On the Veterinary and Client Disconnect - Navigating your Relationship with your Vet
This proved to be a tricky and complex piece to write. It's also a piece that I have been repeatedly asked to write. It's a volatile subject that everyone has a strong opinion about. Being such a complicated issue its long, but please stick with it and read all the way through. It’s so important.
Firstly, let's start with the Not One More Vet movement. Suicide rates in the pet healthcare industry are unconscionably high. Vets and vet techs are under an enormous amount of stress. They are working long hours for unfair pay with emotional strain. They take the brunt of frustrated owners emotions. They have to deal with clients whose animals they treated and then the clients never paid. It's not fair to them. And I will say, this is indicative of a broken system.
I will also be forthcoming about my own bias. I have vet and vet tech friends. I have a huge amount of empathy for their struggles and have worked hard to understand their perspective. But I have also had a wide array of frustrating vet experiences and that does absolutely color my perspective. And, I want to be clear that as much I am trying to step away from my own biases, my lens on this issue is still that of an owner, not a veterinary professional. My frustrations are shared by many. And again, are indicative of a broken system.
If everyone is unhappy, it's not the pieces that are broken, it's the game. I hear a lot of people very supportive of the NOMV movement, as everyone should be. But I also see a lot of: we should support our vets because they have it rough, no matter what. And I think that there is both space for supporting all our vets when they need it and also understanding that client's frustrations are both real and common and there has to be a reason for that.
As I see it, conflict and frustration in the veterinary field stems from two different categories: systemic flaws and interpersonal communication. In truth, most problems in most fields can be boiled down to these to categories.
SYSTEMIC
Chronically Under-Paying Staff- when you first look at this fact, and it is a fact, you may be baffled. Vets and Certified Vet Techs have extensive schooling. How then could vets and their staff be under paid? Let’s look at why that might be.
According to the Bureau of Labor Statistics (BLS), “In 2011 veterinarians earned an average salary of $91,250 per year; while physicians and surgeons, which includes doctors, earned an average salary of $184,650 per year.” Yes, vets are paid on average less than half as much as a human doctor. The same long hours, the same stress (perhaps even more since most human doctors don’t deal with exclusively non-verbal patients nor have over-bearing, over-protective guardians to contend with), the same occupational burnout, yet vets are paid half as much.
Talking with a Certified Vet Tech friend of mine it became clear that much of this is resistance to increased vet bill costs. There is often such pushback to raised veterinary costs that vets hold off raising them, even when small increases in prices would allow vets and their tech and all other staff to make a fair wage (that also means a wage that compensates them for amount of stress their job entails).
Recently, one of the few 24/7 Emergency Vets suspended emergency services in the Seattle area. They simply did not have enough staff to continue offering emergency services. However, it later came out that the company the clinic belonged to had failed to raise wages of their employees, though they raised the wages of other employees at other clinics in the same area. However, those other locations had unionized whereas the struggling clinic had not. Accordingly, wages remained stagnant despite the COVID boom in the veterinary field, and many of those employees went elsewhere where they could be paid a living wage.
Occupational Burnout- this is one of the biggest issues that veterinary professionals face today. Not only is there a shortage of vets and CVTs but their suicide rate is 3.5 times higher than the general population. As I mentioned, before this tragedy has led to a huge and necessary outcry and push to raise awareness for the issue.
https://time.com/5670965/veterinarian-suicide-help/
The Not One More Vet (NOMV) movement was created to help educate the public about the plights of the animal health field and support those veterinary professionals. The group includes a crisis hotline for such professionals. Think about that and really take that in for a moment. Occupational burnout and suicides rates are so high for those in the veterinary field that they have a crisis hotline.
https://nomv.org/
I think many of the causes of occupational burnout can be realized by the empathetic clients. Vets and techs deal with sick animals day in and day out. As I left my vet recently I asked to bring two of my dogs who hadn’t had an appointment in briefly to weight them, the techs graciously agreed but asked if I’d wait to let them let a grieving client out first. I nodded solemnly and realized this was their reality: sick animals, grieving and emotional owners. And yet they were still kind, they still smiled when I wanted to check my dogs’ weight because at least I was trying to be proactive in monitoring my dogs.
