It’s difficult to have to make a statement to the effect that veterinary medicine is NOT as noble of a profession as it used to be. Having no choice but to accept this unhappy conclusion over the past several years, I asked myself why and where did it all go wrong? Surprisingly, it didn’t take long to pinpoint when and what instigated the dramatic change in veterinary medicine from being a profession that sincerely cared about the welfare of the clients and their animals to a profession that’s focused more on the money to be made at the expense (literally and figuratively) of the clients and their animals.
Veterinarians before 1990 were mostly suckers…suckers for people and their pets. Veterinarians were a staple of any small community and frequently treated animals on credit because there’s no way we’d let a puppy, dog, kitten or cat die just because of the owner’s lack of funds. Back then, we also kept our fees reasonable and we only did what needed to be done. One thing you could count on in the “old” days was that we veterinarians weren’t inventing procedures in order to pad our pocket books. We were happy (and considered ourselves lucky) to get paid for the services that were actually needed.
Because of the general easy going nature of most veterinarians in the past, many veterinarians had outstanding balances all over the place yet, most of us never sent our clients to collections. We’d simply wait, send a bill periodically and hope that eventually we’d get paid.
I had my own veterinary clinic in Camarillo, California from 1985 until 2002 and I often had to set aside a balance owed from a client who was going through hard times because they simply didn’t have the money to pay at that time. Not uncommonly, months or years would pass and the client would eventually show up, saying they’d like me to take care of their animals again and that they were finally able to pay what they’d owed. I always accepted these kinds of clients back with open arms.
Yet, there were a few clients (some who were in poor financial straits and some who weren’t) who never even tried to pay what they owed. Many MD’s came to my clinic without a checkbook in hand. How would they feel if I’d done that to them? When these clients didn’t pay, they didn’t make any arrangements to pay the next day or next week. I had no choice but to try and bill them see if they’d pay and many never did. One such family in particular included a wife who’d been crowned “Woman of the Year” and a husband who was a superintendent of schools. I watched as their bill continued to climb and climb after each unpaid veterinary visit. I’d thought that maybe they might be having a difficult time financially because they had several children in college. BUT, when I was invited to one of their Christmas parties, I watched as they showed off how they’d re-done the entire house and added a brand new deck. I couldn’t help but think to myself, “What about me? What about paying your veterinarian who has cared for the pets you love like children?” I was hurt and a bit pissed. I decided at that moment to not allow that family to incur any more charges until they paid their entire bill. The people were in shock when I told them they weren’t going to be able charge anymore money to their account! They actually tried to disregard what I’d said to them and they continued to keep trying to make appointments. I had to repeatedly say, “I’m sorry but you’ll need to go to another veterinarian until you pay your bill.” The wife even sent her “personal secretary” in to pick up some ear medication for the dog and I had to say, “No, I’m sorry, not even if you send in your personal secretary will I incur more charges, especially medication!”
This kind of thing has bothered veterinarians for decades and decades. It hurts to hear people sing your praises and thank you for saving their beloved pet, then not give you the courtesy of a weekly or monthly payment. All we ever wanted was to be appreciated and to have some of that appreciation be monetary. It’s not an unreasonable request. I remember one conscientious hispanic woman who came to my clinic every single Friday (when she got paid) and religiously paid me $20 until her bill was paid in full. That was a completely fine arrangement and I respected and appreciated her diligence.
In an effort to try and not make people feel bad when they couldn’t pay their bill in full, I’d often say that “money down the road is just as good as money paid right now” (as long as the money is eventually paid!) I understood back then that all of us can experience financial struggles from time to time but, when people didn’t even try to pay, I couldn’t help but feel used and definitely unappreciated.
If people wonder why veterinarians won’t accept credit anymore these days, it’s rooted in the way we were treated in the past. But, at the same time, that doesn’t make it okay for veterinarians to behave unethically and to invent procedures to take people’s money all the while putting their pets at risk with these unnecessary procedures. Unfortunately, that’s exactly what’s happening in veterinary medicine these days.
The change in veterinary medicine from a caring profession to one that’s mostly concerned with making money began in the 1990’s because that’s when veterinary after-hours emergency clinics and high-end “specialty” clinics were born. All of us older veterinarians remember this period of time quite well. Up to that point in time, after-hours veterinary emergencies were primarily handled by regular veterinarians. Most of us had recorders and we monitored them after hours so, if an emergency came up, we could meet the client with their pet at our individual clinics.
As a result of these late night obligations, most of us veterinarians were thrilled when the after-hours emergency clinics came into being. We loved not having to go to our clinics in the middle of the night but, in retrospect, this luxury ended up costing the veterinary profession in more ways than one. The after-hours emergency clinics and the high-end specialty clinics that starting cropping up at around the same time were extremely high dollar endeavors. Veterinarians and pet owners alike were initially shocked at the high prices of the after-hours emergency and the specialty clinics but most of us felt it was worth it.
