State of the Veterinary Profession from cofounder of VIN

[August West]

You make some great points and I agree that DVMs are probably much better off than many markets. I too, was in an industry that literally crashed (thus going back to school). It is not doom and gloom for vets, but I do think that some changes need to be considered. I just don't think class numbers need to be increased and I feel like it should be easier to specialize.

I have yet to hear anybody calling for an increase in class sizes. I am sure that funding for new schools like Utah State were conceived and realized many years ago, when the future projections were much rosier and the economy was much more robust. You can't just cancel such plans already in motion. Anyway, we have to hope that the economy will improve. In the meantime, we need to continue to be creative about finding ways to generate new revenue for the profession. And obviously there is no reason for schools to increase class sizes at this time. Many will probably look at out-of-state candidates more competitively as state funding is further reduced. But I have yet to see proposals to increase class sizes at any of the schools I am considering attending.

Actually I stand corrected. Looks like many programs have recently expanded class sizes or are hoping to do so in the near future:

http://www.avma.org/onlnews/javma/feb11/110201b.asp

I agree with those that think this is a questionable decision in light of current economic trends.

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[flyhi]

I have yet to hear anybody calling for an increase in class sizes.

they are not calling for it, but it's happened as recently as this academic year!

ok seriously, i'm signing off.

Toodles

 

[August West]

they are not calling for it, but it's happened as recently as this academic year!

ok seriously, i'm signing off.

Toodles

I updated my previous comment in light of new info I came across. Have a good night.

 

[LetItSnow]

In the meantime, we need to continue to be creative about finding ways to generate new revenue for the profession.

Definitely! I doubt anyone disagrees with this.

And obviously there is no reason for schools to increase class sizes at this time.

Once again - perspective is everything. The schools have a lot of near-term incentive to increase class sizes: more revenue to offset declining state contributions. That's a really big reason, to them.

 

[StartingoverVet]

Wow... this thread has really gotten sidetracked.. but I will join in...

Regarding medical insurance....
The big positive to insurance is that the costs of individual procedures and/or doctors visits are really low to the patient in our current system, so people are more likely to get treated. That is good for the practitioner because:
1) It gets people in the door and
2) They are ok with lots of tests being run to solve their problems.

Unfortunately, the reality is that people are divorced from the true costs being accumulated. The majority of people get their health insurance from their work (or their spouses) so don't realize how truly expensive it is (or in many foreign countries, the government).

That isn't going to work for pet insurance because the owners have to pay for the pet insurance out of pocket and they see the true cost to them of the policy (and their copays).

Sure, if we could get companies to start paying pet costs as a benefit, then that would be a big boon, but the chances of that happening nowadays is negative infinity.

The other big negative of insurance is all the extra testing that ends up happening, ultimately driving up costs and perhaps needlessly subjecting animals to danger and discomfort. Having been through the "let's keep testing until we find out exactly what's wrong" medical system, I don't think that is a model I want for animals. We weigh financial concerns now, and that keeps treatment costs reasonable, and we avoid a lot of unnecessary discomfort. I see even now how vet residents etc, like to find out the cause, without a lot of thought to whether it is worthwhile from a treatment point of view to undergo the test for a treatment plan. This would only be worse with more universal insurance.

 

[breenie]

The school I attend (Mizzou) DOUBLED its class size 3 years ago. Our graduating 4th years will be the last class of only 60 people.

The other OOS school I was accepted to has increased substantially over the past 3 years as well, and of the ones I applied to, only my in state has remained steady (and with strangely low OOS tuition, to boot).

 

[StartingoverVet]

Having said all that I see there are definitely ways for practices to do a better job. Pricing plans can make sense. Especially for multiple animal households/breeders.

One of the problems of expensive equipment is hospitals charge so much for the services that it is not used often enough.

I would like to see them offer fixed price plans to multi-pet households. They get a steady source of revenue, and the owners can access to more sophisticated testing without incurring additional costs. There aren't a lot of variable costs in using the digital x-ray, or the ultrasound, or even doing an endoscopy if you have idle resources (different story if you are busy and time is a factor, but that doesn't seem to be the case at most practices). So you might as well use them as incentives for people to lock in a level of payment.

Anyway, that is one of many ideas I have thought of. Ultimately it is function of what is going on at each individual practice, but getting people to come more often, and getting them to outlay a little more for a much bigger level of service are prime goals.

