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Wednesday, October 1, 2014

Two Spays, Two Costs....What's The Difference?

Here's a recent email from Morgan....
I was wondering if you'd be willing to give your readers some advice on how to choose a good vet. I recently adopted a dog and need to find a vet to get her spayed, vaccinated, etc. I've done some calling around and found that prices for veterinary services vary wildly in my area; one local vet will do a spay for $80 and another wants nearly $300. On the one hand, I don't want to be the sucker who pays $300 when I could get the same thing for $80. On the other hand, I don't want to endanger my dog by taking her to a vet who cuts corners where he really shouldn't. How do I tell the difference? What are some questions I should be asking? Is there, like, a "better" way to do a spay that would explain the price difference?
Any advice you'd be willing to share is much appreciated.
I can 100% promise you that the $300 spay and the $80 spay are NOT the same.  Not even close!  While the end result is the same, I can promise that there are more risks involved in the cheaper spay.  How each vet gets to that end result (no more reproductive organs) is the difference.  So why such a huge variation in price?
Here's the way such cases typically break down:
"Expensive" spay--Pre-anesthetic blood tests, safer anesthetic drugs, more monitoring, pain medications, fluid therapy.
Cheap spay--no blood tests, older anesthetic drugs, minimal or no anesthesia monitoring, no pain medications, no fluids
At my practice the spays fall into the "expensive" category.  I use the quotations because when you look at the breakdown of the costs you actually get a lot.  We do a full blood chemistry profile and blood cell count, use propofol and sevoflurane (human quality drugs, and the same ones I had when I had my appendectomy a few months ago), place an IV catheter and maintain the patient with fluids, have three kinds of monitoring (ECG, pulse oximeter, blood pressure), an assistant standing by the pet at all times, and post-operative pain medications.  All of those things are included in our spay costs, which are in the $300 range.  The only way that someone can do a spay for $80 is to cut a LOT of corners, eliminating most of the things that we do.
The question then becomes "Well, why do you need to do the extra stuff?  Why doesn't the other vet do that?  Is it really that necessary?"
Every week I have a patient come in for a routine spay, neuter, or dental cleaning that has some abnormalities in the pre-anesthetic blood tests.  Most of the time these are of minimal concern.  But we have picked up some hidden health problems in an outwardly normal pet with these tests.  You're not going to know until you check.  Would you want your pet to die or have complications from liver disease because your vet didn't check the tests first?  The more kinds of monitors you use the safer the anesthesia, as you can pick up problems before they lead to serious issues.  I've found arrhythmias on the ECG during spays and neuters and been able to intervene to keep them from getting worse.  Wouldn't you want your vet monintoring the heart pattern and blood pressure to prevent problems or at least catch them early?  My wife had a histerectomy earlier this year and I had an appendectomy.  I can tell you from personal experience with abdominal surgery that pain medication is very important.  Any of us would want it after surgery.  Why shouldn't your pet get it?
If a vet is only doing a spay for $80 I would have to wonder about their overall quality of medicine and their devotion to modern care.  Now, I can't second guess them and would need to evaluate their procedure before I could say for certain.  But there is no way at all that a vet could do a spay for that price and still make it a safe, high-quality procedure.  Truthfully most of their patients will do fine, but the complication rate is certainly higher without proper precautions.  Even if it's a 1 in 1,000 chance of problems, do you want YOUR pet to at that risk when taking full anesthetic measures could reduce it to 1 in 10,000?
So here's what to ask in these cases:  What does the procedure cover?  What kind of anesthesia do you use?  Do you give any injections for pain?  How do you monitor the patients?  Do you do blood tests?  Do you use IV fluids?  Can I get a specific list of everything that is done during the procedure?  You need to compare apples to apples, and price alone won't do it.
I also want to briefly address the other issue of simply chosing a vet.  Make an appointment to meet the vet and staff.  Spend the money to have your pet examined and even let the vet know that you are kind of interviewing them.  Ask for a tour of the facility (though if there are gross procedures being done the vet may not want you to be in the back...this is legitimate and you can come back another time).  Ask what kind of procedures they typically do, whether lab tests are done at the facility or sent out, and how after-hour emergencies are handled.  And just use your instincts on the friendliness of the vet, their willingness to openly answer questions, and the quality of their facilities.