Veterinarians Without Law or Liability

Whenever the issue of pricing or competency comes around, Veterinarians and Vet Techs like to compare themselves to human doctors and nurses, which is quite a fine comparison provided they are comparing themselves to doctors and nurses in 1890.

A case in point from when I went in for kidney stone surgery. The fellow who operated on me was not a general practitioner — he's a board certified urologist (*my* urologist) who is also head of surgery at the local hospital. He’s insured up to his teeth because if things go south, my life and limbs are worth more than a $500 used dog.

There was an anesthesiologist too -- he visited with me before things started up. He too is board certified, and heavily insured. He was going to knock me out in order to shove a camera and a laser up my urethra. No argument from me!

My last major surgery was 20 years ago for the removal of a fatty tumor encapsulating an old nail-gun injury. The growth that was removed from the side of my thigh was pretty deep and ended up the size of a chicken egg. No full knock-out anesthesia -- I was awake through the whole thing. Ditto for some recent dental bone implant surgeries -- no knock out anesthesia. I was awake for all of it.

Why do human doctors and anesthesiologists typically shy away from knocking out a perfectly healthy adult with no heart, blood pressure, liver, or breathing issues? Simple: Full knock-out anesthesia is very dangerous.

And yet veterinarians thinks nothing of doing it to a 15-pound dog for simple teeth cleaning.

Why? Simple: there are "pearly white profits in teeth cleaning and little or no liability if things go wrong. Never mind that your your vet never went to dental school and that dental scaling has not been shown to be of any use even on human patients. Focus instead on the fact that the vet tech never went to anesthesia school, and that vet tech school is often a correspondence school course that qualifies you to do a job that pays all of $34,000 a year.

What’s my point?

My point is my dentist is not my GP doctor and my GP doctor does not do dentistry — he will tell you he is unqualified -- as will the state and a jury if it gets to that.

We can go down the list.

My urologist does not treat skin diseases. He will tell you he is unqualified.

My rheumatologist does not sell food or prescription drugs in his waiting room. If I asked him why not he’d give me a weird look and tell me it’s against the law.

But a veterinarian?

They sell food in the waiting room and prescription drugs as well.

They claim expertise in everything from hip and knee surgery to parasites, from dentistry to psycho-pharmaceuticals, and from endocrine systems to anesthesiology.

To be fair, most vets are doing a pretty decent job within a narrow set of goal posts that involve vaccines, minor skin issues, spay-neuters, and ripped claws.

These folks are "general practitioners" who operate as 19th century general practitioners for humans once did, unencumbered by liability insurance, and laws against bill padding, self-dealing, up-coding, and selling medically unnecessary goods and services.

The good news is that today's vet can lean heavily on simple over-the-counter vaccines, antibiotics, and topicals to prevent and treat a lot of fairly common pet health issues.

But are they the equivalent of human doctors and nurses? Nope. In fact, most of their core business practices would be illegal if they tried it on a human. 

Look at vaccines. Your pediatrician and general practice doctor is not pounding on you to get annual measles, mumps, rubella, typhoid, and polio vaccines because if they did so they would be prosecuted for fraud. Your veterinarian, on the other hand, is free to revaccinate your dog every year, or every three years, for everything under the sun, and never mind if it's not medically necessary.

You know why doctors don't sell antibiotics and Jenny Craig meals in their waiting rooms? Simple: it's illegal, because the enticement for self-dealing and price-gouging is obvious. With veterinarians, it's a never-you-mind.

The veterinary trade is not proscribed from self-dealing, operates with little fear of liability, and has no enforcement mechanism to curtail price-gouging or the foisting of medically unnecessary services. In fact these are core business practices for at most vets.

In the "good old days," you could generally find a rural independent vet who lived within the bounds of his or her knowledge base and what their clients could afford. Today. however, veterinary practices are being vacuumed up by large holding companies and operated as pet store-adjacent service companies. Is your veterinary practice owned by a candy company? There's a good chance it is!

When veterinary practices are owned by candy companies and holding companies, the bottom line is always the bottom line, and the push to industrialized levels of upcoding, bill padding, and delivery of medically unnecessary services becomes their standard "policy".

All of this is abetted, of course, by the rise of pet insurance packages which obscure the costs paid, as well as "pet wellness plans" which offer folks little more than $10 worth of vaccines and puppy worming medicines in exchange for $360 a year in annual premiums ($30 a month).

None of this is to criticize veterinarians for what is their "standard practice" any more than it is it to criticize human doctors for their "standard practice" which too often also involves kickbacks, upcoding. medically unnecessary tests, and massive bills obscured by insurance payments and behind the door "adjustments" designed to extort people into embracing ever-rising insurance premiums.

It is to say, however, that veterinarians and vet techs are NOT operating in the same world as human doctors and nurses, and claims to the contrary are, for the most part, nonsense.