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Dr. Coates is a veterinarian based in the other “Sunshine State” – that's Colorado to the rest of you – where she lives and plays with a varied range of animals. She shares her professional and personal experiences, Monday through Friday, here on petMD's blog, the Fully Vetted. Log in for your daily dose of her insight and wisdom.

 

The chilly veterinary waiting room and the politics of who pays for pet care

December 30, 2010 / (61) comments


The waiting room in any animal hospital can feel like a cold, lonely place when you’re waiting with a sick pet. It’s worse still when it’s a) so early in the a.m. the doctors have yet to arrive; b) it’s an unknown hospital and you have no appointment; and c) you’ve already called your credit card company to get that almighty "available credit" figure … and it’s a paltry $144.

 

Yeah, you’re pretty much screwed. In fact, you’re so acutely aware of this that you’re having a hard time keeping it together. Never have you ever felt so incapable of playing the role of the responsible pet owner.

But there is a silver lining of sorts, if you’ll allow yourself to go there. Because the truth is that most pet owners can think back to a time when they didn’t have the funds they should have had to qualify as "responsible." So finding a kind soul to commiserate with isn’t as hard as you might think.

Unfortunately, what you need now is a friend with the willingness and ability to help you financially; a tough sell in any economy — much less the current one.

This is why the veterinary hospital is always the go-to entity for this kind of problem. Make your appeal to the office manager or veterinarian, and if you have a pre-existing relationship you can typically expect to be met part-way. But if you’re a total unknown to the staff (think e-clinic or recent move), you’re unlikely to be helped in any way beyond a few simple breaks on the bill.

Which makes sense, since someone’s got to pay for the drugs, the supplies, the equipment, the electricity, the phones, and the staff. It all adds up. So what about when you can’t pay and the service is still rendered? Well ... someone else always does pay. Nothing in life is free, as they say.

Scenarios like yours are hard on veterinarians and vet staff. We’re hardwired for animal giving. And yet we’re constantly faced with humans who cannot pay for their animals’ care. To compensate for this daily stress, we either steel ourselves against it with hard-line policies, or offer the typical discounts, payment plans, etc. when we can.

Unfortunately, the detritus of this latter option always emerges — especially at this time of year. Eventually, we have to check our books for the write-offs (i.e., those whose payment is so past due it’s no longer expected) and add up all those unpaid balances. Stiffed again, we sniff, as we tick off yet another name.

It’s enough to make you feel taken advantage of. I mean, no one expects not to pay every last penny for their fast food. "So why, oh why," veterinarians cry, "does it go so differently for us? Do they not value our work?"

I’m sure you’ll agree that the life of a pet is nothing compared to what barely passes for food these days in America. A McMeal is a luxury compared to the need for life-saving care veterinarians are often called on to provide free of charge.

I see both sides. Really, I do. So I comprehend how it is that firm policies mandating pre-payment exist, especially at one-time-only facilities like e-clinics and specialty hospitals. Without them, their books would be riddled with high-priced non-payments much more significant than I see at my general practice. If they took in even one non-paying patient a day, their year-end calculations would show them why they couldn’t afford any new equipment purchases. (And the "needies" come faster and more furiously than a mere one-a-day, I promise you.)

But most clients don’t seem to get it. They see a young woman sobbing in the lobby, unable to pay for her cat’s needed care, and turn fiercely on the veterinary staff. "How could you not treat this animal?" they'll demand.

Now, if we’re talking immediate care to alleviate suffering, that’s another story. We are obligated to render enough of our services to achieve that much. But that’s not usually what people want. They want definitive treatment, and, as I explained before, someone’s going to have to pay … one way or another.

So it is that everyone present — owner, angry bystander, vet staff and veterinarian alike — are all on the hook for the crime of non-treatment. No one, besides the owner, is any more responsible for seeing that this animal’s care gets paid for than any other.

So it was that an exchange between three women in a holiday-packed hospital lobby last week was so interesting to me (I heard of it second hand). One — in angry tones — accused the hospital of failing to render needed help to the poor woman whose cat had been vomiting for two weeks (for the record, it was not my hospital).

"How can you sit there and let this cat suffer?" she yelled at a trio of cowed reception staff.

Which was when another bystander asked the incensed woman, "If you’re so upset about it, why don’t you stop screaming and put down your credit card?"

 

 

Dr. Patty Khuly

 

 

Pic of the day: "Sick Kitty" by pmarkham

 

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COMMENTS (61)
1
by on 12/30/2010 02:13am

My favourite is how they wait until the issue is so severe it's life threatening to bring the animal in.

Had the cat presented at say, the third day of vomiting, the owner would have been looking at a physical exam, some anti-nausea meds and perhaps a change of food with advice to wait-and-see, knowing that the case was a frugal one (correct me if I'm wrong).

The client would be advised that if this basic treatment (which at my vet would run about $75) didn't work further diagnostics would be required, and could be given some idea of the costs of these diagnostics - providing the cat the chance to perhaps improve on his own and the owner an opportunity to perhaps secure a few hundred dollars from family/friends/credit/charities so that if the condition persisted that situation would never have happened.

I've been there, and I don't know many people who haven't at one point in their lifetime. I've sold my television and pawned jewelery, begged and borrowed from friends and family, even $20 at a time until we had enough to make a reasonable payment. I've had friends take out loans on their cars, skip loan payments for other things, stop buying groceries and use food banks for a few months, even take on jobs for the clinic or neighbours - anything to raise the necessary money.

However, I've also done all these things just to stay in my own house. The sad fact is that McFood is cheaper than real food, as well - but that's a discussion for another day. When it comes down to the bills in front of you, and you're looking at electric, gas, mortgage and vet bills - you can see how easily the decision is made. That last one could be a bill to the doctor who saved your child's life last year - the choice is still a simple one. Roof, lights, heat - and then the rest.

The problem is people who simply get their paycheck, pay their bills, and have no moral qualms whatsoever about stiffing anyone who can't directly screw them. These are the people who ruin it for the rest of us. Those of us who WILL pay our bill, even if it takes everything we have and longer than we thought, and even those of us who have every intention of paying our bill in full but who simply can't.

All I'm saying is that unpaid bills don't always fall in the same category. Although as I mentioned, I have less sympathy for those who let these issues continue until the pet is in critical condition and then cry foul. This is inexcusable, regardless of your income bracket.

2
I Agree
by on 12/30/2010 06:13am

It must be heartbreaking for a clinic staff to be unable to render medical care due to a client's finances. People have to understand that if a clinic provided free services for everyone who asked for freebies, the clinic would go broke and would no longer exist.

I was thinking exactly what the last sentence offered:

(Which was when another bystander asked the incensed woman, "If you’re so upset about it, why don’t you stop screaming and put down your credit card?")

I've been fortunate when it comes to having a job and good credit. As a result, I'm the one my not-so-fortunate friends call when Fluffy or Fido has a problem. Luckily, it doesn't happen often.

Of course, I help if I can. I've even called to check up on Fluffy or Fido after the initial emergency room visit and insisted on taking the critter to the vet for a follow-up visit.

I've gently chided friends for waiting too long, but I cannot imagine letting Fluffy or Fido suffer for a human's failings. The most frustrating part is when they don't follow directions afterward and the critter gets sick again.

3
Sick Kitty
by on 12/30/2010 08:10am

I can tell you from experience that people wait hoping that it goes away but unfortunatelly it doesn't always, and I agree that by the time they take Kitty or Fido to the vet the situation is severe meaning it will cost more money:(
I have a dog and three cats of my own and take care of a small colony outside my home, I'm not wealthy and have to be very careful with my money to make ends meet however because I have limitations, I educate myself and have learn to treat certain ailments but when I'm not sure I run to my vet.
The point of this comment is:
After a relationship of more than 10 years with my vet, always paying my bills, bringing her every stray I can get my hands on to spay or neutered I still don't get a break. No discount for multiple pets, no option to pay in multiple payments which I would rather do instead of charging to a credit card, no breaks at all. I think this is unfair only because I am a responsible pet owner, I am responsible when it comes to my money and still there is no trust.
So I can understand why some pet owners get frustrated when they need help and can't count on their vets.
MP

by on 12/30/2010 12:05pm

Inspired by, but not directly in response to your quote- not a personal attack! I hear much of this from different people on a regular basis, and I have the same answer.

If the multiple pet thing bothers you, you may be able to find a vet who does offer a discount, but it does not cost the vet office less to pay for supplies and their staff because you bring in multiple animals.

How long will it take before people generally get that veterinarians Are Not Banks? Multiple payments? That is what credit cards ARE FOR! A vet office giving people a 'break' or a payment plan is the same as your vet giving you a personal loan straight out of their pocketbook. Most people wouldn't dream of asking a vet for that in so many words, but seem to think that asking for it from the clinic is okay. Banks/banker/credit companies and close friends will give you money (maybe), your vet is usually none of the above!

