Veterinary Care - The Price You Pay

This is the first of three articles on veterinary care, pet insurance and managing vet expenses.

Veterinary Care - “The Price You Pay”

By Barbara Dwyer

Recently, the cost of veterinary care has risen faster than human healthcare. Although there are many reasons, a favorite is that more owners view their pets as family members. For example, 40% of dog owners would choose a dog over a human as their only companion on a desert island, and 93% would risk their own life to save their pet (Brandon Gaille, 2017*). In 2011, a study “found that 68% of dog owners said that they would maintain spending on pet health regardless of any downturn in the economy. To put this in perspective, spending on Mother’s Day declined by 10% when the economy slowed” which begs the question, “Are our pets recession proof?” (Pet Life Today, 2018*).

Let’s start with some general statistics from the 2017-18 American Pet Products Association (APPA, 2017-18*). There are 89.7 million dogs in the US living in 60.2 million households. On average, dogs in the US visit the vet 2.7 times per year; the average annual cost is $257. The average cost for surgery is $474 (Pet Life Today, 2018*). You can add to those figures the expense of over-the-counter medications and supplements at $58/year and flea and tick control at $85/yr. Emergency room visits in 2015 were on average $349/year for dogs (Pet Life Today, 2018*). Not included in these figures are things like heartworm testing, medications, special diets and spay/neuter.

Veterinarians are recommending pet health insurance for their patients to help client’s manage costs and reduce the financial risk of facing a serious and expensive illness/accident. Vets believe that having insurance might save dogs whose owners can’t afford the $10,000 expense for cancer treatment and so have to resort to euthanasia. Of course, clients will be more willing to pay higher prices in general if they are offset by insurance payments. In 2015, fewer than 1% of owners bought pet health insurance, but the market is growing rapidly. The average annual cost of the insurance is $518 (APPA, 2017-18*) which would be over and above expenses for wellness exams, pre-existing conditions, spay/neuter and often genetic defects. Most plans are similar to major medical plans for humans. Also, the cost of insurance increases based on the dog’s breed type, age, where you live and inflation. But, more on that in our spring newsletter.

The mean income for a veterinarian is $101,530 and ranges between $53,980 and $198,340. It is not as high as medical doctors yet requires similar extensive post college education. The most expensive areas for vet care are Hawaii, Washington DC, New Jersey/New York area, Nevada and Los Angeles (Occupational Employment and Wages, 2017*)

Expenses for veterinarians and their clinics include: staffing, benefits, rent/mortgage, technology, medical supplies, cleaning, taxes, legal and accounting fees, insurance, equipment, office, products for resale. A large expense is student loan repayment. The average student debt for those graduating now is $160,000. “Student debt has continued to increase at a higher rate than starting salaries for the past 15 years” (Villalobos, A., 2014, Veterinary Practice News). Income is derived from veterinary services, boarding fees, sale of goods and other items that vary from clinic to clinic. Advances in veterinary technology and equipment have contributed to both sides of the balance sheet. New equipment and training can be expensive, but vets are now able to treat conditions they previously could not.

Are veterinarians’ being squeezed between offering the quality of care they’d like and financial reality? A study by the Centers for Disease Control and Prevention from 1979-2015, found that female vets were 3.5 times more likely to commit suicide than the general population, while the ratio was 2.1-to-1 for male vets” (NBC News, 2018*). There are a variety of reasons postulated for this such as overwhelming student debt, low salaries, demoralization, long hours and easy access to euthanasia medication.

Let’s look at the reasons most dogs end up at the clinic. They are: skin allergy, ear infection, non-cancerous masses (removal isn’t usually necessary), skin infections, vomiting and diarrhea, arthritis and toxicity. (Pet Life; Preventive Vet*).

What do typical veterinary visits cost? Below, is a table of the average cost of common procedures nationwide. Of course, the costs can vary widely depending on where you live, the size of your dog and the extent of procedure complications. A client I saw today in suburban Connecticut reports that her vet charges $75.00 of a routine exam.

Procedure Cost in Dollars Procedure Cost in Dollars

routine exam 45-55 allergy blood test 200-300

dental cleaning 70-400 anesthesia for allergy test 45-100

fecal exam 25-45 chemotherapy 6,000-10,000

vaccine booster 18-25 skin allergy test 200

heartworm test 45-60 radiation therapy 5,000-7,000

ear infections 10-40 surgery 2,500-6,000

skin allergy test 200 ER exam 75-125

Information obtained from Care Credit, 2018; Preventive Vet, 2019; Pet Life Today, 2018.*

Does a dog’s breed affect veterinary costs? Yes. If you’re considering getting a dog, you might want to know which breeds are apt to incur the highest veterinary expenses during their lifetime. The top ten are, in order from most to least costly: cocker spaniel, German shepherd dog, bull dog, golden retriever, Saint Bernard, basset hound, Labrador retriever, rottweiler, Newfoundland and miniature poodle. The least expensive? Australian Cattle dogs, Border Collies, Huskies, Beagles and mixed breeds (PetLifeToday, 2018)*. If you want a purebred dog, it is a wise purchaser who checks with that breed’s national AKC club. Most clubs’ websites have sections on health, including breed predispositions for illness like epilepsy or structural problems like hip dysplasia. These clubs are easy to find online, or you can go to AKC* which will direct you to all the major clubs.

