Vets letter to RCVS

[Redders]

Asking if a pet is insured is not a ‘swear word’ or a way to find out if we can get all that extra money from insurers. The treatment cost is the same. I ask because I may discuss the course of treatment in the animals best interests and that owner may feel the need to go in to financial difficulty by going with that recommendation because it’s the best one and they love their pet they want the best for them even though they can’t afford it. I want to be prepared for those types of conversations. Or because we may not do direct claims with that company and the owner may be basing their decisions on the assumption we will. It’s an open discussion. It’s not a dirty sneaky discussion and I genuinely don’t understand why it offends people so much.

 

[SkylarkAscending]

Purely from my professional point of view that shows a lack of customer understanding and service - it immediately suggests to your client that you are wondering how much you can charge for this service, regardless of whether that is the case or not. I understand it is not the reality, but that is the perception of the client. If you can understand that, surely that must give you the ability to support your customer better?

 

[Redders]

I don’t think I am missing the point, or if I am point it out again please. How do you know they exist if you haven’t used them? If it’s because someone saw a vet and they said this and that and that seemed unreasonable, it’s impossible to know what is or is not unreasonable without having full clinical history and results of clinical exam and have that interpreted.

I’m not saying some don’t exist, but I hear a lot of ‘the vet said that and it was completely unnecessary and just after money’ but no other side of the story because vets aren’t allowed to rebut these claims, so I wonder if a lot of these are errors in communication from the vet to the owner where the owner doesn’t understand WHY things were recommended (this is an area we as vets should continually seek to improve)

 

[SEL]

Medication is the bit that threw me. I had no idea vet practices had to buy from certain suppliers - whereas I can go on the internet & get from the cheapest if I've got a prescription. That's ridiculous. Those suppliers to vets have no incentive to price competitively.

 

[iknowmyvalue]

I agree with what a few others have said. Science and technology have advanced, and with that, diagnostics and treatment options available have expanded. Is that a bad thing?

It does mean that the more modern and advanced treatments are more expensive, and there are more options now. Again, it’s not a bad thing, it just is what it is.

Really our job as a vet is to present the gold standard to the client, and if that’s not possible then work out what is. Some clients have lines they draw for their animals for various reasons (no colic surgery, no referral, no GA etc.) It’s all a balancing act of trying to weigh outcomes vs finance vs ethics

vets do have to work within a strict code as to what medication we can prescribe, if we have to see the animal first and where we can source that medication from. Again, this tends to drive costs up but it’s out of our control. And as more licensed animal products are produced, we have to start using those instead of off license ones (and the licensed ones tend to be more expensive)

I hope my clients feel that I don’t judge them for their choices, which often have some financial consideration. What upsets me is when I’m called heartless/money grabbing etc because an owner can’t afford high level diagnostics/treatment costs.

Modern science is costly, things cost less back in the day because they weren’t so advanced. You can’t have more and pay less. If you want me to make an educated guess and treat the symptoms, that’s fine but you also have to accept that it doesn’t always work and we might miss something.

Unfortunately because practices need to invest in modern equipment because a lot of clients DO want to do more (X-rays, scans etc.) overheads are higher. I know multiple practices who have gone under (mostly equine/farm, but smallies too) a mix of corporate and independent, simply because they couldn’t afford their overheads. And independents who sold out to corporates basically to bail them out of a bad situation with unpaid debt etc.

I don’t know how we “fix” things, but bashing individual vets at ground level certainly isn’t it

 

[SkylarkAscending]

OK - how do you know Marks and Spencer will charge more for a sandwich than Tesco? Not just because people “say they do” or a “miscommunication” - same applies.