Dog training can be stressful. I’ve had people yell at me, particularly when discussing rehoming or behavioral euthanasia. But it’s not a constant battering ram of emotion and passion. No wonder people get burned out.
And that isn’t even discussing the verbal abuse and lack of payments vets and techs deal with on a daily basis. People get emotional over their animals. They love their pets deeply and that’s a good thing. But that passion can make people irrational, unreasonable when their animal is in pain. When they don’t understand what’s wrong any more than their pet does. And so they take that out on their vet. They take it out on the techs. On the receptionists. It is the story of any industry with a customer service component, but because feelings are so super-charged, animal health professionals take much more of a verbal and emotional beating than most people could ever dream of or comprehend.
Shortage of Veterinary Professionals & Chronically Over-Working Staff
With COVID there has been a huge boom in the “pandemic puppy”. Waitlists for puppies are long, AKC registrations are up, and vet clinics are booked tightly and many aren’t taking new clients. Having talked with my vet and CVT friends, some of the issue is that with more people home, more people are noticing the small bumps and changes in our canine friends more. So a sniffle that might have once gone unnoticed was then rushed to the vet. But a large number of people also brought home dogs because they had more time.
This has put an even bigger burden on an already heavily taxed infrastructure. The fact is, there simply aren’t enough DVMs or CVTs in the United States. That means several things. First: appointments are hard to come by in many areas. Pet owners have to wait weeks in order to get an appointment, including appointments for urgent issues. Emergency vets are often filled to capacity and diverting to other clinics in the area.
Second: this shortage means the vet professionals are now chronically over-worked (and under-paid as discussed previously). Vets have always worked long, hard hours. This has been true for decades. Now, with the pandemic, this is more true than ever and veterinary professionals not only face compassion fatigue from working with sick animals on a daily basis, they have to deal with physical fatigue as well due to extra long hours.
Clients Not Paying Their Bills
I’ll confess, I had no idea how prevalent this issue was until I talked to my vet and CVT friends. Yes, vet care is expensive, though no where nearly proportionately as expensive as human care. Very often, owners will rush through the door with an emergency, the staff will stay late, working more long hours only to find that the person has no way to pay their bills. But ask for up front payment and people balk.
One CVT friend I spoke to recommended the following for all owners:
1) Pet insurance
2) Pet savings account and putting $50 every month into it (use a high interest bearing account like Ally)
3) Make arrangements with the clinic to pay $50/month into an account to build a positive balance
4) Get a “dog only” credit card
5) Care Credit. Can be used for any purchased at a vet clinic including food and vaccines, just pay in full before 6 months.
Pet insurance can be a game change whether it’s an accident only policy through Pets Best or a comprehensive one through Trupanion. And while I have no horse in this race, I will say that most vet professionals I spoke to vastly preferred Trupanion to other providers because of their ability to directly pay the vet clinics.
Lack of Understanding of Pricing
Here is a category regarding vet care that I’ll admit to not fully understanding or appreciating before embarking on my journey to write this piece. It’s tough when vet clinics raise their prices. I do get it and I have left a clinic after they continued to raise prices. However, looking at the breakdown of what a vet bill goes toward helped me understand why vet bills increase over time and it helped me understand why services cost what they do.
One CVT gave me the following entirely hypothetical example:
Consider a $100 bill for a vet bill and look at how that breaks down.
$20 pays the building lease or mortgage
$20 for payroll
$20 medicine and supply costs
$20 equipment maintenance
$20 utility bills
When broken down in this fashion, it quickly becomes apparent, that there isn’t price gauging going on, but instead vet clinics have a huge variety of expenses just like every other business. This also does not account for increases to cost of living in an area or increases in rent. Is there any wonder why vet bills vary by area and usually increase as time goes by.
