Thursday, April 30, 2015

Rebuttal to Peter Fenton's Washington Post Article, "Vet's Are Too Expensive, And It's Putting Pets At Risk."

The following article was written by Peter Fenton on April 21 for the Washington Post
Peter Fenton is the author of Eyeing the Flash: The Making of a Carnival Con Artist.

My response to each section is identified in italics.

After a terrifying encounter with our automatic garage door, my beloved 23-pound cat Orangey was in trouble — dazed, struggling to breathe and in pain. I rushed him to the nearest animal emergency clinic and quickly agreed to X-rays and pain medication.

 A 23 pound cat??!! The average cat should weigh between 8-12 pounds. Vets often remind our clients that "an ounce of prevention is worth a pound of cure." The best way to avoid healthcare problems is to stay healthy. Obesity is at epidemic proportions in this country and the collateral health costs are staggering. They include; arthritis, cancer, diabetes, among others and also significantly reduce both the length and quality of life.

I didn’t think about the cost of anything at first. But as care escalated, I began to worry about our running tab. Though Orangey’s injuries were minor (and the doctor agreed to perform only essential procedures), he was hospitalized for about 48 hours. All told, the bill totaled $968.29.

It is impossible to offer an opinion without an itemized bill or invoice. As with EVERY transaction in EVERY persons life it is prudent to ask before consenting to any care or service. My personal opinion is that $968 for a 24 hour emergency facility two days of care and work up after a traumatic injury is not excessive. And, it was probably not evident until after 48 hours of monitoring that there weren't any major injuries. Certainly, with an obese cat and a garage door there could have been. These could have included, lung, liver spleen or other internal organ perforation, pulmonary contusions, fractures, etc. Both Orangey and the owner were lucky. Plain, old lucky. I am guessing that radiographs were done, (I am also not guessing that they were done with consent) to rule out fractures. Radiographs at my clinic are $100 to $200 dollars. The x-ray machine is digital and cost the clinic about $90,000. Yes, ninety thousand dollars. How many x-rays do I have to take to break even? (This is the average cost for a good model). I feel obligated to say that I understand most people could not afford $900 out of pocket. The point is not that $900 is not expensive, $900 is a lot of money. The point is was the care Orangey received WORTH $900? I would venture to guess Orangey was given excellent emergency care for traumatic injuries which everyone agrees could have been life threatening. If $900 saved his life would that be an acceptable fee?

I was shocked. And not because I’m a novice pet owner — my wife and I have been rescuing cats for most of our married life. But when we started, vet costs were modest. That’s not the case anymore. According to a 2011 report by the American Pet Products Association, the cost of routine and surgical vet visits has risen 47 percent for dogs and 73 percent for cats over the past decade. Pet owners spent about $8 billion on vet care in 2000; by 2013, that figure climbed to more than $14 billion.

Perhaps 20 years ago an x-ray machine was more modestly priced? Perhaps 20 years ago the cost of a veterinary education was less than the average $150,000 of debt most new graduates bear? Perhaps the author didn't have 20 pound cats? Most definitely the standard of care was not a fraction of what it is today. A point I believe is tied to a few things; Liability. If we all didn't love to sue each other vets could practice medicine that was practical, versus fearing liability. Pets are companions now, not the same label was provided to most cats decades ago.

Disturbingly, many owners are reacting to sticker shock by not bringing in their pets at all. “An estimated 23 million pets in the United States are in homes where the caretakers live at or below the poverty line, and that typically leaves the animals without access to veterinary care,” Humane Society President Wayne Pacelle said in a November 2014 blog post. “Close to 80 percent of their pets have never seen a veterinarian.”

I believe this statement to be true. It is yet another sad reminder of the fragmented society we live in, and this trend does not seem to be getting better. The divide between the wealthy and the poor is only widening. As the demographic fragments the marketplace will respond. In the arena of pet care it is done as an emotional obligation to help pets versus an opportunity to create a business opportunity in a need based area. Non-profits, motivated by emotional need to provide care, are forming simply to provide care to the needy and under-served in our communities. The established vets are too busy trying to respond to the shifts in our business models to care enough to try to figure out how we can help those who cannot afford care. We vets don't want to be working for free (and not many of the rest of society does either), we just don't want you to be able to get help for free elsewhere. (Doesn't make much sense does it?)

Vet incomes are a big part of the reason for the rising costs. According to the Veterinary Medical Association, the mean annual professional income of private practice veterinarians rose from around $60,000 in 1995 to over $90,000 in 2007.* Vets argue that this jump to correct an imbalance. As Veterinary Advantage Magazine explained, between 1965 and 1995, veterinary fees lagged behind inflation. At the same time, student debt for vets grew exponentially. And pet owners began to turn to online pharmacies for medicine. As  Rob Foley of New York, who co-authors The Angry Vet blog, explains, this is a killer for vets. “When a veterinarian loses revenue through pharmacy sale losses, they must make up this income by raising other costs like exam fees or diagnostics,” he writes. “The money simply has to come from somewhere.”

