Vet Bills The Carte Blanche Story and The Vets who respond

Local TV programme Carte Blanche did a documentary about vet bills which received a very big response in the media.

"Rip-off or specialist service? Do specialist equipment and long hours justify what many animal lovers perceive to be excessively high veterinary charges? Is R800 to accommodate a hamster overnight reasonable? What about R2 000 for a sterilisation? Vets tell us how they justify seemingly high costs. "

                                             


Many vets around South Africa felt that this documentary was one sided, and here are extracts of 2 vets' feedback in response to the Carte Blanche Video:

 

Mike Hardwich, author of the veterinary memoirs THE LION AND THE LAMB and THE RHINO AND THE RAT

Reaction to last night’s CARTE BLANCHE

Posted on August 4, 2014

Last evening we, the vets of South Africa, were subjected to a documentary on Carte Blanche that one-sidedly castigated the veterinary profession for excessive fees. I found this interesting but very uninformative; it considered Ashley Hayden’s experience with a particular practice. Nothing was said about any number of practices that work long hours for very little reward. The vet is also required to be on duty 24/7 and will surely hear from the client should the phone not be answered immediately and the response be exactly what the client wanted to hear. Also many of the examples were from the Veterinary Specialist Hospitals and did not show the normal run of the mill practices.

Are the public being reasonable in their attitude and has Carte Blanche realistically portrayed the veterinary profession? Let’s try and answer some of the many questions posed from that program.

When wanting to become a vet, is the public fully aware of what is required? I doubt it. The veterinary faculty in South Africa has in excess of three thousand applicants annually for about 200 places. This means that the first requirement is probably straight A’s in matric and that will certainly not guarantee you a place. I have had an extremely bright student working in my practice who was the top Honours student at the University of Natal last year and she only got in when another student failed to arrive! Yes and Falon has a four year degree with distinction.

So the students who start out to be vets are the academic cream; probably brighter than all the other professions.

They then go through a five and a half year grilling – yes, no other degree has a larger subject content than veterinary science. For five and a half years they are repeatedly tested on every aspect of the chosen degree with very little free board for lack of knowledge.

I have been an external examiner for the final year students for many years and I have seen  final year students break down completely in oral exams; they don’t do this because they lack the knowledge required but because they are exhausted after those five and a half years and have been brought to their knees by the demands.

And then they are freed into the big wide world; the embryo has been born and is now trying to make a way and grow into a useful servant of the public.

The first client that enters the clinic will demand of them from day one until the day they retire. And they will probably start on the long journey of paying back half a million rand of university fees. In my case it took me 13 years to settle my student loans.

That the work is enjoyable is not questionable and further more the variety makes veterinary science probably one of the broadest professions – but also probably the worst paid profession after teachers.

That the clients are enjoyable is probably debatable and this negativity results from very few who believe or behave differently.  We have very many clients who I would not change for anything; their presence is always very welcome and treating the pets is rewarding even when outcomes are not always as expected; we are in these cases working as a team and that is always rewarding. Then there are the exact opposites who bring the animals in, in dire straits and demand immediate one-off cures.

What is expected of the vet? This is something I am sure is answered differently by each client. Some want to get into the surgery and out again in the shortest possible time; others want everything checked and a thorough job done – most vets would prefer the latter because it leaves little doubt in the end and that is important. When half jobs are done it is mainly because the owners are reluctant to spend the money. This is a problem for the vet because the comeback can be severe and in these times the legal repercussions can be costly in both time and money. I recall discussing this with a gynaecologist who stated that he could never be a vet because there was always an end point – ‘put it down’.

The Veterinary Council also dictates to every vet registered and this dictation includes things such as services available, buildings, signage, hours and quality of work. In many instances these requirements exceed those of the majority of clients so the vets are often doing much more than you would require of them.