ETA - asking how I can say I know these vets exist if I don’t use them is akin - potentially- to suggesting nobody should comment on GP dressage if they haven’t ridden at that level. Just because we don’t do it, it doesn’t mean we don’t know it happens

 

[Redders]

Purely from my professional point of view that shows a lack of customer understanding and service - it immediately suggests to your client that you are wondering how much you can charge for this service, regardless of whether that is the case or not. I understand it is not the reality, but that is the perception of the client. If you can understand that, surely that must give you the ability to support your customer better?

could you please suggest a way it can be broached without clients perceiving it as a way to charge more? This is a genuine question, and I often roll phrases around in my head to see how they sound. I always ask ‘what are your aims from treatment/consult’ but that isn’t going to give me any info on what the client may be able to afford. I always list options from gold standard to ‘hedging our bets, May be fine, may not help, if doesn’t help we need to add some stuff in’ and people always generally want top or middle options, but that still doesn’t help me know costs that are affordable to the owner. I always give costs for these options. And often people are disappointed that the top tier options are so expensive and still want them but want me to do them for less. I always work to an owners budget but if I don’t know the budget that makes it challenging, but asking the budget seems to be seen as wanting to know what I can spend. Which actually, it is about me know what I can spend, but not in a ‘licence to print money way’, just in a practical way.

 

[SEL]

I don’t think I am missing the point, or if I am point it out again please. How do you know they exist if you haven’t used them? If it’s because someone saw a vet and they said this and that and that seemed unreasonable, it’s impossible to know what is or is not unreasonable without having full clinical history and results of clinical exam and have that interpreted.

I’m not saying some don’t exist, but I hear a lot of ‘the vet said that and it was completely unnecessary and just after money’ but no other side of the story because vets aren’t allowed to rebut these claims, so I wonder if a lot of these are errors in communication from the vet to the owner where the owner doesn’t understand WHY things were recommended (this is an area we as vets should continually seek to improve)

I think that is a fair point. My small animal vets have been pretty good about discussing options with me although twitchy when I've said no to something that would extend quantity of life over quality for a specific cat.

More of an issue with one of the horse vets who ignored specific instructions when pony was dropped off at hospital and ran up a whopper of a bill.

But I do have an old school friend whose husband sold his small animal practice to one of the massive corporates. It was life changing for them but they do indeed chase profit targets (for shareholders, not to improve the life of vets)

 

[SkylarkAscending]

could you please suggest a way it can be broached without clients perceiving it as a way to charge more? This is a genuine question, and I often roll phrases around in my head to see how they sound. I always ask ‘what are your aims from treatment/consult’ but that isn’t going to give me any info on what the client may be able to afford. I always list options from gold standard to ‘hedging our bets, May be fine, may not help, if doesn’t help we need to add some stuff in’ and people always generally want top or middle options, but that still doesn’t help me know costs that are affordable to the owner. I always give costs for these options. And often people are disappointed that the top tier options are so expensive and still want them but want me to do them for less. I always work to an owners budget but if I don’t know the budget that makes it challenging, but asking the budget seems to be seen as wanting to know what I can spend. Which actually, it is about me know what I can spend, but not in a ‘licence to print money way’, just in a practical way.

If I were a vet (which obvs I will never be) I would simply say - there are a number of options available, option one is x that would cost x, option 2 is y…. etc.


The owner can make their own decision what they can/cannot afford, what they want to pay etc.

Whether the animal is insured is irrelevant to me personally because I never insure my dogs (horses were different but even then they were beset by exclusions) - to be honest cost for me is never something I consider. I’ll always find the money somehow, it is the implication for the animal which matters. Others do not feel the same I understand, hence my suggestion about wording

 

[Crazy_cat_lady]

Thought I'd post on here because looks like there's a couple of knowledgeable people on here

I'm considering upping the cats' level of insurance cover, because I'm guessing most vets fees have gone up due to COL Etc so any surgeries etc would be more expensive?

I originally went for the middle level of cover, because I thought if they need the top one it's potentially at the point I'd deem it unethical to put them through it as it must be something really serious to need that much money spending on it

Now however I'm wondering if the middle tier ops etc will be heading towards the top tier of cover and would hate to be forced into a decision because I couldn't afford thousands more than the insurance cover

I know there's credit cards and as I last resort I'd potentially go down that route, but if it's a case of spending a bit more a month on insurance I'd rather do that

 

[Redders]

OK - how do you know Marks and Spencer will charge more for a sandwich than Tesco? Not just because people “say they do” or a “miscommunication” - same applies.