As for trust- You may well be trustworthy, but most vets have been burned enough on people they believed were also trustworthy that it is just not worth it to take that risk again. I am glad to see more and more clinics offering care credit to clients... and I'm sorry, but if your credit is bad enough that they won't approve you, why, exactly should I believe you're a good risk for me to personally bet money on?

4
To sick kitty #3
by on 12/30/2010 08:30am

Again your asking the vet to take a loss because you have multiple pets. I'm sure the vet has multiple employees and they don't work at a discount so please explain how he should make it up to you. How about performing phantom procedures that are not needed or not really done and then she/he can extend the discount you would like. Its not so much about trust its about meeting their $$$ obligations too.

My vet in Corfu, NY is an absolutely wonderful group of Doctors and the only way I can expect them to be there when I need them is to pay for services rendered. IF they say Len you deserve a break I'll gladly take it but never will I ever feel I should demand one.

To the vet clinics maybe once a year when the books are examined you should post a list of all the stiffs in your waiting room for others to see. So big deal you lose stiffs as clients but then clients like myself won't have to pick up the cost of the slackers.

5
wow
by on 12/30/2010 10:32am

My vet gives me a multi pet discount all the time, it's a fairly common occurence and not something people should be ashamed to ask for. After all, when my two cats are boarded in the same cage and my two dogs are in the same kennel, why should I pay full price? I could easily do my own vaccines on my animals but feel it is important to have a good relationship with my vet, because it pays off in the long run.
I used to work for a small animal vet many years ago and we would always work with our regular clients after an expensive procedure. New(unknown) clients were a different story and we had many animals dumped on us by ignorant owners, some after extensive and expensive treatments. So I fully sympathize with any vet that refuses to treat an unknown animal without some sort of upfront payment. They have bills to pay, just like the rest of us.

6
What most don't get
by on 12/30/2010 10:55am

When a vet clinic is in operation, one must realize the overhead involved.

NOTE: These figures aren't for all vet clinics, but they were the figures when I was an office manager of a clinic this size, which was many years ago.

Let's start with clinic(not people, but the physical location)
Rent on 5000 sq feet: $5000.00 per month
Lights: $200.00 per month
Phone(3 lines): $200.00 per month
Water/Sewage: $100.00 per month
Insurance: $200.00 per month

Employees(Non-Vet)
2 Receptionist, full time: 10.00 per hour, per person $20.00 x 40 hours= $800.00per week
1 receptionist, part time 8.00 per hour $16.00 x 30 hours= $960.00 per week
3 Full time Vet Techs 14.00 per hour $42.00x 40= 1680.00 per week
2 part time Kennel Techs 8.00 per hour 16.00x 30= 480.00 per week

Now, remember, if they are taking out taxes/ss/etc, the vet must match that. So, add another $300.00 per week in unemployment tax, Social Security, etc

Then, if they offer insurance, you need to add, lets say another $200 per week on top of all that.

Other Vets:
2 part time vets, working on 10-99s: $500.00 per week, per vet, to equal $1000.00 per week.

Then there is the owners paycheck(Hey, he has bills to pay to, like car payment, food, mortgage, college loans, etc) So, lets give him/her, $1500.00 per week.

Now, let's not forget, that you have to put stuff in the office, like anesthesia machine, Exray Equipment, diagnostic equipment, etc....So, let's say that they are making payments on all that.....$1500.00 per month.

Now, there is the stuff that is used in-house to clean with, run the practice, etc....Like computers, fax machines, office equipment, bleach, laundry detergents, insecticides, food for humans(Coffee, water, etc), food for house pets(IE, the cat on the counter, etc), and so forth.....So, let's figure in another $500.00 per month(although, that is really really conservative, as are most of the figures...)

So, at the end of the day, you have the following totals:
Building/Utilities: $5700.00 per month
Payroll: $6970.00 per month
Other: $2000.00 per month

Total outlay per month: $14,620.00 per month

Now, let's say that the vet works 22 days out of the month(no Sundays, 1/2 days on Saturdays) The clinic needs to clear $665.00 per day, just to make the overhead that I put up there. Again, that probably isn't even true figures, as that was based on about 10 yrs ago, when I was managing a clinic.

Again, that doesn't allow for a "profit" and I am not covering all of the expenses I know...but it works out to:

665.00 per day, which, based on an 8 hour day, means: $83.00 per hour, or $20.00 per 15 minutes.....So, there goes your office visit fee....

Some food for thought...

7
Crying Poor
by on 12/30/2010 12:45pm

In my personal experiences, some people cry *poor* when in fact they aren’t and have set other priorities over their pet’s care. I’m not speaking about basic life necessities as priorities, just in their minds vets should bear the burden of pet care expenses if they’re not wealthy and have money to burn. I have way too many examples to post here, but it never ceases to amaze me how pet owners expect a break or no cost services as their first choice in dealing with the expense, rather than take the initiative to work out the expenses themselves. Like everything else in life, this attitude forces the vets to end up charging more to their paying clients as they need to recuperate the costs of running their businesses.

At my vet hospital in October, an obese woman and her 2 obese children were crying poor over paying a vet bill when they picked up their newly spayed puppy. The front desk receptionist left to ask the Dr. about a payment plan; the obese woman walked outside to have a cigarette while she waited for the answer. There is no way these people could not have found the money to pay AND help themselves to a healthier life style as well.

In November I had a *friend* call me crying, saying her 6 week old kitten fell and broke its leg (so she thought), and it was just hanging and the kitten was screaming. First words out of her mouth, I can’t afford to take it to the emergency clinic. I told her, take the kitten in to emergency asap and I’ll pay for it. A week ago she proudly told me she bought her husband $95 Chanel cologne for Christmas, and she intended to have the kitten declawed soon. (I hope she reads this post to see how selfish she is).

Enough, I’m just making myself angry now…..

by on 12/30/2010 05:18pm

I encounter this in my own profession as well. I am burned so often by people who I know live comfortable lifestyles with plenty of extras, that I am often left at the end of the month making phone calls begging for payments and -- recently -- taking cash advances on my own credit.

One client has owed me $30k for well over a year, and now that he is between a rock and a hard place (for reasons I can't explain) suddenly he can find several hundred thousand dollars to make sure he doesn't lose his home. Amazing, isn't it? It wasn't possible to make his debt good to me, but when the pain was going to be his - suddenly the impossible became possible times ten.

I feel sympathy for the people who really can't pay, but how am I supposed to know which is which?

by on 12/30/2010 06:30pm

Maybe it's time to take a lien against that person's house.

by on 12/30/2010 06:29pm


I'm nor sure I could keep myself from saying something to the effect of, "Gosh, how could you afford that after you needed help with your kitten?"

8
Not all Vets are honest.
by on 12/30/2010 01:28pm

I am sorry but I have a few comments that I am certain are not going to be popular.
I had a vet in Fort Lauderdale, FL who was fantastic! Always open, honest and understanding. I have never had a problem paying my bill and always felt confident he was treating my 'children' as they should be.
I had recently moved to Boynton Beach, FL and brought my little yorkie to a vet for just routine shots. A few months later he peed on the couch. I knew something was up because that was not him. He was happy and eating appropriately. I suspected a UTI. I brought him in to the Vet and a few hours later I received a call from the tech. She reported he had a mild UTI and then started in on saying the Vet wanted to give him antibiotic and all sorts of IV fluids. I asked how much it would cost. Well in to the 200's. I asked if all that was 'necessary' and she stated "well if you want him to be OK". I just about cried but it was my little boy so he was going to get what he needed. Luckily though, my boyfriend was present and asked what they were saying he needed. I asked the tech to hold on a moment while I told him. My boyfriend immediately took the phone and asked to speak with the vet. He proceeded to ask the vet why my dog needed IV fluids when he wasn't dehydrated while eating and drinking appropriately and showed no signs of lethargy. He also mentioned he wouldn't give one of his human patients IV fluid for a mild UTI who presented in his ER with those symptoms. The vet back pedaled like you wouldn't believe!!! She even went as far to apologize! From that day on I have been skeptical of Vets. Thank God I found another good one in my area, that I trust.
I am not excusing those who do not pay their bills. I have never not paid a bill but I do wonder about those vets who prey on people's emotions to make a buck. And please do not comment back all offended. If you aren't one of those vets good for you, but I can understand why some people may feel suspicious.

9
Why can't we help...
by on 12/30/2010 03:45pm

To make a long story short, about two years ago, we, and a lot of our neighbors paid for cancer treatment for a 6 year old cat that belonged to a widow with two young daughters, the kitty is 9 now and healthy. Our vet was so moved by that that he set up a fund for those who can't afford to pay for treatment (which he will discount for the truly needy). He's got a sign in his lobby telling clients to please give if you can. You add an extra amount to your bill or put cash or checks in a big jar to add to the fund. We've even had "pot luck" dinners and asked for donations to this fund. The fund is administered by a second party who has no affiliation with the clinic except that she's a client and willing to do this. It will even pay for services at another veterinary clinic! It's not unreasonable that all vet's do this, is it? No one is forced to give, but those who are able give for the sake of the pets. Seems like a win-win to me. Those who can't afford the "extra" costs get their pets treated and the vet gets paid...and the rest of us feel good knowing we've helped someone else.

