What You Get for Your 'Walk Through the Door' Fee
Imagine you bring your pet to your primary care veterinarian because s/he’s recently shown some abnormal signs. Your veterinarian examines your pet, performs a few basic diagnostic tests, and suddenly you find yourself on the receiving end of unimaginable news: Your veterinarian tells you your pet has cancer.
What do you do? Where do you turn for more information? How can you determine what your plan of action should be?
Your veterinarian recommends you schedule an appointment with a veterinary oncologist as your next step. You accept the referral and call to set up an appointment.
When you contact the specialist's office, you are transferred to a scheduling coordinator who informs you of the doctor’s next available appointment. They explain what to expect during the appointment. Lastly, they inform you of the consultation fee.
The price of the appointment may seem shocking to many owners. It’s not unusual for specialists to charge anywhere from $100 to $300 or more “just to walk through the door.”
This can be a turning point in the conversation between the pet owner and the coordinator. Most owners continue on with the scheduling process, while others ask the coordinator specific questions regarding their pet’s prognosis or options, or what the cost of further diagnostics and/or treatments will be. Some owners will then ask if they can speak with the doctor prior to coming in for the actual appointment, to determine if they feel consult will be “worth it.”
Owners are informed that the specialist will not speak to them without having previously seen their pet and they will have all their questions answered during the appointment. For some owners, this leads to the misconception that the doctor is chronically unavailable, inaccessible, or solely “in it for the money.”
There are numerous complications associated with a veterinary specialist consulting with owners of pets they've never actually examined. I’ve written about this topic previously, in When the Patient is Absent from the Visit.
I want to raise awareness of a different explanation for why vets refuse to provide medical advice for pets they’ve never seen.
In 1994, Congress passed the Animal Medicinal Drug Use Clarification Act (AMDUCA), which outlines three essential components of what is known as the Veterinarian-Client-Patient Relationship (VCPR):
- A veterinarian has assumed the responsibility for making medical judgments regarding the health of (an) animal(s) and the need for medical treatment, and the client (the owner of the animal or animals or other caretaker) has agreed to follow the instructions of the veterinarian
- There is sufficient knowledge of the animal(s) by the veterinarian to initiate at least a general or preliminary diagnosis of the medical condition of the animal(s)
- The practicing veterinarian is readily available for follow-up in case of adverse reactions or failure of the regimen of therapy. Such a relationship can exist only when the veterinarian has recently seen and is personally acquainted with the keeping and care of the animal(s) by virtue of examination of the animal(s), and/or by medically appropriate and timely visits to the premises where the animal(s) are kept.
This means that legally, veterinarians cannot make medical recommendations to owners when they’ve never actually examined their pet. This is also the reason why your vet may refuse to authorize refills for heartworm preventative, pain medications, or even more critical prescriptions such as anti-hyperthyroid drugs or insulin, when they haven’t seen your pet in a while. Though often perceived as just another way vets look to charge owners more money, in truth they’re doing it because it’s the law.
I would urge owners to rethink the idea that they are “paying ‘X’ amount of dollars just to walk through the door” of a veterinary specialist’s office. The fee quantitates years of extensive training, hard work, and expertise regarding your pet’s condition. Above and beyond the comprehensive physical exam, your specialist will thoroughly review your pet’s medical record and all prior diagnostic test results, and, most importantly, provide the information you need to make a decision about how to proceed regarding your pet’s care.
For most specialists, the appointment fee also includes accessibility to themselves and/or their support staff long after you’ve left the exam room. The average person's ability to recall medical information disseminated during appointments is often poor and inaccurate, especially when they are anxious, as would be expected when dealing with a diagnosis of cancer. The capability to contact a doctor with follow-up calls or e-mails is extremely important, providing owners with the opportunity to ask questions they didn’t think about during the initial appointment.
I’m not suggesting the fees associated with veterinary specialty medicine are inconsequential. What I want to emphasize is the value of the information you receive will far surpass the price you initially pay, even if you ultimately decide to not pursue any further diagnostics or treatment.
In those cases, I always stress this: You’re not electing to do “nothing.” On the contrary, you’ve already done so much for your pet by seeking out specialty care. Just as you’ve done so much more than simply walk through the door.
Which, by the way, is still a free thing to do.
Dr. Joanne Intile