I don't have qualms with any of that.

However, for non-vaccine costs, you have to admit that a certain amount of markup goes on that is geared to maximize profit without going about "what the market will bear." Maybe not at your practice but at many.

To illustrate: the blog of one veterinarian, Peter Glassman. The man had the gall to testify against allowing LIMITED, CAPPED non-economic damages when a vet kills a pet through negligence, arguing that the cost of care would rise and poor pet owners wouldn't be able to afford vet care anymore. Duplicitous and disingeuous I believe this argument to have been, because on his blog he bragged about the % markup he'd been making at his hospital on drugs, saying:

"Everybody likes to make an easy buck here or there and for many years - let's be honest - that's the gravy train that vets have enjoyed. Who cared if you didn't REALLY make money in surgery when you were marking up heartworm preventive 200%?" And adding: "With some exceptions we previously marked up drugs 100% and added a $5.00 Rx fee."

Alas, this blog, formerly located at: http://dvm.typepad.com/peter_glassman

appears to have disappeared now that I try to link to it. Thank heavens for the wayback machine in case I ever need to prove the truth of what I'm saying. Millionaire vets like Glassman can be a litigious lot.

Stefani December 29th, 2008 10:12:32 AM

Errr ... two words:  Loss leader.

If your clients are going to cut-rate clinics instead of the vet because the $3 vaccine is $30 PLUS the exam fee, then you are driving business away, and missing the chance to examine the animal and catch any health issues early.  Certain products and services are not in themselves profitable.  Every retailer knows this; the good ones choose their loss leaders to bring in customers, make them happy, and keep them coming for the stuff that is profitable.  Deal.

I love my vet, but I do my own puppy vaccinations (on the now-recommended conservative schedule), and my own big-dog vaccinations  when I have puppies.

Errr, gee -- I can do distemper today ($4/puppy) and parvo next week ($3/puppy) , including the negligible cost of syringes -- or I can troop all ten of them into the vet and pay about $60 per puppy all told, and the inoculations won't be split, as is considered best practice -- and this is a separate visit from their normal pre-sale vet check with health certificate.

Litter of ten -- gee, $600 vet bill, or $70 vaccine bill.  Huh, how to decide?  Even more tempting when a technician gives the shots.  I'm undergoing a walletectomy for what reason, exactly?

H. Houlahan December 29th, 2008 10:27:18 AM

Every small business owner has to deal with this mindset.  I am a photographer and I can't count the number of people who complain to me that they can get a print made at Sam's Club for $0.25, so why do I charge $20 for the same thing.

People who have never owned a business have no clue about the overhead that running a business entails.  The cost of supplies, equipment, salaries, training ... and let's not forget TAXES.  Most people don't understand that Uncle Sam takes his 50% (or more) off the top. 

I just shake my head.  Some people appreciate the value and service and some don't.  For those who are comfortable doing it themselves, more power to them. My brother was a vet tech for years and taught me how to do my cat's vax, but I still think it's worthwhile to have the vet look her over every year, just in case, and to me it's worth the $60 or $70 that is included in the overhead expenses of bringing her in and handling her for the amount of time it takes.

Kara December 29th, 2008 10:47:31 AM

H. Houlahan: Truth is, the only time I ever give a rabies at that $30 price it's because the owner refuses everything else. I never give a shot without an exam--even if it's just a cursory one to ensure I'm not vaccinating an obviously unwell animal. We work our vaccines into our yearly package so they're MUCH cheaper.My goal in doing this is to minimize the importance of the vaccine as reason for the visit. IMO, the physical exam should be the big ticket item.

Still, you're right. Vaccines are a loss leader for many practices. But it wasn't always that way. we used to profit handsomely from vaccines back when it was a yearly requirement and practically the only thing we did annually that pet owners would pay for.

Thankfully things have changed mostly because pet care is more sophisticated and the need for annual vaccinations is being eroded by good science. But that doesn't mean that we don't deserve to be compensated for the care we take in storing, administering and thinking/explaining about vaccines.

After all, Heather, you have to agree that the vast majority of pet owners is NOT as savvy as you are. Would you really recommend that everyone get their vaccines mail order? I don't begrudge you this savings one bit.  That's because I know you're well educated. But what about the rest of the population?

