After this week’s post on my freebie services, I started to feel unduly praised for the work I undertook on a dying cat’s behalf. I know that none of you willing to read this blog would fail to yield for a roadside feral cat half-kill or even a semi-squished suffering snake. So why praise the vet for what should come naturally?
I bring this up in an effort to be fair. After blogging about taking on cases others would not, I feel as if I’d caught a touchdown pass after trampling my team members. Re-reading the post in question, it’s clear to me that I presented my position self-servingly—to the detriment of my respected colleagues.
So it’s at this point that I feel compelled to step in and defend every vet that's ever declined services due to a client's limited funds. Not that we all deserve an impassioned defense; but our position at least merits your understanding.
Personally, I find it impossible to turn away a dying animal I could easily save. How could I spend my precious time prying tree frogs from the jaws of my sliding glass doors only to refuse to aid someone's beloved pet in comparable distress?
Yet there are plenty of times when I decline to offer aid: When it’s not a life-threatening emergency, when I surmise that I’m being taken advantage of and/or when I slink out the back door before anyone else might make me an offer I can’t refuse, I engage in the same sins of omission we all commit at some point in our careers.
Truth is, every vet has to draw a line somewhere if they want to be treated fairly, avert abuse from an irresponsible contingent of pet owners and get home to their families. Yet it’s somehow different should we spy a dog dodging traffic, see a cat laboring to breathe after an unsuccessful game of suburban Frogger, or catch our own dog dragging a baby opossum into the house. Our hearts go out to these animals immediately. We drop everything, eager to help and proud to know we have a special ability to do so. So why the disconnect between these two categories of needy creatures?
After pondering this dilemma carefully, it’s clear to me that there’s something about getting finances involved that changes the dynamics of “care” (in a global sense of the word). It affects all of us in this profession, as I expect it does those in human health fields. When there’s an owner, an agent, a “responsible” party to be addressed or held liable, everything changes on a dime. It’s not all on me anymore…it’s on them.
We all entered into our respective fields through a sense of duty to our fellow creatures or our fellow man. Many of us expected a certain degree of financial compensation and a commensurate level of respect, too. Without the latter forms of remuneration, it’s true, a great many of us might have chosen other fields. That, however, doesn’t explain why we didn’t go into law or banking in the first place. We all still harbor a squishy spot in our hearts for others’ health and well-being.
Too often (perhaps especially in Miami), we see the Mercedes key in a “needy” client’s grasp and though we know everyone can get into financial trouble (even a luxury car owner), we justifiably feel taken for a ride. It's not our job to find ways to finance others’ emergencies. It’s our job to extend our services in return for a reasonable price because we provide valuable assistance.
I’ve spent countless hours of my time on cases whose owners promised to pay, praised my work, begged my forgiveness for being unable to pay up front…and subsequently absconded on their bills. So you know, this situation bests the grateful and compliant recipient ten to one. It’s no wonder vets try to slip out the back door when they see a money case coming their way. Because it’s not just about the money…it’s also about the lack of respect we have to face down each time someone fails to pay.
I know it’s hard for you all to imagine, pet-centric and responsible as you are, but most people are happy to avoid payment on a “luxury” item if they can get away with it. Sure, I long for a society where people believe their pets are the greatest gift to their lives, but that’s not the realm most of our veterinary clients inhabit. You know it’s true, judging from your responses to so many of my animal welfare-oriented posts.
And yet it seems cruel, inhumane, unfair, even, for a vet to decline to yield in favor of a needy animal—even when an irresponsible owner is attached (perhaps especially when it’s clear the so-called owner is a dud). But, to me, it seems rather more unfair for society to feel the same way about how we fund our child healthcare initiatives—and yet that’s an ever-present political reality in the US.
I realize this post rambles, but it’s clear that healthcare administration is nothing if not as squishy as the hearts that sought to make it their life’s goal. We want to help. We’re available to get it done. Yet universal access to care for pets, as for humans, is no given. To expect a veterinarian to effectively donate their services and give away the drugs she’s paid for is little different than to expect that every human doc work at a free clinic a percentage of their time—and hand out dollar bills, while they’re at it.
Vets want to please, we want to be respected, we want to be paid but, ultimately, we want to be in a position that meets all these wants and allows us to heal pets, too. But we can’t always get everything we want in life. We may just have to resign ourselves to knowing that a certain percentage of the time we’ll be taken for that ride. In the end, I guess it’s a small price to pay for having the opportunity to do what we do.
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Great post. I always hear stories of clients pulling out the line, "Obviously you don't care about saving animals- you only care about the MONEY." Er, if you aren't willing to pay the cost to fix your pet, who is more concerned about money? To me your cat is a patient, but to you your cat should be family...
Another good explanation that I've heard is that if you feel that you're pulling in enough extra money to do a lot of charity work, then are you really charging fair prices to your clients who *do* pay their bills? Prices should be fair, and it doesn't seem fair to bump up the cost to responsible clients to cover the unpaid bills of the irresponsible.
None of that would make me feel a lot better turning away a client for unwillingness to pay, though, since it's the pet that suffers. :-/ I guess that's why they say that you can't care more about your patient than the patient's owner does.
