For Profit Vs Nonprofit Vet Clinics?

[Thelemic]

I just came across this article and this issue:

http://news.vin.com/VINNews.aspx?articleId=31591

What are people's thoughts on this conflict? Have folks, as either practicing vets or veterinary clinic staff, experienced this issue on either side?

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[Trilt]

I was coming to this thread to say "hey, there was a great VIN article on that recently!" haha, seems like you've got that covered. If you're a VIN member, there's some good (albeit somewhat spirited) discussion on the forums.

I say that I don't have issues with non-profits serving low-income communities. I really do believe that there should be income requirements for subsidized care, though, just like in human medicine. I am hardcore judging you if you roll up in your new car and answer a text on your iphone while using care that is meant to be for people who don't have extra money.

 

[battie]

This was a discussion in one vet clinic I worked at. The average clientele were decent middle class to upper middle class at this clinic. There was a slight drop in clientele and one client told the clinic owner straight that she was leaving that clinic for Planned Pethood because of price. The woman could afford my clinic (simply judging from her dress, how much she was willing to spend on her dog's medical care, etc.) and was doing it so she could spend less money. I agree with that to a certain extent. But I agree with Trilt as well. Low cost, non-profit clinics should be utilizing their resources on low-income pets, especially since those areas are seemingly the hardest hit with pet over-population, lack of vaccine use, etc.

It's a personal choice thing. I'm not going to tell people how to spend their money cause it isn't my money to spend.

 

[Thelemic]

So, do you guys feel there should be legislation in place that limits nonprofit vet clinics so they can only provide discounted services to pet owners in lower income brackets, or do you feel the decision should be left to each, individual pet owner, regardless of income?

 

[dyachei]

the thing is, it's our job to educate owners on the differences between medicine at non-profit level versus private practice and we do a crappy job of it. Cheaper care generally stems from cutting corners. It doesn't mean the vets are not good doctors or anything of that sort, but that to make things cheaper you spend less on certain things - like monitoring, equipment, available employees.

 

[pp9]

This was a discussion in one vet clinic I worked at. The average clientele were decent middle class to upper middle class at this clinic. There was a slight drop in clientele and one client told the clinic owner straight that she was leaving that clinic for Planned Pethood because of price. The woman could afford my clinic (simply judging from her dress, how much she was willing to spend on her dog's medical care, etc.) and was doing it so she could spend less money. I agree with that to a certain extent. But I agree with Trilt as well. Low cost, non-profit clinics should be utilizing their resources on low-income pets, especially since those areas are seemingly the hardest hit with pet over-population, lack of vaccine use, etc.

It's a personal choice thing. I'm not going to tell people how to spend their money cause it isn't my money to spend.

....Planned Pethood is a thing? And I can't recall the who/what/why of the conversation, but someone told me the wealthiest people in Chicago go to the clinics in the low income parts of the city for the cheaper prices. No one likes to spend money, no matter how much of it you have.

I've had plenty of clients myself tell me "Oh, my friend knows someone who gave her vaccines for free and I got one" or "Oh, we went to the low cost vaccine day at Petsmart" or anything along those lines when I say that CoCo is overdue for everything. (At least tell us instead of us dragging it out of you...) That and the online vaccine market is BOOMING now. Vet clinics are businesses, and they need that yearly income from your pet.

I think every vet clinic is competing with bigger things than nonprofits right now (aka the internet). If nonprofits were to get big, I could see that as being a problem. Are they going to have a full line of meds/flea prevention/heartworm prevention? Will they only do spays/neuters? I see a future in this nonprofit clinic idea, since pet care seems to be becoming more of a charity than a career.

the thing is, it's our job to educate owners on the differences between medicine at non-profit level versus private practice and we do a crappy job of it. Cheaper care generally stems from cutting corners. It doesn't mean the vets are not good doctors or anything of that sort, but that to make things cheaper you spend less on certain things - like monitoring, equipment, available employees.

One of the recent bulletin boards my clinic put out was why online pet pharmacies are dangerous. Not a non-profit clinic, but similar in the idea of just wanting to save money. Sure, they're cheaper than most of the vet clinics. But the drugs are generic, impure, and regulated differently than the meds clinics sell. You get what you pay for.

 

[dyachei]

....Planned Pethood is a thing? And I can't recall the who/what/why of the conversation, but someone told me the wealthiest people in Chicago go to the clinics in the low income parts of the city for the cheaper prices. No one likes to spend money, no matter how much of it you have.