It would scare me to have to rely on my neighbor's say-so should his dog bite my son. And that's just one public health issue. For the health of our entire human and animal communities I wouldn't like to see a whole nation of people ordering online to save money on vaccinating their kids and their pets.

Dr. Patty Khuly December 29th, 2008 10:56:54 AM

The difference between costs versus expenses should be obvious to anyone, however, because of big-box-store-mentality (thank you, Walmart), a vast number of people have stopped thinking about drugs/vaccines logically. "Just buy in bulk and pass the savings on to me, or I'll shop somewhere else that will. Oh, you mean those things aren't the same as canned peas? I don't want to believe you." I swear that's the overtone I hear from some clients. Thankfully not the majority, but still.

On the other hand, I don't understand the insane markups that happen in human medicine and why people, even through their insurance companies, would put up with it. Just last night my friend's father said he was having a complete blood workup, including CBC, special cholesterol/diabetes panel, thryroid, and what he referred to as a 'special liver and kidney panel.' He said he wasn't looking forward to paying his part of it, which would probably be close to $200 (and he's got excellent insurance, that most of us couldn't get - he worked for a huge, wealthy comapny as a top manager). His insurance covers the other $700. Now, I'm sure that he left out some of the tests (at least I ferverently hope so), but when I stared at him in disbelief, and said those tests, at an expensive vet around here (NE Ohio), might total $250 - he said, "Well, my doc says I need them, so what am I gonna do?" When clients balk at a pre-anesthesic workup that costs them about $75-80, I just shake my head.

KateH December 29th, 2008 11:19:20 AM

As a professional in a small practice, I appreciate your position. We give so many breaks to clients that when we actually try to charge for what the service and product are worth, it is upsetting to have to argue about it.  My vet is not cheap, but he does courtesies for me as a good client.  I appreciate them.

Susan December 29th, 2008 11:44:30 AM

BTW Peter Glassman's practice is a large one in my city, it is VERY pricey, and I only go there for off hours emergencies because it is 24/7. But I've never liked it much. There's a large turnover in vet personnel, and I'm told that even if you are a regular client, you never get the same doctor twice. They have most specialties there, but when I need a specialist, I go elsewhere.

Susan December 29th, 2008 11:48:11 AM

As a consumer, I agree with many of you about the unfortunate and wrong-headed nature of "bottom line price" seeking on the part of pet owners. I do indeed wish that more pet owners thought more in terms of QUALITY than price. But maybe that will happen when more practices think in terms of QUALITY rather than profit. Perhaps Dr. Khuly and those cut from the same cloth can lead the way on that transformation.

How do we teach consumers to understand the importance of QUALITY and to figure out how to get it? And how do we incentivize veterinary practices to make quality care the number one focus?

Stefani December 29th, 2008 12:07:07 PM

I almost always volunteer at our local shelter's quarterly rabies clinics, and I actually give a lot of the rabies vaccines (under vet supervision, of course) to the animals being altered for adoption. That being said, my own dogs and cats get their vaccines at their annual (or semi-annual, depending on their age) vet check-up. Vaccines are given on the three-year protocol, rabies alternating with their FVRCP or DA2P+PV or Bordatella. I consider the vaccines to be secondary to ther exam itself.

Though I don't use them myself, vaccine clinics are a valuable service to lower-income pet owners whose animals would otherwise never receive any vaccines. And with the economy in its current state, I would predict that the clinics volumes will only increase as people become more strapped financially. When it comes down to a decision of whether to buy one's own insulin or blood-pressure pills, or take one's pet in for vaccines, my guess is that in most cases the pet will be the loser. So better the clinic than no care at all, IMO.

Shellie December 29th, 2008 03:03:38 PM

Shellie: That's true. if you're a low-income pet owner and you have no other choice I'm with you on providing rabies in a controlled setting like you're describing. In fact, I do it once a month at a local homeless shelter. (But we perform full physicals and counsel clients as part of this service, too)

Too often, however, private clinics will offer cheap vaccines to bring in new clients. Having worked at one of these places in my days as a relief vet I can tell you that I would HATE to rely on the vaccines at a place that offers the five seconds-per-pet cattle call. The day I learned about the "pink water' in the vials I quit. I couldn't prove it safter the fact so there was nothing I could do...but I should say that it didn't surprise me.