ETA - asking how I can say I know these vets exist if I don’t use them is akin - potentially- to suggesting nobody should comment on GP dressage if they haven’t ridden at that level. Just because we don’t do it, it doesn’t mean we don’t know it happens

I’m sorry I still don’t get it. A sand which tin can often compare like for like. Standard cheese and pickle sandwich. You can’t compare like for like vet services UNLESS it is for routine stuff such as vaccines, but even then, one vet may charge less but have 5 mins per consult, and a vet who charges more has 20min consults and time to discuss/address any concerns you may have, they may choose to include the cost of a kennel cough vaccine instead of charge on top, they may include nail clipping in that where a cheaper vet may charge.
Every vet runs slightly different business models to its very hard to compare like for like with them.
Even consult fees. Some charge less but only 10min consults for high volume, others charge more but you get 20 or 30 mins of a consult time with them.

Some blood tests cost x amount but others will cost double that because of what they are testing for.

Some vets are cheaper for neuterings but don’t include pain relief or post op check, others are more expensive but do include pain relief and a post op check

Some dentals are cheaper because they don’t include x rays or analgesia, other vets do include x rays, analgesia, post op checks

This is what makes it hard for me to understand people saying one vet is expensive one isn’t because we are all different and comparing like for like is very hard to do in medicine.

Im not trying to be a pain, these are genuine things I struggle with

 

[SkylarkAscending]

I’m sorry I still don’t get it. A sand which tin can often compare like for like. Standard cheese and pickle sandwich. You can’t compare like for like vet services UNLESS it is for routine stuff such as vaccines, but even then, one vet may charge less but have 5 mins per consult, and a vet who charges more has 20min consults and time to discuss/address any concerns you may have, they may choose to include the cost of a kennel cough vaccine instead of charge on top, they may include nail clipping in that where a cheaper vet may charge.
Every vet runs slightly different business models to its very hard to compare like for like with them.
Even consult fees. Some charge less but only 10min consults for high volume, others charge more but you get 20 or 30 mins of a consult time with them.

Some blood tests cost x amount but others will cost double that because of what they are testing for.

Some vets are cheaper for neuterings but don’t include pain relief or post op check, others are more expensive but do include pain relief and a post op check

Some dentals are cheaper because they don’t include x rays or analgesia, other vets do include x rays, analgesia, post op checks

This is what makes it hard for me to understand people saying one vet is expensive one isn’t because we are all different and comparing like for like is very hard to do in medicine.

Im not trying to be a pain, these are genuine things I struggle with

Ah - I kind of thought it went without saying that I was comparing like with like……

 

[Redders]

If I were a vet (which obvs I will never be) I would simply say - there are a number of options available, option one is x that would cost x, option 2 is y…. etc.


The owner can make their own decision what they can/cannot afford, what they want to pay etc.

Whether the animal is insured is irrelevant to me personally because I never insure my dogs (horses were different but even then they were beset by exclusions) - to be honest cost for me is never something I consider. I’ll always find the money somehow, it is the implication for the animal which matters. Others do not feel the same I understand, hence my suggestion about wording

This is what I do, but I do at some point need an idea of funds available, because when it comes to a client looking uncomfortable and like they are struggling to make a decision, I say ‘I know it’s hard to choose, I can’t tell you what to do but I can only advise, what is making it hard for you’ and they say ‘the cost’ if I can ask, without them thinking I’m asking because I want to fleece them ‘ok, could you tell me your budget or insurance situation’ that will help me immensely in knowing what options are available to the owner. I don’t understand why people choose to take it as a negative question

 

[SkylarkAscending]

This is what I do, but I do at some point need an idea of funds available, because when it comes to a client looking uncomfortable and like they are struggling to make a decision, I say ‘I know it’s hard to choose, I can’t tell you what to do but I can only advise, what is making it hard for you’ and they say ‘the cost’ if I can ask, without them thinking I’m asking because I want to fleece them ‘ok, could you tell me your budget or insurance situation’ that will help me immensely in knowing what options are available to the owner. I don’t understand why people choose to take it as a negative question

I didn’t suggest in the least it was a negative question when it is introduced in that way - if you read what I actually wrote, I objected to it being the first question asked by the vet. Which sometimes it is.

