I’m hearing a growing number of Access to Care advocates in veterinary medicine argue that the “spectrum of care” should include treatments that pet owners find affordable and ask for, even if veterinarians are uncomfortable recommending them. The fact that some pet owners want to do things their veterinarian might not be excited about is not new or surprising. For decades, pet owners have asked about cheaper alternatives to things like veterinarian-recommended parasite preventions, dental COHATs, and hospitalizations. Pet owners also read widely, think a lot about their pets, and have legitimate questions about what is beneficial. None of this is new, and it’s actually great to see pet owners being involved like this.
When it comes to the cost of care, I don’t think anyone can blame pet owners for asking if there are more affordable options. Many of our services are objectively expensive for the vast majority of pet owners, and if I wasn’t in veterinary medicine I’d be asking the exact same questions. Also, as the cost of everything else in our lives goes up, finding places to save money at the vet is going to become a higher priority.
What is bothering me is the growing perception that effective, affordable alternative treatment paths are not being offered because vets are either hiding or ignorant of them, instead of because the treatments are ineffective, dangerous, or nonexistent. Are there instances where more affordable treatment options might exist and possibly aren’t being presented? There definitely are. Are these instances abundant enough to offer significant financial relief to pet owners across the country? No way.
I understand why people wish there was a big part of the spectrum of quality medical care that we could unlock and start using. I, like most vets, desperately want to help pets and their families get care. Unfortunately, I honestly believe vets, as a group, have been using every trick in the book to treat pets in a way their owners could afford since the days of James Harriott. They are not holding out on anyone.
Yesterday I stitched up someone’s dog that had been in a terrible dog fight. After briefly discussing their financial situation, I quoted them about $400 to take care of their pet. When they asked if there was any way to save them some money, I told them we could cut $16 off by not sending home pain medications afterwards, but I really didn’t want to do that. $400 was a burden for these people and I knew it. It also was the absolute minimum I felt I could do to fix their pet. I didn’t decide not to give them a cheaper option because I don’t know about the spectrum of care or want to help them. I didn’t give them a cheaper option because this was the most basic approach I could take and feel I was helping their pet. Right now, there are scores of veterinarians out there reading this and thinking “that’s insanely cheap!” I agree, but it’s not cheap for the pet owners and that’s where we see differing perspectives from clients and vets.
Training and research on the spectrum of care approaches are still vitally important. Research-backed approaches to treating conditions more conservatively than we have in the past are fantastic and far too rare right now. There is real opportunity for improvement in our profession in these areas. (Feel free to check out my recent Cone of Shame episode on training vets to do more with less)
There is also a justifiable concern about how veterinarians are being trained today to continuously aspire to the “gold standard” of medicine. There is probably truth to the idea that this is happening in vet schools, but more and more schools are actively working to integrate and normalize contextualized care approaches to training (see the podcast link above for an example). Also, for every vet I know who is continually pushing for the top medical standards of practice, there is another who is bending every rule she can to get the costs down and the job done.
Maybe there’s a generational shift taking place that I’m not seeing where younger vets are more fearful of “just trying things.” I think it’s also possible that, as veterinary clinics have become more operations focused through corporate consolidation, veterinarians are more beholden to standardized medical protocols than they have been in the past. Still, when I look at veterinarians on the ground, I clearly see a greater number of vets under-working cases compared to those who are over-working them. I’m not complaining about this trend, but it’s not the narrative that I’m hearing outside the clinical part of the profession. I genuinely think most vets are highly aware of the financial burden pet owners are being asked to shoulder and have already been working against that.
Look, all of this would be so much easier if vets were in the habit of doing way too many tests and therapies, and if there was a super-cheap alternative path that pet owners simply were not being told about. The sad truth is that, in the vast majority of cases, this just isn’t what’s happening. Most of the time, the vet is genuinely trying to help the pet and pet owner get care that will benefit the patient. The average vet is far less concerned with making money than with treating the patient and being liked by the pet owner. If the vets aren’t recommending something, or are recommending against something, it’s usually because that thing will be harmful to the patient – either directly or indirectly by taking the place of something that would actually help.
I care a lot about affordability in vet medicine and access to care. Please believe that. Also, unfortunately, veterinary medicine is like most other things in life: you tend to get what you pay for. In my experience, if there’s a treatment path that is a fraction of the cost of what your veterinarian is recommending and your veterinarian is telling you that she is advising you against doing it, this path is probably not the secret access-to-care shortcut that you are hoping it is. It’s probably just a bad idea.
We need to keep trying to find ways to make care affordable, and to keep researching how best to approach cases from the perspective of contextualized care. We should not, however, kid ourselves that vets are holding people back from effective, affordable care and if they would just get on board with what pet owners want everyone would be better off. That’s not true.