Dr. Patty Khuly December 29th, 2008 03:23:48 PM

The good news for me in this post, is I can stop feeling guilty over refusing vaccines for my elderly...!!

Never have I engaged in the 5 second clinic idea, I want a full exam. It isn't an infallible guarantee, but but narrows unnecessary risks, I hope.

Human vaccines can run in the hundreds, surely some profit there!!

Barbara A.

Pocket's Story from NH December 29th, 2008 07:19:30 PM

I couldn't agree with you more.. You hit the nail on the head..

My vets doesn't do the three year rabies vaccine.. but since I have a trust in them, I go along with it.. Socks needs a yearly PE anyway..

How does laying out $140 per dose on Gardisil sound? We don't lay out the money at the time of purchase, and get a 2% discount if it's paid within ninety days.. another perk.. we use the credit card..  It still doesn't make me feel good when the reimbursement is $2-3 over what we pay..

barri December 29th, 2008 07:36:26 PM

I don't take issue with a $30 vaccine when I know it will bring the animal in to be examed and the vaccine will be administered correctly for those who haven't had the training in how to do it (like most pet-owning friends and family I know).  I take more of an issue with the five-second exams mentioned, where someone is paying $40+  (and sometimes over $100) for an exam visit and the animal isn't even really LOOKED at.  Here it seems like what we are paying for is the vet's TIME and EXPERTISE, not the privilege of sitting in a waiting room for 20 minutes and then sitting in the exam room for 10, with only 2 of those minutes actually given to attending to our pet.  Most pet owners can glance at their pet and see that it looks basically okay, but how many pet owners are going to be doing their own fecals, prying open mouths, listening to hearts..?  What owner is going to run their hand over a lump and say "this is probably a benign fatty tumor" or "this feels like a swelling that might be a concern"?  And yet, SO many times I've seen vets rush through this all-important exam...the only time that year the pet will likely be seen unless illness/injury crops up.  Rushed vets = flustered owners = issues missed and those issues the owner wanted to address potentially forgotten. 

There's unfortunately a reason why I've been hearing lately that exam fees are "scams"...

As far as vaccines go, it's worth doing yourself if you have a few pets or a litter, but for the single-pet owner, it doesn't seem to save them much; certainly not in terms of hassle.

Shavy December 29th, 2008 09:38:01 PM

Overvaccinated animals DIE because their immune system is compromized--most animals acquire autoimmune diseases which KILL our companion animals! What causes the immune system to short circuit and start rejecting normal body tissue? Many theories exist, but the ultimate answer is "We don't know." Jean Dodds, a veterinarian studying immunology, feels that multivalent modified-live vaccines overstimulate the immune system. Others blame environmental pollutants or food preservatives such as ethoxyquin, an antioxidant found in most dog foods. It's not any different from human immunization! How many times were you ALL vaccinated for polio, TB, etc? Why would it be any different for our companions?

Fotini December 30th, 2008 01:35:34 AM

My vets doesn't do the three year rabies vaccine.. but since I have a trust in them, I go along with it.. Socks needs a yearly PE anyway..

Barri, you might want to take a look at this, print it out, and discuss it with your vets:

http://www.aahanet.org/PublicDocuments/VaccineGuidelines06Revised.pdf

Over-vaccinating gives no extra benefit, and can have serious health consequences. Socks should have an annual physical exam anyway, regardless of whether shots are due. Your vets are not currently keeping up with the recommended standard in this area. This doesn't mean they're bad vets, and they might be doing this because they think their clients wouldn't bring their pets in annually if they weren't told, "Fluffy and Fido are due for their shots."

Talk to them, discuss what Socks really needs, and make it clear that you're not going to skimp on the annual exam (which, really, is sort of like a human getting a physical every three or four years) regardless of whether any shots happen to be due in a given year.

Lis December 30th, 2008 08:36:06 AM

"How do we teach consumers to understand the importance of QUALITY and to figure out how to get it? And how do we incentivize veterinary practices to make quality care the number one focus?"

Stefani: We accomplish your first question/mandate by taking the time to explain WHY what we do is important. If we spend two minutes with a client at their first-pup visit, push vaccines and send them out the door loaded with heartworm meds and flea and tick products and don't explain in detail WHY we do what we do then it's not a shock when they don't come back.

