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 was no way we’d let a puppy, dog, kitten or cat die simply because of an owner’s lack of funds. Back then, we also kept our fees reasonable and we only did what truly 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 we were actually needed.
Due to the 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 simply waited, sending a bill periodically in the hopes that we’d eventually get paid.
I had my own solo veterinary clinic in Camarillo, California from 1985 until 2002. I often had to set aside a balance owed from a client who was going through rough times because they simply didn’t have the money to pay a veterinary bill at that time. Not uncommonly, months or years would pass and the client would eventually show up, saying that they’d like to have me take care of their animals once again and that they were finally able to pay what they owed me. I always accepted these clients with open arms.
Of course, there were a few clients (some who were in poor financial straits and some who weren’t) who never had any intention of paying what they owed. Many MD’s who brought their pets to my clinic frequently came without a checkbook in hand. How would they feel if I’d done that to them? These clients didn’t pay and they made no arrangements to pay in the future, ignoring any statements sent concerning the money owed. One such family in particular included a wife who’d been crowned “Woman of the Year” in Ventura County and her husband who was a superintendent of a school district in the Los Angeles area. I watched confused as their bill continued to climb and climb after each unpaid veterinary visit. I assumed that they might be having difficult times financially due to the fact that they had several children in college. BUT, when I attended one of their Christmas parties, I watched as they showed off to the guests how they’d completely re-done the entire house, adding a brand new deck to boot. I couldn’t help but ask myself, “What about me? What about paying your veterinarian who’s cared for the pets you love like they were your children?” I was hurt and a bit pissed off. I decided at that moment to not allow that family to incur any more charges until they paid their bill. These individuals seemed shocked when I explained that I wasn’t going to allow them to make anymore charges on account! They tried ignoring what I’d said and continued to make appointments to which I had to call them personally and reiterate: “I’m so sorry but you’re going to need to find another veterinarian until the time you’re able to pay your bill.” The wife went so far as to send her “personal secretary” to the clinic to pick up some ear medication for her dog and I said, “No, not even if you send in your personal secretary will I incur more charges.”
This kind of treatment 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 demonstrated monetarily. It’s not an unreasonable request. I remember one incredibly conscientious hispanic woman who religiously showed up at my clinic every single Friday (when she got paid) and paid me $20 until her bill was paid in full. That was fine by me.
I actually made an effort to try and keep people from feeling bad when they weren’t able to pay their bill. I always reassured someone who didn’t have the money to pay that “any money I receive in the future will spend just as well as the money I receive today.” There seemed to be an understanding back then (in the 1980’s and 1990’s) that we business owners were a part of a whole, part of a community, and that we needed to look out for our clients because, one day, any one of us might encounter a financial hardship and, if we do, hopefully someone will be understanding and patient while we work to get back on our feet.
If people wonder why veterinarians no longer accept being paid on credit these days, it’s definitely rooted in the way we veterinarians were frequently treated in days past: that, because we were only taking care of people’s pets, our services didn’t seem to rank as high as certain other services. Still, that doesn’t make it right for veterinarians to behave unethically and to invent procedures in order to take their client’s money while, at the same time, putting their beloved pets at risk as a result of these unnecessary procedures. Unfortunately, that’s exactly what’s happening in veterinary medicine these days.
The change in veterinary medicine from a caring community-oriented profession to a profession that’s primarily concerned with making money started in the mid-1990’s because that’s the time period when veterinary after-hours emergency clinics and high-end “specialty” clinics began to show up in the veterinary field. All of us older veterinarians remember this period of time quite distinctly. Until the mid-1990’s, after-hours veterinary emergencies were almost exclusively handled by regular veterinarians. All of veterinarians had phone recorders and we monitored them religiously after hours in case an emergency came up. When an owner had an injured or sick pet, we’d rush to meet the client and their pet at our individual clinics.
As a result of these late night obligations, most of us veterinarians were initially 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 began cropping up at around the same time were extremely high dollar enterprises. Veterinarians and pet owners alike were repeatedly shocked at the high prices the after-hours emergency clinics and the specialty clinics charged but most of us felt that the cost was worth it for the most part.
In retrospect, this is when veterinary medicine began its downhill descent. This descent was intimately connected to the cost of veterinary care going through the roof. It wasn’t an overnight phenomenon and many of us didn’t see how it was all going to play out in the long haul but, the change in veterinary medicine was pivotal and apparently irreversible. Before that the mid-1990’s, most veterinarians were content to make a decent living by providing services that were legitimate and necessary. Our priority back then definitely wasn’t money. Of course, we wanted to make a good living but it wasn’t our primary focus. Before the mid-1990’s, veterinarians allowed clients with financial hardships to pay over time, to barter their fees or, on occasion, we’d take certain client’s bills and toss them in the trash. Before money became the most important consideration in veterinary medicine (as it often is today), veterinarians would never turn away a sick or injured animal because a person’s inability to pay. Before the mid-1990’s, veterinarians regarded the people in their community as friends and neighbors and a veterinarian would have felt ashamed if they turned a sick or injured animal away due to failure to pay. Doing such a thing never crossed our minds.
Unfortunately, when regular veterinarians started to see what the after-hours emergency clinics and the specialty clinics were charging, it was only a matter of time before a majority of those veterinarians wanted a piece of the action. It didn’t take long before there were articles in veterinary journals that coached us veterinarians on how to increase our profits through a never-ending variety of ways. Veterinary “Consulting Firms” started popping up like weeds after a hard rain, promising veterinarians that they would increase the veterinarian’s income three-fold. These consultants charged between $10,000 and $20,000 for their services and, if a veterinarian was willing to pay that amount of money to one of these consulting firms, you can be sure that they’d be increasing their veterinary fees accordingly!
The advice of the veterinary consultants always relied on an overload (almost abusive at times) of repetitive contact with the veterinarian’s clients: owners were sent repetitive vaccine reminders through the mail (snail mail back then, email now) along with persistent phone calls to badger clients about the fact that their pets were overdue for services (vaccines, etc.) In addition to the consultants, the veterinary journals started coaching veterinarians on how to increase their recommendations for various non-routine services such as lab work, x-rays, dentals, laser treatments, etc. What used to be a yearly or bi-yearly contact from one’s veterinarian turned into contact that was monthly or even weekly.
Everything about veterinary medicine changed and veterinarians slowly began to believe the hype that they should be millionaires! This increase in income, unfortunately, did not necessarily result in an increase in the quality of care as one might think it would have. Instead, it often came at the cost of a pet’s well-being. Veterinarians became proficient at convincing pet owners that their pets needed yearly to biyearly teeth cleanings as if having one’s pet go under anesthesia (all the time and at any age!) was 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.