10
Dr. Khuly's Word Power
by on 12/30/2010 06:19pm

You wrote, “Unfortunately, the detritus of this latter option always emerges …” I was a three year Latin student in high school and scored 700-plus on my SAT-verbal. I know the meaning of the word detritus, but how many of your other readers do? Until now, I can honestly state that I have never used this word in a sentence (not even in a college geology class), and I have never seen it used outside of its medical or scientific context. You are notorious for this vainglorious writing in your blogs. Please tell your readership what your intended meaning is. Tell us why “result,” “fallout,” “residue,” or “debris” would not have been a much more appropriate usage for, I assume, your predominantly non-scientific blogship.

I have a word for you: self-aggrandizing. Some synonyms are arrogant, egotistical, exultant, indulgent, pompous and pretentious. You are far too intelligent and should have more than enough self-esteem not to resort to this nonsense in your writing.

I in no way intend to demean the intelligence of the Fully Vetted readership, but maybe the following will help illustrate my point to some of them:

Origin: 1785–95; < F détritus < L: a rubbing away, equiv. to dētrī-, var. s. of dēterere to wear down, rub off ( de- de- + terere to rub) + -tus suffix of v. action –noun

1. rock in small particles or other material worn or broken away from a mass, as by the action of water or glacial ice.
2. any disintegrated material; debris.

World English Dictionary: detritus — n

1. a loose mass of stones, silt, etc, worn away from rocks
2. an accumulation of disintegrated material or debris
3. the organic debris formed from the decay of organisms

[C18: from French détritus, from Latin dētrītus a rubbing away; see detriment]

Medical Dictionary: de•tri•tus definition Function: n pl de•tri•tus:

• loose material resulting from disintegration (as of tissue)

Merriam-Webster's Medical Dictionary, © 2007 Merriam-Webster, Inc.

detritus de•tri•tus (dĭ-trī'təs) n. pl. detritus

• Loose matter resulting from the wearing away or disintegration of a tissue or substance.

The American Heritage® Stedman's Medical Dictionary Copyright © 2002, 2001, 1995 by Houghton Mifflin Company. Published by Houghton Mifflin Company.

Science Dictionary: detritus

1. Loose fragments, such as sand or gravel that have been worn away from rock.
2. Matter produced by the decay or disintegration of an organic substance.

What material, matter, mass or substance are you referencing? Did you mean any of the above definitions when you used the word detritus or was it just a cute little “fit” to stroke your ego? Who are you trying to reach using this word? I would appreciate a response comment to all of your readers.

by on 12/30/2010 06:33pm

LMAO... I love that someone who gloats about a 700 score on their SAT's accuses someone else about self-aggrandizing in the same post. No, seriously, I'm laughing so hard I can barely type.

You see, dear writer, Dr. Khuly does not treat her readers like fools. Are you irritated because you had to look it up? Is that really where this anger comes from? I see no other reason for blasting a veterinarian for using such a big word like "detritus."

You know, sometimes she even says things like "ovariohysterectomy" instead of "spay" or "osteosarcoma" instead of "cancer in dem der bones." Once, I think she even said "supercalafragalisticexpealadocios" just for FUN. Did I just hear your head explode?

By the way, a quick search of teh Google will show you that word "detritus" shows up 301,000 times in a search of blogs alone, with several of those results even being in the titles! Quick, run along and tell them how "high-falutin'" they are!

by on 12/31/2010 12:39pm

Yes, OldBroad, even as I was typing I realized I shouldn't give this troll the time of day but it was just so.... damn.... FUNNY!

To accuse Dr. Khuly of.... what exactly? NOT considering "50%" of her readers to being semi-literate? ASSUMING that this group is, um... intelligent enough to know the meaning of the word "detritus"?

I mean, that's HILARIOUS!

Just picture the little troll in the corner, pointing at the doctor in the white coat with it's hairy little finger, screaming in its scratchy troll voice "She thinks you're all INTELLIGENT! GET HER! Get her now before she... she... proves me wrong or potentially improves your vocabulary! GET HER!" cackle cackle cackle (but you have to picture Dr. Khuly in her cool glasses staring longingly at a tank of medical leeches thinking about the potential for medical breakthroughs in the veterinary field).

See? That's literally what I saw when I read the post. Dr. Khuly and I don't always agree. In fact, we disagree frequently, and sometimes QUITE strongly. However, NEVER have I gotten a hint of that superiority complex that seems to come with a DVM or MD. She treats her readers as equals, and along comes this hairy little troll who starts to criticize her for NOT having this "god complex" so prevalent among the medical set and talking to us like children. So between full out guffaws and uncontrollable giggles, I managed to type out my reply - and I'd be lying if I said I wasn't laughing through this one too.



*still* LMAO....

by on 12/30/2010 06:35pm

@tpschmitt1

Not only is the post completely off-topic, there's no reason to attack the author or the original blogpost for writing style.

by on 12/30/2010 06:47pm

@topshitt, what a ridiculously pointless post.

by on 12/30/2010 07:08pm

A troll.

by on 12/30/2010 08:22pm

tpschmitt1, I got a 750 on the English section of the SAT, and that was nearly over thirty years ago, before they rejiggered the scoring system and a 750 meant something.

I'm sorry you had to dig out your dictionary, and that you're distressed by the fact that Dr. Khuly does not write for a fourth-grade readership, but really, you won't be permanently traumatized by your contact with the dictionary. You might even make friends with it!

by on 12/30/2010 08:24pm

And in the nearly-inevitable consequence of a post about language, I make an editing error and render one of my sentences ridiculous. :)

by on 12/30/2010 09:51pm

Yeah. I hit the high seven hundreds on the English part before they dumbed it down for tpschmitt1. Now that he has visited Latin for "detritus", how about we try Yiddish for "schmuck"?

by on 12/30/2010 10:30pm

Really, you're going to brag about your SAT score and then chastise Dr Khuly for using a big word. By the way, I barely made it thru high school (not for lack of brains but because of a troubling home life) and I knew what detritus meant. Oops, now I'm bragging...

by on 12/31/2010 07:14am

Don't you just love it when when someone is so much smarter then the rest of us. When I come upon words I don't understand I look em up in tat ther ditchinairy on my dsek.

by on 12/31/2010 07:49am

I had no idea Alastair Macaulay read this blog.

Seriously, if you disagree with Dr. Khuly, organize your thoughts and compose a response. If you want to complain about Dr. Khuly's writing, contact USA Today.

by on 12/31/2010 10:22am

You are a knucklehead. ( see definition below).
Definition of KNUCKLEHEAD
: dumbbell 2
— knuck•le•head•ed \-ˌhed-əd\ adjective
See knucklehead defined for English-language learners »
Examples of KNUCKLEHEAD
1. Don't be such a knucklehead.
2.
First Known Use of KNUCKLEHEAD
1942
Related to KNUCKLEHEAD
Synonyms: airhead, birdbrain, blockhead, bonehead, bubblehead, chowderhead, chucklehead, clodpoll (or clodpole), clot [British], cluck, clunk, cretin, cuddy (or cuddie) [British dialect], deadhead, dim bulb [slang], dimwit, dip, dodo, dolt, donkey, doofus [slang], dope, dork [slang], dullard, dumbbell, dumbhead, dum-dum, dummkopf, dummy, dunce, dunderhead, fathead, gander, golem, goof, goon, half-wit, hammerhead, hardhead, ignoramus, imbecile, jackass, know-nothing, idiot, lamebrain, loggerhead [chiefly dialect], loon, lump, lunkhead, meathead, mome [archaic], moron, mug [chiefly British], mutt, natural, nimrod [slang], nincompoop, ninny, ninnyhammer, nit [chiefly British], nitwit, noddy, noodle, numskull (or numbskull), oaf, pinhead, prat [British], ratbag [chiefly Australian], saphead, schlub (also shlub) [slang], schnook [slang], simpleton, stock, stupe, stupid, thickhead, turkey, woodenhead, yahoo, yo-yo
Antonyms: brain, genius
Related Words: booby, buffoon, fool, goose, loony, lunatic, madman, nut, zany; loser; gawk; featherbrain, scatterbrain; beast, boor, cad, churl, clown, creep, cur, heel, jerk, skunk, snake, stinker, villain; bimbette [slang], bimbo [slang], himbo
Near Antonyms: egghead, intellect, intellectual, sage, thinker, whiz, wizard; polymath, Renaissance man; sharpie (or sharpy)
[+]more[-]hide
Rhymes with KNUCKLEHEAD
acidhead, aforesaid, arrowhead, barrelhead, bubblehead, bufflehead, butterhead, chowderhead, chucklehead, colorbred, copperhead, Diamond H...
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by on 12/31/2010 11:18am

I feel so bad for my Siberian Husky now as I call him Knucklehead all the time.