As to your second question/mandate: The incentive is built into the answer to the first question/mandate. Not only do we have a duty to make quality our focus, we also have a built-in incentive to provide it. If we're too busy to offer quality care and teach our clients to seek it out then we won't be rewarded with the income this kind of care brings.

Why do ALL vets not offer it if the incentives are so aligned? Because it's hard to do. Your offers and explanations need to be consistently aimed at a high level. And when the last four clients just rejected your estimates for high quality service it makes you want to lower your standards so you won't get "rejected" again. That's how it happens. Next thing you know you're practicing bargain-basement medicine so your days are easier.

Dr. Patty Khuly December 30th, 2008 08:37:25 AM

This discussion has become much more interesting (to me)  than the original topic.

What it boils down to is that in a professional/client relationship, loyalty is a two-way street.

The client, in most markets, has a lot of options for basic veterinary care -- and vaccinations are the most basic of all.  It's up to the provider to actually provide the service that justifies the price -- not lecture the client about the costs of doing business.

Recently a dog breeder who was having trouble selling her puppies queried my breeders' group about what might be wrong.  We were pretty unanimous in telling her that her pups were overpriced by at least 30%.  She came back with complaints about all the costs she'd incurred for this litter and caring for the parents. But see, puppy buyers don't care that you had to pay for a new fence, or that the sire got hit by a car and needed surgery, or that other breeds are selling for more.  The better buyers will pay a premium for things that they value -- proven working parents,  time spent socializing, good hip scores -- that make the puppy (potentially) a better puppy.  They don't care about things that make him a more expensive puppy to produce without providing a better dog for them.

If your cost-savvy client in the OP was an average pet owner and brand-new client, then it is quite reasonable for you to require a full exam as part of the animal's comprehensive health care before giving a shot.  That's different from pricing the shot at a 1000% markup.  As a client, however, I'd expect to see a properly thorough exam, including being queried on history.

If she was a regular client, and the animal a regular patient who you'd just seen two months ago for an exam and a bordatella booster, say, then it's good customer service, good professional practice, good client relations, and, in my opinion, good medicine, to nip them in quick for a $10 shot.  That shows some loyalty to the client.  Later on, when you think the animal really needs that expensive bloodwork, the client is much more likely to trust that that is your medical judgement, not the boat payment being due.

H. Houlahan December 30th, 2008 11:39:48 AM

"The client, in most markets, has a lot of options for basic veterinary care -- and vaccinations are the most basic of all.  It's up to the provider to actually provide the service that justifies the price -- not lecture the client about the costs of doing business."

Agreed. Which is why I love having the luxury of my Dolittler outlet. Nonetheless, there are times when your prices will be questioned...not the service itself. In those cases clients will specifically ask questions like why the cost of X is different in your hospital than elsewhere.

Here we have an opportunity to explain the difference in service we offer to justifies our price. But when a client comes to me with an 'I know what your markup is and I don't agree with it' statement, we are justified in explaining the economics of the issue and how it all boils down to the level of service we provide.

Fairness is the goal. Which implies an imperative to offer value to your clients. If that value arrives in a way the client doesn't like (i.e., building in a brief exam fee on the cost of a vaccine for clients who decline our standard  bloodwork-fecal-physical exam annual), then that client is effectively urged to go elsewhere. And that's OK. There's a vet somewhere who will do things the way he/she likes.

Dr. Patty Khuly December 30th, 2008 12:53:23 PM

Fallacies in the initial argument (speaking from a position of 40 years professional experience, and having watched how the industry has changed over the years):

1) Vaccines need only ordinary refrigeration. They can tolerate several days at room temperature. (Up to 30 days according to some labels, tho I wouldn't want to risk that)

2) Product expired? Where's your expired-return/replacement agreement with your supplier? one of the vets I know very well is a vaccine broker who deals in million-dose lots (sells them to the county shelters) so I know about this one firsthand. (BTW bulk price on rabies is about 60 CENTS per dose.) Second, don't you keep track of your sales traffic and order accordingly?? Third, if a batch is nearing stale date and you don't have an expired-return agreement, why not put on a vaccine clinic and use it up fast? or offer it at wholesale, in the 25-dose box lots, to breeders who are going to do their own vaccinations no matter what? that way at least you don't lose money, and you gain public good will.

3) Syringes and needles are about 15 CENTS per pair in bulk. Sharps disposal unit costs $3.99 at Costco, and handles up to 1000 needles.