 

[david594]

Regarding pet insurance being the solution: Everyone needs to remember that the pet insurance industry are all for-profit companies. Their goal is to take in as much money as they can and pay out as little as they can. That is the business model of all insurance companies. All they are trying to do is get their share of the discretionary income pie, which may very well leave less money for all other aspects of it(including actual veterinary care).

Regarding fixing supply instead of demand. If I live in florida and want to go skiing, do i try and bring the snow to florida, or do i just move to the snow? We fix what is fixable, one solution is a whole lot more doable than the other. Same with the current state of veterinary medicine. The ~100,000 veterinarians can do a lot more to change the ~30 US veterinary schools than they can affect the mindset of ~300,000,000 US citizens who don't consider saving for veterinary expenses a worthwhile endeavor or simply cannot afford it.

Regarding human health insurance: I fully support socialized health care. If you dont have healthcare and get sick, you go to the ER and get treated anyways. Either way, we are paying for everyone to get treated. The big difference is some of us have a card in our wallet to show for it.


My solution to vet med? We need socialized pet insurance.

Sure would make life as a vet a lot easier if we never had to go over an estimate with clients. Now time to get back to reality...

 

[August West]

I think people need to try thinking about insurance models more abstractly and not looking to the human health care insurance industry for reference. For starters, those companies are "for-profit", which is a flawed business model for delivering services that people need to ensure their health and well-being. My proposal for an area of inquiry that we might benefit from looking closely at involved a much simpler approach than trying to assimilate veterinary medicine into the corrupt, inefficient and unsustainable existing private health insurance infrastructure and underwriting network that has increasingly plagued human medicine. I am looking to fundamental actuarial science and wondering if there is not a simple mathematical formula that practices and/or multi-practice partnerships could employ that would make preventative health care for pets a more manageable and budgetable expense for owners. This model would be non-profit which would eliminate many of the inefficiencies that exist in the human medicine-insurance relationship. By eliminating the profit-hungry glorified middle-man, close to 100% of dollars spent by members of the plan will actually go directly to healthcare services for the patient pool.

Anyway, enough rambling. If you are interested in better understanding where I am coming from, take a look at some of the wellness plans that Banfield currently offers:

http://www.banfield.com/Pet-Owners/Optimum-Wellness-Plans/Plan-Types/Dog/Special-Care

We know that companies like Banfield are in the business of making money, so obviously these things work or they would not exist. If we take such a model and make it non-profit, they will work even better and everyone can benefit. The animals will receive much better medical care, especially at the preventative stage. The owners will be able to budget the care costs into manageable monthly payments that are lower than their cable and phone bills. And veterinarians will have much better financial support to practice the medicine they were taught in school.

Maybe I am being too idealistic and clearly such initiatives would require additional scrutiny and engineering. And I do not think such plans are the silver bullet for fixing the economic deficits in our profession. I like Startingovervet's ideas on getting better use out of equipment and using them as an incentive. David594's saracasm was awesome as well!! Would love to see this discussion evolve and include minds much more knowledgeable than my own getting involved. After all, the veterinary profession is comprised of some of the best and brightest around. I imagine that is what Paul Pion intended and hoped to have happen when he released this message.

 

[bunnity]

Just wanted to point out that there is some of this going on, at least in PA:
Bad economy ---> less state revenue --> less state money to vet school --> vet school goes broke --> increases seats and # OOS accepted
Schools are increasing seats because they want / need the money - not because they particularly care whether or not there is a demand shortage or surplus. Unfortunately unless we fix the economy (ha!) or control seats with legislation, I don't see this changing.

 

[2CatMatt]

Regarding pet insurance being the solution: Everyone needs to remember that the pet insurance industry are all for-profit companies. Their goal is to take in as much money as they can and pay out as little as they can. That is the business model of all insurance companies. All they are trying to do is get their share of the discretionary income pie, which may very well leave less money for all other aspects of it(including actual veterinary care).

Typically medical premiums and human healthcare costs are not considered "discretionary" spending, but a necessity. Insurance companies aren't competing for the same dollars being spent on consumer goods and are therefore much more insulated from economic fluctuations.

Pet/animal health expenditures, on the other hand, are apparently considered discretionary by a large portion of owners. Where a person's dollars are competing between buying that new big screen TV or getting Fluffy his annual check-up. We shouldn't just accept that fact though just because it's difficult to change cultural values in regards to animal healthcare.

Regarding fixing supply instead of demand.

I don't recall anyone saying it's one or the other, just that fixing the demand side might be more beneficial for the profession overall. I could be wrong though since this is a really long thread already.

