I’ve heard it more than once. Okay, let’s be real: I hear it constantly, especially when people don’t think I can hear them. “Vets are greedy.” “Veterinarians are money-focused.” “All veterinarians care about is getting rich.” “They want to get every last penny out of you.” I’ve heard so many accusations in particular that vets run too many tests on their patients just so they can rack up your pet’s bill and make some extra cash.
Is this really what’s going on? And if so, what can you do about it?
Here’s the truth, like it or not…
Before I go any further, let me introduce myself for those of you who don’t know me. I’m the Irreverent Veterinarian, and I give you my honest opinion of issues in the animal care world. Some might say that I’m honest to a fault. I speak my mind and I won’t sweet-talk you or sugarcoat the truth. I tell it like it is: to you, the drug companies, the pet product manufacturers, professional breeders, and pet owners. Some of what I say can be controversial, but that doesn’t stop me – it can be hard to hear the truth.
So, are some veterinarians greedy?
The answer is yes.
Do some vets run more tests than are absolutely necessary or required?
The answer is, again, yes.
Here is the honest truth, and I wish it wasn’t like this:
Just like with any profession, there are good and bad in it. I have to say, after interacting with people in thousands of different professions, vets are pretty darn good people in general. Most veterinarians I’ve met over my career are honest, fair, and kind; they want only the best for the pets they treat. However, there are definitely some bad apples.
Even within the same profession (veterinary medicine), people are paid on different scales. If you ask me, that’s a big part of the problem with over-testing.
As a veterinarian, over the years I’ve been paid in nearly every method possible. I’ve earned my keep as an hourly employee, a salaried employee, and as a production-based employee. This last one means that a vet is paid on a percentage of what they do or the total of their invoices. Being “on production” is sort of like being on commission. Other vets are paid on an hourly wage only, yet more are paid on a salaried basis, and still others are paid an hourly base plus production (usually whatever is higher).
This means that if someone is a production-based veterinarian, they MAY be motivated to recommend more tests than a non-production veterinarian. Each test means a little more cash in their pocket, and that’s especially true if the vet is driven by money or the vet needs to recommend those tests to earn even a fair salary.
Here is an example of what I mean. I have done work at an emergency clinic where some vets are hourly and some are totally production-based. Most don’t know what or how the other vets are getting paid.
The difference can be significant. Imagine this: a dog walks in the door on Sunday morning, having vomited 3 times Saturday night and once that morning. The dog arrives around 8 a.m., running around the room and acting more energetic than it did at home (possibly from the adrenaline of being somewhere new). The physical examination of the dog is unremarkable and the dog’s temperature, heart rate, and respiratory rate are normal. The dog’s abdomen did not seem painful when touched and nothing “seemed wrong.”
Different veterinarians will almost certainly respond differently to this, frequently depending on how they get paid.
Personally, I like to give owners all the options. I usually get more information about the condition and recommend a few courses of treatment based on my professional opinion on what is wrong with the dog, not by how much money this dog and client will bring into the clinic. Based on my recommendation, I can generally sway a client toward one option or the other if I really believe one is better for the pet.
For example, I would ask tons of questions, such as “Was there a diet change or new treats?” “Does the dog get into the trash?” “Are they taking any medications?” Questions such as whether the dog has a history of eating things he can’t digest such as socks or underwear can let me know whether there is anything in this history that really makes me worried that this is something serious and not just a minor viral or bacterial bug. If there is no history that concerns me, such as ingestion of a toxin or substance the dog can’t digest, this information helps me decide how serious the problem this.
What would two vets who are paid hourly and paid on their production recommend in this case?
- A vet paid by the hour given a salary may suggest symptomatic treatment. This could consist of a shot or a drug to control vomiting and maybe some fluid therapyto optimize hydration. Typical symptomatic care also may include instructions for the pet owner to withhold food or water for a few hours followed by a bland diet. The total client bill depends on where you live in the country and your veterinarian’s prices but also includes the office call, the shot, and the fluids. Where I worked most recently, a call of this type would have been $92.00 total. This vet should clearly communicate that tests can be done to help determine the severity of the problem (such blood work and radiographs) and let the pet owner make the final decision for or against testing. However, for this dog with mild symptoms, symptomatic treatment can work great. The vet just needs to make sure that the client understands that if the dog is still symptomatic and seems to not recover or get sicker in any way, they need to return for additional care and possible testing. In my experience, most pet owners will try symptomatic treatment and return if needed.