11
by on 12/30/2010 06:58pm

I have never not paid a bill but I do wonder about those vets who prey on people's emotions to make a buck. ___AJ3130

I too have lost much of my trust. I have felt as though I have the word "Sucker" on my forehead and there are some people who can see it and try to take advantage. And I also think there are some young vets who probably have huge school loans and are trying to get started and have a practice manager looking over their shoulder to teach them how to rip people off. My vet tried to talk me into very expensive abdominal scans as she was worried about my cat not eating. It was a side effect of a drug she prescribed that prompted the problem. Reducing the dose and force feeding solved the problem. Then she called a couple of weeks later trying to drum up business for unnecessary testing. This place also told me teeth cleaning would be $225 and this was years ago. What they didn't say was all of the other procedures like anesthesia and extra anesthesia and on and on would add up to more than $1200. That shocker came when I went to pick up the cat. So I was wary when she called because of the previous hit. Now I'm wary of every encounter with a vet.

by on 12/30/2010 07:12pm


Before any surgery, my clinic presents the client with a written estimate that the client signs. For something like a dental, if there are no complications, the "estimate" is to the penny accurate. If there is a possibility of extractions, they are noted with a price on the estimate. If anything additional is required, they call before doing anything.

I trust my vet completely. Even though I've told him multiple times that if he thinks something is necessary, he already has my permission, only once has he used that permission and it was only for a $60 special blood test because he had to get it in the mail. He called me immediately after the mailman picked it up.

After reading some of the comments, I feel even more lucky than I did before (and I already felt pretty darned lucky!)

12
Human desperation
by on 12/30/2010 07:27pm

I can see why you complain about being the unfair target of anger and accusations when people want service they can't afford. But they are desperate and human and that is what humans do when they can't provide for those they love.

We can make all kinds of assumptions and paint them as unwise and undeserving but at bottom they are desperate and that accounts for their actions. They are just doing what humans do.

I remember being young and never ever thinking about paying when I went to a doctor as that was what my parents did. My roommate and I were working in the mountains and she was in a car accident which crushed her face. I borrowed a car and went to see her in the hospital. It took some time for me to realize they were not going to care for her. They would keep her from dying but that was all. They didn't even clean her up as the clods of mud were still in her hair and she was filthy. She had plastic straws in her crushed nose to keep it open and pain killers. She was on a gurney in a hall. Her parents were unreachable as they had gone on vacation and had not told the neighbors where they had gone. The boy in the accident who was the driver died and finally his parents came and brought their insurance agent who assured the hospital they would be paid. But before that I remember crying and begging the nurses for a pan of water so I could clean her. They wouldn't speak to me anymore. If the money hadn't come through I'm not sure what would have happened. I just thought naively that when you went to a hospital they took care of you. That was 45 years ago. Maybe things are different today. But I still vividly remember being a desperate human.

Since then life has been good to me. But I know that many of the school people I have worked with spent a lot of time trying to get care for a student, medical, dental, hearing aids. The political climate today is against taxes and government spending but I know in my state when health care for children passed it was a blessing for children and the school people who teach them.

And in my county the animal shelter is the place of last resort for animals. They charge fees to turn in a pet and fees to euthanize a pet. I think this is reprehensible. There needs to be a place where an owner can take their pet to be turned over to someone else who might give the pet what it needs or at least destroy the pet humanely at taxpayers expense. Government is the place of last resort and some services need to be free.

13
by on 12/30/2010 08:47pm

If I stop at the gas station and fill up I'm not able to make payments or give them an IOU. Fuel oil...nope I pay as I go. Get my Jeep serviced I've had to pay before driving off the lot. My vet is not different she needs to pay her bills too. I don't get multi pet discounts (10) and I don't expect it. I try to maintain a rainy day fund ( always empty) and sometimes its not enough. My beautiful little beagle Tess was horribly mauled and my vet went above and beyond to try and save her. She refused to take full payment as she knew my husband had just lost his job. It didn't matter if I was going to pay her in full even if I had to beg borrow and steal. It has at times been really tough but if I can't afford a pack then maybe I shouldn't have them. In my life it's pay as you go.....rip Tess

14
I stand by my comment.
by on 12/30/2010 11:28pm

I am surprised and a little disappointed. I actually expected much more vitriol than I have received thus far from the Fully Vetted fandom. Right or wrong, poor Dr. Patty Khuly must be defended. What does the good doctor have to say for herself regarding my comment?

The point (and there is a point) that many of you are missing, I believe, is that Fully Vetted as blogged by Dr. Khuly is first and foremost informational. It is not written by some celebrity for your entertainment. The doctor has a responsibility and trust to reach out to all of her readership whatever their education levels, SAT scores or technical backgrounds. So, why use a word like “lugubrious,” for example, when “sad” will do just fine?

I understand that there will be technical terms used in her blog that many of us will have to wrestle with from time to time, but why use an unnecessary word like detritus and in such a dubious context? Be honest. Have you ever heard it used in anyone’s daily conversation? More to the point, what percentage of the doctor’s readership knows what detritus means? I think it would be kind to say 50 percent. For an exercise in “word power,” we have the Reader’s Digest.

Note to Kattonic Mom and babysweet:

Concerning my SAT score, there is not the slightest gloat or brag in my statement.

Note to babysweet and Eilis:

I clearly state in my comment that I know what detritus means. I did not need a dictionary. The references were inserted simply to show that the usage of detritus by the good doctor is not supported by the accepted definitions of the word. Her use of detritus, in my opinion, was gratuitous and self-serving.

Note to Eilis and Will:

You have both made an incorrect assumption. I scored 720 on the SAT verbal in 1967. That is almost 44 years ago when it was still really “smartened-up.”

Good reading to all.

by on 12/31/2010 09:11am

"I am surprised and a little disappointed. I actually expected much more vitriol than I have received thus far from the Fully Vetted fandom."

You were trying to stir the pot and now we know for sure.

You're disappointed we weren't nastier? Gosh, can you imagine that we can (usually) disagree while continuing to be civil? I confess that I didn't post 99% of what I was thinking because 1) it certainly wasn't very nice, 2) it was definitely personal attacks, and 3) YOUR POSTS ARE OFF TOPIC.

it has now been proven:
The Fully Vetted readership can be polite
[insert personal attacks here]

OK everyone, I suggest we totally ignore any off topic posts in the future. There's no reason to waste our time on people like this.

by on 01/01/2011 07:21pm

We on the editorial and comment vetting side, on the other hand, are gladdened by the lack of vitriol and preponderance of civility, even in the face of such a disagreeable topic as this particular "off topic" comment. I was afraid I would have to edit comments and possibly even issue a troll warning - on this, a holiday - but as we had hoped, the community has self-checked and all is well.

The original comment, while off topic, stands as a valid commentary on the content of the column. I see that Dr. Khuly has not yet answered your query, but it appears the FV community has. Let's not belabor the point.

by on 01/20/2011 12:24pm

Thschmuck, what is your point?

Are you a frustrated editor? Someone recently laid off from the currently suffering journalism inudstry? Are you bored? Do you hate smart people?

Go away. If you have nothing to add to the conversation concerning WHO PAYS VET BILLS, then just go away.

You are a boor. (Do you need me to define that for you?)

15
Allow clients to help
by on 12/31/2010 12:42am

My vet has an "Angel Fund" specifically for those situations where a client may not be able to pay. They have a very small sign taped flat at the payment desk that says something like "Now and then a client is in dire straits, or a stranger brings in a stray off the streets. Would you like to give to our Angel Fund?" They never pitch it verbally. Apparently at holidays when customers send in thank-yous and photos of their pets, they often send a small check as well. When pets pass away, clients have been know to give as much as $200. I know once I was the recipient of Angel Fund help (I didn't ask--the vet offered when I was bringing in a large number of feral cats to be fixed from a downtown colony). This isn't likely to take care of all situations, but it's one idea among many, and there's something very special about knowing you've been helped by other pet owners.

16
Close to home
by on 12/31/2010 03:01am

My nights on emergency are filled with worries about finances, often presenting a first, then second, then third estimate trying to find some balance between what the pet needs for care and what the owner can afford to pay...

And yet we still never seem to be able to make everyone happy. We had a service dog come in with a fractured leg but the owner didn't have enough money for surgery and the dog wouldn't be able to work three-legged... the story ended up on the local news and within 24 hours people had donated so much money that we had to start turning people away. The dr who did the surgery donated his time but the money went to pay for the expensive equipment, radiographs, meds, etc. Owners were happy, dog was happy, community was happy.