In retrospect, this is when veterinary medicine changed and the cost of veterinary care started its climb through the roof. It wasn’t an overnight thing but it was pivotal and quite noticeable. Before that time, veterinarians were mostly content to make a decent living by providing services that were legitimate and needed. Our priority back then wasn’t money. Of course, we wanted to make a good living but it wasn’t our primary focus. Back then, we’d allow clients with financial hardships to pay over time, to barter their fee or we’d simply decide to give someone a break. Back then, veterinarians were an integral part of the community and we were viewed our community as being fair minded and compassionate.
Unfortunately, once regular veterinarians started seeing what the after-hours emergency clinics and the specialty clinics were charging, it was only a matter of time before certain veterinarians wanted a piece of the action. It didn’t take long before there were articles in veterinary journals that would coach us veterinarians on how to dramatically increase our profits. Veterinary consulting firms started popping up all over the place, promising veterinarians that they could increase the veterinarian’s income three-fold. Unbelievably, the consultants charged between $10,000 and $20,000 and, if the veterinarian was going to pay that, then they were definitely going to increasing their fees! The consultants advocated contacting owners through the mail (then email) and phone calls to let them know their pet was overdue for services. In addition to the consultants, the veterinary journals started coaching veterinarians how to increase the recommendation for services (such as lab work, x-rays, dentals, laser treatments, etc.) from being occasional to being routine once or even twice a year. Everything changed and veterinarians were no longer content to simply make a decent living: they wanted to be millionaires. Though this increase in income was going to frequently come at the “expense” of an animal’s well-being, the veterinarians learned how to make clients think just the opposite: that all these procedures were really good for your animal! Like going under anesthesia all the time to clean an animal’s teeth is a good thing!
I distinctly remember referring my first client to a specialty clinic in the mid-1990’s. This was the first specialty clinic of any kind in my area of southern California. Previously, if I’d had an especially difficult case that needed a special workup or surgery, I always referred that client to the Vet School at Davis, California. So, I was initially excited to have a specialty clinic near me that could do chemotherapy, complex surgeries and workups. The first case I ever referred there involved a female Akita had been brought to me because she had a painful lump on her left scapula. I was immediately suspicious that it might be an osteosarcoma (a highly malignant bone tumor.) I put the dog under anesthesia and performed a biopsy and, sadly, when we got the results back, it was indeed an osteosarcoma. I explained to the owners that osteosarcomas were notorious for being so malignant that, by the time they showed up, they would have already had a chance to metastasize to other parts of the body. I also explained that chemotherapy was not helpful for this kind of tumor. I then mentioned that there was a new specialty clinic in a neighboring town and, if they wanted to, they could go and see what they might have to say. They decided to do that and, about a week later, the owners called to tell me that the vet at the specialty clinic had recommended that they amputate the dog’s leg to get her out of pain and that it might be worth it to try some chemotherapy. I was actually a bit shocked but, since the owners were having a hard time dealing with their dog’s illness, I said I understood doing the amputation so the dog would be out of pain for a bit but I didn’t understand why the veterinarian would have recommended chemotherapy.
I immediately called the specialty clinic and asked the veterinarian about the chemotherapy since it was a well documented that osteosarcomas don’t respond to chemotherapy.The veterinarian said that it was their policy to offer any and all treatments to owners and that the treatment would allow the owners to at least feel like they were doing something for the dog. Are you kidding me? I told the owners that the chemotherapy was going to be a true hardship on the dog and that it wasn’t going to prolong the dog’s life but the veterinarian at the specialty clinic had planted the seed of hope and they were now actively hoping for a miracle, Unfortunately, the dog only lived three more weeks and her quality of life was horrible as a result of the chemotherapy making her sick on top of all the surgery, poking and prodding she endured. The dog was miserable for its final days on Earth and, to further add insult to injury, the cost for three weeks of treatment was $10,000! No veterinarian in the past history of veterinary medicine had ever charged that kind of money for services rendered. Remember:this was the 1990’s and $10,000 signified a whole lot more money than $10,000 today would (though, even by today’s standards, $10,000 is a lot of money!)
In the end, the owners felt horrible that they’d put their dog through Hell for nothing. When I went to the owner’s home to put the dog to sleep, I could only apologize over and over again for having ever referred them to someone who clearly did not have the interests of the dog at heart. Instead, the vet had held out false hope in order to run up an exorbitant bill. This kind of attitude and veterinary strategy was something that was completely new in the field of veterinary medicine. I called the veterinarian at the specialty clinic to let her know how upset the owners were and how upset that I was that she’d taken advantage of my clients. Unbelievably, she wasn’t sympathetic or apologetic in the least: she simply said that she’d done nothing more than make a recommendation and the owners had gone with it. What he veterinarian wouldn’t own up to was how she’d completely misrepresented the effectiveness of chemotherapy and held out false hope to people who were vulnerable and emotionally distraught over their dog having terminal cancer.
