The Cost of Loving an Animal Part 2: Why Does Veterinary Care Cost So Much? (#729)

In Part 1, I argued that bringing an animal into our lives involves a financial commitment as well as an emotional one.

Pet owners need to understand that veterinary expenses are inevitable.

Fair enough.

But responsibility works both ways.

If we expect pet owners to prepare for the cost of veterinary care, then the veterinary profession should be prepared to answer an equally reasonable question:

Why does veterinary care cost so much?

It is tempting to respond with a familiar explanation.

Veterinary medicine is sophisticated. Equipment is expensive. Staff must be paid. Drugs cost money. Hospitals cost money to operate.

All true.

But increasingly, I don't think that is a sufficient answer.

Because something much larger has changed.

Veterinary Medicine Isn't the Profession I Entered

When I graduated in 1975, veterinary medicine was a remarkably different profession.

Most companion animal practices were relatively small businesses owned by veterinarians.

The veterinarian might own the building, employ several nurses or technicians and receptionists, buy the equipment, set the fees and treat the patients.

The economic chain was relatively short.

Client → veterinarian → practice.

Today, that chain can be considerably more complicated.

Veterinary hospitals may be owned by regional groups, national corporations, multinational companies or investment organizations.

There may be layers of management, centralized administration, marketing departments, human resources departments, information technology systems, regional managers and corporate executives.

And ultimately there may be investors expecting a return on their investment.

That does not automatically make corporate veterinary medicine bad.

But it changes the economics.

And we should be willing to talk about that.

First, Veterinary Medicine Really Has Become More Expensive to Provide

Before blaming corporations, or anyone else, we should acknowledge an important reality.

Veterinary medicine genuinely costs more to provide than it once did.

Consider the equipment now available in many veterinary hospitals.

Digital radiography. Ultrasound. CT. MRI. Endoscopy. Advanced laboratory equipment. Sophisticated anesthesia and monitoring systems. Intensive-care equipment. Specialized surgical instrumentation.

None of it is inexpensive.

Neither are the buildings required to house it.

A modern specialty or emergency hospital can resemble a small human hospital more than the veterinary clinic of my early career.

And equipment doesn't merely have to be purchased.

It must be maintained, serviced, upgraded and eventually replaced.

Those costs must appear somewhere.

Ultimately, they appear on the bill.

People Cost Money Too

Veterinary medicine is also extraordinarily dependent upon people.

Veterinarians. Veterinary technicians and nurses. Assistants. Receptionists. Pharmacists. Laboratory personnel. Kennel staff. Managers. Specialists. Emergency clinicians.

These people deserve to earn reasonable salaries.

Indeed, veterinary medicine has historically undervalued many of them, particularly veterinary technicians and nurses.

Paying veterinary staff appropriately will increase the cost of veterinary care.

That is not profiteering.

It is part of the real cost of delivering good medicine.

And there is another expense that is easily forgotten.

The veterinarian standing in front of you may have spent eight years or more obtaining the education necessary to do the job and may have entered the profession carrying substantial educational debt.

Expertise has a value.

The Emergency Hospital Is Different

Then there is emergency medicine.

People are sometimes shocked that visiting an emergency veterinary hospital costs considerably more than visiting their regular veterinarian.

But consider what we are asking that hospital to provide.

A building that remains open at midnight. And at 3 a.m. And on Sunday. And Christmas morning.

It must be staffed whether one patient arrives or twenty. Laboratory equipment must be available. Operating rooms must be ready. Drugs must be stocked.

Veterinarians, technicians and support staff must be present.

You are not simply paying for the 30 minutes someone spends examining your dog.

You are helping pay for a medical system that was available when you needed it.

Availability itself costs money.

Specialists Changed What Is Possible

I spent much of my career in veterinary neurology and neurosurgery, so I have watched another transformation firsthand.

Specialization has changed veterinary medicine enormously.

A dog with a spinal cord injury can be examined by a neurologist, undergo an MRI scan, receive sophisticated anesthesia, have spinal surgery performed and recover under specialized nursing care.

That would have seemed extraordinary when I began my career.

Today it may occur in a single afternoon.

But look at what that requires.

A neurologist. An anesthetist or highly trained anesthesia team. An MRI facility. Surgical equipment. Trained nurses and technicians. A recovery facility. Twenty-four-hour monitoring in some cases.

The client sees one invoice.

Behind that invoice lies an entire medical infrastructure.

So yes, advanced veterinary care can legitimately be expensive.

But that still doesn't answer the whole question.

The Corporate Question

Over recent decades, veterinary practice ownership has changed dramatically.

Independent practices have been purchased and consolidated into larger organizations.

Corporate ownership has brought capital, management expertise, purchasing power, standardized systems and, in some circumstances, opportunities that an individual veterinarian could never finance independently.

