For all the reasons you mention, I have gratefully paid my bill at an excellent animal ER. They have board certified emergency care specialists. Even better, it's in the same clinic as a specialty clinic. If a critter is in bad shape, the specialists are right there when the specialty clinic opens. They've pulled more than one of my critters through some pretty scary times.

When there's an emergency at 2 AM, it's reassuring to know that there is help available.

If I HAVE to take one of my kids to an ER I am fully prepared to pay the premium price for all of the reasons you mentioned. I am usually so grateful that an ER is available I don't care WHAT they charge, just so they take good care of the situation. I have only had to use one a few times but it was well worth what I paid.

I worked on Thanksgiving day, and about 75% of the clients I saw complained about cost... and 0% of clients thanked me for being available to treat their pet on a holiday. I'm sort of used to owners not thanking me after cases go poorly, but every case I saw on Thanksgiving went great, medically-speaking. I'm not asking for gifts and trumpets and fanfare... just a sincere "thank you" would go a long way to making me feel better about being away from friends and family on a holiday.

*sigh*

Thank you...for all those you forgot to say it.

Last Wednesday night I found my Basenji bitch who had been lost in Syracuse, NY for 24 days. She was extremely emaciated and scraped up. The billfor her check-up, tick removal and feeding advice was $94. Coming from Boston, I was stunned at how *low* it was . The peace of mind the very profesional exam brought was worth any price. Last5 April, my dughter's dog ruptured a disk in her spine - late at night, of course. The emergency bill for her obviously was much higher, because she needed very tricky surgery, but she is now walking and running almost normally. As good as my regular vet is, waiting until morning would have meant a paralyzed dog. How can one possibly question the price of having professional, high-quality care at the time of an emergency? These specialty clinics are worthe very penny and more!

I Thank God for Them, Oh yes, the cost is very high, but they save our Coco life and her baby boy, only one, Anton (Tee LO) if they were not there, we would have lost them both. We love our Pet Kids............Thank-you Doctor Khuly....good blog

See? You ARE appreciated. Even if those who would appreciate you most aren't always the ones showing up on Thanksgiving. Keep working those tough shifts while you can still manage them (no kids, the late night alertness of youth). They build character and skills(!) via all the different kinds of challenges they offer.

For those of us that have spent enough money to buy a new car at the e vets I say THANKS. You guys are willing to work tough hours/rough cases and people in stressful times. Two tpl surgeries and mrsa and never a problem whenever I bugged them with countless questions. When I need specialists or immediate care I don't give a hoot what it costs. I'm just a sucker for those big brown eyes and will do/pay for the expertise. And Megan ....... Thanks.

I had a cat who struggled with both idiopathic cystitis and hypertophic cardiomyopathy, using nearly all the letters of the alphabet and all my ready cash and then some at one particular emergency facility, but I was never more grateful for their care and fully understood why the bill was so high. My mother also had heart disease, and as I was her guardian the nurses and her PCF explained the disease, conditions and all they did for her; the emergency clinic did basically the same for Namir, using much the same equipment and medications, the same amount of education for veterinarians and so on.

The emergency clinic had been open only overnight and weekends in the same facility as the best specialty clinic around used during the day, but built a new facility where the specialists oeprated day and emergency clinic operated 24/7; I proposed a memorial wing for Namir, since he was in emergency at least twice yearly for congestive heart failure and both specialty and emergency staff loved him so much.

My regular veterinarian only makes house calls, so for clinical needs she can't take care of I'll visit a local for for spays and neuters, but all other needs, which are usually dire emergencies, go to the emergency clinic at her request since she trusts their equipment and their staff.

When I hand over one of my cats because of a situation neither myself nor my vet can manage, I expect them to be able to work miracles when I get there because I've lost all sense, and I expect it to cost me too.

Yup no doubt they do a great job and thanks to our emergency hospital my boy Rock's life was saved.
Cost? 6000 for bloat.

What I did not like was the fact that they did not make a move to save the dog until they had 80 percent of the money up front.

I saw other people that came in and did not have the money to pay and they were turned away. That was the worst part.

I saw one family, mother, dad and son. They were going through every credit card they could find, looking through the purse. Even the little boy told his Mom, I have 50 dollars from grandma you can have it. In the end they did not have enough and they left.