Markup
Back when I had recently started seeing a new vet clinic there was a miscommunication with getting the medication for Argos seizure medication. As such, we got down to the critical last few days of his medication and I was in a hurry to get his prescription refilled. Accordingly, I opted to fill his prescription through my vet as opposed to my local human pharmacy, which at times has trouble filling scripts quickly.
At my pharmacy, a month’s supply of pills cost slightly under $15. At my vet it cost just under $60. I was aghast. They had warned me it might be more expensive but I couldn’t quite believe the difference in price. I paid it because I needed the prescription then, but resolved to make sure I could fill it at my usual pharmacy in the future.
Now, many would say this is a sign of money grabbing on the end of the vets. However, let’s actually look at the situation. Argos’ epilepsy medication is one of the less common medications used for dogs. It is likely, if he’d been on Phenobarbital or Keppra, both of which are much more commonly used there would have been little to no increase in cost. However, since the vet clinic rarely ordered the Zonisamide that Argos needed, it was substantially more costly for the clinic to order it.
Additionally, think about how many medications it is actually useful for a vet clinic to keep on hand. Vets must act as clinic and pharmacy both, a difference from most human clinics. Thus they must choose what to keep on hand.
Where I have grown frustrated is in cases where there is lack of transparency from the vet clinics. My vet at the time warned me that the Zonisamide would be expensive and it would be cheaper to go through a pharmacy. They gave me that option, they never pretended it would be the cheapest to go through them, simply the quickest. However, often I see vets prescribe medication that could be filled through a human pharmacy and their vets fail to enlighten them on that fact. Many clients don’t even realize that it may be both more convenient and potentially cheaper to use a human pharmacy. Even prescription diets, which can make money for a high volume clinic can be a hassle for smaller clinics. Food manufacturers have a required manufacturer’s suggested retail price which all prescription food must be within $0.10 of, which limits the amount of money that vets make off it. I appreciate the clinics that are being transparent with their clients about these details.
Overreach and Over Generalization of Animal Understanding-
I will be frank, I have been appalled at some of the advice that vets have given to clients of mine in regard to their dog’s behavior. I have heard clients tell me their vet told them to tightly hold their puppy’s mouth to prevent puppy biting. I have had clients whose vet recommend they alpha roll (a move that is thoroughly debunked, thank you) their dog to teach them who is in charge. The lack of understanding as far as canine behavior that some vets have demonstrated when talking to their clients in my experience is at times nothing short of negligence.
Very often I will send clients to their vets. I have had multiple terriers who couldn’t sit square that I recommended the owners talk to their vet about patella luxation. I had a standard poodle with intermittent fits of rage. I recommended their owner talk to their vet about getting bloodwork down, particularly the dog’s thyroid. I have sent owners to the vet to discuss their dog’s anxiety or car sickness. But one thing I never did was presume to make a diagnosis. Because that’s not my job. That’s not what I have been trained in. So I do wish that vets would recommend trainers to deal with training issues. They are two fields that should be working in conjunction with each other. Indeed, I do get clients sent to me through their vets, but I would say it is far more common to have to carefully skirt around contradicting what a well-intentioned training advice a vet has given.
In general, I have great respect for the vast amount of knowledge vet professionals possess in regard to keeping our animals healthy. But I have been disappointed across the board in the lack of understanding many of those professionals exhibit when it comes to canine body language. Stress and calming signs go ignored. A vet does not honor a dog’s attempts to avoid heavy handling. They grab a dog when they could have simply instructed their owner (who the dog trusts) to help manipulate them.
There is an increasing movement toward Fear Free handling in the veterinary field. However, I do wish there was also increased acknowledgement that with the exception of the very few certified Veterinary Behaviorists, it is usually a dog trainer an owner should be seeking for behavioral and training issues, not a vet.
Lack of Transparency & Education
And on that topic, I truly believe the is many of these issues could be resolved with client education. Much of what I have discussed thus far is information that I have learned through purposefully seeking it out. I have learned by chatting with vet and CVT friends. I’ve learned by researching what I can and discussing components of this issue with my own vet.