What do most clinics own? Not sure if anyone has thought about this but a reasonably equipped clinic would have an asset base well in excess of R500,000 excluding buildings and drug register. An x-ray machine is not designed specifically for animals so there is no difference in the cost of the human machine and one for animals; the endoscopes, ultrasounds, anaesthetic machines, surgical equipment, sterilizing equipment etc. are all the same.  And vets are expected to charge less for the operations they perform.

What about skills? Most people would not question their doctor’s ability and know full well that they would be referred to a specialist if the doctor felt the need.  Yes there are now veterinary specialists who will do the intricate procedures but the ‘average’ vet still does the sterilizations, bone pinnings and cruciate ligament repairs. If your wife was due for a hysterectomy what would you expect to pay? And yet your vet is expensive when he charges R1500 for the same procedure! And what if the animal is a tiny marmoset or rabbit? Less or more?  The smaller the animal the more difficult the anaesthetic so that should be more; the surgery is virtually microsurgery – operating on an eye requires extreme skill and one would expect to pay more for this skill. So why must a small animal be less than the Great Dane?

The bull or the lion that needs attention both pose significant risk to the vet; should he be adequately compensated for the risk? Well many boerbuls and Rottweilers are just as dangerous – should the vet charge accordingly? Are you, the owner of the animal, going to pay the vet’s medical bill when he is torn apart? No, you will say he is trained to do that and it’s his fault if it happens. That’s fine but then he deserves danger pay in advance of the procedure!

What about ‘rescue’ animals and animal welfare organisations?  Many of these well meaning people cause vets plenty of problems. One lady, new to my practice, came in asking if we would give her a deduction ‘because all the animals were rescued’. Now really; if you rescue the pet do you honestly believe that you deserve a reduced fee? After all it was your decision to get a rescue animal anyway. Must the vet now pay because the animal is a rescue? I find this very difficult to deal with.

And the welfare organisations? Many of these are totally above board and the vets do give them significantly reduced fees but this also often comes with inconceivable problems particularly where the organisations are a little less than ethical. You find yourself working on animals that belong to people who can afford the treatment but the ‘organisation’ is doing the friend a favour or the person has filled in an alimony form despite driving the best Merc available. And in real terms who fits the bill; the vet!

And what about the brazen lady who came in to my practice for the first time and her opening gambit was “Do you give pensioners a discount?”  She was about 45 years old. When I said yes she then asked that all her animals be put on her mother’s account because her mother was a pensioner!

The veterinary profession is well known for its empathy and I feel that this is perhaps our strongest point when it comes to vet : client relationship – no doctor puts down his patients and most doctors are not available 24/7. No doctors are asked to take in children to see if they want to be ‘doctors’ – this is all common in vet practice. And what about the people who are going on leave and ask that the vet look after any medical problems their pets might have whilst they are away and we will ‘sort you out when we get back’. Has any vet ever refused that or asked for a deposit? And try the stress of putting down some loving person’s furry child!

A further well known fact is that if an animal dies whilst in hospital the vet can sing for his money. This is why many of the bigger practices and after hour clinics demand significant deposits before treating the animal. Who created this problem? The vet or the animal owner? Don’t condemn the vet for being strict about this. If you asked the vet to put his hand in a fire and he did this, you would laugh at him if he did it a second time!  That you as the owner have been caught short because the animal fell ill or had an accident at the wrong time is not the vets fault yet you want him to carry the can. How many after hours caesarean sections go unpaid until the pups are sold! So the vet must now finance the backyard animal breeding programs! And when the pups don’t sell once again the vet is singing in the collection choir!

I don’t think that there are many vets that dislike their jobs but there is one very significant aspect that you, the client, need evaluate and that is that the vet profession has the highest number of suicides of all the professions and the SA Vet Association has dedicated vets to help colleagues through difficult times; those times are most often not financial but personal due to the extremely stressful nature of our work.

The pet that dies unexpectedly, the euthanasia of a dear friend and client’s dog, the long hours and the extremely high demands made all add to this – are you doing your share to add to the numbers of suicides? Or do you assist the vet by being reasonable and affording him an acceptable standard of living and seeing his children educated. Oh and a nice car and house would also help as in many instances there is little chance of a comfortable retirement!  The average age of rural practitioners has increased dramatically in the recent past and this is due to no young vets being too keen on a life of relative hardship with a poor chance of adequate financial reward ever!

