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Questioning vet school?
Started by dvmcatdog
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What was your other job? Thats the reason I made this thread, I want to wake up an enjoy going to work. I'm not naive though, everyone has bad day in a job. But overall, I want to be satisfied and happy.
The place that charged me a recheck for a euth was HUGE. I can only imagine how much their rent is, but still! I didn't say "hey can you examine my pet and see if it's time?" No, I knew it was. I'm not a vet yet, but it was obvious in my case. The doc came in and said "I'm sorry. So you ready?" as he's putting the needle towards her. I'd rather not charge a recheck and not lose a customer.
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In my experience, especially if you were a new client to this clinic you went to, the vet may want to formally examine a pet that a new client wants euthanized. Can't be sure that was the case with you, but we had clients screaming at us with the same complaint. I know this isn't something all vets insist on doing, but some do. "We don't need an exam, just put him down!" I've heard that a lot from walk ins or price shoppers, but you have to abide by your individual clinic's policy. Some vets just don't feel comfortable euthanizing an animal unless they can see for themselves something is wrong, or could potentially give you options and let you make the final call. Other vets are comfortable with faxed records with the regular vet's exam notes on the situation if they can get them. I've seen a few pets that were quite clearly just barely alive, and we didn't examine them at that point and the doctor was comfortable with that.
Like I said, I don't know the details of your situation, but having been on the other end of things, all I can offer is a different perspective.
The vet had seen our pet before. Multiple times. He sent out many tests to confirm the diagnosis of her condition and told us to give her palliative care and come back when it was time. My pet was BARLEY and I mean barley alive, she wouldn't have lived much longer and I couldn't bare to see her in pain. But, I do agree with you COMPLETELY to charge for a pet that has never been seen. I wouldn't feel comfortable euthanizing a pet I had never seen without at the very least records from somewhere else and an exam. Or if like you said the pet was barley alive. Some people want to euthanize a healthy pet just because they can't afford it.
Well, my whole career my whole life was being a professional musician. Unfortunately though it doesn't pay well at all. I really made a name for myself and was doing really well but that didn't mean I was making any money. It isn't all about the money of course, but I was tired of constantly struggling and being told what to do from managers, producers etc. I also wanted to make a difference in people's lives. Yes of course I did this through music and songwriting, but it isn't the same. I've always loved animals and worked with them as well as rescuing (another huge passion of mine). In school always thrived in all of my science courses but never thought to do anything with it. I really found a love for animals and science, and I am constantly wanting to learn more. Luckily I can always still have music as my hobby and it will always be something I can still do on the weekends or anytime (all of my instruments are at my apt). I just was not happy doing that anymore, and it's actually a very lonely field to be in.
Sorry to hear that your last moments with her were stressful 🙁
Ironically, I only know two boarded neuros - neither does on-call.
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People say it's not about the money and it isn't for the most part. But along with being happy, you have to be able to support yourself. Struggling isn't fun. My uncle wanted a career in music but couldn't make so now he plays in a band when he gets home from work and on the weekends. He loves it and is very happy to have 2 things he loves. It's great you excelled in science, have you taken all the pre-reqs?
Yes I'm done 🙂 I will be taking two classes in the fall though just to add a couple more schools to apply to.
I know the pain. Why can't the pre-reqs be the same!
One of ours does, one doesn't. But the one who does, it's only one week per month. The surgery service takes on-call for backs the rest of the time.
This is good for MY quality of life, at least, haha. (I'm only on call for backs when the neurologist is)
Our neurologist is on call for neuro one week every 3 weeks, and picks up day ERs on tues/thurs normally. otherwise everything else is handled by surgery here. he cuts any of his own appointments/transfers of course.
Yes, and actually a friend of mine who is is Pre-Med at my school told me that they don't need to take Biochem as it is not a prerequisite!! I was so upset hearing that, especially since I think both should take the same classes. I heard Vet schools are also now considering taking away physics as a pre-req completely. This is because they finally realized that it is not useful or necessary.. I wish that would have happened sooner.
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This isn't necessarily true in your case (because I don't know how the place you were at does their pricing, obviously), but it's a great example of how an assumption could be completely wrong.