However, I still maintain, we would have less conflict between veterinary professionals and clients if prices for common procedures were posted on their website. I have maintained an online store and inventory before. I do understand the potential difficulties of maintaining and updating this list. I also understand that vets offer far too many procedures to list prices for everything. However, being able to get an estimate of a bill (and it would need to be stressed that all prices were estimates) in advanced would ease so much conflict. Allow owners to understand exactly the monetary value of the procedures and treatments they are walking into and they will be less surprised and taken aback. It would also likely save receptionists time so people aren’t constantly calling to ask for estimates. This option does have to possibility of creating more conflict by making people frustrated that what they saw online is different that what happened in reality, but with clear education that all prices are an estimate, I believe that frustration would be mitigated. And I have used a reproductive specialist at dog shows and he lists his prices very clearly on his website and I can tell you, it has made a world of difference for me.
I absolutely understand that educating the public on how the vet industry works may seem exhausting for vet professionals. It may feel like it’s not part of their job, especially when their job already encompasses so much. However, as someone with a rare breed, where the education never ceases, there are ways that vets could help the public at large navigate the infrastructure that is the pet healthcare field. Make cards with links to resources and hand them out for those who complain about markup or increased service prices. Have posters not just about animal health but about the legal ins and outs about why often clients must be charged with an office visit, instead of simply the vaccination or treatment cost.
I am unsure where vet professional don’t realize that many of the realities and finances and reasonings of the business are neither common-knowledge nor common-sense or whether it is deemed less important than caring for the pets (understandably) but this transparency and education could greatly help client relations including their patience and empathy.
Non-Standardized System
One major issue of helping clients navigate veterinary services is that each clinic often operates quite differently. At corporate franchises like Banfield, VCA, and Blue Pearl there is going to be some standardization between clinics. Additionally, records are almost seamlessly transferred between those franchises. However, it also means that if you use those companies that you are stuck with over-arching policies that might not work well for your individual dog. I work with my Azawakh so they can be safely handled by strangers and people other than myself. But taking them back without their owner present is always going to be a hard reality for most Azawakh. Thus, when COVID began and Banfield started doing curbside pickup, I began to increasingly seek vet care elsewhere since I knew any Banfield I went to would have curbside pickup.
There are also differences between clinics such as whether a client can just drop of a fecal sample for analysis or if they need an appointment. Or whether a clinic will fill a prescription for 6 months or 1 year. Again, I think in this regard falling back on education would help ease the tension between professionals and pet owners. A pamphlet of policies with a brief overview of things like the above would be so helpful for owners. Even better would be for those policies to be clearly posted online, so pet owners could see them and decide whether they are to their liking before getting frustrated with the clinic because the policies don’t fit with what they are looking for.
Again, yes putting together educational materials does take time, but it also saves so much time and conflict in the long run. There is a reason I maintain this blog – to help save me time when answering questions for clients, friends, and potential puppy people.
Lack of Trust (on Both Sides)
This could also fall under interpersonal issues but I truly believe that the problem stems from the problematic infrastructure behind the pet healthcare field. How often do you see pet owners complaining about many of the above issues I’ve discussed? They complain that prescriptions cost too much, that services cost too much, that vets are only in it for the money. When in fact, they simply don’t understand the how and the why behind many of the realities in the field.
In contrast, many vet and CVTs have seen the worst of people. They have seen abuse and neglect. They have seen willful ignorance and endured lack of payment. I completely understand why they may be extremely wary of their clients. They might hesitate to take an owner’s word after encountering so many liars.
This is much of the reason that I wrote this piece – to try to bridge the gap between owners with their beloved pets and the veterinary professionals who care deeply for helping those beloved pets.