Vet incomes. This is a point of deep contention for me personally. I will be honest. Everyone wants to quote incomes as if they are outrageous, egregious and unwarranted. What should someone who spends 4 years in college HAS TO make almost perfect grades, and then spend another 4 years in medical college to get a doctorate deserve? What would you want if this were yourself? Or, your child if they spent 8 years earning perfect grades? Did I mention that $150,000 of educational debt? A doctor a lawyer, they meet the same qualifications and make upwards of $132,000 lawyer, and $189,00 doctor. Outrageous that vets make $90? Why, because we treat animals? Shouldn't pediatric oncologists work for free then? 

However, even Foley admits that some veterinarians take advantage of pet owners: “I have seen bills run up. I have seen animals hospitalized who clearly did not need to be and animals operated on who did not have to be.”

There is not one profession that this statement can't be used for. There are bad people everywhere. Healthcare and patient care is based on trust. If you don't trust your doctor find one that you do. In general veterinarians are the most humble, hardest working and most honorable people you will ever meet. (That's why you want your daughter to be a vet isn't it)? There is nobility, pride and humility in being a veterinarian. Oh, yeah, there just isn't the pay, and the emotional guilt that people will lay at your feet is heartbreaking. Did I mention the suicide rate? That department we have cornered.

When owners can’t pay, clinics offer payment plans — but at a price. When my wife and I raised heck at the emergency room over Orangey’s charges, the vet whipped out a brochure detailing the clinic’s plan: a credit card with a high APR. We declined. But others might be forced to saddle themselves with additional high-interest debt. (It’s possible to get pet health insurance, but Consumer Reports says it’s rarely worth the price.) CareCredit, a division of GE Capital Retail Bank, is a major issuer of such credit cards to vets, dentists and other professionals. In an interview with VIN News Service, a company spokesperson affirmed that well over half the animal hospitals in the United States accept the company’s card.  An independent study found that vets who routinely offered the card to customers earned 17.2 percent more total revenue per year.

There isn't one veterinarian on the planet who hasn't tried their own in house payment plans. I did it for 7 years. My default rate about 75%. One year I wrote off $50,000 in unpaid bills which earned myself having to work for free for 2/3 of the year. It came out of my paycheck as the hospital owner because there was no other bank account to pull it from. Without third party billing options there would be no options for clients who don't have either insurance or savings accounts.

According to a 2013 settlement after an investigation into alleged predatory lending practices by the New York state attorney general, “Approximately 65 percent of CareCredit card holders apply for the card while they are in a provider’s office.” In other words, when Orangey or Fido is in distress. “In many complaints to the OAG (Office of the Attorney General), the provider completed the application information and submitted the application on behalf of the consumer,” the settlement states. “Some consumers were led to believe that they were signing up for an in-house, no-interest payment directly to their provider.” Here’s what they got instead: A deferred-interest credit card with charges that accrued at a rate of up to 26.99 percent on the total bill after a promotional period.

All credit cards are bad options. Is this something we don't know yet?

Some nonprofit clinics are trying to blunt the challenge these rising charges create for pet owners. Some nonprofit organizations have established spay and neuter clinics for low-income clients. The surgeries are performed at a fraction of the cost a private vet would charge.

There may be a few greedy veterinarians out there who see low cost spay/neuter clinics as competition. It is a futile endeavor to be upset about a client who couldn't afford us anyway. On-line pharmacies, spay/neuter clinics, and now traveling vaccine clinics are infringing on the once sacred veterinary hospital revenue turf. The marketplace is ripe for disturbing and we live in a land of entrepreneurs who see opportunity. Best to be honest and build a strong foundation of clients who see you as invaluable and indispensable. At some point their price point for our treasured virtues will be tested and scrutinized. Remember when your doctor made house calls, handed you a prescription, knew your first name, and then sent you a modest bill later? Those days are gone too.

But even this goodwill gesture upsets some segments of the veterinary community. A group of Alabama vets, for example, is waging war against the very concept of inexpensive spay and neuter clinics, alleging that they jeopardize the future of the profession.

Ma Bell fought hard to maintain her monopoly. In the end the consumer dictates the course of business. You can fight, scream, and tie up the courts for only so long. Alabama better start diversifying and finding their niche market, spays and neuters, along with flea & tick preventatives, and most likely even vaccines are not your bread and butter any longer.

Michael Blackwell, senior director of veterinary policy for the Humane Society of the United States, offered this response to their claim: “Unhappy with economic realities, some veterinarians are casting blame on the good-hearted souls within their own profession who work with animal welfare groups to make sure poor and financially strapped families have access to care for their pets. By blaming nonprofits, veterinarians are barking up the wrong tree.”

