Dr. Snark

Trials and Tribulations of Veterinary Practice Ownership

Saturday, February 03, 2007

That's Why

As a continuation of the previous post with regards to limited hours, I had two opportunities these past few days that cemented my decision to continue with the hours I'm currently offering and not adding more.

First, a colleague of a dear friend passed away of a heart attack at the age of 51, at his desk, at work, last week. No known health or heart issues. Healthy guy. I will continue to spend time with my family, and take long vacations, because I still can. Too many people put travel and other fun things off until retirement. But what if, by luck of the draw, your time is up before then? You never get the chance. My motto: Never put off until tomorrow what you can do today. And while that does apply to work and chores around the house, mostly it applies to relaxation, spending quality time with my family, and never forgetting to say, "I love you."

Second, I had the opportunity to visit a local family physician's office this week. The posted hours on the door? Monday and Tuesday 9-5, Wednesday closed, Thursday 11-5, and Friday 9-5. Closed Saturday and Sunday. The rest of the time you get the answering service. Need I say more?

Go forth and enjoy life, for tomorrow you may be struck by a bus.

Wednesday, January 31, 2007

I'm Not a Martyr

I had a client call the other day requesting that their records be sent back to their previous vet. "No offense, Doc. It's just that a couple of times we needed you, you weren't here. We like you and all, but we want someone who is more available."

Yes, veterinary medicine is a 24/7/365 job. And in prehistoric times, as we've all read in James Herriot's books, before the advent of emergency clinics, yes, the noble veterinarian was available no matter what the hour, to answer the call of duty.

We've come a long way, baby! Veterinary medicine is a whole new ballgame. With malpractice claims rising (Did ya hear that vets are the new targets of the lawyers? It's true.), advances in emergency and critical care for our patients, no longer is the GP capable of doing it all. I'm not talking about those vets out in the boonies, whose clients have no other option but to call them at 3 am. I live in a fairly large city. Within a 20 mile radius, we have more than 10 emergency and specialty practices that are open 24/7/365. That means that there is no lack of available care for my patients.

Factor in that in this day and age it's not a good idea, man or woman, to arrive at an expensively equipped, drug-laden practice, in the middle of the night to meet someone you don't know. It's just not that safe any more.

Second, if I have to perform a caesarian section at midnight, who is going to help me? I'm just a solo doc with a staff of 4. The two receptionists can't help me. The technician could, but will she be able to work the next day? The kennel assistant, maybe. While surgery time isn't that long in an uncomplicated case, what about aftercare? Who is going to watch the dog overnight on her IV pain med drip? Who is going to make sure the puppies don't strangle themselves in the bars of the cage? Me? If I sit up all night, what about the sick cat I'm supposed to see promptly at 8 am, if I haven't had a lick of sleep?

Trust me, you're far better off taking your pet to a brightly lit, well-staffed emergency facility in the dead of night. Really. Would I send you off to a place I thought would do you wrong? NO. In fact, if my own pet suffered a severe emergency I'd be taking my pet there too.

Third, it's a quality of life issue. I have a wife. I have three sons. There's church and scouts and soccer and baseball. Choir. I'm not about to make my wife a veterinary widow. Did that in the early days of practice, building my clientele. Then the boys came along. My kids need to know their dad. I'm not going to miss their childhoods. Sorry, but my family is far more important to me than your dog.

Does this mean I'm uncaring? Uncompassionate? Hardly. It means that for me and mine, I've chosen balance. After nearly 19 years in practice, I've learned that I can't be all to all people. I close at 6 pm. The person who calls at 6:03 is mad because we refer them to the emergency clinic. I could stay open until 7 pm. then what about the person who calls at 8?

I'm no longer open on Saturdays, either. I can hear the collective gasps from the peanut gallery. "But Doc, every vet is open on Saturdays! It's the busiest day! You could make a killing being open on Saturdays!"

Maybe. What I found that when I was open on Saturdays, sure we were bombarded with business. But Monday through Friday were slower. Factor in a lot of non-client emergencies begging to be seen in the chaos. Forgotten appointments by those who slept in. Employees fighting over whose turn it was to work. I missed many of my boys' games during those times. I missed my eldest son's first home run. No more.