 

[dyachei]

Anyway, enough rambling. If you are interested in better understanding where I am coming from, take a look at some of the wellness plans that Banfield currently offers:

http://www.banfield.com/Pet-Owners/Optimum-Wellness-Plans/Plan-Types/Dog/Special-Care

We know that companies like Banfield are in the business of making money, so obviously these things work or they would not exist. If we take such a model and make it non-profit, they will work even better and everyone can benefit. The animals will receive much better medical care, especially at the preventative stage. The owners will be able to budget the care costs into manageable monthly payments that are lower than their cable and phone bills. And veterinarians will have much better financial support to practice the medicine they were taught in school.

Don't get me wrong, I love the wellness plan idea, but as a Banfield employee, I can tell you that even spending $20-30 a month on a pet is something that many people balk at. Also, although there are discounts for the sick pets, people have a misunderstanding of what is covered (even when well explained) and what is not. I think that there is a slight disconnect between supply and what the client actually wants.

Pet ownership may be going up, but I hear complaints almost daily about how much the "free" pet is costing the owner. They are fine with spending on things that they can see immediately impact the pet (like toys, beds, foods, etc) but not necessarily for health care for their pet.

 

[Trilt]

Had I been in your fantasy land healthcare world, I would have been dismissed and not 'allowed' to go to a specialist.
...
All you are telling me is that you don't know how to budget very well

Wow. You state somebody "obviously hasn't lived in a country with socialized care," then someone who has comes along, and apparently I live in a fantasy land and can't budget. Insulting someone is not productive. Nor, for that matter, is debating on the internet, but oh well, I fell into the trap. Shutting up now as the thread seems to have realigned into its original purpose.

 

[August West]

Typically medical premiums and human healthcare costs are not considered "discretionary" spending, but a necessity. Insurance companies aren't competing for the same dollars being spent on consumer goods and are therefore much more insulated from economic fluctuations.

Pet/animal health expenditures, on the other hand, are apparently considered discretionary by a large portion of owners. Where a person's dollars are competing between buying that new big screen TV or getting Fluffy his annual check-up. We shouldn't just accept that fact though just because it's difficult to change cultural values in regards to animal healthcare.



I don't recall anyone saying it's one or the other, just that fixing the demand side might be more beneficial for the profession overall. I could be wrong though since this is a really long thread already.

We obviously did not work our asses of to get into this profession because we felt that animal health expenditures should be discretionary in nature. One of the challenges we face is to convince others that proper care to ensure the well-being of a pet is the ethical and right thing to do. Thanks for chiming in.

 

[david594]

I am looking to fundamental actuarial science and wondering if there is not a simple mathematical formula that practices and/or multi-practice partnerships could employ that would make preventative health care for pets a more manageable and budgetable expense for owners. This model would be non-profit which would eliminate many of the inefficiencies that exist in the human medicine-insurance relationship. By eliminating the profit-hungry glorified middle-man, close to 100% of dollars spent by members of the plan will actually go directly to healthcare services for the patient pool.

Your missing the one fundamental aspect of insurance, and that is that it is for unpredictable events, and not intended for "preventable health care". If you talk to the pet insurance companies they will tell you this.

If they know they will have to pay out $200 per year for your dog to get his exam, vaccines, fecal and heartworm test, then they will charge you $250 for that part of the coverage. $200 to cover the services they expect to pay out for you, and then $50 to cover their expenses and profits. The actuary only comes into play when they are determining what the likelyhood is of your dog having an unexpected medical emergency in any given year. From that they determine how much they will have to charge you so that they will be able to pay your claim when it happens while still making a profit. This is the actual insurance side of of "pet insurance"

The notion that pet insurance needs to become a non-profit industry is ridiculous. At the same time, you might as well mandate that all of veterinary medicine becomes non-profit because it would be better for the clients and the animals.

 

[August West]

Don't get me wrong, I love the wellness plan idea, but as a Banfield employee, I can tell you that even spending $20-30 a month on a pet is something that many people balk at. Also, although there are discounts for the sick pets, people have a misunderstanding of what is covered (even when well explained) and what is not. I think that there is a slight disconnect between supply and what the client actually wants.

Pet ownership may be going up, but I hear complaints almost daily about how much the "free" pet is costing the owner. They are fine with spending on things that they can see immediately impact the pet (like toys, beds, foods, etc) but not necessarily for health care for their pet.

