Rigid Rules, Restricted Care, & Veterinary Access

In the heart of a small Midwestern town, where community ties run deep, an elderly gentleman found himself in a heart-wrenching situation that brings to light a pressing issue in veterinary medicine: the impact of financial barriers on access to care. This gentleman, in his 70s and living on a fixed social security income, was deeply attached to his three-year-old Chihuahua, who needed immediate medical attention for bladder stones.

His local veterinary clinic, where he had been a client for years, recommended a cystotomy to remove a stone blocking the dog’s urethra. They managed to alleviate the blockage temporarily but informed him that his dog needed a cystotomy within the next 24 – 48 hours to reduce the risk of another blockage. The estimated cost of the procedure was $1,500.

This wasn’t the gentleman’s first encounter with such a predicament. Just months prior, another of his Chihuahuas underwent the same procedure, costing $1,700, which he financed through his CareCredit account. He was still paying off the balance, which had used up all his available credit. With no financial wiggle room, the options presented to him by his clinic were stark: secure the entire $1500 within two days, or he should consider euthanizing his beloved companion.

According to the clinic manager, since the gentleman couldn’t immediately afford the total cost of surgery, she relayed to him that the most humane option was to end his dog’s suffering. He told me he burst into tears in the exam room. No “middle of the road” option was offered, even when he pleaded for one.

Despite this man’s long-standing relationship with the clinic and his impeccable payment history—he had always managed to pay in full for all previous visits—he was met with a rigid stance regarding payment policies. His request to increase his credit limit with CareCredit and an application for new financing through Scratchpay were rejected. His offer to contribute what he could as an immediate down payment —a third of the estimated cost—was not accepted.

While unique in its specifics, this story highlights a broader issue within veterinary care: the ethical considerations of payment policies and their impact on patient care and client relationships. For veterinarians, balancing running a business and providing compassionate care is a tightrope, even in cases involving loyal, longstanding clients who suddenly find themselves in financial distress.

The question of ethics isn’t about the necessity of payment for services – that’s a given; vets have to earn a living. What needs to be asked instead is why flexibility and compassion are not integrated into payment policies. Could the clinic have explored alternative arrangements, considering the gentleman’s history and low risk for non-payment? Would a structured payment plan, available through a payment management provider like VetBilling, have been feasible to ensure the dog received necessary care without compromising the clinic’s financial stability?

What were the clinic’s fears about handling this differently? Did they have any, or was this just a knee-jerk “that’s our policy” response because exceptions to policies should never be made, under any circumstances?

Did they worry that if they helped this gentleman, they would set a precedent allowing other clients to take advantage of them? Did clinic staff lack the empowerment to make a policy exception? If this gentleman, for some reason, defaulted on his bill, would losing $1500 cause irreparable financial harm to the clinic?

We don’t have the answers, but these are questions worth exploring.

This particular story also highlights the public’s perception of how veterinary practices operate. In moments of crisis, inflexible financial policies can too easily be interpreted by pet owners to mean that money outweighs the life of their beloved pet. While this generally isn’t true, this perception damages the trust and respect between veterinarians and their communities. It paints a picture, however unfairly, of a profession driven more by profit than by the welfare of the animals and the people it serves.

Veterinarians are, at their core, animal lovers and advocates. Their challenges, from the emotional toll of complex cases to the practical realities of managing a clinic, are profound. Yet, it is in these challenges that the opportunity for compassionate innovation emerges. Adopting more accessible payment solutions, establishing innovative budget-friendly membership-based care models, offering pay-in-advance options for non-emergent procedures, and launching a clinic-based “angel fund” are among several strategies that help bridge the gap between cost and care and heal the growing rift between veterinarians and their clients.

This gentleman’s story illustrates the profound impact clinic policies and decisions can have on the lives of veterinary clients and their pets. It can serve as a call to action to review and potentially revise outdated approaches and policies for handling financial barriers, ensuring they reflect the economic realities of veterinary practice and the compassion and empathy at the heart of the profession.

But we must also ask how clinic financial policies can evolve to better accommodate the economic realities facing clients, who often feel abandoned at their most vulnerable moments.

The gentleman in this story was clearly willing to pay, but his ability to pay the full cost all at once was hampered by a temporary lack of funds. Is it ethical, right, or sensible to turn away clients like him? Is it a good business decision? Does it truly protect the clinic’s financial health?

Is it worth the other potential costs, like losing a client relationship and the associated revenue that flows from providing a lifetime of care for their pet?

Is it worth perpetuating the perception problem that plagues veterinarians everywhere?

While these are complex waters to navigate, veterinarians are keenly aware that their responsibility extends beyond the animals they treat to those who love them. By finding ways to accommodate pet owners in temporary financial distress, it is possible to uphold ethical obligations and reinforce the trust and respect that is foundational to veterinary medicine. Enforcing policies without considering the context of the client’s and pet’s situation can inflict irrevocable damage on the relationships at the heart of veterinary practice.

Financial obstacles are no longer limited to “underserved” or low-income groups. Post-pandemic inflation and rising household goods and services prices have affected pet owners across the socioeconomic spectrum.

I hope this story sparks discussion and reflection on how we must continue to develop new ways to address cost barriers empathically and compassionately.

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