I've had plenty of clients myself tell me "Oh, my friend knows someone who gave her vaccines for free and I got one" or "Oh, we went to the low cost vaccine day at Petsmart" or anything along those lines when I say that CoCo is overdue for everything. (At least tell us instead of us dragging it out of you...) That and the online vaccine market is BOOMING now. Vet clinics are businesses, and they need that yearly income from your pet.

I think every vet clinic is competing with bigger things than nonprofits right now (aka the internet). If nonprofits were to get big, I could see that as being a problem. Are they going to have a full line of meds/flea prevention/heartworm prevention? Will they only do spays/neuters? I see a future in this nonprofit clinic idea, since pet care seems to be becoming more of a charity than a career.


One of the recent bulletin boards my clinic put out was why online pet pharmacies are dangerous. Not a non-profit clinic, but similar in the idea of just wanting to save money. Sure, they're cheaper than most of the vet clinics. But the drugs are generic, impure, and regulated differently than the meds clinics sell. You get what you pay for.

Vaccines - companies won't guarantee their vaccines unless administered appropriately. Which generally means by a vet or vet assistant in a controlled environment for the vaccines.

Generics aren't necessarily impure. the real issue with online pharmacies are that they will fill Rx without prescriptions occasionally, they also have a history of using expired drugs or storing drugs inappropriately. the truth is, many vets are scared of losing business to online pharmacies. But the majority of income shouldn't be drugs in this day and age - I mean, $4 drugs and free drugs are in EVERY state. We should be making money for our knowledge and diagnostics.

 

[Thelemic]

the thing is, it's our job to educate owners on the differences between medicine at non-profit level versus private practice and we do a crappy job of it. Cheaper care generally stems from cutting corners. It doesn't mean the vets are not good doctors or anything of that sort, but that to make things cheaper you spend less on certain things - like monitoring, equipment, available employees.

I think some nonprofit clinics aren't necessarily cutting corners, but they do get subsidies which allows them to offer lower prices than would be possible in a private practice with the same standard of care.

 

[dyachei]

I think some nonprofit clinics aren't necessarily cutting corners, but they do get subsidies which allows them to offer lower prices than would be possible in a private practice with the same standard of care.

Not always. I've worked with a few and I will say I have no problem with people going to them. But there ARE differences in standard of care. Typically to do with surgery and recovery. And the large majority of pets will do well regardless, but for-profit typically do things to ensure the safety of pets like running pre-anesthetic blood work or doing full monitoring. Many non-profits around here recover animals in large batches and there are issues from time to time.

 

[KCgophervet]

Just throwing something out there but there's a low cost nonprofit spay-neuter thing in my area and they only do them for low income families (and ask for proof via tax returns I think?). I used to volunteer with them so they do exist, and honestly I was kind of surprised to hear that's not the norm for the nonprofit sector.

 

[bunnity]

Not always. I've worked with a few and I will say I have no problem with people going to them. But there ARE differences in standard of care. Typically to do with surgery and recovery. And the large majority of pets will do well regardless, but for-profit typically do things to ensure the safety of pets like running pre-anesthetic blood work or doing full monitoring. Many non-profits around here recover animals in large batches and there are issues from time to time.

Sometimes true, sometimes not. There is efficiency in specialization and repetition. Most of what makes a spay/neuter clinic fast is that the vet is just doing surgery and the techs are just inducing, prepping, monitoring, and recovering. You don't have things like hospitalized patients, sick patient drop offs, and appointments for the vet to contend with and you don't have overhead for unrelated equipment like X-ray, ultrasound, and a large pharmacy. Plus if you do the same thing over and over you tend to get good (and fast) at it.

I have been lucky to have visited many for-profit and nonprofit clinics through jobs and externships and I have seen the spectrum from truly sketchy things to really awesome care. There was not really much correlation as to which was happening where. It is true in my experiences that for-profit places TEND to own more monitoring equipment but that does not necessarily translate to maintaining and using it properly (or at all), or to good surgical and sterile technique.

 

[dyachei]

Sometimes true, sometimes not. There is efficiency in specialization and repetition. Most of what makes a spay/neuter clinic fast is that the vet is just doing surgery and the techs are just inducing, prepping, monitoring, and recovering. You don't have things like hospitalized patients, sick patient drop offs, and appointments for the vet to contend with and you don't have overhead for unrelated equipment like X-ray, ultrasound, and a large pharmacy. Plus if you do the same thing over and over you tend to get good (and fast) at it.