 

[Redders]

Ah - I kind of thought it went without saying that I was comparing like with like……

No. Because it is very hard, almost impossible to compare like for like in medicine. So we can’t really say ‘that vet is expensive, that vet isn’t’ without actually knowing what they offer for their charges. And we can’t know that without having first hand experience, or having a like for like estimate printed out in front of us for comparison

 

[SkylarkAscending]

No. Because it is very hard, almost impossible to compare like for like in medicine. So we can’t really say ‘that vet is expensive, that vet isn’t’ without actually knowing what they offer for their charges. And we can’t know that without having first hand experience, or having a like for like estimate printed out in front of us for comparison

Cool if that’s your experience - it certainly isn’t mine, horses for courses and all that

Sorry I’ve got work tomorrow, got to go……

 

[Redders]

I didn’t suggest in the least it was a negative question when it is introduced in that way - if you read what I actually wrote, I objected to it being the first question asked by the vet. Which sometimes it is.

But why is it a negative if it’s one of the first questions asked? Knowing budget saves all parties time and potential feelings of upset and guilt if we can tailor to budget from the off. I guess I just don’t understand why people choose to see it negatively. Why can’t it just be part of a conversation with a trusted professional?

 

[iknowmyvalue]

Thought I'd post on here because looks like there's a couple of knowledgeable people on here

I'm considering upping the cats' level of insurance cover, because I'm guessing most vets fees have gone up due to COL Etc so any surgeries etc would be more expensive?

I originally went for the middle level of cover, because I thought if they need the top one it's potentially at the point I'd deem it unethical to put them through it as it must be something really serious to need that much money spending on it

Now however I'm wondering if the middle tier ops etc will be heading towards the top tier of cover and would hate to be forced into a decision because I couldn't afford thousands more than the insurance cover

I know there's credit cards and as I last resort I'd potentially go down that route, but if it's a case of spending a bit more a month on insurance I'd rather do that

I’m not a small animal vet so I can’t help, but might be worth a convo with your regular vets, most I know would be happy to give a ballpark idea of the costs of common “emergency” surgeries etc (I would be more than happy to do this for our clients if they asked the same question for equine)

 

[Redders]

Cool if that’s your experience - it certainly isn’t mine, horses for courses and all that

Sorry I’ve got work tomorrow, got to go……

I’m very sorry, this is the first time I am doing this ever, but I am placing you on user ignore. Your attitude upsets me and you seem to think you know all about how vets work and that you can compare like for like and your experience is all that counts. I’m presenting a different view point from the other side of the fence and I feel like you are quite dismissive of the points I am making, and to be honest, a little rude about it.

I may well be totally unjust in my feelings, and you know, that’s ok, because they are just my feelings. I am allowed to be upset, as is anyone, about anything. So I’m just going leave our interactions. Not saying I’m right and you are wrong or visa versa, just that I’m sad and I don’t want to feel sad

 

[Crazy_cat_lady]

I’m not a small animal vet so I can’t help, but might be worth a convo with your regular vets, most I know would be happy to give a ballpark idea of the costs of common “emergency” surgeries etc (I would be more than happy to do this for our clients if they asked the same question for equine)

That's a good idea, thank you - I could pop them an email so I can properly read and compare. I think I know what would be my "red lines" but could certainly ask for things like a broken bone/eaten something that needs removing surgically, as I'll know from those whether there's enough of a buffer for after care if needed or even, the surgery itself

 

[Redders]

Thought I'd post on here because looks like there's a couple of knowledgeable people on here

I'm considering upping the cats' level of insurance cover, because I'm guessing most vets fees have gone up due to COL Etc so any surgeries etc would be more expensive?

I originally went for the middle level of cover, because I thought if they need the top one it's potentially at the point I'd deem it unethical to put them through it as it must be something really serious to need that much money spending on it

Now however I'm wondering if the middle tier ops etc will be heading towards the top tier of cover and would hate to be forced into a decision because I couldn't afford thousands more than the insurance cover

I know there's credit cards and as I last resort I'd potentially go down that route, but if it's a case of spending a bit more a month on insurance I'd rather do that

I always have the top level I can afford. Not because I would necessarily go for spinal surgery etc but because the cost of little things can add up. What I talk about with clients when they come in asking about insurance, is I give a cost break down of treatment recommendations for ‘vomiting for 24hrs, now not eating and quiet in self’ type consults.
Consult fee 60
Bloods (in house because poorly and need info within couple hrs) 262
Fluids as not eating and will dehydrate if doesn’t eat soon 220
Day hospitalisation and nursing fee 30
Medications including anti sickness and analgesia for likely pain relief, and maybe antibiotics 70-200
X rays in case foreign body 315, 100-200 on top if sedation needed depending on drugs used and nurse monitoring needed

If all improves within 12hrs then go home meds 100 ish

And that’s not even gold standard for vomiting unwell animal - there are bits to add In to give us more info/insight/enable a diagnosis

Of course the option is there for approx 200 for antisickness injection, analgesia, trial at home, BUT if symptoms persist then the next steps are those listed above.