I never said changing people's views would be easy. I have worked in clinical veterinary settings for long enough to realize that financial concerns are one of the biggest obstacles veterinarians face when practicing medicine and deciding how to treat patients. Many people will balk at the idea of paying a monthly premium to cover the treatment of their pet. This strategy is not without shortcomings and concerns. However, I do feel that many other pet owners will embrace such products. And over time, this group will grow (as we've seen in Europe) and consequently the insurance market will become much more robust. Since private insurance carriers would never be willing to set their rates at levels that would make their services accessible to the largest number of people, i.e. a non-profit model, it is up to the practices and doctors themselves to come up with an much more efficient, alternative system. I think such a program is possible. More importantly, we all seem to agree that parts of the current system are broken and somethng must be done to help protect the livelihood of animal medicine. I am no expert in actuarial science, but I am very interested in researching and analyzing such an idea further and hope to do so as I progress within my studies and this profession.

 

[LittleWiz]

 

[david594]

I have worked in clinical veterinary settings for long enough to realize that financial concerns are one of the biggest obstacles veterinarians face when practicing medicine and deciding how to treat patients.

What is your background? I'm really quite curious at this point. What type of practice do you work at and how long have you been there? And what is the average household income of the city your in, and in what part of town is the practice located?

 

[August West]

Your missing the one fundamental aspect of insurance, and that is that it is for unpredictable events, and not intended for "preventable health care". If you talk to the pet insurance companies they will tell you this.

Preventative medicine and wellness plans AND catastrophic care/emergency insurance coverage are two very different entities. The product that I was envisioning incorporate both. They could be offered separately or packaged together. Do you not feel that such offerings are possible without incorporating large financial underwriters? Or do you question the validity of the idea for other reasons? Thanks.

If they know they will have to pay out $200 per year for your dog to get his exam, vaccines, fecal and heartworm test, then they will charge you $250 for that part of the coverage. $200 to cover the services they expect to pay out for you, and then $50 to cover their expenses and profits. The actuary only comes into play when they are determining what the likelyhood is of your dog having an unexpected medical emergency in any given year. From that they determine how much they will have to charge you so that they will be able to pay your claim when it happens while still making a profit. This is the actual insurance side of of "pet insurance"

I am well aware of the role of actuarial science in creating insurance products. That is why I mentioned it.

The notion that pet insurance needs to become a non-profit industry is ridiculous. At the same time, you might as well mandate that all of veterinary medicine becomes non-profit because it would be better for the clients and the animals.

A non-profit insurance model would help regulate the costs of the entire industry without forcing competitors to become non-profit. And I never even mentioned making veterinary medicine a non-profit industry. That is absurd. In fact, my proposal was based upon making the profession more profitable and more efficient by creating a larger demand for our services and creating a more budgetable way for owners to cover health care expenses for their pets. You seem quite adept at criticizing others and being sarcastic. How about you harness such energy to come up with and present one or two of your own ideas instead??

 

[August West]

This is more fun than watching a GOP primary debate. Grab a beer to wash down the salty butter and enjoy.

 

[August West]

What is your background? I'm really quite curious at this point. What type of practice do you work at and how long have you been there? And what is the average household income of the city your in, and in what part of town is the practice located?

Why are you trying to make this personal? I am just offering my opinion and ideas. Not sure what your motivation is here. If you disagree with my suggestions, fine. Would love to hear a few of your own. Anyone can see by looking at my posts that I am a pre-veterinary student and that I reside in Los Angeles. What more would you like to know, my friend?

 

[breenie]

Why are you trying to make this personal? I am just offering my opinion and ideas. Not sure what your motivation is here. If you disagree with my suggestions, fine. Would love to hear a few of your own. Anyone can see by looking at my posts that I am a pre-veterinary student and that I reside in Los Angeles. What more would you like to know, my friend?

I think he honestly wants to know your perspective. Those things shape the things we say, and I think it might speak to your reasoning for things.

For instance, I worked at a small, very new veterinary practice with two doctors. It catered to a "certain" owner and we were a little boutique-y.

I had an exam, in house glucose, CBC, chem, and thyroid panel (sent out) done on my cat yesterday, and I was OVERJOYED to pay $225 for it. I probably couldn't have gotten it for that at my place of employment.

My experiences shape my world view. I'm sure yours have shaped yours-- I think he merely looks to understand that.

 

[flyhi]

Shutting up now as the thread seems to have realigned into its original purpose.

Good idea

 

[flyhi]

Bad economy ---> less state revenue --> less state money to vet school --> vet school goes broke --> increases seats and # OOS accepted

This is what is disturbing. Not only are seats increasing, but OOS at that! Why don't we just put the screws to the vet students, while we are at it. They are probably in cahoots to accept less IS and more OOS.