I have been lucky to have visited many for-profit and nonprofit clinics through jobs and externships and I have seen the spectrum from truly sketchy things to really awesome care. There was not really much correlation as to which was happening where. It is true in my experiences that for-profit places TEND to own more monitoring equipment but that does not necessarily translate to maintaining and using it properly (or at all), or to good surgical and sterile technique.

Which is essentially what I'm saying. There's a tendency. It's not always true. But it is still up to us as veterinarians to explain the value of our services. In my area, there are not for profit low cost spay neuter that are open to everyone. They get a pulse ox during anesthesia. You pay under $100. They don't run blood beforehand. That's very different from what I do. I explain that difference to clients. Often it makes a difference.

In Knoxville, the not for profit did full blood and more monitoring due to subsidies. But not every place has that. That was my only point. It is up to us to explain why our prices are what they are. Sure some clients will still choose a cheaper option even though they can afford it. But very few places have actually required proof of low income that I have personally seen.

I still think we are failing as a community of professionals to explain the value behind what we do. I have very good relationships with the non-profits here. I am a wildlife drop off point for them, am entering a partnership with them for free office visits for newly adopted pets, etc. I certainly have no problems with my lower income clients choosing to get their spay/neuter done with them. But I do tell them what I do and why my prices are what they are. And I usually let them know it's ok to ask what the low cost places do

 

[pp9]

Vaccines - companies won't guarantee their vaccines unless administered appropriately. Which generally means by a vet or vet assistant in a controlled environment for the vaccines.

Generics aren't necessarily impure. the real issue with online pharmacies are that they will fill Rx without prescriptions occasionally, they also have a history of using expired drugs or storing drugs inappropriately. the truth is, many vets are scared of losing business to online pharmacies. But the majority of income shouldn't be drugs in this day and age - I mean, $4 drugs and free drugs are in EVERY state. We should be making money for our knowledge and diagnostics.

Yes, these companies won't guarantee their vaccines unless properly administered, but they are still sold to the pet owners directly. I believe rabies is the only vaccine that must be administered by a veterinarian.

You're right that most vet clinics aren't depending on those cheaper meds. But when we get into heartworm and flea prevention, the ability to get these prescriptions online is a serious threat to vet clinics. Those prescriptions are pretty decent chunks of income for the clinics I've worked at. A year of large Heartgard hovers around $100 per dog in my area. Multiply that by 100+ dogs we see on that dose....you see where I'm going. If that revenue is lost, you're sunk. Vaccines and heartworm/flea prevention are now available online. Part of this was due to the actions of veterinarians with personal interests, which is why the new flea preventions that are coming out have tracers on the packaging. I think that might help the problem, but where there's a will, there's a way (see the Frontline Plus disaster).

As for generics, they are often tested less frequently/rigorously when compared to name brands (this goes for human medicine too), allowing more frequent changes in purity and inactive ingredients. Actually, generics aren't tested at all sometimes. As long as the potency of the active drug is the same at the initial request to manufacture, they can bypass the testing periods the name brand went through and sell their generic with the same drug, but different inactive ingredients (sounds like it shouldn't be allowed....but what do I know). I'm not saying that you're going to kill your dog if you give it a generic (often that's all some vets carry) or that drug companies are producing placebos and selling them as active drugs, but it's something to think about.

 

[DVMDream]

You're right that most vet clinics aren't depending on those cheaper meds. But when we get into heartworm and flea prevention, the ability to get these prescriptions online is a serious threat to vet clinics. Those prescriptions are pretty decent chunks of income for the clinics I've worked at. A year of large Heartgard hovers around $100 per dog in my area. Multiply that by 100+ dogs we see on that dose....you see where I'm going. If that revenue is lost, you're sunk. Vaccines and heartworm/flea prevention are now available online. Part of this was due to the actions of veterinarians with personal interests, which is why the new flea preventions that are coming out have tracers on the packaging. I think that might help the problem, but where there's a will, there's a way (see the Frontline Plus disaster).

Do you know how much it costs the vet to purchase that year of heartgard themselves? It is not cheap, by any means. Also, you might be thinking that if the Heartgard is $50 for you to buy and you sell it for $100 that is $50 in your pocket. It isn't.