So it adds up surprisingly quickly!

 

[SkylarkAscending]

I’m very sorry, this is the first time I am doing this ever, but I am placing you on user ignore. Your attitude upsets me and you seem to think you know all about how vets work and that you can compare like for like and your experience is all that counts. I’m presenting a different view point from the other side of the fence and I feel like you are quite dismissive of the points I am making, and to be honest, a little rude about it.

I may well be totally unjust in my feelings, and you know, that’s ok, because they are just my feelings. I am allowed to be upset, as is anyone, about anything. So I’m just going leave our interactions. Not saying I’m right and you are wrong or visa versa, just that I’m sad and I don’t want to feel sad

Yes I feel the same about your responses - but hey we are all different

 

[Redders]

Medication is the bit that threw me. I had no idea vet practices had to buy from certain suppliers - whereas I can go on the internet & get from the cheapest if I've got a prescription. That's ridiculous. Those suppliers to vets have no incentive to price competitively.

As part of my employee discount, I get medications at cost price. I still write myself prescriptions to get online because it’s cheaper than our cost price!

 

[Redders]

I think that is a fair point. My small animal vets have been pretty good about discussing options with me although twitchy when I've said no to something that would extend quantity of life over quality for a specific cat.

More of an issue with one of the horse vets who ignored specific instructions when pony was dropped off at hospital and ran up a whopper of a bill.

But I do have an old school friend whose husband sold his small animal practice to one of the massive corporates. It was life changing for them but they do indeed chase profit targets (for shareholders, not to improve the life of vets)

That’s a shame about running up such a bill - I work in a hospital and worry about this so much I am regularly checking the costs on the account alongside the estimate given and update the owner regularly and always call before I do something that will increase costs - it’s really easily done as even increasing a pain killer will have added costs. I am so careful about that.

Corporates will have their targets etc. they would be right over my head. I do t really think about my ‘main’ employer much say to say, I just view my clinical director and practice manager as my actual employers. the one I am employed by does not operate a bonus system for anything, no bonuses for performance, sign ups etc. actually I think that is a local level decision and some of the practices owned by them might do, but mine don’t.

 

[meleeka]

I’m going to give a quick couple examples where I have not money grabbed.
Had a dental booked for a cat yesterday, lovely older boy cat, handsome little love. Had two things that technically should have been an additional fee, but it was one of those rare beautiful moments I knew I could fix these two things in just a few moments and train another team member with no increased time to his procedure. Normally these things take longer so have to be charged, but this was one of those beautiful times, so I did it and didn’t charge extra (I called the owner to get consent as legally have to).

I had someone bring two small mammals to an appointment, they had same symptoms. I knew before I asked any questions that the treatment would be the same and could be obtained without a prescription (licensed pet product too) so I told the owner I would examine one and she could then decide if she wanted to pay for another consult for the other one after I discussed the likely diagnosis and treatment. I had to charge for one because she was there having pet examined in a slot that is a chargeable slot, she actually had two slots booked, and should have been charged for two, (reduced second pet rate) but I didn’t charge for 2, even though I did a quick exam to check no biggies were a concern in the second pet.

These opportunities don’t always come up often, but when they do, I do what I can, and many of my colleagues do the same. We can’t do it for everything though, if we don’t make money, the practice won’t stay open, and then we won’t be there to help your pets in need

This is what vets used to be like and you’ve quite rightly posted this as something not that common anymore. I can’t see why you would charge more for something that didn’t take anymore time (your first example).

The other thing to mention is that I don’t think anyone thinks the actual vet decides how much to charge. I wish vets did get a share of the profits, but mostly they are underpaid too.

 

[Redders]

This is what vets used to be like and you’ve quite rightly posted this as something not that common anymore. I can’t see why you would charge more for something that didn’t take anymore time (your first example).