So, dear client, I'm sorry I have a life. I can't be available all the time. Good luck with the new place. Their extended hours are convenient, I'm sure, but they're split up amongst FIVE doctors, not one. And, bet you didn't know that they, too, are not available at midnight. Seems their docs need a life, too.

Tuesday, December 26, 2006

What Were They Thinking?

Recently we had some new clients come in with two bouncy Golden Retriever puppies. Littermates, brother and sister. We went through the series of vaccines with them, seeing them every couple of weeks until they were all set.

Now the time is upon them to have them spayed and neutered. Appointment all set, made a few weeks ago.

Owner called today. They just can't spend the money on it. They don't know what to do. They don't want to reschedule. Could be it's the holidays and money is tight. It could also be that they've heard through the grapevine that Dr. X down the road will do it for $130 each (mind you, that's with no IV catheter and minimal pain meds, but we won't go there. Scroll down for the spay/neuter speech).

But what I want to address is this: These people have gone out and purchased two purebred dogs. Golden Retrievers sell for anything between $350-900 in these parts. They bought TWO. So, did they not realize that meant vet bills would be doubled? That surgery costs for sterilizations would be doubled? Did they even think?

Sometimes I wonder where people's minds are. To me, acquiring a pet is a lifetime commitment. The first year is the most expensive, usually, due to the frequent visits to complete the vaccine series and for spay/neuter surgery.

I can only shake my head at the things people do. What were they thinking? My guess is that they did not.

Friday, December 15, 2006

We're Not Wal-Mart

Ever wonder why small vet clinics seem to be more expensive than the big guys up the street? You got it. Bulk purchases. We little guys don't need 20 cases of heartworm prevention a month. We don't order 500 pounds of prescription diets a week. We also don't order 100+ blood tests a week at the lab.

Our prices are higher simply because we don't qualify for the quantity discount. And, unfortunately, as this is a business, the costs get turned over to you, the client. Even though we're smaller, our costs of doing business are sometimes higher.

We recently had one of our vendors in with a special offer. If our volume is >150 transactions per month, we pay only $200 for this offer. If we're between 20-150, we'd pay only $400. But since we only do less than 20 transactions a month, our cost for this 'special offer' soars to $750. Well, as a single doctor practice, spending $750 for what this vendor was offering, especially when the 10 doctor, 24/7 hospital has a much higher cash flow to support a payment of $750 than I, the little guy, do, is a bit too much. I said thanks, but no thanks.

It's a trade-off, I think, depending on what you want from your veterinarian. Do you just want cheaper prices? Do you mind a long wait? Do you like being treated like a number? Or, would you rather pay a little bit more for a more personal relationship with your vet, who knows you, your pets, your kids, who can spend 30 minutes with you?

You decide.

Thursday, December 14, 2006

Give Them an Inch...

I love these calls, I really do. Some days I feel like I'm auditioning actors for a play. All you vets out there know who I mean.

The calls come in. The person, usually a woman and never a client, is sobbing about how her dog is dying and nobody will help her. She's called everywhere, but nobody will help her and her poor dying dog. Sympathetic staff that we have, they want to help. But, as you've guessed, the lady has no money. Some of these actors will go so far as to tug your heartstrings by telling us how their mom/dad/grandma/child/neighbor has just died, and now the poor dog needs to be put out of its misery.

Okay, I can be a hard ass about money (read previous posts), but I'm not about to allow a suffering animal to die a miserable death. Though I really want to tell this person how they should have cultivated a relationship with a veterinarian before getting into this predicament, I refrain. So, against my better judgment, I allow the lady to come in.

I will (and most other vets will, too) euthanize a suffering pet for free, on occasion. Key word: on occasion. It's amazing the stories and lies people will come up with to get out of paying (they have the money but it's for the lottery tickets/cigarettes/beer/new plasma TV, etc). The truly destitute are GRATEFUL. These story weavers are not.