You have the rent on the building, employee salaries (receptionist, tech, etc) are all involved in getting that Heartgard to the client. You have any associate vets to pay. You have electricity, water, your own early professional fees as a vet, etc, etc. So by the time it is all said and done, you might make $5 off of that $100 year supply of Heartgard. Sure, multiply it by 100 clients and you have $500, but it really is not that much money when you look at everything.

 

[dyachei]

Yes, these companies won't guarantee their vaccines unless properly administered, but they are still sold to the pet owners directly. I believe rabies is the only vaccine that must be administered by a veterinarian.

You're right that most vet clinics aren't depending on those cheaper meds. But when we get into heartworm and flea prevention, the ability to get these prescriptions online is a serious threat to vet clinics. Those prescriptions are pretty decent chunks of income for the clinics I've worked at. A year of large Heartgard hovers around $100 per dog in my area. Multiply that by 100+ dogs we see on that dose....you see where I'm going. If that revenue is lost, you're sunk. Vaccines and heartworm/flea prevention are now available online. Part of this was due to the actions of veterinarians with personal interests, which is why the new flea preventions that are coming out have tracers on the packaging. I think that might help the problem, but where there's a will, there's a way (see the Frontline Plus disaster).

As for generics, they are often tested less frequently/rigorously when compared to name brands (this goes for human medicine too), allowing more frequent changes in purity and inactive ingredients. Actually, generics aren't tested at all sometimes. As long as the potency of the active drug is the same at the initial request to manufacture, they can bypass the testing periods the name brand went through and sell their generic with the same drug, but different inactive ingredients (sounds like it shouldn't be allowed....but what do I know). I'm not saying that you're going to kill your dog if you give it a generic (often that's all some vets carry) or that drug companies are producing placebos and selling them as active drugs, but it's something to think about.

I'm replying to you as a practice owner. I am well aware of the differences but many times it doesn't make a difference.

And if you are depending on flea/hw you are doing it wrong. End of story. That's how you get yourself into trouble

 

[LetItSnow]

I'm *somewhat* uncomfortable with 'educating' clients by talking to them about monitoring in low-cost clinics versus what you/we/whatever may be offering at a more traditional practice. I don't have even a single shred of evidence to suggest that the difference between what I might do for monitoring versus what some low-cost clinic is doing (or not doing) has any effect on outcomes. Since I'd essentially be using the 'education' as a means of implying "Okkkkk..... you can go there..... but you're taking a risk....." I don't know that *I* feel good about that. (But I also won't criticize someone else who feels it is an important client education point.) It feels kinda manipulative to me. Same thing with pre-anesthesia blood work. Do I feel more comfortable doing it? Yes. Do I have any real evidence to say that it matters? Nope. Is that counter-intuitive? Sure - it seems intuitively obvious that running pre-anesthesia blood work should help us avoid high-risk surgeries. But for young patients coming in for spays/neuters there's pretty much zero evidence to suggest that it really does. The only thing you can honestly say for sure is that it adds cost.

I'm a lot more comfortable talking about things like patient comfort. If a low-cost clinic is avoiding iv fluid therapy or using minimal pain management or other techniques that may play into patient comfort, I think that's something I can talk about more factually. "One of the differences that helps them keep costs down is that they minimize their use of perioperative pain medication. I believe in a more aggressive approach, including pre-, peri-, and post-operative pain control that, in my mind, keeps the animal more comfortable."

I'm definitely splitting hairs a little bit - I won't argue against that. But I think there's a little better leg to stand on with patient comfort and pain management than some of the "they don't monitor as well" or "they don't do pre-anesthesia blood work" arguments where we really don't have good evidence to say that it impacts outcomes at all.

 

[pp9]

Do you know how much it costs the vet to purchase that year of heartgard themselves? It is not cheap, by any means. Also, you might be thinking that if the Heartgard is $50 for you to buy and you sell it for $100 that is $50 in your pocket. It isn't.

You have the rent on the building, employee salaries (receptionist, tech, etc) are all involved in getting that Heartgard to the client. You have any associate vets to pay. You have electricity, water, your own early professional fees as a vet, etc, etc. So by the time it is all said and done, you might make $5 off of that $100 year supply of Heartgard. Sure, multiply it by 100 clients and you have $500, but it really is not that much money when you look at everything.

