Are all veterinary practices the same? Surely when you castrate a dog it's the end result that counts, and it must have been done the same way. So why would one practice charge more than another? Why would removing a stick from a dogs stomach have a different cost at different vets?From time to time a client might mention that a practice in the next town or some out of town area is cheaper than we are and I ask they remember not to compare oranges with apples. The current recession is making it difficult for people to afford the essential things in life including good veterinary care. So I thought I'd write an article explaining why we are different to some practices, including some of the experiences during my career that have shaped the way we provide our services today.
Almost all vet practices are run as a business and contrary to popular opinion they are not very profitable. After all the costs are paid and the government has taken its share of tax most practices make a 5% profit if they are well managed. So that is £5 profit banked for every £100 charged. The average vets salary in the UK is about £30k which is less than half that of a GP or plumber. Despite not paying excessive salaries, staff costs are one of the major costs to any vet practice. So although prices can look high there are many hidden costs our fees have to cover.
It may sound strange but practices that charge the least for their services and operations can be the most profitable businesses because they often spend less on equipment and qualified staff. Someone charging £10 for a consultation but cramming the examination, diagnosis and treatment into 5 minutes is charging the same per hour as vet charging £30 for 15 minutes. However it's not the same service, there's less attention to detail and and they see 3 times the number of sick patients so it's more a stack them high sell them cheap approach. The quality suffers and although on surface you seem to be saving money for the same service, if you dig deeper you may not be. As a client you do not always know what makes a procedure safer; what might get missed in a short consultation; how safely an anesthetic is administered and managed; if the nurse your speaking to is properly educated and registered; were the blood tests you paid for accurate or the x-rays of diagnostic quality etc. You just trust that all vets are the same. Well they are not. At the very least the practice you go to should be part of the voluntary RVCS Practice Standards Scheme but even this is very limited in scope when comparing facilities and quality of care.
Purton Veterinary Group is not the most expensive or the cheapest practice you will find in the area, we are positioned in the middle ground and offer good value for money. We are one of the only vets in the area to publish our prices on our website, and you should ask yourself why other vets don't do the same. To provide your pets with quality care we charge fees that reflect the costs we need to cover. We employ registered and qualified clinical staff who have formal education behind them because its vital your pet is properly looked after. We provide for continuing education every year so our staff can keep their skills and knowledge up to date. We invested in our facilities at the clinic to make sure our hospital is comfortable, hygienic and as stress free as possible with separate wards for dogs and cats, and an isolation ward for infectious disease patients. We have CCTV monitoring of patient wards if needed so we are never far away. At £50k our X Ray and Ultrasound facilities are at the leading edge of technology because we need the best images to be as sure as possible about our findings. We have a complete in-house laboratory for blood testing and a high specification laboratory microscope for analysing samples taken from lumps. We have separate sterile and dirty operating theaters and always wear surgical gowns and gloves to prevent infection. We spend more time consulting (which sometimes results in longer waiting times) to make sure your pet gets the attention required.
All these things cost money and have to be covered by fees.
All these things cost money and have to be covered by fees.
I have worked as a veterinary surgeon in a number of practices in the south of England over the last 15 years and my partner has worked in even more practices as a veterinary nurse. I have seen a huge variation in service and quality of care. Although most vets and nurses have their patients welfare at heart it's often the business side of practice that determines the level of care a patient receives. Some vets are paid on the basis of their turnover, the more tests and surgery they perform the more money they receive as a salary. I used to work for someone who paid me this way and I don't think it's fair on staff or clients. Our vets are get a salary that is not proportional to their turnover.
The following are examples of some of the experiences that have shaped the way I practice today. I promised myself I'd never create these environments for my patients, clients and staff.
The Sweat Shop Environment
One of my first jobs was in a practice not dissimilar to Purton Vets in terms of size. The similarity ends there though. There were restrictions on the use of equipment, and time allowed for consultation and operations. To cut costs my employer spent as little money as possible on staff and continued professional development. The equipment was old and of poor quality. We had no dental facilities so we could not remove damaged teeth or treat dental disease properly, we were not allowed to put intravenous catheters in patients for anesthetics to cut costs, and we had to see clients in 5 minute consultations. I remember a day when so many operations were booked in that there were 3 animals asleep in the very small operating room at a time, one on a blanket on the floor and 2 on the same operating table! Unqualified staff were used to nurse patients and assist in operations. The boss would "train" them so they new how to work an anesthetic machine etc but they did not know anything about how anesthetic drugs work or what to do in those critical moments if something went wrong. The same staff helped look after critically ill pets overnight.
I left that job as soon as I could and promised myself I'd never work in a sweat shop environment again. It wasn't a good introduction to veterinary practice.
It still happens today. Recently a patient of mine was seen by another practice via a charity because I'd found a broken tooth during a health examination. This practice charged 50% less than I had estimated. I could not understand how they could do it so cheaply. It all became clear when I saw the the patient back to find that the infected broken tooth had not been removed. The clinical notes showed the elderly dog had been sedated (rather than anesthetised) and that the vet doing the dental procedure noted that the tooth was broken but left it in and gave antibiotics. This would not resolve the problem. It is standard practice to use a general anaesthetic for dentistry especially for extractions and to leave a broken tooth behind is not acceptable. On further investigation it turned out that the practice did not have the appropriate equipment to remove the tooth so they could have done more damage removing it. Why they do any dentistry without investing some of their profit in the basic required equipment I don't know. The dog had to have a second procedure at Purton Vets to remove the infected tooth. The client had to pay twice for the "same" procedure.
The Empire Building Corporate Environment
I've worked here too. In London I worked for a large group and got to run my own branch for several years. I learned a lot working there. The group had a few Veterinary Hospitals that allowed patients to be looked after through the night. I worked in this hospital every week for a few hours as did 30 other vets on a rota basis. The patients had so many different people looking after them I decided that one day I'd try provide the continuity of care only a smaller practice can offer. In fact most veterinary hospitals have no one awake at night monitoring inpatients, instead they have either a qualified or unqualified nurse who sleeps on the premises and wakes up to check patients from time to time depending on how ill they are. There are no checks in place and it's all down to how conscientious the nurse is.
I left them eventually because they would not allow me to replace a qualified veterinary nurse to help with patient care and anaesthetic monitoring in my branch surgery. They also paid me and the nurses a percentage of the money we generated with no basic salary. The ethos of the business was maximum profit. Do you think that this is in the client and patients interest?
As there were only ever two of us on site they also expected the "nurse" to be a receptionist, answer the incoming calls, help clients who walk in through the door, monitor patients recovering in the kennels from anaesthetic and at the same time assist me during an operation. They threatened to fire me if I locked the door while we were operating. Did my patients receive the care they needed? It would have been a lot better if I had someone with a proper formal education available to nurse patients.
It soon became apparent that their primary interest was to build a large business that spread over the local area and the fact they did not employ many nurses in their branch surgeries did not concern them. They felt that with a weeks induction training and a vet on site, anyone could move for being a bank teller or taxi driver to being a veterinary nurse in a week.
There are vets in the UK who present unqualified people to clients as a nurse, allow them to manage inpatients overnight in hospitals and monitor anaesthetics. Anyone can call themselves a nurse under current legislation, only the term "veterinary nurse" is protected.
All vets are not the same!
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