Megan October 24th, 2007 11:39:00 PM
Great post! In my 14 years of working in a busy 24 hour critical care center, we would be inundated with "special" cases, people pleading for us to make "just one exception". Even after being declined for CareCredit financing, many of these folks continued to beg for some sort of payment plan. When I would tell them that maybe a friend or relative could help them, I would get the blank stare of "what? Ask someone I know for money....never!"
What many folks fail to realize is that veterinarians and veterinary hospitals do not get breaks on electricity, telephone costs, computer costs, or most importantly, medical supplies. Johnson and Johnson does not charge one price for bandaging material to human hospitals and then a second, lower one to veterinarians. Veterinary hospitals are also not subsidized by the goverment or any kind of third party insurance. When people fail to pay their veterinary bill, they are taking money from the doctor and their staff, but more importantly, they are removing the opportunity for that veterinarian to expand his or her business, buy updated medical equipment and supplies and provide that same level of care to other animals in need.
Most veterinarians will, in some cases, provide lower cost services...but it should not be expected. If the first words out of the client's mouth are "Do you take payments?" then often there will end up being an issue. AND...just because you send that person to collections and get a judgement against him does not mean that you will ever see that money.
Obviously, you touched a pet peeve of mine. I will get off my soapbox now and again praise you for the wonderous words that you share with us!! :-)
Tomcat October 25th, 2007 10:12:00 AM
People also forget that most vets have MUCH higher overheads than most MDs... when was the last time you went to your GP and were able to get bloodwork or X-rays done in-house? Forget about surgery! But vets are expected to have in-house X-ray machines, fully equipped labs, treatment areas, surgical suites - and the trained people to staff them.
There are lots of other professions that are MUCH easier to get into, with much more reasonable hours, much more affordable school costs and that pay MUCH more than veterinary medicine does. Every time I hear someone say that a vet is "just in it for the money" because they wouldn't treat THEIR pet for FREE, I tell you I throw up in my mouth a little :-).
Barb October 25th, 2007 04:52:00 PM
Bravo to all vets who do the occasional "pro-bono" services!!
Tomcat and Barb------Amen to the high overhead in the cost of supplies.
I won't post under my usual name, as it could cost me my job if I were recognized. I am an ER charge nurse, and a shelter volunteer. I see many thousands of dollars discarded at my job every day, in "disposable" medical products which could have good use at the pathetically underfunded shelter where I volunteer, often serving as a substitute vet tech since I know my way around a sterile field in surgery, and can do simple things like dressings and injections of vaccines, etc. Our full-time vet makes less than I do at my job; he is devoted, knowledgeable, and caring; he is a gifted surgeon; he often does surgeries and procedures many shelter vets would not attempt, saving animals that would otherwise be euthanized
The vast amount of waste in hospitals is a major factor in the high cost of human health care; but that's another post. I have become a scavenger at work; snatching up perfectly good supplies destined for landfill. Boats of sterile gauze (10 per pkg.) opened for a single dressing which would be thrown out--I grab 'em and they are autoclaved at the shelter. Those 9x12-inch basins used for hospital baths or as vomit basins--once they are opened for a patient they are discarded even if unused--snatch them up for use as litter pans for kittens or small cats in shelter cages. IV bags removed from their protective outer wrap--discarded even if the bag of fluid is unspiked and still sterile--those also go into my "salvage box". Drug vials (and very expensive drugs at that) whose protective cap is loose or missing get tossed---right into my box. I've made friends in Central Supply, Clinical Engineering and the OR to obtain equipment that was to be discarded. When our ER replaced all of our cardiac monitors this summer, the hospital declined to donate any, despite a signed release of liability from the shelter director and veterinarian. So a friend in the clinical engineering dept. called me one morning to tell me that monitors, cables and all would be going to the dumpster in 20 minutes--I was there to retrieve them and into my car they went. Same with electronic IV controllers (the shelter now has 2 of each). Some days when I arrive at the shelter, I need to make 3 or 4 trips to my car just to carry in supplies. I would estimate that I drag in well over $1500 worth of perfectly usable supplies every month--and that is money saved by the shelter that can be spent to feed and house the animals in our care.
Our surgical services are mostly spays and neuters, but every animal in need of a dental gets that at the time of their spay/neuter; we also do the occasional amputation or bowel obstruction repair; then we become a mini-ICU for a short time due to the pilfered equipment. I would guess that in most shelters you would not see a post-op dog being walked by a vet and a nurse--one to hold the leash and one to push the IV pole and pump. Now if only I could make friends with a radiology equipment repairman to replace our broken x-ray machine!...........
Nurse-Volunteer October 26th, 2007 02:15:00 AM
Nurse-Volunteer: If only there were one of you at every hospital I'm sure we could make a serious dent in the pet overpopulation problem. The waste I see in human health is extraordinary--and I dont get to see too much. Thanks for pointing out that there might be a better way with more judicious utilization of tools an supplies!
Dr. Patty Khuly October 26th, 2007 01:16:00 PM
I personally believe in risking being taken for a ride if there's a good cause involved.
Diana November 1st, 2007 10:33:00 AM
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