Saturday, January 24, 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.


fishofdeath said...

As a pet owner, and a somewhat novice one at that, I agree with Sarah. My question is, how do you (or her) suggest that we go about finding vets like Sarah?

PBurns said...

They are out there, but are easier to find in small towns and rural practices. I recommend people do most of the basic stuff themselves. It's not hard to learn or do.


Matt Mullenix said...

Excellent commentary. And sad, given the outcome.

But I bet you Sarah finds a way.

Anonymous said...

What a great post. I had he fortune of being a clinic associate with a progressive clinic in the San Diego area.

We not only had a holistic veterinarian and another veterinarian that made house calls but also an animal nutritionist, animal communicators, a cryobank, bodywork therapist, all in addition to my animal behavior services.

I find that the veterinary profession and some of the others allied to the profession have become too segmented or too much into a mindset that does not serve the clientele.

This is a trend that is really awful in the medical is a mindset permeating pet services of all types.

I believe this can only be overcome by searching out small practices (non-chain or corporate) and those practitioners that serve you.

In time, my hope is that such trends will falter and go back to a more interactive and holistic model where vet clinics will still make a good living for their practitioners but not be so focused on the business model instead of serving the health and wellbeing of their furry clients.

Anonymous said...

Did not know you had a Laika :o)

....not that I should know, but I thought I visited this site enough to at least glance at most of the stories....I guess not ;o)

Has she been introduced previously in your blog?

Look forward to reading about her hunting adventures too!

Anonymous said...

Whoops! Just realized that the Laika is Sarah B.'s!

Sorry for the confusion and please disregard my previous comment!

...although I am a bit disappointed, as I was looking forward to hearing about Tuli's hunting adventures!

Anonymous said...

Yes, I enjoyed seeing the Laika, too--Sarah, do you know Vladimir Beregevoy, who also now lives in Virginia, and imported and raises West Siberian Laikas there?...and very sad to hear the Vetinary profession lost another good one. I was very spoiled for many years having GREAT vets; now I am really having a hard time finding one--I keep running into the dishonest, greedy, crooks. The vet I grew up with, and then worked for during my college years WAS like Dr. Herriot! Still an old time farm vet--that's a rare species now! I asked him once when I was working as his kennel boy,"Doc, you could make a LOT more money than you do, why don't you charge what other vets charge?" He replied, "I'm interested in making an honest living, NOT a killing!" His waiting room, consequently, was ALWAYS packed! Alas, he is long retired.......L.B.

Anonymous said...

document sent:
The business of drugs
The pharmaceutical giants have discovered the business of puppy - Max, a German shepherd tireless three years living with his Parents owners in Lafayette, Calif., can help us understand the paradox of "BigPharma" (the nickname of large pharmaceutical companies Americans).

On the one hand the industries are struggling for the first time in a decade with an economic slowdown (and in April and May of this year even with a decline) of the turnover of medicines sold under the prescription of the doctor, the other sector seems better than others face the storm which hit Wall Street. In June, the index of pharmaceutical titles was up 7.4 percent, while last week the companies in the health sector have exceeded the stock market capitalization of the banking and finance, and are now behind only those of electronics and energy.
What this has to do with Max this paradox? Simple: to alleviate the psychological problems of the dog, too restless and often suffer from separation anxiety from the owners, the veterinarian has prescribed a pill a day to Reconcile. This is the new antidepressant medication for animals of Eli Lilly. The only difference with Prozac is that the pill does not swallow, but you chew (and has the taste of a beef steak). Max takes her along to mush, and seems much happier: the same happened to 72 percent of dogs in experiments that preceded the introduction of the pill. Obviously, the Eli Lilly senses the deal: in the States for 42 percent of the dogs sleeping in the bed of the "father" and "mothers" and - perhaps for this - 14 percent suffer from terrible anxiety when the "parents" go to work or shopping. Bark relentlessly, are nervous or apathetic.
The antidepressants are not the only veterinary products on which "Big Pharma". Riding the trend towards the "humanization" of animals (which continue to fight ethics experts) and taking advantage of the increasing medicalization of Snoopy Americans (77 percent of the owners of dogs and 52 percent of cat owners buy drugs regularly ) industry expands the range of the offer. For example, Pfizer launched Slentrol, a medicine to help the 20 percent of dogs that the fault of the owners permissive, suffers from obesity.<<< It multiplies the turnover of all veterinary treatments for domestic animals, the chemo therapy in cases of cancer de vitalisation of decayed teeth.>>>