Where I work, if I set foot in an exam room and talk to a client, I am supposed to charge for it. Period. I have two options: 1) an emergency exam fee, and 2) an emergency charge. The 'charge' is half the cost of the 'exam'. We use it for things like transfers from one of our other hospitals (where the heavy lifting has already been done by one of our other doctors and we're just moving the patient or something) or for pre-decided euthanasia (the owners that call and say "I want to bring my animal in to get euthanized and don't want an exam by the doctor."). But the bottom line is that our "charge" fee is very similar to a GP practice's "recheck" fee - the idea is that the doctor involvement is more brief/limited. If people come in for something my technicians can handle without my involvement, we'll charge the 'Charge' fee, for example.
Occasionally people will complain about the "charge" ("But I didn't really TALK to the doctor about my pet's case! He just came in and did the euthanasia! Why am I getting charged??")
Doesn't change the fact that I deserve to get paid for my services. The euthanasia charge is for the solution, catheter placement by my staff, etc., but doesn't include ME. The "charge" is for me. And I deserve that. Every penny. Some day when you've done a dozen euthanasias in one day you're going to realize "oh wow - I really deserve every last penny I got paid for those euths."
I tend to cut people slack when it comes to euth, so there have been many times someone comes in wanting an exam (the full exam fee is applicable) and then decides to euth. I often cut it back to a 'charge' out of compassion if all I've done is talk to them and look at their animal (no real work-up, etc.). End of life just plain sucks, and I don't need to add to their misery. While I deserve to get paid, I don't mind cutting them a break in those circumstances if I didn't do much more than counsel them about their pet. But yet, I've had a couple people gripe about the "charge", even though I'm actually giving them a discount!
Similarly, that vet that came in to help you deserved to get paid, and it's entirely possible that the "recheck" fee was where his fee comes out of. Not necessarily the case, but it's certainly possible. He may have actually been cutting you a break with the recheck fee.
Anyway. Not saying that's exactly what happened to you. Just saying that it is really easy to mis-interpret things and make assumptions.
I KNOW RIGHT. Some med schools don't require ochem 2. WHY. I'm in physics 2 right now, of course they would consider it now.😵
I have a question that I have asked several veterinarians I've worked for. Do you ever stop feeling 'bad' for charging people for things? What I mean is, as dicsussed above, animal clinics are not run the same way as human doctor visits are. So most MD's when treating aa patient do not feel bad about charging the client since it doesn't work that way. There's always going to be people who are not financially able to afford all of the things you recommend, and of course this will be frustrating. So dealing with clients about cost of services is always an issue. Let's say an animal comes in very dehydrated, not eating much. Let's say now that all of the different treatments you recommend to figure out what's going on with the animal is going to be $400. Do you sometimes not recommend certain things or not include things because you know they can't afford it, don't want the client to be freaked out by a huge price? Or do you include everything, they get everything done but yet they complain about the price. When does a Vet ever stop feeling bad for charging people? This is something that I have struggled with in every clinic I have, so it is definitely something I have to work on.
I just took my Physics II final. Finally done with Physics!!
You're so lucky! I just started it and end in August thankfully. I agree with your question above, it's one of the reasons I started thinking about human med unfortunately.
i'm not sure since i'm still early on in my career, however, i always offer all medically appropriate diagnostics and treatments. i work at a specialty/referral practice and as a starry-eyed young doctor, i believe in offering the standard of care and then working with client to find their middle ground. when i talk about diagnostics and treatments, i let clients know and understand that it is their choice to do as much or as little of what i recommend, and we discuss a multitude of plans sometimes. i then give them an estimate for care, and again reiterate that they are allowed to opt for some, all, or none of the plan and that it is completely up to them. people will always complain about cost, but we try very hard to be up front about our expectations and their expectations.
i think that some people feel bad for life because thats just who they are, some feel bad but understand the realities, and some that are able to take a more practical and business approach. i am starting to fall into the middle category more than the first category, which is a better fit for me.
