it comes to dealing with the cost of veterinary care,  I really wish both vets and pet owners would stop blaming and shaming each other, and instead begin an open, respectful dialogue aimed at finding solutions.

snarling-shepherd

Let’s stop all the fighting! Image via Reader’s Digest

 

When a pet owner’s complaint made the Washington Post

Last year, a gentleman named Peter Fenton wrote an article in the Washington Post titled “Vets are too expensive, and it’s putting pets at risk.”  Mr. Fenton wrote the article after having his cat, Orangey, treated for injuries at an emergency vet clinic.  While Orangey’s injuries were minor and the treatment he received was limited to “essentials” (Mr. Fenton’s words), the cat’s 48 hour stay at the hospital resulted in a bill of $968.29.

Mr. Fenton, like many pet owners who have been in the same situation, was shocked by the cost.  He claims that this isn’t because he doesn’t know anything about the cost of caring for pets – he and his wife have had cats for years.  What took Mr. Fenton aback was how drastically the cost of veterinary care has risen in recent years.

If there is any pet owner out there who hasn’t noticed that, raise your hand.  Yep.  I don’t see any hands.

What Mr. Fenton then set out to do was share his experience, including his outrage over the cost of emergency veterinary care (well, actually, veterinary care in general.)  However, instead of writing a piece that called for an honest exploration of the issue, Mr. Fenton instead took the path of blaming. 

Maybe it’s just me, but blaming doesn’t ever seem to accomplish much, apart from inviting counterattacks (case in point: the current Presidential campaign.)  Blaming stirs up strong emotions and knee-jerk responses.  And that is exactly what Mr. Fenton’s article did.

Mr. Fenton did a little bit of research, and based on that, arrived at the conclusion that “vet incomes are a big part of the reason for the rising costs.”  It seems that Mr. Fenton cherry-picked some statistics and quotes to substantiate this claim, and it made a lot of vets mad.  Really mad.  Understandably mad.  (If you want specifics, just read the explosion of angry responses to his article.) 

Vets and income: Mr. Fenton connected the wrong dots

I’m not a vet, but I spend a lot of time working with vets, talking to them, listening to them, sharing friendships with them, and reading about current issues in veterinary medicine (not to mention having my animals cared for by vets.)  And I can flat-out tell you that rising vet costs have little to do with padding veterinarian’s wallets.  

It is the rare veterinarian who is earning money hand over fist.  These doctors didn’t get into veterinary medicine because they thought it would make them rich – they did it because they had a passion for science, and for helping animals.  In fact, they knew when they chose this profession that they weren’t going to be rolling in money.  Ever.

Young veterinarians come out of vet school with an enormous amount of debt  –  so much so that many of them accept that it will be many years before they can ever buy a house!  The average debt load for graduating vets can well exceed $150,000.  Compare this to the fact that veterinarians earn far less than other medical professionals with an equivalent level of education (physicians, dentists.)¹  The mean starting salary for veterinary graduates who accepted a full-time position was just over $67,000 in 2014.

But let’s get back to Mr. Fenton.  He asserts that veterinarians are charging pet owners out the wazoo for two major reasons: 1) to pay off their educational debt; and 2) to offset the inroads that online veterinary pharmacies and big box stores have made in taking revenue away from practices.  While these are two very valid concerns for today’s veterinarians, increases in veterinary costs can’t be attributed to these two factors alone. 

Let me throw out a much more common-sense reason for rising veterinary costs: significant technological advances in diagnostic and treatment options.

Expensive things are…well, expensive

Today’s pet owners have more choices than ever before when it comes to diagnosing and treating their furry companions’ ailments.  There are a number of medical interventions that have made the leap from human medicine to veterinary medicine.  I can name several that have become available in just the last decade or so (and this is by no means an exhaustive list:)

It seems obvious to me that advanced treatments would come with a hefty price tag –  that should be a no-brainer.  It’s also clear to me, as a dog and horse mom, that if there is a treatment out there that can save or improve the quality of my animal’s life, I am very likely going to want the option to choose that treatment. 