Terrible to see and I hope I never have to see that again.

So yes it is great the hospital is there, watching the horror show of others that loose their pet because they can't cough up two or three grand not so great.

I went through the same thing last Christmas. My son's dog came down with a bladder infection 2 days before Christmas - we took him to the vet and got antibiotics and things seemed to go ok. Then on the Saturday after Christmas, he stopped peeing so I called our vet who was closed. We took him to the ER vet and they examined him and said that he needed surgery to remove a stone stuck in his urethra. They then told us it would be $5000 up front or they wouldn't do anything for him - the day after Christmas? They wouldn't work with us at all....it ended up costing me over $500 dollars to have them euthanize a beautiful young dog, simply because they weren't willing to take half down until we could get the rest (and I didn't have enough $$ on me at the time so that we could take his ashes).

And yes, a year later I am still angry and sad - I feel like I failed both my son and his dog.

hi redkitty

I am so sorry to hear that. It was horrible to see that young boy looking at his parents to help save his dog. I will never forget that look.

Because Rock had bloat ( he woke me up at 3am ) I was not sure how much time I had. So I had to go to the closest place.
We had to wake relatives and go get a check from them because we had only 2200 hundred on hand. The hospital can electronically deduct the amount in seconds so a bad check wont work.

there is a hospital in manhattan that will work with us on price and allow you to work out payments.

I would suggest you look for an aspca hospital or something like that around you. They will work with you usually.

By the way it is not your fault about what happened. You were willing to pay half and these people would not budge.

wait a minute...what I meant by bad check was if you need to wait till morning to borrow funds and put it in the bank to cover the check, that wont help.

they want it all right then. not a few hours later, not tomorrow, right now!

The problem with a lot of these places is that by the time you get there you're usually stuck. After all, you wouldn't be there if it wasn't an emergency, right?

You're dealing with a new facility, new staff, your pet potentially in mortal peril, and the feeling that your pet is being treated as a commodity, not a family member.

Not only that, but many of these facilities have the benefit of being the only one available (in my city of 750,000 people there is ONE emergency veterinary facility).

And so we chose a facility that is a 30 minute drive from our home. This is our regular veterinary facility that is large scale with as many of the bells and whistles one could ask for. It also has a full scale retail operation and both operations are open 24/7. Staff, including veterinarians, work shifts. Being such a large facility, I would be surprised to learn that each vet did more than one week of ER every two months. A bit more for techs, but the techs that I've talked to enjoy this kind of work.

The exam fee is only $20 more than their regular exam fee. The remainder of their fees are identical to those you'd be charged if you showed up at noon.

The only way you'd get me into our local ER was long enough to stabilize a seriously ill animal in order to get it to my regular vet.

Regular clients who can't pay are given an account and asked to make a payment of 50% - but reception is flexible, particularly if you are a long standing client. However, I've been there in the wee hours of the morning and watched them treat a poisoned dog with no money on the table whatsoever for a woman who had to wake a neighbour up to drive her in because she can't afford a car. She promised to pay $20 a week until her bill is paid off, and the vet gave her a generous discount.

One has to wonder how many people, after a horrific experience at an ER (such as the one described above with the little boy and his grandmother) will instead next time simply wait until their regular vet is available - perhaps too long. How many of those pets are simply turned away to die?

The angriest I've ever seen an ER vet is when I tell them to stabilize a pet just long enough for a 30 minute car ride - to another vet.

I have serious issues with the way that after hours clinics are run - from the top down. Those that are ER only have little choice but to do things like charge $6,000 for a case of bloat simply because of the way they are set up. Without the dentals, the vaccines, the exams, the spays/neuters and other such procedures that cost very little overhead and make up the bulk of a vet's income, they need to do what even some average vets do - pad the emergency bill. This is the same reason vets will warn you not to call around for price comparisons for average services - because that's not what will get you in the end.

Are there good ER facilities? Certainly. But these facilities tend to exist in areas where competition is high and word of mouth keeps the competition up and prices under control.

The rest of us? We're at their mercy, and that's just not right.

Great points on all of these, thanks for bringing light to those who work tirelessly to keep our pets healthy.

We have several 24/7 facilities in the DC areas. They are all pricey, but some are more predatory in their pricing (and practices) than others. Of course, I won't name names.