- A vet paid on production only may be more inclined to recommend more tests. This is especially true on a slow night. They may commonly recommend blood work and x-rays. Regardless of what is wrong with the dog, this would not be incorrect. To know that everything is ok with this dog is a good thing. The vet could even recommend hospitalization to give fluids and ensure that the dog’s vomiting is under control, releasing the dog only after they are eating and the vet is sure that the problem is resolved. This isn’t necessary wrong, but it could be considered over-treatment or over-testing. Some clients want this option because they want to know absolutely everything about their pet’s health. Others will do it they think that it’s a serious enough illness, but would prefer to wait otherwise.
What Can You Do to Prevent Over-testing?
If your vet strongly recommends testing, I’d consider it. If you are concerned about the necessity, ask your vet to explain the pros and cons of the different tests and what each one will determine.
Be honest with your vet. If you have financial limitations, tell them. Explain that you want the best for your pet but don’t have a lot of resources right now. Sometimes it helps to ask them if they had to choose one test which one they would do first. Try one test and decide on the benefits of further testing based on those results.
If you are really concerned that your vet is over-testing, you might want to consider a different vet. I think it is important to have a good relationship with your vet and feel as though you can trust him or her, and that kind of distrust doesn’t foster good communication or, ultimately, good care.
Are some vets greedy? Yes. But so are some mechanics, store owners, restaurant managers, police officers, teachers…and there are a lot of trustworthy and honest ones, too. Every profession has “good apples” and “bad apples”.
Most veterinarians don’t let their commission or compensation sway their decisions because most veterinary practices that compensate vets based on a percentage take averages in mind and know that some pets need more tests than others. They way they calculate compensation works such that if a vet practices good-quality medicine and does what is right for both the pets and the pet owners, it all works out in the end. One invoice might be $92, another $40, and the next could be $400 or more. It generally all averages out and allows a vet to earn a decent (but rarely lavish!) living.
Personally (and this may sound corny), I try to treat every pet as thought they were my own or my brother or sister’s pet. I do whatever I can to be kind but very honest with pet owners. I usually say things like “I think this is a minor problem and will respond to symptomatic treatment, but if you want to be sure, we can do blood work and x-rays” or “we can try the symptomatic treatment today, but if your dog doesn’t eat, is vomiting, lethargic or anything else changes, you need to call me back.”
If the symptoms are severe and I’m really worried, I’d recommend all of the above and maybe more, including bloodwork, x-rays to start, and maybe urine testing and an ultrasound. If a pet seems mildly ill, though, I know based on my experience that symptomatic support will treat over 90% of pets – and I’ll do that.
For the pet mentioned above, I personally wouldn’t care about how much money I‘d make but rather what is best for the dog. I’d give them fluids and drugs for nausea and vomiting, and provide their owner with instructions for a bland diet. With all this being said, you know what? There are some pet parents you just can’t be made happy. You’ll recommend a thorough group of tests and they’ll swear you’re fleecing them. But if you don’t do tests and their dog is in the 10% where the symptomatic treatment didn’t work, they’ll be angry that they have to come back for tests and the treatment wasn’t successful. Other times, the pet owner may be worried and want testing (which is normal), but they are upset when the tests come back and they didn’t show anything.
Darned if you do…and darned if you don’t. It’s just all part of being a vet.
What are your thoughts? Share your comments below.
The Irreverent Vet is a columnist that regularly contributes to PetPlace.com. The goal is to add a balanced and alternative view of some controversial pet issues. As happens with all of us, veterinarians can’t say what they really think without offending some clients. This commentary allows vets to say what they think and give you, the pet owner, the opportunity to consider another view. All opinions are those of the Irreverent Vet and not the views of PetPlace.com and are not endorsed by PetPlace.com.