Just the love of dogs (and cat lovers) to revive a "Big Pharma"?
For now contributes optimism analysts already met for the market that opens for the anti-cholesterol drugs after the American Academy of Pediatrics has suggested the adoption, if necessary, even for children from eight years in up. On the other hand on American medicinal various clouds are gathering. For many medicines is about to finish the term of the patent: the Pfizer Lipitor (13 billion dollars in sales) will expire in 2011 and after will be produced by other companies. Not many seem to be imminent approval of drugs.

Both candidates for the White House, John McCain and Barack Obama, promise a greater role of the State in medicine. And a little 'for the recession, a little' to the rise of the ticket, Americans are buying less medicine recipe._______________________________________________________________
The policy of the multinational drug companies, manages the
disease runs its dependence on the drug, and where a
drug seems to do well at something, is preparing the
need for another drug so that the patient
become a consumer of drugs succulent.As if to say: Enter with a small problem and you will be

Pups treated with vaccines just days before being born!
A veterinarian has told me that a practice that he does not recommend! That medicines should be used in the right amount not too much!
Go by some veterinarians with a dog that mastitis and says this is needed, an operation for cancer Mammel and then sterilized !

For treatment of mastitis should be a small incision on Mammel is to remove the infected fluid (not required Anestis) and will need 2 tablets' s antibiotic! do not open the dog as a pig to the slaughterhouse then reseal and put it in the oven! The thicker and less than that of cancer and sterilization !

The bigpharm europa same thing!

Anonymous said...

To cauterize wounds use common salt Vai dal veterinario sutura

Go by the veterinarian
1 disinfects
2 suture
3 antibiotics

4 shows the account

I harbor after it has healed to control!

The salt is used for storage of meat and fish,
therapy recommended by a veterinarian few years ago


Anonymous said...

L.B., Bigshrimp and others:
Yes, I know of Vladimir Beregevoy though we have never met. We've had some sparse email contact over the years and I have some copies of his book entitled "The Hunting Laika Breeds of Russia". He has been very instrumental in importation of nice WSL bloodlines in the U.S. He writes a column for Full Cry sometimes. One of these days (isn't that always the case!), I would enjoy the opportunity to visit him and his dogs!

Patrick is an avid Terrier fan. I doubt I or anyone else could get him to convert...but perhaps with his permission I can supply some photos of my Laika Trio and our adventures periodically! :)

Warm regards

Anonymous said...

"Patrick is an avid Terrier fan. I doubt I or anyone else could get him to convert...but perhaps with his permission I can supply some photos of my Laika Trio and our adventures periodically! :)"

I would really enjoy that!

Love to see any working dog do what they do best...."explode the code" as Patrick says!

Anonymous said...

I, too would like to go visit Vladimir--but I am terrified I'd come home with a Laika pup or two! Since I have a self-imposed limit of only 10 dogs at a time, and I am currently over that limit by 2, I had best wait awhile! I have also read his articles in "Full Cry", and communicated through letters and E-mail--a fascinating guy! And I for one, would love to see some of your and other Laika pics and info on this website sometime!....L.B.

Unknown said...

She is the kind of vet I am looking for! I like that she cares enough to help out her clients with offering locations with discount pricing where available. She is exactly what is needed in a veterinarian! The vets now days are more about the bottom line and less about the care and treatment of the animal. Prices are so high that it's hard to take your animals to the vet. If they didn't rape you every single time you came through their door we might be more apt to come to the vet for the little things. I wish she had a practice in my area! She would do really well here :)