4) In most (not all) states, only Rabies requires a regulatory form. Other vaccines are not controlled anywhere, tho I'm sure many vets would like that to change (which will do nothing but ensure that many puppies receive fewer or no vaccinations).

5) Professional know-how? Maybe. But giving vaccines isn't rocket science, the protocols are well-established and readily available for anyone to study, and in my observation the decision on which brand/type to give is usually based on marketing from the manufacturers and perks that come with bulk orders. Most vets I've spoken with believe that one vaccine is much like the next, so marketing wins the sale, rather than preference based on experience.

Covering your overhead (facility rental, insurance, materials, employees, etc.) is fine, and necessary if you're to stay in business. That's what the office call charge is for. But it's not fine to try to fool people about the real cost of that vaccine.

The worst case I've ever seen? I've seen a vet charge (are you sitting down??) $192.00 just for a set of basic vaccinations - standard 7-way and rabies.

cat December 30th, 2008 04:52:22 PM

Talk to them, discuss what Socks really needs, and make it clear that you're not going to skimp on the annual exam (which, really, is sort of like a human getting a physical every three or four years) regardless of whether any shots happen to be due in a given year.

Socks might be getting the Purevax non-adjuvented rabies vaccine, which has to be given yearly. It's considered safer for cats, as the risk for vaccine-associated sarcomas is greater with an adjuvented vaccine vs non-adjuvented. See http://www.vas-awareness.org/vaxreccs.htm for more detailed information.

Megan December 30th, 2008 05:40:21 PM

cat: Points well-taken, but not all apply to all veterinarians.

1-Ordinary refrigeration--with a back-up generator in hurricane-prone states. But we take no chances. Vaccines that do not arrive at refrigerated temps get sent back. That costs. Stocking costs. Ordering them costs.

2-Product expired? We have no such agreement with our supplier on biologicals.

3-Syringes with needles cost 22 cents each. And we replace the needles at an additional 16 cent cost after drawing up the vaccine to make sure the pet feels as little pain as possible.

4-Other vaccines may not be controlled but our medical records are a regulatory form in and of themselves. We than back up that information on the computer for safe-keeping.

5-The protocols may be well-established but deciding who gets vaccines and who doesn't, which vaccines to give and which not to give, which brand of each to administer, etc. does take some expertise. It's not the sexiest part of my job but my decisions matter.

$192? Highway robbery, perhaps. But that all depends on the wheres, whos, whys and hows. I won't judge that practice until I get the back story on that invoice.

Dr. Patty Khuly December 30th, 2008 09:53:23 PM

Thanks Lis

I printed out  the guidelines.. Will bring it up to the vets, when I go in next visit.. Socks isn't due for a PE until June. I had brought it up a couple of years ago.. and forgot what the answer was.. Was also thinking about titers.. I'm such a bad mom for not worrying about these things.. I'm having issues with human vaccines and all the combos..  that I left the vet stuff to the vets.. but I knew I had concerns about it..

Think I'm getting addicted to this blog..   Actually called a mohel had a lovely discussion with him and a bunch of Jewish patients regarding the use of topical anesthetics in the the ritual circumcisions (Brissim). In this neck of the woods they do not use topical anesthetics.. I don't know where Shavy is from, but I'm surrounded in  a predominantly orthodox neighborhood.

barri December 30th, 2008 09:59:30 PM

Since I didn't see it already mentioned, I'll bring up two more downfalls of 'do it yourself' vaccinations. Vaccine Reaction & combinations! Vaccine reactions are fortunately rare but if that happens an pet owner wouldn't know what to look for and may not have the time to get fluffy or fido to the vet in time to help him. Is the life of your pet worth the risk just to save $25?? Not to me it isn't. There's also a variety of strains of diseases. Not all vaccines are created the same. In my area the 4 way lepto is commonly used by the local vets, however most of the pet stores etc. that sell vaccine do NOT carry that version, and if they did the pet owner does not have the knowledge to know that's what their pet needs. So then the pet owner happily vaccinates, content that their giving their dog it's 'shots' at a savings, and all the while not actually protecting fido from the risks he's exposed to. By the way Dr. Patty I love your blog!

cl December 30th, 2008 11:45:04 PM

The problem is not reactions (for the most part), it's efficacy.  Vaccines are chosen based upon it, and I refuse to believe that the $7 vaccine at the farm store has the same efficacy as FD, Pfizer or Schering.