And my closing story:

An extremely well dressed young lady, maybe in her early 30’s, came in and asked if I could check her dog’s ears. The dog was a beautiful, well manicured and clipped white Poodle. Yes it had a bow in its hair and smelt wonderful. It had spent the previous day at the parlour and the person who had groomed it told the owner to have the ears seen to.

On examination the little dog’s ears were in a shocking state and needed an ear lavage.

The poodle would not allow me anywhere near so I took the dog into the clinic and after tranquilisation managed to clean the ears meticulously.

That evening the young lady called for her dog but took a step backwards when the account was just over R1000. She paid.

The next day I got an e-mail thanking me for the work done but she stated that I had destroyed her month and could I please give her R800 back and she would pay off the rest over the next few months!

Did she ask that of her hair stylist; or her clothing company or possibly where she purchased her expensive perfume? And if she did, did they agree? I somehow doubt it. So maybe vets are just fair game and if that is the case it is probably our own fault for being too apologetic for our fees in the first place!


Another public letter that went viral on the internet is a response from Dr Kathryn Knipe (BVSc):

 

Hi Guys, here’s my Carte Blanche letter that prompted tomorrow’s interview, am nervous as anything, just hoping to give an accurate representation of what vets are really about.

I would like to tell you a story about exorbitant vet bills…

There was a request that people submit their stories regarding exorbitant vet bills. I would like to request that when these stories are evaluated, the following be borne in mind.

Firstly, I do not believe that it is fair to include stories that are related to diseases that the owner of the animal could easily have prevented. A bill at a private veterinarian for parvo-virus infection can run up to R5000-R10000 depending on how long it takes for the animal to get better.

This disease is preventable if the owner has taken his/her pet for the appropriate vaccinations at the correct time and if the mother had appropriate immunity (in other words, if the animal had been purchased from a reputable breeder with up-to-date vaccinations for the bitches in his care).

The same is true of distemper virus infection. Also, if the individual accepts that the first vaccination was administered by an unqualified person, such as a breeder, and not a qualified animal health technician, nurse or vet, they must accept that the vaccination may not have been administered correctly and that the dog or cat may still fall ill.

Did you know that many of the companies that supply veterinarians with vaccines, will pay the vet bills in full for suspected vaccine failure? However, for them to do so, the vaccinations need to be administered by a qualified individual. The packaging for dog and cat vaccines clearly states that the vaccine may only be administered by a qualified person. Therefore, if these conditions were not met, the owner (and the irresponsible “breeder”, a better description would be puppy or kitten farmer) is responsible for the animal falling ill.

Another such condition is tick-bite fever or babesiosis, along with ehrlichiosis that it is commonly accompanied by. The only way to prevent the disease from being contracted, is by preventing the ticks from attaching to the dog or cat, by applying an appropriate antiparisitic/arcaricidal product. It is the responsibility of every pet owner to prevent their pets from becoming parasite-infested.

Dogs and cats that are not sterilized are far more likely to be wandering the streets after escaping from their homes, as well as more likely to fight with one another at home. This leads to these animals being more likely to be hit by motor vehicles, get into fights with other animals as well as contract certain diseases such as Feline Immunodeficiency Virus in cats and Transmissible Venereal Tumour Virus in dogs.

Sterilized female dogs are also at significantly reduced risk of contracting mammary gland cancer and due to the removal of their uterus, are also not able to develop a pyometra (uterus infection which is life-threatening). Additionally, most large cities have bylaws stating that it is illegal to keep a sexually intact animal on your property without being a breeder registered with KUSA or a similar governing body, and without permission from the council. Therefore pet owners who do not have their pets sterilized at the onset of puberty, are not only in many cases breaking the law, but are choosing to gamble their pet’s health and welfare.