Yes, I know that. But erasing that income, however much it is, will affect your practice don't you think? My state is beginning a minimum wage increase in a few months, so we have to increase the prices on everything. If we lose business to online pharmacies even if we still do vaccines and exams, it's not going to end well. The clinic I just left was much more money-tight than other clinics I've been at, so that my be why my opinions are disagreed with. Every bit counted, and my boss could trace back to when the online pharmacies started booming because her numbers show it.

I'm replying to you as a practice owner. I am well aware of the differences but many times it doesn't make a difference.

And if you are depending on flea/hw you are doing it wrong. End of story. That's how you get yourself into trouble

Hence why I said you won't kill your dog or be getting a placebo. Maybe that was lost since it wasn't very straightforward on my part. I didn't say you are solely depending on two products sold in order to stay afloat. But revenue is revenue, and if you wipe out some of it, you would feel it, wouldn't you? Maybe you run a much larger practice than the ones I am familiar with, allowing yourself to have more of a cushion.

 

[Thelemic]

I'm replying to you as a practice owner. I am well aware of the differences but many times it doesn't make a difference.

And if you are depending on flea/hw you are doing it wrong. End of story. That's how you get yourself into trouble

Dyachei, what does it look like when a vet clinic 'does it right', in your opinion?

 

[LetItSnow]

Yes, I know that. But erasing that income, however much it is, will affect your practice don't you think?

Of course it does. But that doesn't mean it's worthwhile to sell it. There are a lot of ways to look at it .... how much money do you have tied up in your inventory that could be better used for other things? What's your profit margin on it? Could the space being used to store that inventory be put into another revenue center in your practice that generates more revenue or profit? The traditional "pharmacy as a revenue center" for vet clinics is fading super fast and clinics have to find other ways to make money. (My personal opinion is that the industry blew it YEARS ago by undervaluing the expertise of the vet with stupidly cheap physical exams and consultations. They tried to make money off of 'stuff' instead of services and expertise. Now it's really damn hard to convince people that our services are actually valuable and we're paying a big price for that lack of forethought.)

If you 'wipe out some revenue', but you save more cost by doing so ... then no, you won't feel it. If you 'wipe out some revenue' but you replace that space (either physical space or time) with something else that makes more money, then yeah, you'll feel it: in a good way.

 

[DVMDream]

I'm *somewhat* uncomfortable with 'educating' clients by talking to them about monitoring in low-cost clinics versus what you/we/whatever may be offering at a more traditional practice. I don't have even a single shred of evidence to suggest that the difference between what I might do for monitoring versus what some low-cost clinic is doing (or not doing) has any effect on outcomes. Since I'd essentially be using the 'education' as a means of implying "Okkkkk..... you can go there..... but you're taking a risk....." I don't know that *I* feel good about that. (But I also won't criticize someone else who feels it is an important client education point.) It feels kinda manipulative to me. Same thing with pre-anesthesia blood work. Do I feel more comfortable doing it? Yes. Do I have any real evidence to say that it matters? Nope. Is that counter-intuitive? Sure - it seems intuitively obvious that running pre-anesthesia blood work should help us avoid high-risk surgeries. But for young patients coming in for spays/neuters there's pretty much zero evidence to suggest that it really does. The only thing you can honestly say for sure is that it adds cost.

I'm a lot more comfortable talking about things like patient comfort. If a low-cost clinic is avoiding iv fluid therapy or using minimal pain management or other techniques that may play into patient comfort, I think that's something I can talk about more factually. "One of the differences that helps them keep costs down is that they minimize their use of perioperative pain medication. I believe in a more aggressive approach, including pre-, peri-, and post-operative pain control that, in my mind, keeps the animal more comfortable."

I'm definitely splitting hairs a little bit - I won't argue against that. But I think there's a little better leg to stand on with patient comfort and pain management than some of the "they don't monitor as well" or "they don't do pre-anesthesia blood work" arguments where we really don't have good evidence to say that it impacts outcomes at all.

I have seen one puppy where pre-op bloodwork allowed us to find a liver problem prior to surgery. Yeah, big number there, but the chance is still there. We still have to recommend it and we still have to explain to clients why that pre-op bloodwork we perform but the non-profit does not might be an issue. Because there is that one in a xxxxxxx chance that you have the puppy with the bad liver or bad kidneys or whatever. I get why it seems awkward and strange, trust me I have explained it to a lot of people and it is uncomfortable, but you do have to warn them for their pet's benefit.. even if there is only a <1% chance that they have that special animal with the health problem.