Jackson December 31st, 2008 12:15:03 AM

Vet Economics 101 “veterinarians don’t consider vaccines to be moneymaking items. Not anymore. … Sure, we might have believed so in the past.“ Well, maybe if you hadn’t been excessively padding for profit for years, we consumers might be more sympathetic to your plight. To the extent that the profession did partially bring this upon itself by price gouging, suck it up. As a consumer, I want to be charged and pay for what I’m getting. Charge for professional services and advice separately so we know what we’re paying for. Don’t give a super low “office fee” and then add on 20 small items that add up to a $400 bill at the check out. Go ahead and charge me in 6 minute increments just like a lawyer. I’ll pay and, by gosh, I expect you to answer my questions knowledgeably and accurately AND admit when you don’t know the answer. Back to vaccines… First, Vets are NOT pharmacists and are no more qualified to be giving advice on medications than most M.D.s who are pathetically UNqualified and that’s a simple fact. You’d need a whole other degree to be fully qualified in this area. Simple example: When I ask my pharmacist if he’s dispensing Albuterol or Albuterol Sulfate, he understands my question and the implications but my doctor last week didn’t know there was a difference between the two and couldn’t tell which was the ingredient in the medication of the script he had just written. I’ll take the compounding veterinary pharmacist I have access to on line over every one of the Vets I’ve ever met in this area of expertise. It isn’t the least bit unthinkable to outsource vaccinations. If you find items 1 through 5 that much of a hassle, write a script and advocate the elimination of the need of scripts so we can get them from another source. I know many, many who can give a shot better than many of the Vets I’ve seen over the years and I’ve yet to see a Vet or Vet Tech who could give any of my critters oral meds better than I can. BTW, it’s been some of the most pricey Vets I’ve seen over the years who wouldn’t review my vaccination records and just wanted to shoot up my babies with every vaccine in their fridge! (I’d like to thank them for sending me on a research binge so I know better than to trust any of you wholeheartedly now. And I’ve certainly NEVER gotten a mailed vaccine reminder that was accurate.) As for the M.D.s whining about the vaccines, well I’m old enough to remember the first round of this nonsense when my son was getting vaccines. They all wanted to have a monopoly but didn’t want the regulation and restrictions and responsibilities that go with a protected monopoly. Yes, if you want a monopoly, there’s a balance to be struck and it isn’t “whatever the supplier decides” to cram down our throats. This was about 25 years ago and about the same time many states outlawed physicians from being pharmaceutical dispensaries; partly because they were requiring things like monthly “female” exams for dispensing each pack of birth control pills! It was outrageous, expensive, unnecessary and invasive. So, if the Vets don’t want to play by the same rules as pharmacies, stop being pharmacies and let your clients have the option of a script they can take to another pharmacy!!! The vast majority of prescriptions you dispense can be filled by mail (local pharmacies might even pop up if you’d let loose of the strangle hold you have on dispensing) and, of the “emergency” type, most are available at Wal-Mart pharmacies for a better price (and don’t tell me there’s a difference either because most come from exactly the same sources these days and, oddly, many of the Vet grade pharmaceuticals are of lesser quality but more expensive now). As long as we’re on the topic of “extra” services, STOP pushing “prescription” pet food too (which has apparently taken the place of the vaccines and other pharmaceuticals in the “profit” margin) and, if you MUST provide them, isn’t there one single decent one out there? So far, I haven’t been offered one that didn’t cause an immediate need for rescue prednisone and THAT food allergy was exactly what the Vets were supposed to be helping with; yep, Vets, plural, all 5 of them. (BTW, I’ve figured that part out all on my lonesome too; well with the help of other pet owners after dealing with Vets and their prescription diets and lovely drugs to the tune of thousands of dollars.) Apparently Vets also share a lack of knowledge about nutrition with their M.D. colleagues. And then there is the gross unprofessional discourtesy of overbooking. I really appreciate sitting in the waiting room until an hour or more after my appointment time to be given a vague excuse about how busy, busy the Vet is. Well, excuse us, but our schedules are booked too and many of us clients are professionals too! You’re in business to serve your clients, they should not be waiting unless you’re willing to pay their professional rate for that wait time unless you’re in a true emergency and, even then, your staff should be offering to reschedule rather than just having them sit there stewing. I may choose to wait but I’m entitled to know the real reason and to an appropriate genuine apology, at a minimum. What Vets don’t understand is that they provide a professional service, emphasis on professional AND service. Get over yourselves. Many professional services are both art and science and not all clients are dumb as rocks. Whether you like it or not, we often know our pets far better than you ever will in the few moments you spend with them, despite what they told you at school. Many of us would be even better clients if you weren’t in such a rush and so very willing to keep the “mystery” going, like you’re exercising trade secrets and protecting them. Of course, we’re also not likely to be in the best condition, able to think nimbly, if we’ve been wrangling our dogs in a waiting room filled with other dogs for an hour or more either, waiting for our 5 minutes with the Vet who expects us to go from 0 to 60 brain speed in the first 10 seconds of the exam. I’ve learned to make a list but I watch my Vet’s eyes cross when I pull it out and watch them start edging toward the door rather than face intelligent questions. Professionals provide services and darned few of them do so effectively and efficiently which results is dramatic overcharging. I see quite a few very poor business practices in your response to Cat that obviously result in expenses you pass along to clients rather than adjusting your practices or charging them back to suppliers, as they should be. “Next thing you know you're practicing bargain-basement medicine so your days are easier.” Who told you being a PROFESSIONAL was going to be easy? It darn sure shouldn’t be! It is a part of your professional obligation to set and maintain the standards, not only in your own practice but throughout your profession. Ever known an incompetent or unethical colleague? Did you report them or do ANYTHING else? Or did you do that “I won’t judge…” deal? Well, that would be the biggest problem in all professions. No one wants to be a “narc” and the public suffers for each professions’ failure to police itself. Would you testify against another member of your profession if they harmed their clients? If not, you’re failing in your professional obligations. It is only by holding your colleagues responsible that your profession retains its standards. Charge for what you actually provide and provide all that you charge for. I am tired of living in a country of arrogant liars and fraud feasors. Yes, taking the easy way out, failing to maintain standards, misrepresentative listings on bills, and even ineffective or inefficiencies are all forms of lying and many are outright fraud. There’s a steep slippery slope from puffy and fudging to FRAUD and most Americans and made it a long, long way down that slope as evidenced by the current events on Wall Street. It is bad enough when this happens in the caveat emptor (buyer beware) environment but it is pathetic when it goes on in professions. Clients have the right (and often no choice but) to trust the professionals they consult and there is NO excuse for a failing of professional obligations, else it is no profession at all. PS: If you think this is harsh, you should see my criticisms of own colleagues, attorneys. :)