Until a couple days later, when we start getting angry calls from owners who are wondering why we didn't start looking for donations when their pets were critically ill or injured, why we didn't donate our services to help their pets out, etc. I had a client complain that we lost her dog's $15 bed, even though I provided hundreds of dollars in free services while her pet was hospitalized. Just tonight I've been called "heartless" for telling someone that an emergency exam fee is $85 and fees are due at the time service is rendered- because she was petsitting the dog and didn't feel like she should be responsible for the bill. And now our clinic has a lovely mildly lame young shepherd that needs a home because the owner wouldn't pay for an exam plus pain meds to go home since that cost more than euthanasia.

I just feel like we give SO MUCH but the community and our clients have no idea how often we perform services without charging, how many stray animals we provide vet care for and adopt out so they won't have to go through the shelter, or how often we just plain don't charge appropriately.

by on 12/31/2010 12:57pm

Megan, I'm sorry you have so many horrible and incredibly insensitive patients that would treat you this way.

Unfortunately, I'm doubly sorry that you have such an insensitive clinic manager.

The clinic I worked at was one of the worst I could describe - mistreatment of animals, padding of bills, charging for services that weren't received, extreme overcharging for meds, many veterinary services being performed by techs and even receptionists.

However, upon receiving an ill service dog through our doors one day and an owner who could only come up with about 1/10 of the bill, we pro bono'd the entire cost. Don't rely on my memory 100%, it was over a decade ago, but it was well over $3,000 at regular price. I don't recall what the injury was (I wasn't there that week and my memory works better visually) but bottom line this young dog was going to die and leave his owner stranded without help. According to the receptionist on duty, there was very little conversation, and the vet on patrol was totally pissed about it, even though she was assured she'd be paid.

The clinic manager called the clinic owner who immediately ok's WHATEVER the dog needed and even sent him home with a few bags of food that he got Science Diet to donate.

All follow up care was also covered, and the vet agreed to treat the dog for life for free provided that the owner kept the agreement between the two of them (lest every service dog in our very large city show up at the door).

I'm sorry, but as far as I'm concerned, what you did was wonderful, but the way the clinic above handled the situation was the correct way. This is not just a dog, this is a person's entire life. Their freedom. Their independence. There are times in our lives when we need to give of ourselves, and this was one of those times.

I also completely realize that as the front line all the crap flows downward - been there, done that, couldn't take it, so credit to you - seriously. And my criticism here is not for you, but rather for the clinic owner, so PLEASE don't take it personally. It's not an attack on you in any way, I assure you.

by on 12/31/2010 06:34pm

While I appreciate your perspective, I must respectfully disagree that there is a single right or a single wrong way to handle cases like this. This case was difficult (medically, ethically, and emotionally) and there could have been MANY right and wrong ways to approach it. We treat a large number of service, therapy, military, and police dogs and they all get discounts. We are a business and have to meet our bottom line... Should we have done the $5000 surgery for free to help a single dog, or given our usual discount and continue to help out the hundreds of service dogs we see?

If your vet felt that that patient deserved free care for being a service dog, why did he also feel that the owner couldn't tell anyone about the free service? Why did THAT dog deserve free care, but no other service dogs?

And removing the service dog part of the equation, how can we ethically justify giving ANY pet owner discounts if we don't give EVERY pet owner discounts? I was mad at the caller who felt we were unfair in giving away services to the therapy dog, but he has a valid point... How exactly is it fair for some owners to have to pay the full fees while others get breaks on the bill? We are essentially using the funds of owners who can afford to pay to subsidize the care of those who can't. If our clinic can handle the losses of giving away services, then really we should just reduce our fees across the board. But if I feel that my clinic's fees are reasonable (which I do), then I should charge everyone the same way. Is it my right as the doctor to 'take from the rich and give to the poor'?

In the situation of the service dog, we could have done the surgery for free and used the money that the clinic makes from our paying customers to cover it. Or we could put a call out to the community to let people voluntarily decide to help cover the bill, while also giving the owner a discount by having the doctor donate his time, etc. I think either approach is valid and I think any time we give discounts we have to seriously think about the ethics of doing so.

by on 12/31/2010 11:22pm

We didn't want to become known as the "come here for free service" clinic. At the same time, when faced with a client (we had never seen this client before, btw, it just happened that we were the closest clinic and the client was unable to get any further while carrying the dog) who depends on his pet not only for love and support but literally for his LIFE, yeah, we paid for it ourselves, and we were happy to do and would do it again.

If you or someone close to you depended on a service dog literally from the moment they woke up until the moment they went to bed at night, perhaps you would feel differently.

In regards to K9s and K9 soldiers, I believe that the government should be paying these animals FULL medical bills along with arranging for their adoption and lifetime medical care, period. That being said, these types of dogs are literally trained to be expendable. They are trained to enter into intensely hostile situations so that if there is a danger it meets a dog and not a soldier.

This is not to be compared to the situation with a service dog. This is why this blog literally imploded when suggestions about faking service dog status were made - these dogs make life possible for people who sometimes otherwise could not live on their own or perhaps even leave their own homes. They allow them to have jobs and live NORMAL lives in a society not built for their disability.

You said the surgeon donated his time, and we both know that that's where the money really is. When you break it down to COST, not retail, of sedatives, anaesthetic, a few x-ray films, some pain meds, the use of a surgical room, antibiotics and some recheck appointments, we're not talking about a $5,000 overhead if we're being realistic.

We can talk about where to draw the line regarding discounts, but in my books a service dog in an emergency like this doesn't require discussion where I come from - he gets treated, we worry about money later. Period.

by on 01/01/2011 03:09am

While I don't want to get into the specifics of this case, I will say the dog was not required for this individual to be a functional member of society, nor was his injury life-threatening. Potentially career-ending for his service work, but he was also a dog still early in his training.

I am okay agreeing to disagree. I still argue picking and choosing which animals you think deserve a discount and which do not is something worth critically evaluating, both on an individual basis and as a clinic (why THAT service dog but not other service dogs?). I know I have become extremely emotionally involved in some of my cases and extended discounts for no reason other than that I loved the animal as much (or in some cases, more) than their owner did and couldn't bear to see the pet go home with sub-optimal care due to financial constraints. We are not always as rational as we'd like to be...

I could be really cynical and say that people who are reliant on their service dogs to lead a functional life should really have pet insurance or an emergency fund to handle emergency vet bills, since the loss of their animal is a major major problem...

by on 01/01/2011 01:25pm

Why this service dog? Because he presented at our door.

Why this dog and not the lady down the road? Because the lady down the road doesn't DEPEND on her dog, as I explained before.

These are not pets, they are tools. They are LIFE to the people who use them.

Regarding your comment that the individual didn't depend on his dog, how do you know that? By law that individual does NOT have to explain his own medical history to you until you deem him worthy. Tell the owner of a seizure alert dog that they don't really NEED their dog to leave the house, and you're likely to have to begin ducking things. The reason they feel safe enough to be in public is because of these incredible animals. Thousands of dollars and even more hours go into the training of these animals, and this is not done just for fun.

I agree - we can agree to disagree. But on this one, Megan, I disagree with you strongly. You even admit to offering additional discounts for emotional reasons, but can't see why providing this animal with free care was simply the right thing to do? I'm flummoxed, to be honest.

Although we DO agree on one thing - ALL of these animals should have pet insurance, and pet insurance companies should offer this insurance at a GREATLY reduced rate (I believe their current discount is like 15%?).

Incidentally, it just so happens that the CNIB headquarters used to be located a block from my old house - small world. Unfortunately, in Canada, ONLY service dogs for the blind are covered by laws that protect them, thanks to organizations like the CNIB. There are dozens of uses for service dogs, and in my country, only one is legally recognized. Thankfully our general attitude towards the disabled and service dogs in general is a positive one and "other" service dogs are treated the same, but it would be nice if a group like the CNIB would use its impressive power to lobby for a more inclusive law, particularly after seeing what a difference these dogs can make in the life of a person who feels small because they must rely on others.

It's certainly a cause that deserves a champion.

by on 01/20/2011 12:34pm

That's all well and good, but if we're talking about someone whose only income is SSDI, that's easier said than done!

by on 01/01/2011 02:37am

It's hard to believe that there is no recourse for owners of service dogs when the animal needs emergency care. The dog's health is part of the person's health. Here's an example of an organization that covers most if not all of such costs for blind people's guide dogs:
http://www.cnib.ca/en/living/guide-dog/assistance/
There must be similar organizations for people with other disabilities, in both Canada and the US. Does anyone have information on them?

17
by on 12/31/2010 02:08pm

I want to take a moment to address this.

Do I believe that every clinic should provide a discount for people who have multiple pets registered under the same name?

No.

Do I believe that every clinic should provide a further discount for people who bring multiple pets at a time in an organized fashion for easy appointments like wellpet checkups and vaccinations?

No.

Do I believe that both of the above practices are excellent ways to attract larger revenue streams and make perfect sense economically?

Emphatically YES.

