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Wednesday, June 23, 2010

Not Apologetic

I have a client whose cat was recently diagnosed with diabetes.  This can be difficult to regulate in cats due to the nature of the disease in this species.  In any species a newly diagnosed diabetic patient needs frequent follow-up visits and lab tests to determine the right treatment regimen. This disease is not as simple as picking a dosage of insulin and seeing them back in six months.  Each patient reacts a little differently and you have to slowly tailor the dose so that the blood glucose is in the normal range.  Too little and you remain diabetic; too much and you can become severely hypoglycemic.  Cats are special because their glucose can jump over 100 points merely due to stress, so we have to do different tests than we would in dogs.  In our practice this is about $130 every three weeks until the pet is regulated.

This cat belongs to Ms. Howlett (remember her from a May post?) a client that unfortunately annoys me to no end.  I spoke to her yesterday about the latest results and where we go from there.  Her cat is still in the process of being regulated, so we have a ways to go and several follow-ups left.  In our discussion she constantly talked about the costs.  "Is there going to be another office visit charge?"  "Is it going to cost this much each time?"  "That insulin is $88. Can you give me a volume discount?"  She doesn't seem to understand that there are charges with these things, and is continually griping about having to do more tests and charges.

I got over charging clients a long time ago.  As someone who manages and runs a business, I know that the charges are very appropriate for the services provided.  Most of the people who complain about costs don't run a business or understand how one is managed.  They especially don't understand what it takes to run a medical practice.  I was even talking about it with my dentist this past week (had to have a filling replaced) and she has some of the same problems.  Her clients also complain about charges and costs, not realizing how much money goes into keeping a medical facility open.  There are a lot of unseen costs and a lot of overhead, and most small medical practices do good to maintain a profit and aren't making money hand-over-fist.

So I don't apologize for our charges.  It is what it is, and it's what it takes to stay open.  The charges are fair and appropriate.  Yes, I know not everyone can afford it, but to be blunt and extremely truthful, it's not my job to watch out for a client's pocketbook.  We do offer credit options to help out clients, and even have a charitable fund grown through donations that can help those who don't have any money at all.  Beyond that we have to charge for what we do and I'm not sorry about that.  Honestly, most veterinary practices under-charge for what they do, and that's been shown by numerous practice consultants.

And to head off any critics, this isn't about being money-grubbing.  It costs money to have proper medical equipment.  When I send samples to our diagnostic lab, they charge me for it, so I have to charge the client.  I have staff to pay, insurance, utilities, supplies, and so on that all cost money.  I don't gouge my clients and charge them for things unnecessarily.  But I also concentrate on what is medically best, and if it costs a few hundred dollars, well, so be it.  I once heard that a client has three options in services:  fast, cheap, or good.  They can have two out of the three, but not all three.  So if they want something cheap, it's either not going to be good or is going to be very slow.  Honestly, I concentrate on quality and timeliness and charge for that.  And seeing as how my practice has grown steadily for the past three years, despite the economy, that's not a bad way to go.


  1. Thank you for saying this: I know how difficult it can be to REQUIRE payment for something that is inherent in your nature - to help an animal in need. It is extremely difficult to balance love for animals with the fact that this is our livelihood.

    I am an associate veterinarian in Nevada and I run into this problem on a daily basis. I often go home at the end of the day feeling like "the bad guy."

    I think there are several reasons so many people think that vet care costs "too much." 1) People, for the most part, have medical insurance. Pet insurance is widely available and WILL PAY OFF for the inevitable illness and accident and in the best cases will help pay for preventative care such as exams, vaccinations, dental cleanings and early detection bloodwork. 2) Veterinary drugs and equipment in the BEST of cases costs the same as human equivalents: often it is MORE expensive due to the specialized nature and less demand for the product. 3) Superfluous lawsuits and inqueries not only raise the cost of medical malpractice insurance but INSURE the likelihood that baseline tests (that may not seem obviously needed) are imperative so that nothing is missed. 4) I am a bit unsure on this last point but it is my understanding that if a human is in immediate need of emergency care that it is required (and subsidized) for minimum care: this is not the case for veterinary medicine. Once an invoice has been made, whether the client chooses to pay it or not, our hospital must pay income tax on that invoice. 5) Medical billing is not an option for veterinary hospitals. Medical billing laws are complex and requires special licensing otherwise we would be considered nothing more than loansharks by our government. Therefore, asking a veterinarian for a payment plan is akin to arraging payment plans between you and anyone on the street. There is no guarenteee of payment and no recourse if you do not pay the bill except for sending a client to a collection agency - which is basically selling a debt for less than it is worth, ie a large loss and often more expensive then then paying taxes on the non-collected income.

    There are a multitude of other reasons for things costing what they do. I feel really badly when a client can not afford the health care for their pet that they would like but I agree, I have stopped apologizing. I do still fret over the negativity a pay my note on my old truck and pay my rent for my one bedroom apartment.

  2. Great comments, Anonymous, and I completely agree. It's hard to talk to people about money and have them understand if they don't own or manage a business themselves. Most people don't realize how much it takes to keep a veterinary practice open. I also feel very bad when someone can't afford proper care, but if we give away all of our services or discount them too much, we end up closing. And who can we help then?

  3. Here here. I agree with you. Plus the cost of vet care to human care is about 10 to 1.

    What would you say to actually talking to the client and asking her why she feels so angry?

    Sometimes talking about the 800 lb gorilla in the room can lead to a better understanding.

    She must be very fearful and it sounds like there has little faith in the world and so that makes a person angry. Or maybe she is just a pain but that would be my suggestion.


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