This is actually why I have seriously considered also getting a Master's in Public Health during Vet school. It really interests me, and you don't deal with clients on a day to day basis so it is completely different. I also definitely want to teach, so if I can somehow figure out how to do all of this that would be great haha. I have so many different plans I would love to achieve!
I've only been practicing a year, so I'm probably not a good person to ask. Maybe one of the longer-time vets has thoughts. But...
I always recommend the work-up/therapy I feel is indicated. Partly because that's my job - to offer gold-standard medicine - and partly because you shouldn't ever make assumptions about which clients will pay and which won't. If they decline your recommendations, then sure - you start trying to come up with a way to be most efficient in caring for the animal. But yes, fresh out of school I think a lot of people feel intimidated giving big estimates to clients. You get over it.
A lot of times rejection can be frustrating. The classic gripe in vet med - you make all the recommendations, and they decline it all and ask for something stupid. It happens every day. Meh.
But sometimes it can be freeing, too. It can be pretty cool to work with owners who you know are TRYING to do their best - they just don't have the money. Sometimes that frees you up to focus on what you think is the problem rather than rule out the million other things that might be - but probably aren't. When you're right, it can be really satisfying because you just helped a sick animal AND managed to do it cost-effectively for a client who valued your service but just couldn't pay. When you're wrong ... well, you did your best with the limitations you had. Example, I had a cat a few months back that ingested a shoelace and had been vomiting ever since. Sent over to me from a GP, who requested scoping to avoid surgery. Typically, I'd do things like re-radiograph it (to make sure there's still something in the stomach to grab), do pre-anesth bloodwork, etc. No way this lady could afford all that plus scope. We talked over the risks, the possibility of a negative scope, the chance that I wouldn't be able to get it out, etc., and went ahead with it. When I came out to show her the shoelace, she was crying and hugging me. A few days later she called to say her cat was doing fantastic. How awesome is that? She didn't gripe about the cost one bit - she just acknowledged she couldn't afford much, understood the risks associated with that, and wanted us to do what we could. Love those clients.
My basic rule of grumpy clients is this: Never. Ever. Ever. Under any circumstances. cut a break for clients that bitch about the cost. Not ever. They are the clients that won't be grateful for it, and on top of it you've basically just validated their gripe that your prices are overcharged. Nope. The only people I ever cut some corners with are the people that don't give me a word of grief about the cost, who pull out their cell phones and start calling everyone they know looking for help. Those types. The ones who make it obvious from their actions that they understand that their pet's care is their burden financially. I love to find ways to help them out.
At the end of the day, you have to remember that you can't take final responsibility for the patient. It isn't your pet. It isn't even your job. Your job is just to offer medical advice and therapy. It's up to an owner to take it. And if they don't ... shrug ... you do your best and move on to the next one. We all bitch about the PITA clients (including me - just ask @dyachei ), but at the end of the day you should try and focus on the good clients or you'll burn yourself out.
Thank you for your post! It definitely helps. Also since I am the one deals with clients about the treatment costs and prices, I think it especially effects me. I hope it is not something that I will feel bad about forever though!
You always include everything. If you don't, you could be liable for medical negligence for not recommending something. If the client can't afford it all, they can speak up and you can move on to a plan B or plan C.
You shouldn't feel bad for charging people. Things cost money. It is no different than taking your car to a mechanic and it being expensive. You can definitely empathize with a client if they can't afford something, but feel bad about charging what you deserve to be paid, no. There is such a thing as empathy without feeling "bad", to me you are implying there is some guilt associated with this feeling bad. And that just shouldn't be the case, you have nothing to feel guilty about
Thank you so much for writing this. I really appreciate you taking the time out to write this. It definitely helped me a lot reading this. Especially this, "At the end of the day, you have to remember that you can't take final responsibility for the patient. It isn't your pet. It isn't even your job. Your job is just to offer medical advice and therapy". It is really hard to separate yourself from the situation, client and patient. You are right though in saying that you will burn out if you take every situation to heart. I think that is why so many Vets do burn out.
Again, thank you so much!