Now, talking about IV fluids and pain medication is much easier. Although I still get surprised at the people who don't think a spay is a big surgery or that their dog/cat will be in pain after.

 

[DVMDream]

Of course it does. But that doesn't mean it's worthwhile to sell it. There are a lot of ways to look at it .... how much money do you have tied up in your inventory that could be better used for other things? What's your profit margin on it? Could the space being used to store that inventory be put into another revenue center in your practice that generates more revenue or profit? The traditional "pharmacy as a revenue center" for vet clinics is fading super fast and clinics have to find other ways to make money. (My personal opinion is that the industry blew it YEARS ago by undervaluing the expertise of the vet with stupidly cheap physical exams and consultations. They tried to make money off of 'stuff' instead of services and expertise. Now it's really damn hard to convince people that our services are actually valuable and we're paying a big price for that lack of forethought.)

If you 'wipe out some revenue', but you save more cost by doing so ... then no, you won't feel it. If you 'wipe out some revenue' but you replace that space (either physical space or time) with something else that makes more money, then yeah, you'll feel it: in a good way.

What LIS said. I have nothing else to add.

 

[LetItSnow]

I have seen one puppy where pre-op bloodwork allowed us to find a liver problem prior to surgery. Yeah, big number there, but the chance is still there. We still have to recommend it and we still have to explain to clients why that pre-op bloodwork we perform but the non-profit does not might be an issue. Because there is that one in a xxxxxxx chance that you have the puppy with the bad liver or bad kidneys or whatever. I get why it seems awkward and strange, trust me I have explained it to a lot of people and it is uncomfortable, but you do have to warn them for their pet's benefit.. even if there is only a <1% chance that they have that special animal with the health problem.

Now, talking about IV fluids and pain medication is much easier. Although I still get surprised at the people who don't think a spay is a big surgery or that their dog/cat will be in pain after.

You're posing "what ifs" to say "we should do this," but that's not EBM. There's no actual evidence that the practice of doing pre-anesthesia blood work for young animal spays/neuters has any impact on outcomes.

Sure, we might catch some animals that are a higher ASA risk. But, we also see some end-of-the-bell-curve animals that get excluded from an appropriate procedure just because they had some blood panel result that was far enough out on the curve to call them 'abnormal' even though it might be perfectly normal for them. You're ignoring <that> adverse outcome of the pre-anesthesia blood work itself. And there's is, as best I know, nothing to show which outcome is more common.

The big mistake here is that we aren't accounting for how blood work may cause us to make an incorrect decision for the animal.

I think it's just so hard for us to step back and say "is this really necessary" because a) it seems so intuitively obviously beneficial, b) it's pounded into us from day 1 of vet school that you need pre-anesthesia blood work for all surgical procedures, and c) we're afraid of an adverse outcome biting us in the ass with someone saying "What? You didn't do blood work?". But if you really step back and think about it objectively: we don't actually know that it's a practice that in the end is benefiting more animals than it's hurting.

 

[dyachei]

Dyachei, what does it look like when a vet clinic 'does it right', in your opinion?

Clinics that do it right make their money on procedures and diagnostics. You cannot assume you will make money on drugs in this day and age. Too many alternative options.

LIS I'm not saying tell them what the other places do. I'm saying let them know why you charge what you charge and encourage them to do an apples to apples comparison.

 

[LetItSnow]

Clinics that do it right make their money on procedures and diagnostics. You cannot assume you will make money on drugs in this day and age. Too many alternative options.

LIS I'm not saying tell them what the other places do. I'm saying let them know why you charge what you charge and encourage them to do an apples to apples comparison.

I dunno that I think your average client *can* do an apples to apples comparison when you're talking about things like patient monitoring. What do they know about which components might be more important? I mean, about the best they can do is "well.... that place said they monitor more stuff. that must be better."

I'm all in favor of telling them "this is what I do and this is why I think it's important."

 

[dyachei]

I dunno that I think your average client *can* do an apples to apples comparison when you're talking about things like patient monitoring. What do they know about which components might be more important? I mean, about the best they can do is "well.... that place said they monitor more stuff. that must be better."

I'm all in favor of telling them "this is what I do and this is why I think it's important."

That's what I'm talking about

 

[DVMDream]

You're posing "what ifs" to say "we should do this," but that's not EBM. There's no actual evidence that the practice of doing pre-anesthesia blood work for young animal spays/neuters has any impact on outcomes.