And therein lies the rub: wanting something, and being able to afford that something, are two totally different things.

That’s easier to swallow though, when we’re talking about, say, a luxury car.  Just because I want a fancy car, doesn’t mean I have the money to pay for it.  And if I were to spend my time casting aspersions on high-end auto dealerships for not making their cars available at a price I can afford, I’m pretty sure I’d get laughed right off the parking lot, as well as skewered on social media. 

And rightly so.  We Americans are very invested in our belief in the American Dream: in order to get what we want, we must be willing to work hard, make sacrifices, and be patient.  And we tend to get pretty irritated at those who think they deserve to get something for nothing. 

If you can’t afford a Mercedes, you probably shouldn’t have a pet.  Wait – what???

This philosophy seems to work pretty well when it comes to paying for material things, like cars and clothes.  But when it comes to paying for health care — for ourselves or our family members (which for most of us, includes our pets), things start to get a little fuzzy.  And it’s all because of that powerful emotion we call love.

To really get to the heart of this, let’s pretend for a moment that human medicine is like veterinary medicine (cue Twilight Zone theme music)...

Part One

 

So…let’s pretend that you are NOT one of the 2% of people out there who has insurance – instead you’re like the majority – uninsured. (I’m flipping the script here, so bear with me.  Only about 2% of pet parents have insurance on their pets.  See where I’m going with this?  If not, just hang on.) 

 

Let’s also pretend that you maintain an emergency savings account, but all the funds you had in it ($2000, nothing to sneeze at) were wiped out by the fact that the transmission in your car conked out last month.  Your emergency fund today equals ZERO.

 

Let’s also assume that you are married, with two average incomes.  Let’s say that you have a mortgage payment, two car payments, two children, one dog, and a host of other recurring expenses such as car insurance, a cable bill, utilities, groceries, gas, etc.  You and your spouse earn a decent living, and would be categorized as “middle class,” not “working poor.” 

 

Still, you are like many other families with a similar financial profile, and try as you might, you end up living paycheck to paycheck because there just never seems to be enough disposable cash left over after you’ve met all your monthly obligations (including setting aside dollars for that emergency fund that is now gone, thanks to your transmission dying.)

 

Finally, let’s say that a few years back during the Great Recession of 2007-2009, you were laid off from your job.  You were out of work for a while, and during that time — out of necessity — a lot of expenses got charged to your credit cards.  You got behind on some payments, but once you were working again, you brought your past due accounts current, and haven’t missed a payment since. 

 

But because you are still carrying balances on some of those cards, your debt-to-income ratio doesn’t look so good.  Not to mention those few late payments that were flagged and are now part of your credit report.  That dropped your credit score by more than 100 points, because just a single late payment can do that. And those late payments will continue to show up on your credit report for the next 7 to 10 years.  

 

Now — Heaven forbid this should happen to any of us — but imagine that this morning, a bright sunny Saturday, your child runs out into the street after a baseball, and gets hit by a car.  You frantically dial 911 and an ambulance rushes your injured child to the ER, where you immediately consent to whatever medical intervention is necessary to save his life. 

 

Now imagine that, throughout the course of the night, your child’s condition remains unstable, and additional procedures must be performed to ensure the optimal outcome – survival.  At each juncture, you are shown an estimate of the costs.  And each time, your eyes blur as you see the total costs rising astronomically. 

 

The fact that you’re going to have to pay for this flitters through your mind and then vanishes, because at this moment, your emotional – not rational –  brain is engaged.  Your sole, all-consuming concern right now is the well-being of your child.

 

Part Two

 

Fast forward to a happy outcome: your child survives his injuries, and is eventually deemed ready for discharge.  As you await discharge instructions, it comes time to pay your bill.

 

When you see the total amount due, you feel queasy and suddenly the room starts to spin.  You owe the hospital $100,000.  But you don’t have $100,000.  And you don’t have credit cards to charge to — because you’re still paying them off from when you were out of work.  Even if that weren’t the case, your measly credit limit of $3000 wouldn’t help, anyway.