INTERPERSONAL
Empathy for the Animals, But Not the People
One of my strongest memories from when I first started working at the training center was when I was still working in their dog daycare (rather that the training side of the business). On the wall was posted the company motto: “We are a people business first. A dog business second.” And I spent over a year questioning that statement. I almost worked exclusively with the dogs while I was working in the daycare. Yes, I learned the client’s cars, their names when they came for pickup. But rarely did I interact with them in a meaningful fashion except when I always seemed to land the duty of having to talk to an owner about their dog’s injury or behavioral issue.
When I moved to the training side of the business, I started to understand. You can train the dogs. In many ways, training the dog is easy. You have a set of methods and tools in your repertoire and you find the one that works best of the dog in front of you. But here’s the thing, just because the dog can do a three minute out-of-sight Down/Stay for you doesn’t mean their owner will be able to achieve the same thing. And unless you can help the owner to understand how you achieve what you do, unless they begin to understand how to change and adapt their methodology for the future, the help that you’ve given the dog is limited.
I have quite often heard vet professionals proclaim that they’re dog people. Not people people. And I empathize – me too. But working with the people is part of a vet or CVT’s job. And if you can make the owner feel at ease, respected, and valued you stand a much better chance that owners will do better in the future. I absolutely understand, as I talked about above, the hesitancy to trust owners when vet professionals are in the trenches, but people feel that lack of trust. They respond to that lack of trust
Better understanding of human interpersonal communication would go so far in bridging the gap between clients and their vets.
Listening to the Client
I have seen clients come to me for training feeling completely demoralized about an issue they’re having that didn’t seem to be taken seriously. Again, I believe this stems from vets reacting to previous bad experiences. Certainly Dr. Google can be dangerous and frustrating when owners bring their pets in claiming their pet has some type of rare type of cancer. But when a human doctor vents to me about how their vet continued on and on about the dangerous of long term prednisone usage, when that owner prescribes prednisone to humans on a weekly basis, that’s a problem.
I grew up playing sports. I grew up doing some small aspects of sports medicine like wrapping ankles for soccer and volleyball teammates. I know how to take care of a minor ache or tweak. Whether that would be for myself or my dog. Accordingly, my vet understands that when I come in for an injury, it’s likely serious.
Yes, vet professionals see a dizzying number of clients. Remembering the intricacies of each client’s understand of their pet’s health might be unrealistic. But a simple note in their chart saying: human physician, prior dog with epilepsy, etc would help vet professionals understand their client’s overall understanding of their dog’s health.
Personalize Solutions & Read the Room
Diseases are not homogenous across the country. That is simply a fact. There are areas of the country that are high risk for heartworm, parvo, leptospirosis. Just like there are areas that are low risk areas. From what I have seen both with my own experiences and those of clients, it does not help a vet build trust with their clients by recommending the same protocols across the board for every area of the country and every dog.
A dog that doesn’t board doesn’t need a Kennel Cough (Bordatella) vaccination. A state with one reported Leptospirosis case a year might not need a Lepto vaccination. Areas where it doesn’t remain warm enough for heartworm to survive don’t need preventative for heartworm. Yet I often see a one-size-fit-all solution and protocol for every animal that comes through a clinic.
Additionally, there are some breeds that are particularly prone to issues with particular procedures or medications. Understanding that sighthounds are sensitive to anesthesia and avoiding it when possible will build trust (and many clients don’t realize this). Labs and Goldens are more prone to certain tick borne illnesses, small dogs struggle more with plaque build up on their teeth. Breed specific issues should be factored into veterinary care.
And while there are protocols I understand vets would very much like absolutely everyone to follow – flea and tick preventative for instance. Or maintaining insurance. Or purchasing a wellness plan. However, repeatedly broaching these topics every time a client comes in for an appointment will mostly serve to alienate clients. Most people find being lectured (particularly repeatedly) aversive and push those lectures too often and people may be driven to seek out their vet less and less often.
For dogs that are sensitive to vaccines, create a personalized vaccine protocol one that involves a higher use of titer testing. For breeds and individuals who are chemically sensitive, vets should be taking that into account.
Understanding a Client and Their Abilities and Skillset
When I first went for a reproductive consulta