 

[August West]

I think he honestly wants to know your perspective. Those things shape the things we say, and I think it might speak to your reasoning for things.

For instance, I worked at a small, very new veterinary practice with two doctors. It catered to a "certain" owner and we were a little boutique-y.

I had an exam, in house glucose, CBC, chem, and thyroid panel (sent out) done on my cat yesterday, and I was OVERJOYED to pay $225 for it. I probably couldn't have gotten it for that at my place of employment.

My experiences shape my world view. I'm sure yours have shaped yours-- I think he merely looks to understand that.

Fair enough. I'm sure some of the pressures and challenges our profession face varies by region and practice type. Honestly, I did not expect this discussion to get so heated. Just wanted to respond to the initial "call to arms" message with a couple ideas and see what kind of feedback they garnered. No worries. Cheers!

 

[jradjsb]

LONG-ONE, SORRY,(RANT) I don't think that all blame can be put on the vet education system, but it does deserve a lot of it. Like I've stated on other threads, academia is all about the money and don't worry about the job market they are preparing us for. This is evident in the increasing class size for OOS and new schools opeing, even though there is evidence that vets are oversupplied. Something should initially be done at this level to help the problem. If a school is increasing the number of seats for OOS ($30-50K per seat), then why is there still a need to increase the overall tuition? Back in the early 90's it was appalling to see a 3% increase in tuition, now it is an annual 7-12% increase. Why? (SOLUTION) 1) First of all during all during an economic recession it is going to be hard to get more people to bring their pets in for treatment. I hate to say it, but Vet care is a luxury that a lot of people can't afford right now. This is one reason for many people dropping their pets off at shelters. 2)I know a lot of people will hate me for this, but I think that reopening equine slaughter will be a positive move for vet med. From my experience the lack of slaughter has over populated the equine industry and made horses a dime a dozen. In my area you can't give a horse away (I know I've been trying). Right now it is cheaper to buy a new horse than treat the one you have. Hopefully slaughter will reduce the population, thus increasing the financial worth of quality horses (notice I said financial worth, not personal).3) Another possible solution that I know people won't like is for veterinarians to make price cuts. I know it sounds stupid to charge less when you need to make more money, but it will increase demand. Like I said earlier alot of people can't afford vet care right now so charging $150-200 for an annual checkup and shots is driving a lot of business away. I understand that the cost of running a practice, student loan debt, and equipment is high, so you have to charge accordingly. I have spent my time at a small rural vet that practices 'old school' medicine. By this I mean no cardiac monitoring during surgery, don't require blood work and overnight stay for surgery, no required annual tests for shots (blood work and fecal are offered but not required), etc. This allows them to charge a lot less therefore increaseing the demand. I paid $300 for bloodwork, surgery and dental for my dog, when the same surgery w/o dental was $1400 50 miles away at a bigger clinic. The owner told me that he has more business now than ever. It's not uncommon for the clinic to see 30-40 clients and perform 10-15 surgeries a day. There is a lot of OOS business that comes to them for this reason. Decrease cost=increase demand. Sorry it's so wordy and controversial, just my $0.02

 

[katryn]

3) Another possible solution that I know people won't like is for veterinarians to make price cuts. I know it sounds stupid to charge less when you need to make more money, but it will increase demand. Like I said earlier alot of people can't afford vet care right now so charging $150-200 for an annual checkup and shots is driving a lot of business away. I understand that the cost of running a practice, student loan debt, and equipment is high, so you have to charge accordingly. I have spent my time at a small rural vet that practices 'old school' medicine. By this I mean no cardiac monitoring during surgery, don't require blood work and overnight stay for surgery, no required annual tests for shots (blood work and fecal are offered but not required), etc. This allows them to charge a lot less therefore increaseing the demand. I paid $300 for bloodwork, surgery and dental for my dog, when the same surgery w/o dental was $1400 50 miles away at a bigger clinic. The owner told me that he has more business now than ever. It's not uncommon for the clinic to see 30-40 clients and perform 10-15 surgeries a day. There is a lot of OOS business that comes to them for this reason. Decrease cost=increase demand.

This. I'm with you on this one. I worked reception for a year and a half and the vet who owned the clinic just couldn't wrap her head around why visits dropped every time she increased prices, and why no one thought that her 400$ geriatric wellness screening was a good deal even though it was for everything you got. (It was an effort to get people to pay for things that no one usually goes for like three view chest x-rays on a dog with no suspicion of cancer...just in case....)