 

The sympathetic patient care representative sees that you are distressed by the bill, and tells you not to worry – the hospital works with a third-party financing company that will allow you to make payments over time.  She tells you that she just needs you to complete a short application form, and that you will likely be approved for a payment plan within a few minutes. 

 

Relief washes over you with such force that you feel like your legs are going to buckle.

 

A few minutes later, the patient care representative returns with a look on her face that tells you something is wrong.  “I’m sorry,” she says, “but you weren’t approved for a payment plan.  As you know, you’re responsible for paying your entire balance in full at the time of your family member’s discharge.  Is there someone you can call, who can help you make this payment?”

 

Well, no, there isn’t.  There isn’t anyone in your extended family who can just cough up $100,000.  And most of your friends are in the same financial boat as you are — they don’t have a glut of extra cash available at a moment’s notice.  Not to mention the embarrassment you would feel, calling up a friend or family member, asking for money. 

 

There’s really only one option that’s feasible for you: making installment payments.  It might take you a loooong time to pay this bill off, but that doesn’t really matter to you – your child is going home with you all fixed up and in one piece, and if making payments is what you have to do, you will do it.  

 

Even if you temporarily have to work more hours or take on a second job, you’ll find a way to make this work.  You’ll find a way to make those payments.  After all, the medical team at the hospital saved your kid’s life.  

 

You explain all of this to the patient care representative, who listens with a sympathetic ear.  She seems truly distressed when she has to tell you that the hospital doesn’t make these sorts of payment arrangements.  They’re not able to provide billing services – they simply don’t have the administrative manpower to manage it. 

 

Besides, she tells you, since you weren’t approved for a payment plan through the third-party financing company the hospital uses, it means – and she says this as gently as possible – you’re a poor credit risk and unlikely to make your payments.  The hospital is, after all, a business.  If they gave a payment plan to everyone who needed it, she explains, they would have to close their doors, and then they wouldn’t be there to save children like yours.

 

You and the patient care representative stare at each other in silence. Neither one of you knows where to go from here.  You’re doing your best, she’s doing her best.  You want to pay your bill, and you know you can make those payments over time even if your credit report doesn’t look so great.  It’s not the whole story about you, even if the credit bureaus think it is.

 

You just don’t have all that money right now, today.  You need a way to pay.  The patient care rep wants you to pay your bill, too.  But she doesn’t have any other options to offer you either.  You’re both stuck.

 

Left with no alternatives, you only have two choices, and they’re equally horrendous and unimaginable:  1) Euthanize your child.  2) Turn him over to a shelter.

I can only guess at the number of times this kind of scenario plays out at veterinary hospitals – particularly emergency facilities.  I know it’s frequent – I’ve read more than my share of horror stories on this topic, written by both vets and pet owners.  Mostly, they just lash out at each other and call each other names.  Both sides want to deny that they play a role in perpetuating the problem. 

Sam the lampshade head after his vet visit

Sam, VetBilling Office Dog #1, wearing the Cone of Shame

Understanding the pet owner’s position: when $1000 might as well be $100,000

Vets, I have no doubt that you already understand that most pet parents are a lot like the human parent I described in the fable above.  They see their pets as children, and they love them as fiercely as they do their human kids.  When you complain about pet owners and tell them that they shouldn’t get upset because veterinary medicine is so much cheaper than human medicine — well, do you really expect them to do a happy dance because a $1000 veterinary surgery would cost ten times more if it were for a human?

That’s why the figure I used in my little story was $100,000.  It seems ridiculous, doesn’t it, to expect someone to be able to come up with $100,000 at the drop of a hat. 

But for many, many pet parents, there isn’t really any difference between $1000 and $100,000.  Their vet bill might as well be $100,000, because they just don’t have all that money available today.  You can tell pet owners what a bargain their vet bill is – compared to a human doctor bill – until the cows come home.  But they still won’t have any way to come up with $1000 all at once.

