Sunday, June 5, 2016

Why the Spay Price Isn't Fixed.

Three reproductive tracts of the three spays I did a few days ago. They are an excellent explanation as to why there is not a flat fee for spay surgeries (at least at my clinic).

Could you guess which reproductive tract belong to which patient?

Patient Number 1;
A 7 month old domestic short haired cat.

Patient Number 2;
An 8 month old 38 pound Cattle Dog.

Patient Number 3;
An 8 month old Labradoodle who is 55 pounds.

At my clinic I try to do everything I can to treat every case independently and be fair to each. Therefore, providing a "one  size fits all" approach doesn't work in many surgery cases. With the exception of routine cat and dog neuters, every other surgery has a price range and every other surgery is based on the patient. 

Historically vets have put themselves in the predicament of dismissing spays as a "basic" surgery done so often that it has been diminished to "routine" status. This perception has understandably caused clients to price shop and balk at spay costs of anything over $100. High volume low cost spay and neuter clinics have popped up to meet demand and only reinforced the perception.

For all of the knee surgeries that I do weekly with a $1200 price tag, that clients are more than happy to pay based on the specialists average going rate of upwards of $3,000, I have to argue and justify a spay price of $200 plus. Ridiculously that spay has a much higher chance of causing a life threatening post operative complication than my knee surgery does. I will take a bad knee to correct over a fat dog in heat to spay any day of the week.. and I make 5 times the amount of money doing it. 

Why does "one size not fit all"? Because some dog spays are ridiculously difficult to do. And some patients need more time, more pre-op consideration and more peri-op care, not to mention post-op goods and services. All of these cost more time and more money. Wouldn't you want your vet to tailor and customize your pets care to their needs. Isn't it fair to pay for that?

The three uteruses (probably grammatically correct to say 'uteri' but that just sounds snooty scholarly, which I am not, so I'll move on).. belong to the pets above and listed in their perspective order. (Note; I did not use the actual patients for this,, they are in fact my cat Wren, and my dear friends Madeleine and Maizie.. but they represent the actual patients very well.). The top uterus is an early pregnancy in a feral cat. Middle is an 8 month old who is 38 pounds and in heat, and the last is also an 8 month old who is 55 pounds and not in heat.

The costs of a spay should vary based on the patient. If your dog is in heat, pregnant, or has a uterine infection it is going to be more difficult to perform the procedure. It will take more anesthetic time, require more equipment and suture and should also be followed up with post operative medications to include analgesics and antibiotics.

As I  discuss why spay surgeries are each entitled to their own charges I will admit that I never charge a different price for cats. A pyometra cat is the same cost as a pregnant cat is the same cost as a regular cat spay. In truth there is not enough of an additional degree of difficulty to warrant the extra fee. The only exception to this is the post operative care and medications. I challenge other vets to argue differently. I especially challenge the emergency clinics who give estimates of cat pyometras in the thousands of dollars. 

The cat below is also pregnant. Although no one wants to be stuck in the middle of this moral and ethical argument it is Spring here and the kittens are blooming as fast as the flowers. Sadly, many of the cats in our rural area are also feral. Feral cats having kittens perpetuates more feral cats having kittens and many of these are eaten, killed, or die of infection. When a feral cat  is caught and brought to us for a spay or neuter we can't touch them, examine them, or even know if they are pregnant. Once they are sedated they are all spayed and neutered regardless of their condition. It is the only way the cats can be released responsibly and spared their life. But a cat is a cat and a cat uterus is easily surgically removed regardless of uterus size. If your cat is given a thousand dollar estimate (or anything near close to that call me. I will do it for a fraction of that.

If you asked me to spay your dog as I would my own dog here's what I would do;

1. Have the vet who is performing the spay on your dog do a physical examination while you are present. Can you imagine going in for surgery and never meeting your surgeon, OR, having never met them and they never examined you? That's plain neglectful.

2. Every human patient has pre-operative blood work done to check basic organ function. I now want to check clotting function too.

3. Your pet should be free of internal and external parasites. Having fleas walk through the surgery site is not maintaining an acceptable sterile field. People with invasive surgeries these days have to use a special surgical soap and shower with it every day.

4. Every spay should be intubated and maintained on inhalant general anesthesia. The best way to maintain an open airway is to have one. The best way to maintain an acceptable anesthetic plane is to use gas.

5. Intravenous fluids via an indwelling iv catheter. I use it for every spay these days. Why risk it for $80?

6. Every spay gets and goes home with analgesics. For the cats most of these are injectable. or the dogs a 24 hour dose of an NSAID is given pre-op and oral meds go home for the next 4 days.

7. Suture material. The glue that holds the tissue together and keeps your pet from bleeding internally or opening up their incision. You get what you pay for in this department and no one ever asks what this vital material is. There is still debate in the veterinary field about what  is and is not considered acceptable standard of care. For many experienced vets I will not argue that using what works for you is fine, but, the rules of engagement are shifting and clients have the right to know what we use and why we use it. If a surgery fails they also have the right to their pets records and challenge us on our choices.

There is a terribly fragile line between low cost and affordable and borderline substandard care.

Chloe who needed an emergency pyometra surgery and couldn't afford the ER price.
Her story below.
We all like to have an idea of what something will cost. It allows us to plan, budget, and bargain shop. Medicine allows for only so much planning and presuming.. the rest is decided on luck, fate and preparedness for worst case scenario.

If you are price shopping for a spay you are asking for more cut corners than I would ever be comfortable with. If your pet has a problem while being spayed or neutered your vet has a much better chance at your pets survival if they are intubated, under inhalant anesthesia, with iv  fluids, and a full sterile surgical suite. Wouldn't you expect the same for yourself?

There are a few brave clinics who provide set prices for a service and rely on the law of averages to make the bad cases dilute out the overwhelmingly easy cases. It allows for clients to not be side swiped by sticker shock when those inevitable outlier surgeries are their pets surgery.

I much prefer the open and honest approach. I treat each case as their own and each is priced fairly based on their own merit. I also care far more about every pet walking out of surgery happy, comfortable and safe. If you cannot provide optimal care due to financial struggles we will work with you,, it is the reason we maintain a fund for hardship cases at the clinic. Good patient care should not be  about bottom lines, budgets, and unacceptable risks.

Related Blogs;
The Ode of My Obligation. Why does the ER charge so much?

Chloe's Emergency Pyometra. Saving Your Pets Life When Optimal Options Aren't Possible.

Jarrettsville Vet Price List 2016 Edition.

Pyometra. Finding a Happy Ending With A Preventable Disease.

If you would like to discuss your pets medical or behavioral condition with me you can find me on Pawbly is a free online community dedicated to helping people who love their pets. If you are a pet lover please join us in and share your experience and expertise. Together we can shape the destiny to provide more happy endings to those who need them.

If you would like help and you are in the northern Maryland area come visit me at the clinic, Jarrettsville Veterinary Center in Harford County.

Or find me on Twitter @FreePetAdvice.

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