In veterinary medicine, your patient (and therefore your money maker) is the animal. Your client (and therefore your marketing target) is the owner.

By offering a 10% discount on owners with two or more pets (admittedly most clinics raise their overall costs about 5% to cover this) and promoting this discount you only need to attract one client (owner) to receive multiple new patients (pets). Not only that, but you're specifically targeting those clients who will bring in a higher cash flow PER client.

Now, your income per patient may be lower as those who own multiple pets are probably more likely to ration care and avoid "extras" - for example, I will never allow our savings account to get lower than 50% for any one pet unless we're looking at a REAL chance for a cure. The reason is that another one of our pets could get ill or injured in the interim - and we have many to care for, and have to keep everyone's well being in mind.

That being said, I can guarantee that even when you remove the rescue animals from our bills (who receive no discount beyond the multipet discount but often just "aren't charged" for certain items like blood draws or nail trims, things that don't really take a lot of time but are generally charged for - unless something big comes up in which case our vet basically offers it at cost) my own personal vet bills FAR outweigh those of the individual down the road who has a single Retriever, or a single cat - even if said animal is receiving ongoing care for a health issue.

Multipet discounts make fiscal sense. I presented the case to a dear friend who has several degrees in Economics and the like and he too was "flabbergasted" (his word) that multi-pet discounts were not the norm.

In my particular area, they ARE the norm. Competition has made it so that they are. First question new clients ask: what's your exam fee? How much for yearly vaccines? What's your multipet discount and how does it work?

I guess my point is that those people who have more than one or two or three... or like some earlier posters fall under the category of "many" SHOULD expect a discount.

An earlier poster mentioned getting her Jeep serviced. Guess what? If you owned as many Jeeps as I owned animals, you'd have garages clamoring over themselves offering you free crap and discounts begging you to make them YOUR garage. Why shouldn't we expect the same service? Vets go on and on about how they are like any other service provider and should be entitled to the same rights.

I agree. 150%. But I also agree that your clients should be held to the same standard, and I don't see that happening.

Let me tell you, if you brought the van belonging to a group that serviced handicapped kids whose loader was broken to a service station near me, and all it needed was a few hundred dollars worth of parts and hours of work, it would be completed for free.

Mind you, I'll admit to having a different perspective, and coming from a country with a different perspective whether we like to admit it or not. P - I've seen my friends injured numerous times, and done that hospital run. A few times were extremely serious - a few times the injured party was me. But I live in Canada, and when you walk in and you are, in fact, seriously injured, they don't even care what your name is. I once had a dog almost take off a chunk of the left side of my face when I was eight and my mother wasn't asked to fill out paperwork for three hours - when the surgery began - right after the helicopter arrived with the best available plastic surgeon.

Yes, we pay high taxes, but we pay no insurance and after three days in the hospital making sure there was no infection and that the wounds were healing nicely (all the while the surgeon stuck around) along with several brain scans (can't really remember what, now) to ensure that my concussion was nothing more and multiple x-rays to ensure my back was alright after being flopped around like a rag doll by a great dane, our bill was a whopping... $22. The ambulance fee because we lived in a rural area.

You guys think you have angry veterinary customers in the US? Try up here in Canada where we don't pay for our treatment. We don't even SEE the bill. Ask the average Canadian what a doctor's visit costs, and they CAN'T tell you. Now try having a conversation about medical costs and payment up front.

I realize I spun a bit off track there, but I do have one additional point to make. I don't think that the veterinary community does a good job of preparing either new pet owners or their own staff for these situations.

More training needs to go in to how staff deal with these situations. Personally, I think this is something the AVMA or the CVMA could put some funds behind to commission a third party study regarding how these situations are best handled.

They should also have information for new pet owners regarding just such a situation that should be handed out with every first visit. Explaining in clear english what the clinic policy is, suggesting learning the local ER policy and pricing, and the importance of having a plan for these situations. Statistics from insurance companies regarding what percentage of their clients submit claims for accidents and for illness, and the average cost of these claims. This pamphlet should not just be tossed in the medical record, it should be clearly explained to the pet owner and stressed thoroughly. Insurance can also be discussed at this time.

When said pet owner returns in an emergency situation you now have a staff member much better equipped to deal with the situation and a client who can't claim ignorance regarding your policies and procedures in these situations.

The way the system is set up now, the client is in a panic, the staff is stressed out - torn between their concern for the animal, their sympathy for the client and yet their understanding of their need to do their job... and frustration over the whole ordeal. The client feels taken advantage of, those same smiling faces they've seen over and over at checkups and ear infection appointments, the people who coo and coddle over their pets like they were their own and have always treated them so well - and are now, in their opinion, acting like they don't care, acting cold hearted and even cruel.

Are there clients that are simply out to screw you? Certainly!

I've seen plenty of clients pull up in brand new $80,000 trucks or Cadillacs and then cry poor when their custom ordered $3,000 sharpei has an obstruction. "Can't we just put down $300 for now?" Uh, yeah... I think not.

But I do believe that an open communication of policies and better training of staff (and I don't just mean a handbook, I mean a well studied and constructed course including instruction - I'm sure you can get a drug company, etc to sponsor it) to take some of the strain out of what is DEFINITELY one of the most stressful part of the jobs and surely contributes to burnout. With both sides fully educated from the beginning, the staff have guidelines to follow, removing the pressure, and the client has no way to place blame on the clinic - the clinic practically TOLD the client that there was a good chance of this happening one day, and TOLD them of the many ways to prepare for this day. They also TOLD them that the clinic does not extend credit and expects payment up front.

Dr. Khuly (or any of the other DVMs, RVTs or Veterinary Receptionists who frequent the board), I'd be interested in hearing your opinion on this. The last bit, not my rambling beforehand. Would this situation not be better handled through improving education all around and setting up boundaries from day one?

18
by on 12/31/2010 03:09pm

Speaking for equine...

>>your income per patient may be lower as those who own multiple pets are probably more likely to ration care and avoid "extras">>

Bingo.

There are three basic groups of owners who have more than 2 horses in my practice:

1. Those who can truly afford to do so and cut no corners.

2. Those who can't afford more than one horse and want me to subsidize a horse-owning habit they actually can't afford.

3. Those who maintain a herd of working "schoolies".

Owners in the second group tend to use me only for basic vaccinations (almost a loss leader in my practice) and emergencies. Those in the third group call me only for rabies vaccinations, Coggins tests and emergencies. Professional services (the fun, interesting work I was trained to do, with the best profit margin)... not so much. As for emergencies: yes, I make money on emergencies, but I hate going out on calls knowing referral is not an option (e.g. colic surgery) or, worse, knowing the client has already attempted treatment, unsuccessfully and frequently inappropriately. It's demoralizing.

New Year's resolution for all pet owners: do not acquire more animals than you can reasonably afford. Develop a household budget. Create a small emergency fund and add to it when possible. Pet ownership should be a pleasure, not a source of financial stress.

If you run the numbers and discover you currently own too many, well, please don't acquire any more. Some of you may discover you can support two dogs, not three. Some may realize one cat is your limit. That's responsible pet ownership.

Another option: when I got the urge to adopt a second horse from a rescue, I sponsored him instead. Good karma all around, and I didn't have to clean the stall!

by on 12/31/2010 11:33pm

I agree with you, EquineDVM, although sometimes where we are when we acquire an animal and where we are a few years down the road are very different things. Particularly when these animals live as long as yours do.

There's also a bit of a different perspective coming from you, because I would imagine that most of your horse owners are multi-owners, or if they are single owners they board their horses and use whoever the barn recommends (at least, thats the way things are done up here for the most part). Regular vetting is done on a schedule, and boarding facilities generally DO get a discount. Individual owners with more than one large animal do not.

My feelings on the multiple animal discount is more of a small animal situation. I'm speaking more about people who have three dogs - not trying to feed three and care for three giant horses. Incidentally, I vacation in Northern Saskatchewan and out there they're referred to as "Hay Burners". Luckily, there's lots of land that's inaccessible via anything BUT animal so there's lots of grass for them to eat in the summer, but they do need to be fed in the winter and hay is NOT a cheap commodity up there because of how poorly it grows. Word got around last time I was there that I was one of those "animal people" and I had at least a handful of people offer to GIVE me their horses, and dozens of offers to buy horses for under $100. Everything from young colts to big Clyde mixes.

Sorry, got off track again. We're trying to sort something out to help with the horses up there and I can hear the frustration in your post. Let's just say... I understand it. I don't think it applies to what I intended to say originally, but I definitely understand it.

by on 01/01/2011 10:58am

>>I would imagine that most of your horse owners are multi-owners>>

No. That is incorrect. The vast majority of the horses in my practice are owned by one person, the only exceptions being some of the racehorses and very expensive ($100K+) show horses owned by investment groups.