So – if you don’t want pet parents to apply the human medical payment model (where the only out-of-pocket cost might be an affordable co-pay) to veterinary medicine  — please don’t beat them over the head with the tired, old argument: “But it’s cheaper than human medicine!”  It doesn’t matter.  You’re taking pet owners right back to an erroneous comparison.  

For those with human health insurance, out-of-pocket costs for human health care are often less (yes, less) than out-of-pocket costs for surgical or emergency veterinary care.  So it doesn’t make sense to compare the two – it’s the old “apples and oranges” thing.  

And one more thing: the majority of pet parents don’t object to costs because they don’t want to pay you.  Really!  It’s mostly because they don’t have a feasible way to pay you, that you are willing accept.

Unless you’re Warren Buffet, stay away from having kids or pets – you can’t afford them

The other thing I often hear from frustrated vets is “having a pet is a luxury.  If you can’t afford to care for your pet, you shouldn’t have one!”  Well, I’ve addressed this in earlier blogs, but I don’t think it hurts to repeat myself on this.  That argument takes us down the proverbial slippery slope.  How many people can afford children, for the love of Pete?  I mean really, really afford them? 

Are we going to become a society that prohibits people from having pets (or children) based on their income, or their credit score?  Are we going to penalize parents – pet or human – for not being able to foresee every possible disaster that might befall them or their kids, or for not having the money set aside to pay for all of these possible disasters in advance?  

While it would be ideal for pet parents to have large lump sums of money readily available to pay for veterinary care, it is simply not realistic.  This isn’t the world we’re living in.  Especially in a post-recession economy that hasn’t made much more than a tepid recovery.

Pet insurance and back to Mr. Fenton – remember him?

Let me assure you that what I’m saying here is not intended to give pet parents a pass on educating themselves about the costs and responsibilities of pet ownership.  And here’s where I want them to pay close attention: 

Pet parents, emergencies can and do happen.  Don’t live in a bubble, thinking that your dog is never going to eat your trash and need an emergency surgery to extract chicken bones from his intestines.  Don’t think that your cat won’t get a urinary blockage, or will never get into a tussle with the neighbor’s dog (or cat or raccoon) because “he never goes outside anyway.” 

Indoor cats do get out.  The most conscientious dog moms forget to put the trash out (like me, and it cost $5000!  For more on that frightening adventure, read this blog post: How Our Easter Dinner Turned into $5000 of Veterinary Care.

Anything can happenAnything does happen. And when – not if –  it does, and your veterinarian saves your animal’s life, he or she deserves to be paid.  And you need to be able to afford it somehow.  So…

Please, please look into pet insurance.  Right now it’s really the only viable way to protect yourself from incurring a catastrophic financial injury along with your pet’s injury or illness.

There are many more options now than there used to be.  Many plans offer a fairly low monthly premium payment.  Ask your veterinarian – or anyone on their staff – who they use, and/or who they recommend.

[Having said this, I feel compelled to mention that I do think more pet insurance companies need to work on getting direct reimbursement to vets without a waiting period, though, because without this, pet owners still face the significant hardship of coming up with the total cost of vet care on the front end.  I know there are a few companies that are now starting to offer this service.  For a comprehensive overview of pet insurance plans, see Canine Journal’s “Pet Insurance Comparison 2016: Who’s Best?” or visit Pet Insurance University on the web.]

And back to Mr. Fenton.  Remember him, the Washington Post complainer, about 3000 words ago? I really wish he had used his experience to encourage an honest, open dialogue about veterinary costs, instead of making the chasm between vets and pet parents even bigger, by pointing the finger of blame at vets, yet at the same time telling his readers that pet insurance is “rarely worth the price.”

WRONG.  And if you don’t believe me, let me tell you how many times my schnauzers developed acute pancreatitis on a weekend, how much it cost, and how much easier it was to handle the cost thanks to pet insurance.

Can we just talk? I mean really talk?

There’s already more than enough misunderstanding to go around.  So let’s stop fighting over the cost of vet care, and instead start talking about ways to pragmatically deal with it. 