In retrospect, this was the beginning of the end, the beginning of a shift in the attitude of veterinarians from being fair and compassionate to being obsessed with making large amounts of money even to the detriment of the pets. Both veterinarians and clients know that this change has taken place yet, no one talks about it. The worst aspect of this change from being fair and compassionate to being completely oriented around money is the fact that, despite the fact that veterinarians are charging a whole lot more money than they ever used to charge, the quality of the service provided is often less!
Unfortunately, owners have no way of knowing what goes on in the back rooms of many veterinary clinics. The truth is many clinics are NOT providing services that are up to an accepted standard of care (the standard set by the American Veterinary Medical Association.) I didn’t know myself how bad things had gotten until I sold my veterinary clinic in 2002 and started doing relief work when I moved to Nashville Tennessee. I was shocked and completely taken aback by what I saw. Over time, it became impossible for me to work at certain veterinary clinics because they had such unsafe practices and, on top of that, their recommendations for dentals and other procedures were more money-oriented than based on need.
When I refer to certain veterinary practices that are not performed to an accepted standard of care, one concerns the anesthesia that certain veterinarians use. In the section titled “Important Information about your Pets” on the home page of this website, I discuss “anesthesia” in dogs and cats. I explain that certain veterinarians continue to use injectable anesthesia despite the fact that it’s unsafe and dangerous. It’s hard to believe that any veterinarian would ever put a pet at risk by using injectable anesthesia when gas anesthesia is so much safer (please read the section on anesthesia for more details.)
Another unsafe anesthesia practice that fails to measure up to a good standard of care has to do with the fact that many dogs and cats are not being monitored by anyone while they’re under anesthesia! This is completely reckless and irresponsible. At many clinics, I’m asked (by the veterinarian who has hired me) to do surgery without the presence of a technician to monitor the animal’s anesthesia. This is insane and demonstrates a complete lack of regard for the animal’s well-being. There are so many things that need to be monitored while an animal is under anesthesia: the animal’s heart rate, respiration, color, jaw tone and blink response. It’s also critical that certain aspects of the gas anesthesia machine be monitored such as the oxygen and anesthesia gauges and, most importantly, the pop-off valve that controls the fullness of the rebreathing bag so that it doesn’t get too empty or too full. This is especially vital because, if the rebreathing bag becomes too distended, the cat or dog won’t be able to breath at all!
The current trend of veterinarians who persistently pressure owners to put their animals under anesthesia so as to keep their pet’s teeth free of tartar is not only irresponsible but it verges on being unethical. What owners don’t understand is that veterinarians are NEVER the ones who are performing dentals these days! It’s always a clinic employee who performs the dentals and these employees may or may not have much training or experience and, even worse, they’re often in a room by themselves with no one to monitor the animal’s anesthesia. This is crazy! There is no way of knowing just how many pets have died because of unqualified technicians and irresponsible anesthesia practices.
I can’t believe that any veterinarian would ever recommend that an owner put their older dog or cat under anesthesia just to clean the pet’s teeth. This is incredibly dangerous as all older animals walk a tricky tightrope when it comes to their health: all it takes it some kind of insult (like anesthesia) and an older animal will be pushed over the edge into kidney or heart failure which will typically occur within a month of the procedure that involved anesthesia. Tragically, once an older animal goes into kidney or heart failure, it’s pretty much the end of the story. This new and dangerous trend of owners being pressured into having their pet’s teeth cleaned (both young and old) is now verging on malpractice in my opinion. To do a procedure that isn’t in the best interests of an animal and that can actually hurt the animal or cause death is simply not right. This is something that wasn’t recommended even ten years ago: it’s all incredibly new.
What none of us will ever know is how many animals die as a result of negligence. The majority of owners simply accept their veterinarian’s reassurance that their beloved pet died while under anesthesia as a result of some atypical sensitivity on the part of the pet (instead of negligence by the veterinarian.) Most owners don’t question or demand answers as to why their pet died. In quarterly veterinary reviews that are sent to all veterinarians that are members of the American Veterinary Medical Association, veterinary cases are discussed that concerns veterinarians that have been forced to pay punitive damages due to the veterinarian’s failure to provide an accepted standard of care. For an owner to ever know that a pet has died as a result of veterinary negligence, the owners must ask for an investigation by the board of veterinary medicine. This is a difficult thing for an owner to do.What the majority of these cases demonstrate is that many veterinarians are still using injectable anesthesia and they’re allowing unqualified individuals to perform the anesthesia or procedure.
I honestly don’t know that there’s an easy answer to all of this but I do know that owners deserve to know what’s going on in many veterinary clinics today. The more information owners have, the better they’ll be able to make an informed decision and protect their pets from unnecessary and unsafe procedures that are being done solely to pad a veterinarian’s pocket book. Owners need to know what questions to ask when their pets are going under anesthesia so that their pets will have a greater chance of surviving the anesthesia. Veterinarians need to know that they’re on notice and that they’re expected to provide an acceptable standard of care for the pets under their care.