>>if they are single owners they board their horses and use whoever the barn recommends>>

No. In my area, multiple veterinarians service multiple barns. Additionally, the vast majority of horses in my practice live in the owners' backyards. There's no monopoly, and I am in fact uncomfortable with barns that encourage all of their clients to use me.

>>Regular vetting is done on a schedule, and boarding facilities generally DO get a discount.>>

If I see more than 10 horses for vaccinations, I do not charge a farm call. That's it for discounts, and this is customary in my area. Heck, the local floaters don't offer discounts unless they're floating the entire barn twice a year, and some only accept cash.

>>My feelings on the multiple animal discount is more of a small animal situation.>>

But it's really the same issue: money. Pets are luxuries. It's less obvious because the average person can afford to acquire and feed cheap food to multiple dogs and cats, and these pets live in the house with the humans. In areas like SK where land is plentiful, however, you clearly see the same situation with horses; owners acquire more than they can truly afford, and veterinary care is one of the first "luxuries" to go. Owners believe they can afford the animals until a major medical crisis occurs... or until it's time for routine care like vaccinations.

Owners of multiple animals generally provide them with the basics (vaccinations and heartworm preventative). They'd like a discount on these services, the problem being these services are low-margin for the veterinarian. Multi-pet, discount-seeking owners are also (IME, and by your own admission) less likely to provide "extra" services, like dentistry and senior bloodwork, and less likely to bring the animal to the veterinarian for "minor" problems. They're also (IME) less likely to be able to afford optimal treatment of "major" problems. Professional services are high-margin for the veterinarian, and our time is the most profitable commodity we possess. We also prefer to practice a high standard of medicine, not necessarily because we earn more money but because we want our patients to survive with good outcomes. A shot of penicillin or a prescription for dexamethasone may be cheap, but that just doesn't cut it anymore.

Why should veterinarians discount low-margin services for a group of clients who are also less likely to utilize high-margin services?

Thought question: do U.S. pediatricians offer a volume discount to parents with multiple children? Or, consider, are Canadian pediatricians paid less for seeing multiple children from the same family? I don't think so.

by on 01/01/2011 02:03pm

You misunderstood this question:

">>I would imagine that most of your horse owners are multi-owners>>

No. That is incorrect. The vast majority of the horses in my practice are owned by one person, the only exceptions being some of the racehorses and very expensive ($100K+) show horses owned by investment groups."

What I meant was, I imagine the majority of your clients own multiple horses.

As for the margins, let's get serious here.

I bring my two cats and three dogs to the same vet. Let's look at what I'd be paying for them on their own.

Clinic visit - $55.00 x 5 = 275
Cat vaccines - $54.00 x 2 = 108
Dog vaccines - $49.00 x 3 = 147
Dog Heartworm test - $65 x 3 = 195
Dog blood draw fee - $22 x 3 = 66

We take them in one visit, my husband handles the in and out, getting one prepped while I handle the one on the table, then doing a handoff. The entire appointment takes about 20 minutes (my clinic books in 10 min sections, so I've just paid for the next three people in line, too).

The vaccinations cost a few dollars a piece, and with the exception of the rabies vaccine, I can actually get them done at a co-op down the road for $2 a piece. Rabies I can get done in the summertime at rural clinics for the whopping price of $7. The heartworm test has more than a 100% markup.

So yeah, if I'm going to pay $800 a year before anyone even gets sick, and BEFORE I even purchase any flea, deworming, or heartworm medications, in exchange for 20 minutes of your time and under $100 worth of actual cost, I expect something in return, or why shouldn't I choose the clinic down the street?

I also really don't appreciate the assertion that owner who have more than one pet are less likely to spend money on them. Would I take advantage of your so called "high margin" services? It would depend on the situation. After all, we do have a pack at home that we have to consider as well. What happens if we spend all of our money on Rover to no avail only to get home and find out that Fluffy has eaten a thread?

Speaking of "high margin" having done the books for a vet clinic and knowing exactly what the target margin is, I shudder to think of what you consider "high margin". I also find it troubling that your "high margin" treatments are the same ones that are needed in emergency or life saving situations.

I mean no disrespect, but this seems predatory to me.

by on 01/01/2011 04:39pm

>>What I meant was, I imagine the majority of your clients own multiple horses.>>

You're wrong: most of my clients own only one horse.

>>The entire appointment takes about 20 minutes (my clinic books in 10 min sections, so I've just paid for the next three people in line, too).>>

Like DrV, I'm puzzled: why are you paying for 50 minutes yet spending only 20 minutes with the veterinarian? That, to me, sounds dishonest.

Honestly, $200/year for routine health care sounds reasonable, on a per-animal basis.

>>I expect something in return, or why shouldn't I choose the clinic down the street?>>

No one is saying you can't choose the clinic down the street.

Maybe I want you to choose the clinic down the street. I have no desire to be the cheapest veterinarian in town (FYI, I'm not the most expensive, either).

>>I also really don't appreciate the assertion that owner who have more than one pet are less likely to spend money on them.>>

On a per-pet basis, this is generally true. You've heard the term "horse poor", no?

>>What happens if we spend all of our money on Rover to no avail only to get home and find out that Fluffy has eaten a thread?>>

That's why I advocate owners' budgeting for routine care and maintaining an emergency fund. If you've delayed dentistry for Rover for 3 years because Fluffy had foreign body surgery 6 months ago, well, you shouldn't acquire any more animals because you have too many already. You also probably won't be able to take care of yourself should you lose your job, hot water heater dies, car transmission expires, etc.. That's not okay with me; I've seen overextended clients lose their homes, especially since 2008 or so.

>>I shudder to think of what you consider "high margin".

High margin = high ratio of professional service vs. cost of materials. Lameness exams are high margin. So is colic surgery (though I don't perform colic surgery). And, yes, treating a medical colic on the farm or suturing a laceration are also high margin (there's also an opportunity cost to me, as a result of providing emergency coverage).

Vaccines are low margin. Vaccine is expensive (much more than "a few dollars" per dose) and then there's the cost of maintaining inventory, sharps disposal, etc.. I keep vaccines low margin because at absolute rock bottom, I want my clients' horses to be vaccinated with the AAEP core vaccines.

>>I also find it troubling that your "high margin" treatments are the same ones that are needed in emergency or life saving situations.>>

Sure. They're professional services. The most valuable commodity I possess is my knowledge. It's what differentiates me from the feed store selling vaccines, the on-line pharmacies, and the local trainer who hog-ties yearlings and castrates them without anesthesia. My clients value my professional opinions and are willing to pay for my time.

>>I mean no disrespect, but this seems predatory to me.

It's business, and I suppose capitalism is inherently predatory. My business is NOT low margin/high volume. First of all, I don't think rushing through appointments with minimal diagnostics (even a basic physical exam = diagnostics) is good medicine. Second, it's boring to do nothing but vaccinate and have little opportunity to provide interesting, medically necessary diagnostics and care.

In this sense, plumbers are also predatory, and mechanics, and even the corner convenience store. Still, most people are willing to pay the plumber when the toilet is leaking sewage, pay the mechanic when the timing belt snaps, and pay for that last, overpriced quart of milk on New Year's eve.

by on 01/01/2011 04:54pm

"Vaccines are low margin. Vaccine is expensive (much more than "a few dollars" per dose) and then there's the cost of maintaining inventory, sharps disposal, etc.. I keep vaccines low margin because at absolute rock bottom, I want my clients' horses to be vaccinated with the AAEP core vaccines."

Once again, we are talking apples and oranges. There's a pretty big difference between a $30 tetanus vaccine and a $2-3 DA2PP vaccine.

In addition, $200 a year for a checkup and vaccination for an indoor cat? Methinks not. Remember, these are prices BEFORE any medication has been purchased.

And something tells me you weren't referring to suturing up a laceration when you referred to "optimum treatment" choices.

You're coming from a different world, EquineDVM, and while you may be a veterinarian, small animal and large animal medicine practice simply is not comparable, as you've proven here.

by on 01/01/2011 05:32pm

>>There's a pretty big difference between a $30 tetanus vaccine

Tetanus vaccine is dirt cheap because it's used in cattle and other food animals as well as horses. It's comparable to a DA2PP vaccine, AAMOF. You can check the cost on-line easily.

>>In addition, $200 a year for a checkup and vaccination for an indoor cat? Methinks not. Remember, these are prices BEFORE any medication has been purchased.>>

Yes, that's comparable to what my friends and family members pay per dog or cat annually. I don't think it's unreasonable for an office call, exam and vaccines but then again, costs add up quickly when you own more than a couple of animals. That's my point: don't own more than you can afford, and don't expect veterinarians to absorb the costs of owning multiple animals.

by on 01/01/2011 06:23pm

It's telling that you didn't quote the cost for a DA2PP, which is about $2-3/dose.

I also never suggested that vets should be expected to "absorb" my veterinary costs because I own multiple animals. I clearly outlined my economical reasoning for offering multipet discounts in a small animal practice.

I don't appreciate you twisting my words or my intention.