In general, the ERs in Northern Virginia have been outstanding and I will be forever grateful for the times they were there for me, despite the cost. I hope not to need these type of services again anytime soon, though. It's still good to know they are there if and when.

Megan: I am sorry you received no appreciation for giving up your holiday , I can only suspect it was beyond your control and due to other circumstances and perhaps silent grumbling over the bill.

For at least 5 years, I worker EVERY single holiday at a 550 bed general hospital (human). I never expected thanks, I felt it was all part of my job and future career.

Babysweet:One has to wonder how many people, after a horrific experience at an ER (such as the one described above with the little boy and his grandmother) will instead next time simply wait until their regular vet is available - perhaps too long. How many of those pets are simply turned away to die?

You have no idea how true that statement is.

This blog reminded me to post one of my own little "destiny & fate" about seeking care in an emergency. LUCKY, lucky for me, I did not have to go to an ER. Nor was I pressured into immediate surgery at possibly a below "quality" referral place.

http://walnut-hill.bravejournal.com

I have had to use our animal emergency clinic and I believe they do a wonderful job here in El Paso. Also, I had to have surgery done by a vet who uses the facility during the day and is a specialist. So I came often for 6 weeks for dressing changes, being a large hygroma removal with some healing difficulties on the elbow of my dog. I got to see many animals, mostly dogs, brought in and the techs did a very professional job of handling the cases. I do not begrudge the higher charges one bit because like any ER, you are paying for urgent/emergent care that is needed immediately, and the equipment they have is also expensive. I feel that we are very lucky to have them here.

How heartbreaking to witness pets and their parents being turned away, rockjdog! That would haunt me! We have only gone to ER once (A blessing with 3 cats and 2 dogs). I took a copy of my cat's vet Hx with us. I keep a copy for each pet. It really helped the vet understand her background and minimized diagnostics, ergo cost.

Actually, the ER vet noted crystals on a lab report that no one had caught...which landed us in the ER at 3AM with a kitty with a bladder full of stones.

I sure appreciate those of you who said thanks :)

Dr. Khuly, I certainly agree that ER shifts build skills- just performed by first solo emergency c-section and brought two lovely little pups into the world (and momma ended up spayed, thank goodness)!

Barbara, I do not practice vet med because I expect thanks, but I am only human- after experiencing the emotional trauma of euthanasia after euthanasia, or making sad diagnoses, or having to tell people that the way to fix their sick pet is to spend $1500 that they don't have, the simple things like a "thank you" are what help me to recharge emotionally. For every owner who leaves grumpy, there are usually a dozen who do manage say thank you and let me know that I made a difference to them. I work 70 to 80 hours a week and have very little time for myself... so it is nice to know that the time I devote to pet owners and their animals is valued by those I'm trying to help.

Megan, And I did not mean to imply that you shouldn't receive courtesy and thanks. I suspect it is out of your hands and the resentment is felt at the "front desk", as others have cited.

I have been very, very lucky to receive courtesy for all the "emergencies" we have undertaken. Perhaps that is because my "wallet" was never empty.

Therefore I could always offer thankyous profusely and never harbor resentments.

Oh, that is...except for once, that readers all know about
(Pocket's Story from New Hampshire , for those that don't)

Our Emergency Vet is not only wonderful, but I find them to be quite reasonable. And we've been there a number of times. Staff is great, cost is low. It doesn't cost any more than my regular vet, maybe even less in some situations.
I am very grateful to have them just ten minutes from my house. The staff is wonderful. I never hesitate to jump in the car and take any of the animals if I have even an inkling of a problem. I know we will get great treatment and interact with a caring and compassionate staff. The vet who told me that our poodle, who had never had a sick day and just had a swelling on his side, most likely had a hemangionoma was as kind as he could be even with me telling him he was nuts and there was no way the dog had cancer. He did. And I apologized to the vet the next time I saw him. He couldn't have been more thorough in his initial exam with Buddy or kinder when I apologized for my rather smug behavior.
I count on them being there 24 hours a day. It's one thing in my life I don't have to worry about. The animals are covered.

An hour is an hour in the health care field- whether its 2 am or 2 pm- the cost for the hour should be the same.