"Greed is the lack of confidence of one's own ability to create." Vanna Bonta

Thankfully, my cat Orangey is back to his old self. He’s purring on the desk beside me because of the care he received at the emergency clinic. Like most pet owners, I would have paid anything to save him. But veterinarians shouldn’t take advantage of our devotion to enhance their bottom lines.

So, let me get this right? We spent the whole article casting blame about how ridiculous veterinary salaries are (to which I might add the author doesn't disclose his). You further cast doubt that perhaps the outrageous bill was not warranted (because we dare not admit that we were not intelligent consumers but instead emotional worried parents who closed the garage door on our cat who most closely resembles a chair cushion), and now we are grateful that the emergency clinic did such a great job allowing our beloved family member to be back home with us. Mr. Fenton I think I lost your point? 

Let's recap:
1. What should a straight A 8 year college graduate earn who works 50-70 hours a week and gets bombarded with guilt because "this pet needs something that I either 'can't, don't want to, or don't feel responsible for' or else it will die" scenario be paid?

2. What is a pet? A right? A responsibility? Societies responsibility? The vets responsibility? Where does the burden of responsibility lie? If you treat your pet as a companion and member of the family their care warrants the equivalent. What is the prudent cost for this? Is modest cost in this day, with this classification?

3. Who bears the financial burden for other peoples life choices?

4. There is this odd emotional perception that vets (all who most certainly go into this profession with a deep seated calling to help animals, whom many of us vets believe are the most needy beings on the planet) to be met by a society that feels we, not unlike them, are wrong for trying to earn as much as we can so that we too can live in a nice house, with the nice car and the white picket fence. So, why can't we share this dream with the rest of our fellow Americans? Do you work for free? Do you get asked daily to work for free? Do you think that you should be paid what the degree of your earned and paid for education warrants? And the abusive guilt. That I would never wish on anyone.

5. If after 8 years of college that included studying, ulcers, and self sacrifice to have any kind of life at all, you graduated from vet school with upwards of $150,000 of debt and were then faced with justifying being paid for 2 days of emergency care, monitoring and a knowledge base broad enough to manage this, wouldn't you feel a bit bitter about NOT being compensated equivalently to what your peers are paid? 

6. Human healthcare model. If you were obese, hit by a solid object that weighed 10 times more than what you do (23 pound cat, estimate 200 pound garage door), then spent two days in the hospital, what do you think it would cost you? Let's say you had an emergency visit, digital x-rays and a 48 hour hospital stay. (1,700 for a one day hospital stay, times 2 days, x-ray $200, oh, wait, not even Mr. Foster knows what they did for Orangey for $900..).

7. The closing statement is particularly offensive and disturbing; "Thankfully, my cat Orangey is back to his old self. He’s purring on the desk beside me because of the care he received at the emergency clinic. Like most pet owners, I would have paid anything to save him. But veterinarians shouldn’t take advantage of our devotion to enhance their bottom lines." This was an emergency, Orangey was seen immediately, provided all of the care he needed and there is a cost for this. Perhaps, the author has no idea what the cost to run a facility of this magnitude entails? Should you ever find yourself in an emergency bind, perhaps under arrest? audited by the IRS? in court? etc, how much would it cost you to find someone who excels in their field of expertise at the drop of a dime? Probably more than $900. I don't believe that Mr. Foster was taken advantage of, I believe he was a poor consumer, who is now bitter, and his gratitude is mired in a diatribe of buyers remorse. Added to a poorly acceptable note of gratitude. 

It will become increasingly impossible to demand the same standard of care and NOT pay for it.

We all live in a country of unparalleled expectations, desires, and possibilities. We also all have to learn at some point in life that it is ALWAYS BUYER BEWARE. If you are not financially responsible get insurance, or simply do not adopt a pet. Should you choose to get a pet expect that there will be accidents to which you as the parent will be responsible for. There are options available for every pet parent and every situation. Should you be an otherwise educated, financially sound adult please don't moan about it afterwards. 

My last words. I agree that if you are not emotionally prepared for an accident it can quickly escalate out of control. Have a good solid relationship with your primary care physician. Most of my clients have both my cell phone and email information. I also provide help while my clients and patients are at the emergency facility. The landscape of medicine is changing. Are you ready for an educated empowered consumer? Are you one yourself?

Related blogs;
How to Get the Best Deal at the Emergency Veterinary Hospital.

There Has To Be Mercy Before Money

Making Vet Care More Accessible

Burnt Out From Being Burned

Compassion Fatigue in Veterinary Medicine.

I am a practicing veterinarian in  Maryland. If you would like to visit me in the clinic you can find information about us at Jarrettsville Vet, in Jarrettsville, Maryland. Or you can ask any pet related question at Pawbly is free for all to use and open to anyone who cares about animals.

I am also on Twitter @FreePetAdvice.

1 comment:

  1. I thought the bill was reasonable considering all the care Orangey received. I hope the thoughtful clients you see make up for the unrealistic jerks like the author of that article.