Is the gold standard the old standard?


Is the gold standard the old standard?

What happens when the highest level of care just isn't an option for most of the clients you serve? Answers from the dvm360 Spectrum of Care survey point to a new world order: The days of providing nothing less than the gold standard might be numbered.
May 10, 2016
By staff

(Getty Images)In an ideal world, pet owners would say, “Yes!” to whatever it took to keep their pets healthy. You would recommend the gold standard of care for every condition you diagnose and every preventive step. But that’s not reality. So, how do you adjust care to varying levels of financial means and pet owner commitment? (For your own sanity, keep in mind the wise words of one associate’s boss: “You can’t care more than the client does.”)

With medical and technological advances taking place every day in terms of diagnosis and treatment—some of which are more costly than the older options—are we pricing people out of owning pets?

In the dvm360 Spectrum of Care survey, we asked you: Do you think the increased opportunity to provide high-quality veterinary medical care is putting pet ownership out of financial reach for average middle class people? Your response:

When asked to elaborate, here's what you said:

“I consider mine as an average middle class family and know the estimates I give clients would significantly impact my quality of life if I was to spend the money.”

"I couldn't afford our clinic’s prices for veterinary care for all of my animals without the clinic discount. I'm priced out of my own services, even though I believe they are exceptional and necessary."

"My clients are shaping my answer. And no, they don't stop owning animals—they just stop seeking care from 'greedy veterinarians who want to sell them everything under the sun.'"

"All day every day I have clients asking about price of procedures whether over the phone or during an exam. I've had many clients say that they'll just get a new dog instead of fixing their current dog."

"The majority of my clients have no interest in pursuing advanced care or are unwilling to prioritize that care, they want some medication and a quick fix. At the same time I find it increasingly difficult not to offer the ‘gold standard’ care for fear of risk to my license or under-serving the client."

We want to help! In the links below, we explore these intricate issues in three specific conditions: separation anxiety, periodontal disease and cranial crucitate ligament rupture. Our board-certified practitioners explain the common spectrum of care, while in-the-trenches practice owners and associates offer some of their thoughts about the day-to-day struggles of matching their abilities, their clients’ money and their patients’ needs in private practice. Plus, we peppered in exclusive data and responses from the dvm360 Spectrum of Care survey—because it’s your world, doc, we’re just living in it.

Separation anxiety: The worry over worry

The periodontal conundrum: "Sorry doc, not doing that treatment."

Critical decisions in cranial cruciate ligament repair

I think that to explore the

I think that to explore the issue of the prohibitive-to-some cost of veterinary medicine by prefacing the issue with "are WE (veterinarians) pricing them out of owning pets" demonstrates one of the major problems in out profession. An attack on our profession because not every client can afford the best to medical care. By our own profession! It is a common complaint by some clients that veterinarians are "in it" only for the money. It is common for some clients to decline treatment based on perceived ability or willingness to pay, for a variety of reasons. Some clients legitimately can't afford to provide good medical care, or any medical care for their pets. But WE are not responsible for them being in those categories. Our job is to provide, they have the option to accepts or decline, they are the ones who make that decision. Clients make the decision to have pets they can't afford. Clients make the decision to not purchase health insurance for their pets. Clients decide not to do wellness care and live with the consequences. Clients get pets they know they can't take care of and know they will just euthanize it and get another one if they can't afford care, or choose not to give care. This is all on them, not on us. We don't work for nothing just like these clients don't go to work every day then decline the paycheck.

Veterinary medicine has always had tiered levels of care, it's not something new, what's new is the ever expanding capacity to do more. But more costs more, whether it's a Ford, a purebred dog, a home, a cell phone, a computer, a graduate education, a medical degree, etc. We don't say Ford Motor Company is pricing us out of owning a car. We pick the car we can afford or we don't have a car, but it isn't Ford's fault if we can't afford one of their cars. (and if you have stock in FMC you want Ford to charge people to buy their cars!)

When you as the doctor have to go to a client who came in with a pet for a wellness check and expects to pay for a wellness check, and you discover the pet has diabetes, the bill will be 3-5 times what the client expected to pay when he left home that day. At Ford, this is called sticker shock. The prospective buyer declines to buy the car but spends a while wondering around the lot, thinking about that beautiful car and all the things he will do with it. Sometimes someone who "couldn't" possibly afford the car returns and buys it. I call this the getting used to the idea period. I think out clients need this period as well. My job is to present a treatment plan so that the client understands the reason for every item on it, so that there is no suspicion of "adding tests just to make more money", and leaving the client with a clear understanding of what is necessary to treat the patient for the best possible outcome. Then you may have to give the client time to get used to the sticker shock. People need this time to evaluate the situation without the pressure of little time remaining in the appointment. I think of this as the soaking period and I would like to have a soaking room in my clinic! People often come up with an entirely different decision after they have had time to absorb all the new and unexpected information and fully evaluate the impact on their own financial situation.

There will always be clients who truly can't afford your services, suspicious clients who decline because of a poor perception of veterinary medicine, clients who want to try a little bit of medicine first, them more later if it doesn't work, we all know the reasons. But for all but the first, WE can effect how the client decides, because it is up to us to change those perceptions and justify trying the best medicine first. There will be some we can't ever convince because of preconception and/or suspicion of the profession (these people are probably suspicious of other service providers as well), but I routinely walk people out my door with invoices hundreds of dollars more than their bottom line when they came in because I taught them the value of good medicine. Their pets win, they win, and so do I, with self satisfaction for a job well done and the financial reward of having practiced good medicine. This doesn't mean that I never have to under practice and under serve, but almost all of those cases are true cases of inability to afford good care.