Gotta disagree here. It's much harder to work at night. Try a career at night and you'll see how hard it is to get normal stuff done. And it's an issue of supply and demand, anyway. Simple economics. If fewer people want to work those shifts, the price of the labor goes up for those that do a good job of it.

Let's not forget the large segment that prefer or need shift work to avoid full-time day care for children or students that attend college during the day or even enjoy later-late hours.

Companies and medical/hospitals pay shift differential as an incentive for: evenings, weekends, holidays---but it certainly isn't "double wages"

... except that working nights is physically, emotionally, and mentally taxing.

I don't get paid differently whether I'm on nights or days since I'm an intern, but I would definitely expect higher pay for the sacrifices you make when you work nights.

@lbl1228 - I'm very happy you seem to have found an ER service you are as happy with as I am with mine. Sadly, few people are as fortunate.

@Pepin AND Megan - you're BOTH right. This is why I pay $70 instead of $40 for my examination fee after hours.

But should a bag of ringers cost $50 after hours?

An X-ray $100 a frame?

Should the treatment of bloat warrant a $6,000 bill?

Should the catheterization of a blocked dog cost more than a few hundred dollars regardless of what time it is? Enough emergency care to get the dog through the night until the regular veterinarian can be consulted?

Do you know how often I have been offered "stabilization until morning" by an ER vet? Not once. Thankfully, I insist on it - and our local clinic charges almost $200 just to walk through the door, and sometimes you're waiting at the front desk for 20 minutes before anyone comes out to even see what your problem is because they don't even have a full time receptionist. You think they couldn't hire a full time receptionist, nights, for minimum wage?

The fact is that there are hundreds of people I have met personally whose ER situation caused them to euthanize and cremate their dog due to financial situations. When I explained to them that stabilization was possibly an option and asked if the ER vet ever suggested it, they were in shock.

These were situations of bloat, blockages, broken limbs, torn ligaments, etc. When you have a vet in front of you telling you you're looking at between $3,000 and $5,000 just for the bloodwork and xrays to even diagnose the problem, what's a distraught customer with no credit card or knowledge in the ways of the ER vet to do?

My single most important piece of advice to anyone taking a pet to ANY ER is this: Treat the staff, ALL the staff, with respect. They're screamed at, berated, belittled and generally treated like crap all night. Once you see the veterinarian and discuss options, discuss stabilizing your pet until the morning (or through the weekend, whichever applies) on whatever medication or treatment is required. If this is absolutely not possible, you have a few options, one of which is to find another nearby clinic if you're truly not happy with the one you're at. If stabilization IS an option, be SURE to get a full and complete list (and PLEASE write it down) of any signs or symptoms you may need to keep an eye out for that suggests for one second your pet is not responding to treatment.

If this occurs, you have no choice - back to the ER with you! Hopefully, in the interim, you've called every pet owner/lover you know and asked for ER recommendations and experiences with any they've attended. Now that you're prepared you can make a more educated decision.

Of course, the really smart thing to do is to make those calls and emails TODAY. Find the clinic you're comfortable with. Ask them to take a look at their prices - basic blood panels and x-rays along with hospitalization and consultation charges, as well as blood draws and IVs are some great things to target - these are pretty standard fare when treating a patient that can't say "doc, my appendix hurts!"

Megan, it's not that we don't appreciate what it takes to do that job. I do rescue, so my "tech" job is 24/7. I feel for you, I have enough pressure and I don't have a pet owner breathing down my neck. But what you need to understand is that it's not the techs and the vets who are employed by these establishments that bother those of us who have an issue with ER bill padding. We have an issue with the clinic owner, whose responsibility it is to set pricing. Including the 300-500% increase on prescription drugs they charge.

None of this is your fault. Let me ask you something - when I was a tech at a clinic, they used to send the docs in to explain the options and the techs to explain the quotes. Do they do that to you to? There's a reason YOU are the first and last person that patient sees. Now before everyone jumps on me, this is not how all clinics operate - but I've had enough experience to know that at least in my area this is not the exception but the rule.

I'm truly sorry you get the bulk of the wrath, Megan. I'll admit to taking my frustration out on a tech or two - but I generally send a card afterwards unless there was a damn good reason they had it coming to them. As you know, just as there are poor vets, there are poor techs, too.