Sure, we might catch some animals that are a higher ASA risk. But, we also see some end-of-the-bell-curve animals that get excluded from an appropriate procedure just because they had some blood panel result that was far enough out on the curve to call them 'abnormal' even though it might be perfectly normal for them. You're totally ignoring <that> adverse effect. And there's is, as best I know, nothing to show which outcome is more common.

I think it's just so hard for us to step back and say "is this really necessary" because a) it seems so intuitively obviously beneficial, b) it's pounded into us from day 1 of vet school that you need pre-anesthesia blood work for surgical procedures, and c) we're afraid of an adverse outcome biting us in the ass with someone saying "What? You didn't do blood work?". But if you really step back and think about it objectively: we don't actually know that it's a practice that in the end is benefiting more animals than it's hurting.

The practice I worked at offered it as an option. Trust me, I get what you are saying. I also get the adverse affect of not doing the procedure then even though it would be fine for that dog. I have seen that occur as well, though not often, but more often than the puppy with a severe problem.

The one I was talking about was a significant liver issues that ended up being diagnosed in the end, I can not recall what.

The issue you run into is more a legal one. Pre-op blood work is standard of care, you have to offer it, if you do not, you can be sued if something goes wrong. We are running into an area now of yes, I agree with you 100%, it is being done for the "what ifs", but if we don't at least offer it, then we can be sued. Which is what you are saying with the "biting us in the ass" comment.

I am not disagreeing with you at all.

 

[pp9]

Of course it does. But that doesn't mean it's worthwhile to sell it. There are a lot of ways to look at it .... how much money do you have tied up in your inventory that could be better used for other things? What's your profit margin on it? Could the space being used to store that inventory be put into another revenue center in your practice that generates more revenue or profit? The traditional "pharmacy as a revenue center" for vet clinics is fading super fast and clinics have to find other ways to make money. (My personal opinion is that the industry blew it YEARS ago by undervaluing the expertise of the vet with stupidly cheap physical exams and consultations. They tried to make money off of 'stuff' instead of services and expertise. Now it's really damn hard to convince people that our services are actually valuable and we're paying a big price for that lack of forethought.)

If you 'wipe out some revenue', but you save more cost by doing so ... then no, you won't feel it. If you 'wipe out some revenue' but you replace that space (either physical space or time) with something else that makes more money, then yeah, you'll feel it: in a good way.

I didn't think of it that way, and you're right.

 

[bunnity]

My current job requires a CBC and mini Chem for all animals undergoing anesthesia, regardless of age. Penn only did an automated CBC and creatinine on young animals. The nonprofits I'm familiar with require CBC and Chem on animals age 6+ and offer it for all animals. I had surgery (on myself) and had no pre-op testing whatsoever.

It seems to me there is not necessarily a standard consensus in our field (or in human med maybe?) about what bloodwork should be run (suggested? recommended? required?) prior to anesthesia. From what I have seen there is a big variation from clinic to clinic in other surgical practices as well. Therefore I think one should be careful when talking to clients. It's one thing to talk about what YOU offer but it's another thing to assume you know what someone else is offering. Or, as LIS said, that there is evidence that what you're doing is going to make a positive difference to that patient.

 

[StartingoverVet]

My current job requires a CBC and mini Chem for all animals undergoing anesthesia, regardless of age. Penn only did an automated CBC and creatinine on young animals. The nonprofits I'm familiar with require CBC and Chem on animals age 6+ and offer it for all animals. I had surgery (on myself) and had no pre-op testing whatsoever.

.

really? I assume it wasn't "major" surgery.
For my surgery they had pages of blood tests they ran, I just assumed that was standard.

 

[dyachei]

really? I assume it wasn't "major" surgery.
For my surgery they had pages of blood tests they ran, I just assumed that was standard.

Every time I've gone under I've had to have a full panel plus clotting times.

My current job requires a CBC and mini Chem for all animals undergoing anesthesia, regardless of age. Penn only did an automated CBC and creatinine on young animals. The nonprofits I'm familiar with require CBC and Chem on animals age 6+ and offer it for all animals. I had surgery (on myself) and had no pre-op testing whatsoever.

It seems to me there is not necessarily a standard consensus in our field (or in human med maybe?) about what bloodwork should be run (suggested? recommended? required?) prior to anesthesia. From what I have seen there is a big variation from clinic to clinic in other surgical practices as well. Therefore I think one should be careful when talking to clients. It's one thing to talk about what YOU offer but it's another thing to assume you know what someone else is offering. Or, as LIS said, that there is evidence that what you're doing is going to make a positive difference to that patient.