Both vets and pet owners have a role to play here.  I’m not saying it’s going to be easy, but this issue is not going to go away.  It can’t be wished away, it can’t be yelled away, and it can’t be dealt with by sticking our heads in the sand and resisting the current reality.

Ignoring the problem, or blaming and shaming others, doesn’t do anyone any good.  Least of all our precious pets. 

And please, remember that the biggest, most important thing vets and pet parents have in common is just that — our pets!  We both love them.  So let’s begin there. From a place of love and mutual respect. 

That’s the only way we will be able to solve this problem that hurts us both.  So let’s start talking.

Doggie Love

 

¹For comparison to veterinary salaries:  According to a 2010 survey by the American Dental Association, the average annual salary for dentists under age 35 was $178,470.  At that time, 54.8% of dentists reported that they worked between 30 and 39 hrs/wk.  Only 6% of respondents worked more than 50 hrs/wk.  By contrast, 1 in 3 (33%) vets work more than 50 hrs/wk, and this typically includes weekends and holidays.  I was unable to find more recent statistics on dental salaries and hours worked.

References:

Vets are too expensive, and it’s putting pets at risk: Costs have risen wildly in the last decade, and clinics are taking advantage of owners who can’t pay.  Fenton, Peter.  The Washington Post.

Really, Mr. Fenton? A response to Peter Fenton’s Washington Post article entitled “Vets are too expensive, and it’s putting pets at risk.” Brenegan, Heidi, MBA CVPM.  Animal Emergency and Referral Center of MN blog.

Rebuttal to Peter Fenton’s Washington Post article, “vets are too expensive and it’s putting pets at risk.” Magnifico, Krista, DVM.  April 30, 2015.  Diary of a Real-life Veterinarian Blog.

How veterinary medicine is like a T-bone steak.  Dicks, Mike PhD. DVM360 November 2014.

Making yourself scarce: how relative scarcity affects veterinary incomes.  Dicks, Mike PhD.  DVM360 April 2015.

Truth or trash: Examining debt-to-income ratios for new veterinarians.  Dicks, Mike PhD.  DVM360 February 2015.

¹American Dental Association Dental 2010 Survey of Dental Practice: Income from the private practice of dentistry.  ADA Survey Center.

Stem Cell Therapy Changed The Way I Practice Veterinary Medicine.  Miliaresis, Cristina.

Laser Therapy is Good Medicine.  Dr. Karen Becker.

Can pets receive or donate organs? Transplants are possible, but options to donate organs are limited, and finding donors is complicated.

The History of Medical Imaging in Veterinary Medicine

Paying for Pet Emergencies: The Importance of a Financial Plan for Your Dog.  Nicholas, Jason, BVetMed.

Emergency Veterinary Hospitals Are Not Charity Clinics.  Elfenbein, Felissa.

CyberKnife RadioSurgery in Pets.  Susan Ettinger, DVM, Dip. ACVIM (Oncology)

New technology could help reduce bone fractures in horses: Purdue DVM collaborating on system that uses sound waves to monitor for microcracks. Lewish, James M.

Orthopets! More vets turn to prosthetics to help legless dogs and cats: More veterinarians are using wheelchairs, orthotics and prosthetics to improve the lives of dogs that have lost limbs to deformity, infection or accident, experts say.  AP.

3 Comments

  1. Krista Magnifico

    Beautifully, impressively and expertly written! Poignant points showing both the perspective of an educate insider and a pet parent. Brava Suzanne!

    Reply
  2. Lauren

    Very informative article! Like you said, emergencies can and will happen so it is important to invest in pet insurance. Thanks for sharing!

    Reply
  3. Pedro

    Very informative blog. I do have a veterinary clinic running .
    The lovable pet are the most reliable friend of a person.Our pets are there for us when nobody else is. They’ve seen us at our worst and still love us unconditionally. They’re there to celebrate when life is good, and lift our spirits when times are trying.

    Reply

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