I was a little disappointed recently to read a certain celebrity vet’s blog post about ‘overcharging vets.’ Despite a couple of sentences that attempted to act as somewhat of a balancer by ‘hoping that their view is coloured by bad personal experience’ and acknowledging that not all vets overcharge, I couldn’t help but feel that the comments were misguided, unhelpful and may simply act to further add to the list of grievances, both reasonable and unreasonable, that some may wish to level at the veterinary profession, whom the vast majority of the general public still imagine rake it in and live the lives of monied privilege, whilst the opposite is usually the case.
Although it is undoubtedly true that some vets may be tempted to propose additional tests and treatments that may ultimately, in hindsight, prove to be somewhat superfluous, I firmly believe that the motives for 99.9% of vets to make recommendations and suggest preventatives, procedures and other treatments are clinical, sound and ethical, with little or no concern for their own material gain. Granted that with the introduction by some veterinary employers of incentive schemes and bonuses linked to things like turnover, some individuals may feel the pressure to over-emphasise certain options in the pursuit of a boost to their salaries. However, if the vet in question is paid appropriately for their skills and expertise then I don’t see how the potential promise of a few extra quid in the monthly pay packet can really lead to their clinical morals becoming corrupted. If they’re the kind of person who is overly motivated by money then they probably wont spend a lengthy career in veterinary anyway and will probably work out that there are significantly easier, and possibly less stressful, ways of making themselves rich than trying to fleece the pet owning public. Personally I don’t view financial incentive schemes as being a particularly great idea in veterinary as I fear that they do introduce the risk of conflicts of interest developing, even if those conflicts never actually manifest themselves. Most organisations that employ turnover based bonus schemes use them as a means by which to justify keeping base salaries towards the lower end of the scale, especially as vets on lower salaries can “earn more of a bonus as a result if they exceed their monthly turnover targets,” due to the difference between the target monthly turnover figure, usually based on the current salary and the actual monthly turnover figure achieved, which can ultimately vary with the cases that walk in the door that month. I had a debate about exactly this when trying to negotiate a perfectly reasonable salary increase with my first employer a year after graduating and starting work as a vet. I ultimately left as a result of their refusal to appropriately value my training, skills and experience, preferring to espouse the apparent merits and “additional earning power” of the bonus scheme. Myself and my colleagues at that practice, and others that I have since worked at, did not make clinical recommendations because option A was going to make us an extra £15 compared to option B, but instead used our training and judgement as vets to discuss the various options with the owner and ultimately make recommendations, with the owner ultimately making the decision having felt satisfied that they were getting value for money.
The example given by the author of a friend whose dog was taken to the vets suffering from “mild intermittent digestive upsets for a while” and subsequently received a bill for £1700, which was then derided for being unjustifiable and clearly motivated by profit seemed to me to be one-sided, emotive and jumped to a number of conclusions, which was unfair to air publically without offering the vet in question the opportunity to justify the charges. There was no mention of the dog’s previous treatments or the nature of the digestive upsets that had been the problem. Nor did it make clear whether the owner had been involved in any discussion about the investigation options, including potential costs, and thus whether in spite of the final amount being quite a lot and the ultimate diagnosis – note that a diagnosis was reached – being fairly benign (hindsight is a wonderful thing), the owner knowingly consented to the range of investigations carried out and their cost. If not then yes, there is a problem, but that problem is one of proper client communication and customer care, not of profiteering. £1700 is not a lot of money for such an exhaustive, all encompassing investigation into a problem that by the sounds of it had been grumbling on for a good while. The alternative, of course, could have been to conduct the various tests over a longer period of time, but then that may have involved having to administer multiple anaesthetics (additional cost and risk to the patient), and may have simply served to prolong the period that the animal was suffering from the problem and the course of supportive therapy, such as prescription diets, that may have been used in the interim. The result? That the final bill would have potentially been significantly greater than £1700 and that the vet is accused of dragging the entire process out in order to maximise profit. Damned if you do and damned if you don’t.
People talk a lot more with each other than they ever used to and one result of this is that if there is something that people don’t like, whether it be poor service or excessive charging, then it is not long before everyone is made aware and if the issue is not addressed then the individual or organisation runs the risk of being adversely affected, especially if the messages are consistently poor. Vets that overcharge – and it is easy to ascertain whether this is the case by comparison with other vets, offering a similar service – will find that word gets out and they will either have to bring their prices and practices in line with their professional peers or risk not remaining in business for very long. As such, I simply don’t believe that overcharging is a real problem in veterinary medicine. In fact, I think that pet owners get a very good deal considering that they have access to exceptional standards of private medicine, often with the convenience, clinical and cost advantages of same-day diagnoses and treatments, especially when you compare that humans pay many times more for similar tests and procedures privately themselves.
I will be very interested to hear the kind of stories that are submitted to the author and predict that he will undoubtedly receive an electronic sackful of complaints and countless accounts of “profiteering” within the veterinary profession. However, what I suspect won’t be accompanying those stories are clear, detailed explanations for why various treatments, tests and procedures were advised, what the animals’ previous histories were, or whether the options were clearly discussed, explained and ultimately consented to, including knowledge of potential costs. Incidentally, you don’t see many vets driving Aston Martins, living in mansions or sending their kids to Eton, so I do wonder where all of these scurulous profiteers are hiding out?