Nowadays, with the large variety of breeds that are being manufactured and in some cases even designed to cater to the growing demand, we are finding a significant increase in the number or diseases that are directly breed-related, as well as many that are genetic defects (bred into animals by breeders/puppy-farmers who do not exclude animals with genetic faults from their breeding program and then sell these resultant litters to uninformed clients).

I also will clearly exclude congenital defects that are not passed along are poor breeding. Many of these diseases are then further exacerbated by individuals feeding their pets the lowest quality pet food they can find. You cannot possibly expect a puppy (especially one predisposed to musculo-skeletal deformities) to grow a healthy skeleton when fed saw-dust, chicken litter and mielies. Dogs and cats need a source of high quality animal protein to develop as well as live a healthy life. I urge you to do a program on what is actually inside commercially-available dog and cat food.

You will find that supermarket foods contain mostly down-graded (“unfit for human consumption”) cereals, left-over skins, pips and rinds from vegetables used for human food production, rendered fat from slaughterhouses, hoof meal, bone meal, feather meal and excessive amounts of salt which are harmful to animals with pre-existing heart and kidney disease. We know that humans that eat healthy, balanced diets, live longer, healthier lives.

So if we expect our pets to be healthy, we should be feeding them high quality, nutritionally-complete and balanced diets. Supermarket pet foods do not meet this criteria, however pet owners choose to feed their pets these “cardboard diets” as that is the value that they attach to their pet’s health and welfare.

I give all pet owners that enter the veterinary practice I work at, the same speech, I probably recite it ten times a day:”These are the four things that you can do to keep your pet healthy and avoid seeing me”.

I tell clients this to try to drive the point home that veterinary care costs money and that I would like for their pet to stay healthy and not have to see me, except for vaccinations, than for their pet to fall ill and cost them thousands. Make no mistake, we make far more money off a sick animal requiring our expertise than we do off a healthy animal coming for an annual vaccination!

But preventative or primary veterinary keep is what I strive for, in order to keep animals healthy, rather than line my pockets (or those of my boss more accurately).

Now we have established that pet owners can take certain precautions to prevent their pets from falling ill and incurring the resultant vet bill. It is the same as us taking our vehicles for services and checking and filling the oil and water on our cars to prevent them from breaking down.

But sometimes animals fall ill regardless of our best efforts to keep them healthy. Did you know that there are at least 3 or 4 companies that supply pet health insurance? This puts an owner in a position to be able to provide their pet with the necessary veterinary care should the unthinkable happen. This fact, I also communicate to clients on a daily basis and again pet owners choose to gamble that their pet will not fall ill because they are not willing to commit any of their money to their pet’s health.

Now that we have established that pet owners are offered a variety of methods with which to not only avoid their pets falling ill, but also to assist them with covering vet bills, we can move on to the point where we realise that owning a pet is not a right, it’s a privilege. It is far too easy for any (I dare say even well-meaning) individual to simply acquire a pet. The truth is that a pet will require veterinary care, whether it’s an operation, vaccination, parasite-control or euthanasia.

Just as we cannot buy a motor vehicle and then go cry outside the dealership when it runs out of petrol or breaks down, it is not the responsibility of a vet to care for every animal that a person feels that they have the right to own. All individuals that acquire an animal, should have the common sense to realise that they are responsible for their pet’s welfare and that drugs, x-rays, anaesthetic and veterinary degrees do not rain down out of the heavens, we have to pay for them.
Now let’s address the exorbitant vet bills.

Firstly, I implore you to compare these exorbitant vet bills that individuals are likely to present as evidence, firstly with the recommended veterinary rates as prescribed by the South African Veterinary Council (to which veterinarians are legally obligated to belong to in order to practice veterinary medicine in South Africa and by whose laws we are bound to operate) and secondly with bills from private hospitals for comparable procedures and treatments.

Why should you compare it to human hospital bills?

Firstly, our expenses are no less than a human hospital would incur just because we are treating animals. The Joburg city council doesn’t charge our clinic less for electricity to light our theaters or autoclave our instruments just because we are servicing animal patients and not human ones.