Together veterinarians and their patients are facing another challenge as large corporations buy or force out smaller veterinary clinics. The Mars corporation (yes, of candy bar fame) which owns all the Banfield Hospitals has bought out 800 VCA clinics (DVM360, 2017*) and, through some extreme practices, has taken over smaller veterinary clinics (Consumer Affairs, 2013; Vin News, 2014*). It’s tough for small clinics to compete with the giants. These corporate shops set goals for their vets to meet which may induce upselling[1] services to meet corporate benchmarks. They are forcefully pushing medications, supplements and unnecessary dental cleaning (Bloomberg Businessweek, 2017; (Courthouse News, 2014*).

After initial puppy vaccinations, at one year the dog is given his core vaccines which remain effective for at least 3 years. Scientific findings and the AVMA suggest that core vaccines, i.e., distemper, parvovirus, adenovirus, rabies, need not be administered more than once every 3 or more years. Scientists have done studies that suggest immunity from vaccines may last for 7 or more years (Brown, J., 2017. “The Immunity Challenge;” Bloomberg Businessweek, 2017*). To be cautious some vets recommend doing a blood test (i.e., antibody titer) first to assure that further immunization is needed.

Although Banfield has changed its former policy, it now follows AVMA guidelines for core vaccines. Yet, it still routinely pushes annual boosters for others the guidelines say should be given “only in special circumstances.” Shots for leptospirosis and Bordetella are examples of vaccines the AAHA says most dogs don’t need, but which Banfield regularly recommends (BloombergBusinessweek, 2017). For large corporate-owned vet hospitals like Banfield and VCA , there is another accounting line on the expense side - profit. They are growing in number. “This is all happening despite laws in most states banning corporation from owning veterinary practices. As old-fashioned as it may sound, the idea behind the laws was that doctors employed by corporations might have a harder time exercising independent judgment on behalf of patients; commercial interests could intrude (Bloomberg Businessweek, 2017*).”

Veterinarians competing with Banfield and VCAs are already struggling to make a good living because they can’t beat the big box prices. Even your neighborhood vet may find it necessary to upsell services and products, e.g., supplements, tests, special dog chews, or procedures like elective dental cleaning. Even your neighborhood vet may find it necessary to upsell services and products.

Some vets believe dental cleaning acts as proactive prevention of dental disease. Prophylactic dental cleanings can actually save lives (Dodman, NH. 2019, personal communication). “Dr. Marty Becker, one of the country’s leading experts in veterinary care, said he wouldn’t recommend a cleaning ‘unless [the dog] needed it’ and that putting the dog under anesthesia can be dangerous (ABCNews, 2013*).” Research shows that the actual risk is very low, 0.17% overall and only 0.054 for healthy dogs, but that increases if your dog is sick, elderly or over weight (“How safe is anesthesia for dogs and cats,” 2012*). “Anesthesia allows for a better cleaning because your pet is not moving around and risking injury from the dental equipment. If radiographs (x-rays) are needed, your pet needs to be very still in order to get good images, and this is unlikely without heavy sedation or anesthesia (AVMA).” There are services being offered for dental cleaning without anesthesia at reduced prices. But veterinarians’ prevailing view is that a thorough cleaning is difficult to achieve without anesthesia. Hard-to-see plaque, if not cleaned off regularly, absorbs minerals and forms hard tartar (aka calculus), which damages the gums leading to gingivitis (periodontal disease). In addition, plaque contains bacteria, which produce acids that attack tooth enamel as well as damaging the gums (Dodman, N.H., personal communication, 2019).

According to the American Veterinary Medical Association, (AVMA) “your pet’s teeth should be checked at least once a year by your veterinarian for early signs of a problem and to keep your pet’s mouth healthy. Have your pet’s teeth checked sooner if you observe any of the following problems: bad breath, broken or loose teeth, extra teeth or retained baby teeth that are discolored or covered in tartar, abnormal chewing, drooling or dropping food from the mouth, reduced appetite or refusal to eat, pain in or around the mouth, bleeding from the mouth, and swelling in the areas surrounding the mouth”

But don’t sit back and allow procedures to be done that you don’t understand. Be proactive. Ask your vet why your dog needs its anal glands expressed? Groomers routinely do this as an added service; some vets do as well. But you don’t need to do it unless there is a medical reason like an infection or blockage. Once you start doing it, you may need to continue because it can cause damage to the glands so that they no longer function normally[2]. (Critical Care DVM, 2016*).

Build a trusting relationship with your vet; talk to her/him about options. Feel confident that you are not putting your dog at unnecessary risk. Good veterinarians want what’s best for the patient and you. Don’t be afraid to get a second opinion. Beware of what you find on Google. Treat your vet with respect and thank them for what they do.

References

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[1] A sales strategy where the seller will provide opportunities to purchase related products or services, often for the sole purpose of making a larger sale. A popular example of upselling happens when a fast-food customer orders a hamburger, and they are asked by their cashier "Do you want fries with that?", in an attempt to get them to purchase more food. Other examples of products that are upsold are warranties on electronics purchases, and the purchase of a carwash after you purchased gas at the gas station (the Business Dictionary, 2019) [2] Note to reader: Feeding a higher fiber diet to produce a firm bulky stool empties the anal glands naturally (as long as they haven’t already been damaged). Chronically loose stool is the enemy of the anal glands (more appropriately called anal sacs) (Dodman, N.H., personal communication, 2019).