Once again, let me repeat - we're going to have to agree to disagree.

by on 01/01/2011 06:44pm

Just to clarify:

According to EquineDVM et al, $4 in vaccinations and 10 minutes of booked time should equal $200 in fees? This is what I was referring to when I said that if this is what is considered by the veterinary community as "low margin" services, I have some concerns about what classifies as a "high margin" service.

19
to each their own
by on 01/01/2011 03:08pm

babysweet,

Your approach is one of many, and it works for you. I have no problem at all with people seeking to minimize costs of wellness visits with vaccinations. As long as the vet actually has time to do a reasonable exam on your animals before vaccinating them. So I don't really understand why you spend 20 minutes on all five animals when you're entitled to the full 50 minutes you've paid for.

But when you write about "high margin" services and predatory attitudes, this is just too vague. Rather than shuddering to think of what could be considered "high margin," let's try to name some specific services in specific situations. Bloodwork, for instance, is needed in most but not all emergency situations, but also highly recommended for an older animal who's "slowing down" (which is not a medical condition, that's why we vets want to know what's causing it). What are your examples?

by on 01/01/2011 03:30pm

Thanks for the opportunity to clarify.

I was responding to this quote by EquineDVM:

"They're also (IME) less likely to be able to afford optimal treatment of "major" problems. Professional services are high-margin for the veterinarian, and our time is the most profitable commodity we possess. We also prefer to practice a high standard of medicine, not necessarily because we earn more money but because we want our patients to survive with good outcomes. A shot of penicillin or a prescription for dexamethasone may be cheap, but that just doesn't cut it anymore.

Why should veterinarians discount low-margin services for a group of clients who are also less likely to utilize high-margin services?"

What I was pointing out was that not only are these "maintenance" services NOT "low margin" by any means, but that her assertion that a "high standard of medicine" DOES qualify as a "high margin" service seems to suggest an even higher margin on invasive services, for example.

These are predatory practices, and veterinarians even warn their clients against them. Dr. Khuly herself I believe has said, beware of the cheapest vaccination in town - they're likely to provide the highest cost surgery. In my opinion, judging by the paragraph above, this is exactly what EquineDVM is confirming.

I apologize if the term was vague, but I was quoting a previous post.

Regarding full examinations, I'm mainly interested in heart findings, abdominal palpation, and an inspection of their eyes. Things that I won't find during their weekly grooming/physical exam. I should also note that any older pets (my current crop is fairly young, with the exception of the cats who are in perfect health and get their own personal exam every other year for this reason including senior panels) are treated differently.

I would like to mention, however, that when we do have an issue that needs to be checked out, we are frequently not charged for things like blood draws or nail trims or those little add-ons that can quickly inflate a bill. They treat me well, and have earned my trust, AND my very lucrative business.

by on 01/01/2011 05:19pm

>>These are predatory practices, and veterinarians even warn their clients against them.>>

Is it predatory for me to recommend a lameness exam, nerve blocks and x-ray or ultrasound vs. handing over a bottle of bute and telling the client to call me back in 10 days?

Is it predatory for me to recommend a power float, with re-check in 3 months, for the aged horse with the wave mouth I could not correct in one visit without risking damage to the pulp cavities?

To me, that's good medicine. It's also interesting, professionally. It's boring to bute horses after a cursory exam and file teeth without attention to detail.

>>Dr. Khuly herself I believe has said, beware of the cheapest vaccination in town - they're likely to provide the highest cost surgery. In my opinion, judging by the paragraph above, this is exactly what EquineDVM is confirming.>>

No, that's not at all what I'm confirming. Have I seen this? Yes, of course, but that's not at all what we're discussing.

Why is pricing professional services appropriately a problem? There was an interesting article this summer in one of the veterinary industry publications (DVM? Veterinary Practice News?). In the article, a veterinarian hired a plumber to fix a leaking toilet. He charged her cost for the parts (which were cheap at Home Depot) but much more for professional services.

The point of the article was: veterinarians must change the typical veterinary business model. Clients are fully aware of the cost of vaccines; I can't raise my prices above a certain point. Similarly, I can't mark up drugs above a certain point (and I don't - I prefer, when possible, to write prescriptions to human pharmacies). We can't bury our profits in the cost of vaccines, dispensed drugs and, in the case of small animal veterinarians, flea control products. If we're going to make money, we must charge for professional services at a rate sufficient to provide the bulk of our income. That's honesty, IMO.

FYI, in my area, clients enjoy the following options:

Dr. Palm Beach, who goes south every winter ($$)
Dr. Creaky, who is semi-retired and provides no emergency coverage ($)
Dr. Lasix, a racetrack veterinarian who dabbles in farm practice and provides sporadic emergency coverage ($-$$)
Dr. Omni, who owns a mixed practice, employs new graduates and has a 30% equine caseload ($$-$$$)
Dr. Megabucks, who charges $200/hour, not including farm call or any services ($$$)
Dr. Baffled, who owns a mixed practice and practices equine medicine circa 1980 ($)
Drs. University, at the local veterinary school ($$$$)
Or, Equine DVM ($$), who owns a solo ambulatory equine practice

That's probably about typical for a given region.

Dr. Khuly has also written about the $3000 board-certified surgeon fee vs. the $1500 local hack fee. Is the board-certified surgeon predatory? Surely, her costs aren't greater than those of the hack, and her surgical time is probably faster, so her potential income is also higher.

by on 01/01/2011 06:26pm

Yes, and there's the hack who charges $4000.

The highest price isn't always the best service, despite what the highest price service in town will tell you.

by on 01/01/2011 08:04pm

>>The highest price isn't always the best service, despite what the highest price service in town will tell you.>>

I hope that's why most of my clients use me. It's certainly not my winning personality, for sure.

by on 01/01/2011 09:00pm

I'm interested in your observations from your time as a bookkeeper for a veterinary practice. In particular, what factors determine the fees a client is charged.
Every practice is different, but in any case the veterinarian is only part of the equation, the leader of a team of more or less trained personnel. Most practices employ at least one trained technician while others employ veterinary assistants trained on the job to do a technician's work, and yet others - personnel without any formal qualifications. Employees must receive different pay based on their qualifications and experience, and this must reflect on the fees the practice charges clients, for better or for worse.

20
by on 01/01/2011 08:00pm

>>It's telling that you didn't quote the cost for a DA2PP, which is about $2-3/dose.>>

Why should I quote that price when you already did?

>>I clearly outlined my economical reasoning for offering multipet discounts in a small animal practice.>>

And I clearly stated why the economics of offering multipet discounts just don't work, except perhaps in a high volume/low margin practice model, which I do not favor.

>>$4 in vaccinations...

Let's suppose it's $4 for vaccine alone. Then add in the cost of maintaining inventory, shipping and handling, the cost of storage (refrigerator, electrical bill, etc.), price of needles and syringes, cost of technician to restrain animal, continuing education (to know which vaccines are appropriate for each animal, because risk profiles differ), client education (a professional service), receptionist's salary (to schedule the appointment), phone service, etc.. Do you want me to continue?

>>...and 10 minutes of booked time...

Physical exam, which is professional time, should cost a lot more than a vaccine. $55 is a bargain. I realize you live in Canada, but it's not unusual for U.S. pediatricians to charge $150+ for a 15 minute exam (and no, I don't think veterinarians should earn as much as physicians do, and I also think pediatricians are underpaid, but let's not bother with that tangent, okay?).

>>should equal $200 in fees?

Well, actually, you said your veterinarian charges $55 for an office visit and $54 for vaccines. That's not even close to $200 per cat, unless my math is incorrect.

>>This is what I was referring to when I said that if this is what is considered by the veterinary community as "low margin" services, I have some concerns about what classifies as a "high margin" service.>>

Why be concerned? Choose a veterinarian whose services you value at a price you can afford. If you can't afford to pay the prices charged by your veterinarian of choice, well, stop acquiring animals and take care of the ones you have already the best you can. Stop worrying about how much money veterinarians earn, because 1. It's really none of your business (no more than my plumber's salary is any of my business), and 2. If you don't value the service at the stated price, you can either find another veterinarian or stop acquiring animals.

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About fully vetted

Patty Khuly, VMD, MBA

Photo of Dr Khuly

Dr. Khuly is a former petMD blogger and small animal veterinarian in Miami, Florida, where she practices medicine at Sunset Animal Clinic and serves on the board of the South Florida Veterinary Medical Association. She is a graduate of Wellesley College, the University of Pennsylvania School of Veterinary Medicine, and The Wharton School of Business.

As a significant sideline, she writes...a lot. She authors pet health columns for USA Today, The Miami Herald and Vetstreet. She also writes a popular monthly column for Veterinary Practice News and serves as regular contributor to Veterinary Economics, The Bark, and the Veterinary News Network.

Dr. Khuly lives in South Miami with her brood of hens, goats, dogs, cats...and humans.

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