But yes, I agree with you - ER services should cost more. Reasonably more. And they should act reasonably when they have someone's family member dying on their table. That's all we're asking

I couldn't have said it better. We weren't even given the option of stabilization - it was we either do this, or we euthanize - make up your mind. And the office staff was pretty cold too. Made me wonder who was paying for the lovely brickwork, glass walls and designer coffee they were serving...

Listen folks, you would be very smart to comprehend what @babysweet is saying. She has clearly been "down the road" and articulates it very well.

I could type a huge post about all that I have learned since a horribly traumatic experience with my dog and a large specialty vet hospital in Georgia a few months ago. But, I will bottomline it for you:

1) KICKBACKS - there are many states in the USA that have NO laws prohibiting the payment of kickbacks between vets. Example: the specialty vet pays your regular vet for sending over you and your ill animal. Perhaps you think, 'aaww, so what's the problem of $50 or $100 changing hands between vets?' Well, what if it's alot more than that.....like a percentage of billing! Would you then believe that you are getting an independent assessment from your regular vet related to what the specialist is recommending? It's a total conflict of interest.

2) ACCOUNTABILITY - animal law is in the dark ages. You suffer what you rationally believe, and evidence indicates, was malpractice by a vet? Well, have fun trying to rectify that. Lawyers don't have expertise in that type of law, monetary awards are tiny and you'll have to pay the attorney out of your pocket. You get the idea here? The threat of lawsuit or any real recourse is VERY minimal for vets. That is an ugly realization for us animal owners.

So, you have a very sick animal and can be sold what amounts to an extreme (and expensive, NATURALLY) surgery that is supported by your longtime primary vet -- who may be getting paid a fee or percentage, but hasn't told you about that. And when it all goes badly because of fate, but maybe because of sloppy surgery technique or the (undisclosed) high probablility of known complications from this radical surgery --- there is almost nothing you can do but watch that helpless animal suffer horribly. Think this type of scenario is rare? I have heard stories galore from other pet owners since this occured to me. As far as I'm concerned, it is one of the great untold stories of our time.

3) RESEARCH ER's & SPECIALISTS - do this before ever needing to go to an emergency OR specialty vet. And re-evaluate every couple of years in case the place/vet you felt was good has gone sour. And when your primary vet recommends you somewhere ask him or her, point blank, whether they receive any compensation for the referral. If so, I'd run the other way.

***IMPORTANT -- are there decent, honest, dependable vets? Of course there are. Ahem...it's worth saying that I thought I had one of those in my primary vet of 8 years. But found out that her true allegiance is to the almighty greenback. So, I certainly can't tell you who the good ones are.

Also see a post from Mar 26 titled: Why So Negative? Biting Online Reviews in Veterinary Medicine. The last poster #30 - Stefani has some relevant things to say.

My post above may seem a bit off topic so I thought I'd clarify, in the light of day. Had a couple of other points typed originally on that post but the login timed out and the first writing was lost.

There are many valid reasons, already stated in other posts, why emergency animal health care can be costly. What I wanted to add to this discussion were some things that most people seem to be unaware of, or unwilling to speak about.

I do not exaggerate when I say I have almost enough stories for a book of the experiences some people have had at the prominent facility I went to. Stories of unnecessary tests, radical recommendations (translate: expensive), bill padding, releasing animals while very sick, ignoring the feedback and wishes of owners and on and on.

SO, sometimes, the ER's are expensive because the client(you) is being sold a wing and a prayer. You've come to them for a solution and, by golly, they're going to give you one. Even in situations where a positive outcome is very minimal and the best option is euthanasia. CAVEAT EMPTOR!

AnimalsRule: I think that is commonly referred to as a "referral fee or fee split"---done in many business activities, rarely acknowledged and against the AVMA principles of Ethics---not that "that matters".

However, I have some good recent news to report. A close friend wasn't lied to or sold a bill of goods recently for her dog's terminal condition. And guess what? She spent a small fortune anyways in diagnostics. Her pet did NOT suffer, she brought him home for hospice care and everyone came out win-win.

Shame on those who can't see or appreciate a true caring person and possibility of repeat business & corresponding dollars. The creeps are out there , but to figure out where is another huge problem.

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