Back to my sobbing lady. She comes in. She acts grateful that we will put her poor dog out of its misery. BUT, (you knew there was a catch here, right?). She wants to be present (that incurs extra costs on our part by increasing staff costs, catheter placement, room use, disruption of scheduled appointments, etc). Then, rather than take the body home for burial (which she can do for FREE, because, you see, she did tell us she had NO MONEY), she wants a private cremation, which, for a dog this size, costs $200. Hello?!

Sorry, Honey, but you're a scam artist through and through. And, unfortunately, I've heard all of this before (as has every vet on the planet) not once, not twice, but too many times to count. Is there some scam school out there that teaches these things? Because you all say the same things!

For free, I will put the dog down on my time in my way and you will take the body home. If that's not acceptable, please take your dog elsewhere.

Tuesday, December 12, 2006

Just the Shot, Doc!

Our clinic requires a comprehensive physical examination before administering vaccines to our patients. But oftentimes we get requests for 'just the shot, Doc!'

In my opinion, the examination is far more important than the vaccine. Why?

First off, we need to make sure that your pet is healthy. Many diseases can leave subtle clues that even the most observant pet owners can miss, but our trained eye can detect. So even if you think your pet is healthy, there may be some underlying disease present. We want to know this before injecting your pet with a vaccine. Many times we also uncover minor issues, such as fleas, ear infections, dental disease, a heart murmur, an enlarged thyroid gland, etc. Things we want to know about so we can treat them before they become a bigger issue.

Second, if your pet is not healthy, the immune system may not be able to mount a proper immune response to the vaccine. We don't vaccinate unhealthy pets for this reason.

Third, we want to take a history on your pet to determine which vaccines are needed for your pet's particular lifestyle. Not every pet needs every vaccine. Our knowledge allows us to determine this.

Is there ever a time where we don't require a full exam? Yes. If the pet was just in for a full physical exam within the last 6 weeks and a vaccine was overlooked (usually the kennel cough vaccine) because the owner forgot they needed to board the dog. Or, if the pet was in within the last 6 months, we require a brief exam rather than a comprehensive exam.

Remember, a year to us is like 7-10 years for your pet. Things can change quite quickly. Early detection of disease is important. In short, you're paying for our knowledge and expertise in your pet's health.

Anyone can administer 'just the shot.' But why would you want them to?

Monday, December 11, 2006

Client Diagnoses

Got a call today from a woman who says, "My cat has crystals and needs some antibiotics. I don't want to pay for an exam, I just want the medication."

Who diagnosed the crystals? Was it me? I pull the chart. Well, no. Seems I've never seen this cat before, and the only time the client has been in was August 2004 for a different cat.

Repeat after me: Federal law prohibits the dispensing of prescription medications without a valid veterinarian/client/PATIENT relationship. That means that the veterinarian MUST HAVE EXAMINED the pet before prescribing medication.

Why is that such a big deal? Clients tell us all the time that they know what the diagnosis is, so why can't they just get the meds? Um, tell me, when did you graduate from vet school again? Right. Didn't think so.

To clear this up for those who don't see what the big deal is, it's only antibiotics, what harm could they cause? Let me explain.

In this scenario, the cat could very well have crystals. Many cats with feline lower urinary tract disease do (FLUTD). Or, the cat could have inflammation of the bladder (idiopathic intersticial cystitis). Can't tell them apart without examining urine under the microscope. Plus, most of these urinary issues in cats are bacteriologically sterile; in other words, they're not an infected, and antibiotics are not usually necessary.

That said, what if the cat is, in fact, obstructed and is not urinating? And I just give the antibiotics on the owners's say so? Then, in a day or two, because the antibiotics were not the correct treatment for the problem, the cat is now dead from uremic poisoning? Who do you think the pet owner is going to blame? Herself, for being too cheap to pay for an exam? Or the vet who gave her the wrong medication for her pet's true ailment?

The vet, of course, that's who. And what is the state board going to say when I explain why I didn't examine the cat to determine it was blocked rather than just having mere crystals?

Whose license and livelihood is on the line? The client's? Or mine?

I'd rather keep practicing, thank you. Which is why the answer to the original question will always be NO.