Saturday, April 8, 2017

Veterinarian Rants. Our Failure To Take Responsibility or Compromise

Sweet Baby Rae, looking for a home now, come meet her at the clinic
 In general I get a bit miffed when I read many of the most popular current veterinary blogs these days. (I admit I have angst,, I'm working on it. Based on current affairs it is going to take a while).

Not to say that I am not equally guilty of self-sought pity parties, BUT, I am utterly sick of veterinarians claiming naive oversight to the huge pitfalls that plague our profession. My latest tirade is centered on Andy Roark's published article on "The Bad Economics Of Veterinary Medicine." Written by a surgical specialist (which is the absolute best way to make over $200,000 a year in vet med), it serves to explain that we are underpaid, in huge debt, and struggling "to practice the best quality medicine possible ... at the lowest possible cost."

Wylan,, lap dog
I went to vet school before the advent of outrageous school debts, (yes, these days did exist). They are the same days that students looking into colleges with published price tags made decisions based on what you could get into AND what you could afford.  I don't know if this rationale is still employed? Most of my friends with college age kids use the axiom "if they can get in I will find a way to pay for it" thinking. (HUH? Maybe that was the spawn of the economic dilemma? So much for "leading by example?"). Every single student knows what their school is going to cost. My parents were open and honest about this price tag. It was the single reason I attended a free and flipping hard painfully brutal school that began with the all caps "UNITED STATES",, and ended with .."ACADEMY". It was not fun, nor easy, but then neither was vet school. I had excellent pre-vet training. I also had no debt. While I agree with the premise that vet students get very little (or more aptly NO) business training, the field of medicine has not changed that much save for one BIG exception,, women (we are classes of primarily women) got empowered in the 80's. We were fed a steady diet of "you can do, and have, anything you want" and we believed it. This gender equality mantra remains strong and ingrained. We all wanted to be veterinarians with the same delusional dream-like perception of saving the fluffy critters we adored. That tiny simple equation led to personal quests that provided the market to supply and permit almost "anyone can get in" vet schools to feed the demand (at outrageous costs). These determined students didn't do their homework, didn't employ a better discipline than their equally over extended in debt parents (who not coincidentally also bought houses they and the mortgage companies knew they couldn't afford), got in to schools they couldn't afford, dismissed the price tag, and fed the off-shore pop-up vet school machine that doesn't have a conscious nor responsible soul.

Coot insists Loon make room.
When the motto is "vet school at any cost" the collateral damages include sensible debt loads, expected post graduation income, calculated debt to income ratios, a long term vision for a life to include other debt related items (house, car, kids, vacations), and, we also forgot to reflect on the pressures, realities and landscape we were stepping into once we got out of vet school.

We all trained with vets before we went to vet school (it is after all a pre-requisite). How many of those vets drove luxury cars? How many of them lived a lavish life? How many of them were arrogant outspoken advocates for anything? How many of them gently warned us about the pit falls of vet med? (OK, all of mine did, I just thought I would be different and knew better). They were, and remain, humble quiet hard working 'salt of the earth' people. They also rarely complained. Why was that? It wasn't that they worked less than we did. It also wasn't that they didn't have financial pressures, bad clients, or weren't ridiculously underpaid for their degree of expertise.

Quality control crew

Here's where we failed to stay in the firm footsteps of our veterinary forefathers. We forgot to think about our futures past our own graduation, OR, if we did we thought we would be different.

I have new vet school grads seeking employment with over $400,000 of school debt. I know they will never, (yes, never), pay them back. I also know I can't pay them enough to get out from under that rock. At some point their bad debt decision IS going to affect their professional decisions, my ability to provide a satisfactory workplace and something will give. Will it be theft? Or, adding diagnostics that aren't truly indicated? Or, self-medicating to avoid self-doubt/loathing/futility? The potential scenarios were all too bleak to warrant employment.

Too many vets want to blame the economic environment, plea for pity that they didn't know what they were getting into, didn't know how much they would make, AND THEN want to charge clients more to compensate for these, WHILE, arguing about how intelligent and skilled we are. It is an argument that sounds like it is based on a juvenile temper tantrum.