I'm saying educate them on what you do and have them ask what the other places do. I work pretty closely with several places here and I know their typical procedures. They don't do full blood, they don't do full monitoring. I don't tell the client that, I tell them what I do and why I charge what I do. That's all I am saying. Most clinics don't do that though. so they don't understand why my spay is $300 and why the place down the street is $75. It is part of our job to explain the value in our services.

I'm going to reiterate, I work closely with several shelters in the area and have no problems with them. But the way medicine is practiced is different (which doesn't mean bad, at all). Veterinary medicine fails to explain the why to clients fairly often. So I tell them what a spay is, that I intubate, monitor with equipment which I detail for them, do blood work, give pre meds based on how their blood looks, and use a catheter in case we need emergency drugs (and to give IV fluids). This isn't about how non profits operate, it's about how we explain the value in services and allow clients to make comparisons through education. If that non profit does all that because they get subsidies, great. The majority of the ones down here do not.

 

[bunnity]

Every time I've gone under I've had to have a full panel plus clotting times.


I'm saying educate them on what you do and have them ask what the other places do. I work pretty closely with several places here and I know their typical procedures. They don't do full blood, they don't do full monitoring. I don't tell the client that, I tell them what I do and why I charge what I do. That's all I am saying. Most clinics don't do that though. so they don't understand why my spay is $300 and why the place down the street is $75. It is part of our job to explain the value in our services.

I'm going to reiterate, I work closely with several shelters in the area and have no problems with them. But the way medicine is practiced is different (which doesn't mean bad, at all). Veterinary medicine fails to explain the why to clients fairly often. So I tell them what a spay is, that I intubate, monitor with equipment which I detail for them, do blood work, give pre meds based on how their blood looks, and use a catheter in case we need emergency drugs (and to give IV fluids). This isn't about how non profits operate, it's about how we explain the value in services and allow clients to make comparisons through education. If that non profit does all that because they get subsidies, great. The majority of the ones down here do not.

I totally agree with what you wrote here. I have skimmed the VIN discussion and I think that is why I get a little up in arms about this as a lot of people assume terrible things about nonprofits. I think it's awesome that you work with each other... in my hometown both types of clinics get along and refer clients back and forth, but in many places there is a lot of tension.
@SOV it wasn't a big surgery but I was heavily sedated (ie I have no experience/memory of it) and they were cutting into me, so... haha I don't know why they didn't do blood.

 

[dyachei]

I totally agree with what you wrote here. I have skimmed the VIN discussion and I think that is why I get a little up in arms about this as a lot of people assume terrible things about nonprofits. I think it's awesome that you work with each other... in my hometown both types of clinics get along and refer clients back and forth, but in many places there is a lot of tension.
@SOV it wasn't a big surgery but I was heavily sedated (ie I have no experience/memory of it) and they were cutting into me, so... haha I don't know why they didn't do blood.

I also work at the local vet tech school and we do procedures for animal services. It allows our students to learn anesthesia and running labs, etc. it allows them to have increased safety for patients. I've halted more than 1 procedure they've wanted us to do because of blood work (most recent was canine hepatitis case - the school covered the costs so the students could learn about it).

 

[Kpowell14]

Just wanted to add- I also had surgery (ACL reconstruction) about a month ago and was pretty stunned / nervous bc they didn't run bloodwork on me. They just said I was young and healthy and didn't need it. Eeeep.

 

[WillowLeaf]

For nonprofits that have lower costs only because of government funding or private donations, that still seems unethical for someone to use the nonprofit if they don't need to. I've heard a few people say that they can afford regular vets, but they think vets are overpriced/greedy, so they use the nonprofit spay/neuter/vaccine clinics just because. It's frustrating because they're using money that's intended for pet owners who really need it. Around here, the nonprofit clinics fill up and have a waiting list, so they're taking appointment/surgery time slots that should be available to animals who can't see a vet otherwise.

 

[devyn]

Oh there are people like that everywhere.... I used to work in a specialty hospital in LA... we would get clients who would drive in in mercedes, rolls royce, etc, nice clothes, and then say they had no money to pay for their pets ER procedure.....

yeah I don't buy that one bit....

you cheap mofo lying sack of ****e....

 

[WillowLeaf]

Yeah, I know. It's disrespectful of the people who actually need the financial help.