The other thing to mention is that I don’t think anyone thinks the actual vet decides how much to charge. I wish vets did get a share of the profits, but mostly they are underpaid too.

We are still like it, but the opportunities to do it don’t present themselves as often as they used to sadly! For this particular one, it was a very small bit that I could sort, but the majority of similar presentations require likely oral surgery and thus more time so more charge (years ago a different method was accepted and super quick so didn’t cost more time or kit to do, but now we know better and that method is considered negligent) but this particular one was like a little magic bean, I could do it fast and free and not be negligent, train a team member and help the cat! I actually can’t tell you how happy I was about it, probably seems a bit sad but I get my kicks from little joys!!

I’m very open about my salary and hours etc. I’m actually mostly happy with my pay and things, it’s not huge and could be more but I’m content, my only grumble is we are so busy and so understaffed (as are a lot of places) that I wouldn’t mind more days off to recover, but hey, who doesn’t want that whatever their job!

 

[SO1]

But why is it a negative if it’s one of the first questions asked? Knowing budget saves all parties time and potential feelings of upset and guilt if we can tailor to budget from the off. I guess I just don’t understand why people choose to see it negatively. Why can’t it just be part of a conversation with a trusted professional?

I think perhaps you can't tell how much someone is willing to spend budget wise or what treatments they might consider just by asking if they are insured or not.

I do appreciate that that to be 100% sure of a diagnosis lots of tests might be required and things like MRI can have high prices. Ideally to prevent antibiotic resistance you would want to make sure a problem was bacterial and that the right antibiotics were being given.

I would say explain the different options and what the risks are with the cheaper ones and let people decide.

Couple of examples arthramid is more expensive for treatment of arthritis in equines than steroids. You give the clients the costs explain with steroids there is for an example a risk of laminitis that does not come with the arthramid treatment and that arthramid may last longer etc. Client then makes a decision.

I was in a situation where the vet suggested my horse needed 4 filings. He was insured but the cost quoted seemed alot more than I saw elsewhere. I asked the vet about the costs and he said it was the x rays that were the expensive bit and I said what was the risk of not doing the X rays and he said none and that he was perfectly capable of doing the filings without X rays but gold standard was doing x rays. They also recommended that he stayed overnight to be monitored after the filings were done in case the sedation caused colic again this was gold standard but put the price up.

I decided that he would have the filings but no point doing the Xrays if vet said he could do them without with no additional risk and if not doing Xrays less sedation needed which meant he could come home to be monitored rather than having an overnight stay.

The risk of not doing the filings was that the teeth might fracture and in the worst case scenario need to be removed which may involve drilling through my pony's head which would be more traumatic and expensive than doing the filings. Or as my vet said the teeth might be absolutely fine and not fracture. He also said there was no guarantee that the filings would prevent the teeth from fracturing but it would reduce the risk.

I would also want to know what the side effects of any treatment was and the sucess rate not just the cost.

With horses some people may prefer to turn away rather than do treatments that involve long periods of box rest and it may be nothing to do with costs.

Some people are more risk adverse than others and things like GA are not without risk.

People need information in order to make informed decisions. I think what would help clients would be fact sheets with information on for common conditions what treatments could be offered for the conditions pros and cons for treatments and estimated costs.

 

[Redders]

That’s exactly how consent for a procedure should be done, discussing pros cons risks benefits, costs etc, as above SO1, it should be a two way conversation as yours was. I won’t do a procedure unless an owner understands all of the above. We have extra forms with our consent forms and sheets we give out when we do estimates listing risks and benefits for all of our ‘common’ procedures like the ones you describe, but we can’t have them for all because some procedures are very tailored (emergency stuff for example) so we do discussions only for those ones. It’s important to remember for us as the vet team that these info sheets don’t replace an actual discussion.

 

[scats]

I think people are best off trying to seek out the smaller independent vets than the corporately owned ones.

Ive always said that horse vet fees are very reasonable compared to small animal. Even more so nowadays.

 

[LEC]

This whole thread makes me bang my head and I am not a vet.
we are going to be in a crisis of vet care soon and I hope it means that vets get to choose their clients and dump the ones who are bad payers or arseholes.