Thank you for your response as well, it is good to hear. You're right about everyone charges for things and they do cost money. I mean heck, lawyers charge you for talking to you on the phone! So yes, I think it is important to remember to not feel guilty. Also with the debt that Vets have, they can't go not charging people for things. So many clients are clueless when it comes to how much debt Vets have and their salary.
Yes we always offer care credit to clients and most of them are happy to try and sign up for it.
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even if they did understand, its important to remember that even the people who don't have debt (vets or other fields) deserve to earn for their services.
i didn't stress the legal importance of offering what is necessary, but it is VERY important to document what is offered and what is declined. it is likely that at some point in your career someone will threaten to sue you/take your license to the board (particularly if you are in ER or specialty practice) and you need to keep in mind that not offering whats necessary or not documenting it can get you in a world of trouble. good records keeping isn't just for 4th years on clinics! it isn't going to bring you a ton of comfort when a client threatens or does take those actions, but you'll feel better than if you didnt offer or didn't document it. trust me.
I worked for a vet who had a saying about this...something along the lines of "Always offer the Cadillac" but I can't remember the second half of it, lol. Basically, offer the best diagnostic workup possible, but be prepared to work with just rads or just bloodwork for example. At my last job, I was the one who brought the estimate to the client and went over everything and why the doctor is recommending it. Explaining is really important...not everyone knows why the doctor feels a $200 blood panel will be helpful, what x medicine does and why Fluffy needs it, etc. If someone is really not wanting to go ahead with the full estimate, my last boss would say, "well they can do without x, but without it, I cannot see the full extent of what's going on so we may not get the best diagnosis/treatment here and can only get an idea." If they decline to do something, you make note of it in the record. It's their choice, and they can't be angry with you if you explained why it was recommended and they still didn't want it.
I've also found that seeing an itemized list of services performed and supplies/meds used on a hospitalized patient actually helps clients see why their bill racked up to $1000 or whatever. I swear, some people think we're just charging an arbitrary number.
I've worked for one vet who didn't blink an eye when someone would give her a sob story, and I've worked for one that got pushed around far too often. Guess which one regularly told me not to use her as a business role model and regularly stressed about her clinic's finances?
Same here it's really annoying.
This really got me too. I never thought about it that way and I have to thank you @LetItSnow. Also, @PreVetMed I wanted to wish you all the luck on all your different endeavors!
Yes! My boss is a teacher as well at Vet schools so he has taught us that from the beginning. Very important.
Thank you! To you as well!
Why doesn't it work that way for MDs?
I don't feel badly for charging clients for things - I believe my time, knowledge, and skills are valuable, and I know that running a clinic with equipment, supplies, and good staff is not cheap (and some of those costs to run a clinic are higher in an after hours clinic). I do feel badly if I estimated a cost that turned out to be wildly wrong, but not because of the amount of money -- I feel badly because I should have done a better estimate. I also feel badly if an owner is unable to do something because of the cost, but that's not the same as feeling badly for charging for something -- I feel badly for their situation, not badly for my charges.
Do I not recommend things because I know they can't afford it? Yes, if I truly KNOW they can't afford it (i.e. they told me), but not because I made an assumption of what I think they can or can't afford. It's hard not to pre-judge a client's ability or willingness to pay, and that took me a couple of years to get used to. If I know a client has limited funds (whether they told me it's "limited" or if they've actually given me a dollar amount) I try to do the best I can with what I've got to work with. I actually like it when clients with limited finances actually tell me that, because it's easier for me to build a plan with limited money than to offer my preferred full plan and then have to cut it back. I also take their financial limits into account when looking for a diagnosis -- if they have limited money and I use it all on diagnosing, they won't have anything to treat the patient with, which means the diagnosis was worthless. So I try to balance the costs of diagnosis and treatment -- but all of this is only when I KNOW any type of cost limits.
Clients will often complain about the price, regardless. Even if they've agreed to an estimate and know in advance, they're still likely to complain about the cost.
Thank you so much for your response! I am feeling better and better and you all respond! Thank you!
If they have insurance.
they still do. even with insurance.
there are still deductibles for 1 thing - needing an MRI and having to meet something like a $1500 deductible is a hurdle some can't overcome.
And many still believe dr. google over doctors.