We are all consumers. Perhaps not all in the same market places, BUT, we vets balk about the cost of human healthcare, brag about how much more efficient and sensible we are, (where else can you get your exam, blood work, x-rays AND a diagnosis in the same building for less than a grand?), and then try to berate our customers for not understanding the value in our services. Why? Why do we show contempt for the exact things we disparage the MD's for?


If my clients cannot afford, (yes, I do believe them because we have already shelved the pointing fingers and placing blame argument as fruitless, haven't we?), then we find affordable options. It is exactly what my mentor did all those decades ago. It is the cornerstone of the mercy AND accessibility we pride ourselves in being so much better at than our counterpart MD's. "Best medicine" is great IF your clients can afford it, and it is a death wish to your patients who cannot. Get off your soapbox pedestal and work with people to save your patients. How many of us don't offer options because there is not an incentive that is economically feasible for us to do so? And then why do we denigrate the vaccine/spay/neuter clinics? (Starting to look like a vicious avalanche on a merry-go-round yet?).

Lilly gets her ultrasound

Let's go back to the Bad Economic's article..  Let's discuss the only example cited; "The best example of this is the dilemma of overnight care in general practice". It isn't that over night care options have changed. What has changed is our perception of what makes us the most money, what our clients can manage, or want to do (many of mine do not want to go to the ER based on previous experiences there (shelter head from angry ER vets,, sorry,, truth)), what is considered "best medicine", and it is STILL (just like it was for the old timers) cost prohibitive to provide 24/7 care at my clinic. Nothing here has changed.

Except,, I follow the precedent set by the vet I learned from. I do not live in the vet clinic (the ultimate all access vet).. but I do provide help after hours to the best of my ability.

Here's my favorite example, I do orthopedic surgeries for the clients who cannot afford it elsewhere. I literally say this; "I only do the surgeries that you cannot afford to do where they should be done; at the referral center." My knee surgery is about $1500, referral is about $3500. They are the oranges, I am the apple. Go to the specialist, if at all possible. Your pet will stay and be provided with excellent 24/7 oversight for 3 days. Mine go home post-op 6 hours later for you to stay up all night next to them to monitor. We rarely keep pets overnight. Why? well, because there isn't any staff member who stays overnight and I don't want your pet here without supervision. I send my patients home with my email, phone number, and directions to the ER. How many post-op patients have gone to the ER overnight, NONE (knocking furiously on wood). That's best medicine based on the client economics... it is what we do with every patient in every situation.

My pup Jekyll

Where is the responsible ownership of acquiring bad debt?

My personal debt is not my clients problem. Nor is it my business to judge or scrutinize where they allocate their resources. My problem is their pets needs and figuring out a mutually agreeable compromise to getting to "better."

It is time to be fair, honest and transparent.. the finger pointing, self-pity and arguing for a landscape economic environment which has not changed save for our naive oversight and self-imposed debt.

Reference article; The Bad Economics Of Veterinary Medicine. by Sarah Boston, DVM, DVSC, Dipl ACVS.

My related blogs;

Ethical Fatigue. The Crossroads Of Vet Med and the Public Conscious Awakening.

Euthanasia. Why Do We Make It So Convenient?

Affordable Options Are Everyone's Right

The Jarrettsville Veterinary Center Policy For Clients With Financial Constraints

Rescue Economics, When The Expense Costs You Your Ability To Care.

We Don't See You. How Vet's Became Biased and Lost Our Clients in the Process.

Compassion Fatigue.

Rocky,, eye on the prize

As always JVC, and I, are here to help you and your pet. If you would like to meet the amazing staff and hear more about the ways that we can help you and your pet live longer happier and healthier lives we would be happy to show you how the face of veterinary medicine and the care we provide can ext end past the traditional options of hope and luck. Please also follow our amazing Facebook page JarrettsvilleVet. Or find our 2017 Jarrettsville Vet Price List here.