We don’t pay lower rates and taxes. We don’t pay less for water. We don’t get discounts on properties to house our practices. We have to pay all the regular taxes and levies expected of all other businesses. Furthermore, we do not use sub-standard equipment. There is no discount intravenous anaesthetic for animal use, no super cheap suture materials, surgical instruments, intravenous fluids, administration sets, syringes, needles, intravenous catheters etc. made cheap especially for us because we service animal patients and not human patients.

Unlike a gp, we also have to keep a fully-stocked dispensary, as a matter of both necessity as well as convenience for our clients (who then subsequently write letters to your program about how overpriced our services are).

And that brings me to our services. Did you know that I studied for a year longer than a gp in order to be able to practice veterinary medicine. I did not get to pay less for my university fees because I was learning to treat an animal and not a human. I did not get paid for my year spent gaining practical experience, I had to pay for the privilege of working for the Onderstepoort Academic hospital for a year of my life. Now, not only do we study for longer than a general medical practitioner, we are also expected to be able to do all veterinary work. We do dental work, internal medicine work, orthopaedic as well as soft-tissue surgery, gynaecology and obstetrics, nutrition, radiology, anaesthesiology and laboratory work to mention but a few.

The vast majority of veterinarians is expected to excel in every field of expertise by our clients (again, the same ones that are writing you letters about our exorbitant fees). We therefore have a significantly larger skill-set than your out-of-university gp, and we are then bullied for asking the same professional fees. And on top of that, the general cost of seeing a veterinarian is still lower than calling out unqualified plumber to your home.

And not nearly as high as costs of lawyers, accountants, personal trainers and a multitude of other professionals that individuals happily dish out money to that are not providing as skilled a service as a veterinarian. We are expected to work for free because we love animals, but the love of animals doesn’t pay our bills, our student loans, our homes or our vehicles that we need to drive out to house-calls.

Then also bare in mind, that veterinarians are expected to be able to practice all veterinary procedures, diagnose and treat all diseases in at least 5 separate species of animals by the time we leave university. At the risk of stating the obvious, all animals do not contract the same diseases and cannot be treated with all the same drugs.

So not only am I able to perform a Caesarean section on a cow, a sheep a dog and a cat, but I am also qualified to administer anaesthetic to a hamster, a parrot and a horse.

Then comes the real clincher of this whole situation, and probably the most relevant argument; our patients do not speak to us, they cannot tell us what is wrong. Therefore we often have to perform various tests, which we try our best to select based on what is most cost-effective for the client and will yield the best results or data in our search for a diagnosis.

Imagine, if you will, a day in my life; it goes something like this…
“Doctor, my dog is not well…”
“Is your dog vomiting?”
“I don’t know, he sleeps outside”
“Does your dog have a normal stool?”
“I don’t know, the gardener cleans it up”
“Is your dog eating and drinking?”
“I don’t know, my maid feeds it”
“What food do you feed?”
“I don’t know, something we find at Spar”
“What is your dog doing that makes you think it is ill?”
“I don’t know Doc, he’s just not himself”

Now I ask you with tears in my eyes, where should I start? The good news is that I’ll wipe those tears out of my own eyes because I do know where to start…at the beginning…

Oftentimes, we have to start from scratch to find out what is wrong with an animal. If our first, cheapest test for the most common disease is negative, unfortunately we need to move on to the next test. Because if we do not find out what is wrong with an animal, I cannot make it better. But most people will not let us do the necessary tests as it is too expensive.

And then they are angry at us because their pets deteriorate to the point where it needs to be admitted to hospital. Or they leave the animal to die a slow, painful death and accuse the vet of charging them R500 and then just leaving it to die…
There is the odd situation where treatments for dogs are more expensive. For example, dental procedures.