PJBoosinger December 31st, 2008 02:38:57 AM

PJBoosinger: I know you're new to Dolittler. I know this because you and I would not be at odds on ay number of the issues you just raised:

1-AVMA reform

2-Non-economic damages for pets

3-Increased scrutiny of the vet profession and better self-policing where rogue practitioners are concerned

4-Minimized reliance on pharmacy, food and product sales.

etc...

You say the veterinary profession needs a makeover? Welcome to the club. You clamor for what most of us here seek. Stick around and feel free to bash me when you think I deserve it. I can take it.

btw, switch your browser to Firefox and your paragraph breaks will show. ;-)

Dr. Patty Khuly December 31st, 2008 08:23:05 AM

Greedy Vets: The "Not So Much" Edition:

Several months back, my older cat had a dental including two extractions. Blood test beforehand, follow-up exam afterwards, etc. Recently I got a postcard telling me she was due for a dental exam. Made the appointment for today. Managed to get there despite the snow being dumped on us.

It was a full exam and consultation with the vet at that practice that I prefer for my cats (I have a different preference for the dog.) Her teeth are fine, apparently the lack of new tartar buildup is impressive. We discussed her weight, her diet, and whether we wanted to do a blood panel this time. (We decided not; her numbers last time were fantastic for her age; her annual isn't that far off; there's no indication of anything but excellent health right now.)

No charge. Included with the dental several months ago.