But corporate ownership introduces another participant into the economic relationship.

The investor.

And investors invest for a reason.

They expect a return.

That creates a question we should be willing to ask without turning the discussion into an ideological argument about corporations:

How much of the price of veterinary care reflects the cost of delivering veterinary medicine, and how much reflects the financial structure surrounding its delivery?

Those are not the same thing.

Cost and Price Are Not Synonyms

This distinction is critical.

Cost is what it takes to provide something.

Price is what someone charges for it.

Suppose a diagnostic procedure costs a hospital a certain amount to provide when equipment, staffing, facilities and overhead are considered.

The price charged to the client must exceed that cost or the hospital cannot survive.

Every sustainable business needs a margin.

The interesting question is:

How large should that margin be?

And what determines it?

The cost of providing the service? The price charged by neighboring hospitals? What the market will tolerate? A corporate pricing formula? A required financial target? A return expected by investors?

These are uncomfortable questions.

But when veterinary medicine asks the public to accept increasingly large bills, they are legitimate questions.

The Problem of Transparency

Most veterinary clients have little idea how prices are determined.

In fairness, most veterinarians working within larger organizations may not know either.

The veterinarian recommending the blood test or MRI may have had no role whatsoever in determining its price.

That creates an interesting situation.

The veterinarian discusses the medicine.

The client sees the bill.

But somewhere between those two things, somebody determined what each item would cost.

Who? And according to what principles?

Greater transparency would help both veterinarians and their clients.

A $3,000 bill does not necessarily mean someone is making an excessive profit.

It may reflect genuinely expensive care.

But the profession should be capable of explaining the difference.

More Medicine Is Not Always Better Medicine

There is another contributor to cost that has little to do with corporate ownership.

We can simply do more.

When diagnostic possibilities expand, so does the temptation to use them.

A generation ago, a veterinarian might have reached a reasonable diagnosis through history, physical examination, clinical judgment and a limited number of tests.

Today there may be an extensive laboratory panel, radiographs, ultrasound, CT, MRI, specialist consultation and additional testing.

Sometimes all of that is entirely justified. Sometimes it isn't.

Technology is seductive. It provides information. But information is not free.

Every test should therefore answer a basic question:

Will the result meaningfully change what we do for this patient?

If the answer is no, perhaps we should ask why we are performing it.

The Estimate Has Changed the Conversation

There was a time when the financial conversation in veterinary practice was relatively simple.

Today, owners may be presented with estimates containing dozens of individual items and totals running into thousands - or tens of thousands - of dollars.

An estimate is important.

It provides informed financial consent.

But it can also become something else.

A menu of everything that could be done.

The question should not be:

What is everything modern medicine allows us to do?

It should be:

What does this particular animal actually need?

We Need a Spectrum of Care

For many conditions there is not one acceptable treatment.

There may be an ideal option. A very good option. A reasonable option. A palliative option.

And sometimes an option to do nothing beyond maintaining comfort.

Veterinary medicine should be comfortable discussing all of them.

That is not second-rate medicine.

It is contextualized medicine.

The best treatment plan is not necessarily the most expensive one.

It is the treatment that appropriately balances medical evidence, prognosis, animal welfare, the owner's circumstances and the relationship between that person and the animal.

Money is part of that context.

Pretending otherwise helps nobody.

So Why Does Veterinary Care Cost So Much?

There isn't one answer.

Veterinary medicine costs more because it can do more.

Equipment is more sophisticated. Hospitals are more complex. Staff should be better compensated. Emergency care is expensive to maintain. Specialists bring expertise requiring years of additional training. Drugs, supplies, buildings and technology cost money.

And yes, the changing ownership and financial structure of veterinary medicine also deserves scrutiny.

We should resist two equally simplistic explanations.

Veterinarians are charging too much.

And:

This is simply what good medicine costs.

Neither adequately explains what is happening.

The truth lies somewhere inside a complicated mixture of medical progress, labor costs, technology, client expectations, business economics and changing ownership structures.

And perhaps the veterinary profession owes pet owners something in return for asking them to bear those costs.

Transparency.

Tell people what is necessary. Tell them what is optional. Tell them what the alternatives are. Tell them what each choice is likely to accomplish. And tell them what it will cost.

Then allow them to decide.

Because the goal of veterinary medicine should never be to deliver the maximum amount of medicine that someone can afford.

It should be to deliver the right amount of medicine for that animal and that family.

And that leads to an even more difficult question:

What happens when we can keep treating an animal, but perhaps shouldn't?

Next

Part 3: When Everything Possible Is Too Much

Modern veterinary medicine has made everything possible an increasingly realistic option.

But ability and obligation are not the same thing.

Part 3 will examine the point at which more testing, more treatment and more expenditure cease to serve the animal, and why choosing to stop can sometimes be an expression of love rather than its abandonment.

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