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  1. Great post. I totally believe everything you say about vet school costs and loans, and what you have to charge your clients for different surgeries. However, I watch "Dr. Jeff, Rocky Mountain Vet", who has the most reasonable prices I've ever seen for his surgeries. To be honest, if my pet needed expensive surgery, I'd probably hop in my car, drive two days to Colorado, have the surgery done on my pet for 1/2 or 1/3 of the prices quoted at other vets, then drive back. How does Dr. Jeff do it? I'm wondering if it's because he has a very busy surgery, and he has high volume. I realize you may not be able to comment on this, but I think you enjoy getting feedback on your columns, so I thought I'd share my thoughts with you. :) Roberta in sunny California.

    1. Hello Roberta!
      I actually just watched this show for the first time on Sat.. I have to say I have a tough time watching reality vet shows... there is a huge (like enormous) amount of relevant detail omitted (no doubt for time and audience interest),, so too much of the show is edited and therefore hard to use as evidence for real medicine and even scrutiny on my part. While I do think he is very reasonable in his costs his surgical standards are appalling!! I mean really really appalling.. I cannot even believe he would let anyone film him.. no gown, no mask for an orthopedic surgery is insane for me to excuse or accept.. It would NEVER happen at my clinic BECAUSE I worry for my pets and they deserve better. While there is a fine line between affordable and meeting the needs of your clients there is also acceptable standard of care.. we do not exchange one for the other,, regardless of how comfortable the vet is with it AND how many times you have gotten away with the results being "ok". just my two cents on his show.. I cannot watch it without wanting to throw tomatoes! lol
      thanks for reading and leaving your thoughts!
      take care and please keep posting comments. I love to hear what everyone is thinking.

  2. Hi Krista -

    If the current trend continues, and everyone follows your advice, then only students with wealthy parents will get the opportunity to go to veterinary school.

    I am a 2006 OSU alum, and while I was in veterinary school tuition increased 12% a year. My parents were not able to help me with tuition and the only thing I wanted to be in life was a veterinarian, so I took out loans. Due to rapidly rising tuition at my school, those loans ended up being more than I anticipated. Fortunately, I had been able to complete undergrad with no debt thanks to scholarships and working several jobs, but we all know those opportunities don't exist in veterinary school (scholarships are minimal and while one can certainly work in veterinary school - and I did - it's impossible to work enough to support yourself and still graduate). Military options are a fantastic way to pay off your veterinary loans, but that option isn't open to everyone as their are few positions available.

    A young woman came to me recently and asked about becoming a veterinarian. Before sitting down to speak with her, I checked the current tuition at OSU. It was DOUBLE what I paid. And we all know salaries have barely risen since 2006.

    Far be it for me to discourage someone from following their dreams, but I truly believe we in the profession need to be brutally honest with those that wish to follow in our footsteps about the current cost of doing so. It is my fear that our profession is losing some really talented potential future veterinarians due to economics, and we need to figure out a way to remedy this situation without blaming those who have already found out too late that their profession's economical state cannot sustain itself.

    There are times I wonder if the we in the Class of 2006 were the last ones who will be able to make a living in this profession.

    -Sarah Barr, DVM

    1. Hello Sarah,
      I agree the situation is VERY complicated and that the current trend is not enlightening, nor, reasonable for those of us from humble beginnings. I also fear that we are losing talent due to the outrageous costs of our education when compared to the financial return on that investment.
      I was the class of 2005 and I agree that this was likely one of the last affordable classes. Even amongst our class there were students who barely got by and had to do so on a shoe string budget. We are 12 years out and still a significant percentage are paying off that debt.
      The for-profit vet schools are preying on people like us,, so desperate to be a vet we turn a blind (naive) eye. Wealthy parents or not, this is a difficult demanding and emotionally trying profession. The passion is what gets us through. Money or not, you have to start there. It is the only thing to pull you through the dark days.
      I too struggle with providing advice. Most concerningly because of our suicide stats. I don't want to encourage a profession plagued by so much despair,,, I also don't want to paralyze a young-rose-colored-glasses girl who dreams big.
      We are already showing the signs of our profession burgeoning on destruction. I don't propose to know what the answers are for everyone. I can only provide my story, my side and a soap box plea for help from all sides.
      I wish you the very best! I sincerely do,, from one lifelong-destined-to-be-the-dreamer veterinarian to another.
      With love,

  3. Thanks for sharing. I work in a exotic animal veterinarian as a volunteer because I want to help in pet community and for me to able to know what in the pets world.