All of the time. There's a reason hospitals have pre-drafted up forms for you to sign if you leave against medical advice.
Some patients also just plain don't follow medical instructions. I know my own father was fired as a patient from no fewer than three doctors for being such a bad patient.
Absolutely I think they do. And just like in human med, people will neglect to go to the doctor even for severe, critical problems until it's so late that the options for treatment become severely limited or outright nonexistent. I'm sure the percentages are different, but they at least <experience> it in human med just like we do.
I mean, one super obvious current event example: How many times a month do you suppose a pediatrician hears "we have decided to not vaccinate our child because [insert stupid reason here]"?
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"My coconut oil and essential oils can do more for me than your medications"
Think of all the poor coconuts this hurts! They need their oils for protection from the harsh sun!
Stop coconut oil collection 2016.
Advice? Absolutely. People ignore or screw up medical advice all the time. It's a common frustration in people medicine. I have no idea how compliance in human medicine compares to compliance in vet med, but I wouldn't expect it to necessarily be any higher.
Are you familiar with GomerBlog? It's the medical version of The Onion. They just published this piece the other day that should give you a sense of what human doctors, nurses, and support staff deal with: http://gomerblog.com/2016/05/health-report/
Some people still can't afford medical care. Some are still uninsured. Others can't afford even reasonable deductibles, and others yet have such crappy plans that a lot of things are out of reach. Of those who can pay, some portion will still refuse treatment (or fail to follow through or fail to take responsibility) for various reasons -- denial, fear, distrust of doctors/medicine/"chemicals"/BigPharma, religious/personal beliefs, ignorance/lack of understanding, or just plain bad life situations that get in the way. Maybe someone really needs to get an MRI of their torn rotator cuff, but they need to keep working 60 hours a week to keep their crappy insurance plan and scrape up enough money to pay the out-of-pocket costs that are stupidly high thanks to crappy coverage. So maybe they put it off for a long time. Or maybe they think that tea tree oil and headstands will cure their child's pneumonia.
As for insurance companies, oh my lord, even with an admin helping you, it's a nightmare. This is honestly one of the big reasons why I couldn't do people medicine. Even if I could make myself tolerate touching people, I couldn't imagine myself dealing with the American health care system on a daily basis without wanting to blow my brains out. There are many things an admin can't do, and many practices, especially primary care, can't afford the overhead of having staff to deal with insurance companies. As a people doctor, you are basically required to justify your diagnostics and treatment plans to the insurance companies, who will question the necessity of many of the things you want to do. When a doctor appeals a denied claim, they have to do a "peer-to-peer" talk with a doctor who is affiliated with the insurance company, and that doesn't guarantee anything except that they'll spend time waiting on hold on the phone while patients are waiting to be seen. In the end, you waste a lot of time and resources either trying to tailor your plan for your patient to what their particular insurance plan covers or fighting to get what you want covered. Maybe you want to draw blood and run a lipid panel, but this particular patient's insurance will only cover bloodwork if it's done at the lab 30 minutes away. Before you do anything, you need to figure out exactly what that patient's insurance plan's guidelines are or you risk either making your patient pay out of pocket or eating the cost yourself. And some doctors have complained that they find their decision-making ends up being dictated by what's on the insurance company's formulary. Maybe one type of treatment would've been ideal, but they settle for second best because the first one may get denied, and who has time for yet another peer-to-peer/appeal where you sit on the phone waiting for 20 minutes only to argue with someone in a different specialty about the exact drug your patient needs?
All of that isn't even touching the effects that the Medicare reimbursement formula and insurance reimbursement formulas have had on patient care and the doctor/patient relationship. There's a reason why primary care doctors have 15 minute appointments where the patient gets maybe 5-7 minutes of actual face time with the doctor. Practitioners are expected to see X number of patients every day, however they can manage to make that happen while also juggling all of the paperwork and mind-numbing insurance insanity.
It's just not a very pretty picture. Yes, it's true that more people have access to more advanced care than pets do and that your average American isn't declining standard annual bloodwork or antibiotics because they can't afford it, but each system has its own set of serious, complicated problems.