Dental procedures and wound stitch-ups are often far more expensive than people expect for one simple reason, the patients require an anaesthetic. If any pet owner is able to restrain their pet calmly for me to place sutures without the need for general anaesthetic, I do it with a smile on my face and give them a much smaller bill. However, I have only ever met one individual that has been able to restrain her dog in the required manner (a 50kg great dane no less).

Why? Because again, people simply acquire a pet, without fully comprehending what their responsibility of a pet owner is, they do not take their dogs for training classes, do not socialize or discipline their pets correctly etc.

Then if I need to do a procedure on that animal, I need to administer an anaesthetic and again a letter is written to Carte-Blanche about the exorbitant vet bills.

And finally, at the end of the day, I go home, collapse in bed and cry. Cry for all the patients that didn’t make it, that were too sick, that got to me too late, for all the hearts broken because the new puppy wasn’t vaccinated or because the family needs to eat out at the Spur once a week more desperately than it needs to deworm their dog or treat it for ticks.

Once, a lady brought me a 4 month old puppy, which had received none of it’s vaccinations and had gotten parvo virus infection. The lady said to me; “I cannot afford this, put the dog to sleep”. I tried to convince her to let me give the dog some shots and a referral letter for her to take the dog to the SPCA the following day for cheaper treatment.

She refused. I was very impressed with how well her children were handling the situation when one of them asked; “Mommy, what does it mean to put her to sleep”. To which the woman replied:”The lady doctor is going to give her injection and she is going to die”. This was of course met with mass hysteria and I was the monster to blame for this tragedy, for the rest of that girl’s life, she is going to think I was a monster.

I have literally hundreds of photos of the patients I have loved, of the lives that I have held so dear, and cried over, that weren’t even my own pets. I invite you to come see my photos, share my memories of joy, of pain, of sadness, of triumph, of lives saved, of nights passed without a wink of sleep, of blood, of pus, of ear smears, of angry clients and broken hearts.

And I have only worked for 5 years.

I, the exorbitantly expensive vet, do not own a home, I do not make a penny of profit from the work I do, I work for someone, I simply get my salary, whether the patients live or die, whether I tell them how to keep their pets healthy or not. I choose every day, to do my work to the best of my abilities, to find ways in which to help people who have not made provision for the pets they so self-riotously feel they deserve to own, but are not willing to pay the price of a bottle of brandy to buy dewormer for.

This while other people my age are 7 years ahead of me in their lives, raising families, earning three times my income for doing unskilled work, and then I get to come home and watch television programmes accusing me of being greedy? And I can honestly say, that the vast majority of vets that I know, feel the same way about the work they do that I do.

The veterinarians that are being accused of charging exorbitant rates, are in most cases, simply trying to the best of their abilities to find the answers for the pet owners, because I’ll promise you one thing, not a single one of us wants to have to euthanise an animal because we failed to diagnose the problem or treat it.

Tweet: #VetBills The @carteblanchetv Story & The Vets who responded http://ctt.ec/cD3G2+ #SouthAfrica

I pray that this will help to shed at least a little light on the subject and provide your team with an opportunity to produce an objective insert on veterinary care.

Kind Regards, Dr. Kathryn Knipe (BVSc)

 


After having read their responses, one has to keep in mind that no matter how big or small your pets are, they are a life that needs to be kept alive, healthy and most of the time ... they will need specialist care that only a veterinarian can provide.  The smaller the animal the more complicated and delicate care will be needed.

Thank you to Carte Blanche for bringing forward a matter that needed to be discussed, as this created an amazing opportunity for the vets to also share what was needed to be said a long time ago.  Sure, there will be situations that could be justified by unhappy pet owners, but we believe in our hearts that our vets will only do their utmost best to help an animal as best as they can.

Can you afford your next vet bill?  What if its R1 500 or a whopping R15 000 as mentioned in the video above? The good news is that Pet Insurance cover for 1 year could set you back just under R 2000.  This equates to 1 emergency visit to the vet indeed.

If you still have not considered Pet Insurance for your pets, then now is a good time to make sure they have adequate cover in a time when they will be needing it the most. 

Get a Pet Insurance Quote today!

 

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