Lis December 31st, 2008 04:43:13 PM

i just stumbled on your blog, and i gotta say: yay! as a half-vet tech, half-receptionist, i wish all our clients had to sit and read these pages in the lobby.

regarding this particular topic, it sounds like you really value your license, your employees, and the quality of care that your patients receive. kudos to you. it's hard to work in this field because you have to have revenue to stay in business but you constantly have to defend yourself against people accusing you of overcharging.

especially on receptionist shifts i'm always fielding loaded questions from people who want to get vaccines from the local feed store or whatever, and while i guess that's better than not vaccinating, i wouldn't trust those vaccines on my own dogs. there are so many reasons to get an exam before vaccinating, and where i work we also give diphenhydramine to the top 5 vaccine reactor breeds with most vaccines. plus, a few vets i've worked with feel that the vaccines you can purchase at feed stores may be improperly refrigerated. everyone has a different opinion of course, and i'm sure thousands of dogs do fine with those vaccines. in any case, are you really expecting the receptionist at the vet to tell you to turn around and leave?

lindsay January 1st, 2009 12:44:36 AM

I cannot speak for the entire profession, only for myself. I am a solo practitioner in a rural area. AAHA certified, laser, ultrasound, fluid pumps, tonometry, in house lab, high speed dental equipment, et.(no digital xrays yet). My employees (#5)receive full medical, dental and pet insurance plus retirement (15-25% of salary. My expenses this past year were over $600,000, before I made a penny. I have to charge enough on things I do on a regular basis (like vaccines and exams)to pay bills and still have some left for me. I would love to charge strictly by the minute but I doubt that will ever be feasable in this profession, it is not that simple.

Hobson January 2nd, 2009 12:10:53 PM

...continuing previous post. I do agree with PJBoosinger on the point of us not policing our own and not turning in colleagues. I regret not turning a colleague (former mentor and friend) who admitted that he did not complete his required CE. Fortunately he has since retired. I won't turn a blind eye next time. I almost lost the message however, having to read through all of the inflammatory language("price gouging", "excessively padding" "whining" "dumb as rocks" "pathetically unqualified" "cram down our throats" "stranglehold") I don't think or practice that way at all. As a general practitioner I don't have the luxury of narrowing my skill and knowledge to just one area such as nutrition or pharmacology. I have to rely on those that specialize in these areas, whether they are employed at specialty paractices, universities, pet food companies, phamceutical companies or pharmacies. But I am qualified to prescribe medications that I use regularly and are familiar with. When I don't know, I know who to ask. Human pharmacists are not educated in animal medicine, toxicology or pharmacology nor are they required to maintain any continuing education in such. There are some major differences in species that are important. I tell people when I don't know something or someone can do a better job on something than I can. I sit down on a stool at each patient visit and ask the client if they have any questions before I get up. I never overbook and clients rearely have to wait except in an emergency. I don't expect anyone to feel sorry for us, but I think most of us earn the salary we make and we are underpaid compared to other professions. We are begrudged more than similar professionals for the money we do make. I would love to never dispense anything, but that is what helps pay the bills. Many clients like the convenience of buying things from vets. I hope I practice long enough for that day to happen. Clients may see higher exam, lab and surgical fees to offset this loss of revenue. We still have to pay our bills that are not connected to drug costs.

Hobson January 2nd, 2009 06:45:02 PM

Hobson, And you called "me" on the carpet for inflammatory language?? Although I think "pathetically unqualified" might be more than appropriate in Dover & Hampstead, New Hampshire...

PJBoosinger: I truly feel bad about Beanie. All I could do for 7 months was cry uncontrollably, I'm glad to see you stand up for what is right.

My link is highlighted.

Barb Albright

Pocket's Story from NH January 2nd, 2009 09:10:24 PM

Hobson: Thanks for taking the time to express your opinion in a more sober and thoughtful way than I often do. And thanks for speaking out against the inflammatory laguage. It doesn't help further the discussion and it's not a fair assessment of the profession, anyway.

Dr. Patty Khuly January 3rd, 2009 07:44:20 AM

dr. patty .. its great content .. thanks ..

كتكوت

كتكوت January 4th, 2009 07:53:18 AM

I'm seriously behind on my blog-reading...What about the markup for microchips, then? I can understand the markup for vaccines. They have specific handling instructions and must be kept within a narrow temperature range. So, why the markup on microchips? My rescue group can get AVID microchips for $10, which includes the chip in a pre-loaded syringe, AND registration, so why do vets charge upwards of $50 for this, usually NOT including the registration (for AVID, that's an additional $18.50). Sabrina

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