Sick Kitty and ER Vet issues (long and kind of rant-ish)

ER vet clinics are more expensive because of their type of practice. My daughter’s good friend is an ER vet. Some nights, she doesn’t see a single animal. Other nights, she works as fast as she can, seeing one animal after another, all night long. The fees for the dogs and cats she sees have to cover the expenses for the nights that no animals come in.

A daytime clinic can get by without expensive equipment. CBCs, chemistry analyzers, and other lab equipment for the clinic can cost $100,000. Digital radiographs, ultrasound and other “basics” quickly add another $100,000+ onto the clinic costs. The animals seen in the ER are usually much sicker than those seen in a daytime practice. They can’t wait for their lab results. Therefore, all of the high priced equipment has to be there. The techs have to be able to put in IV lines and draw blood, as well as running anesthesia. Therefore, they are paid double what an unlicensed vet assistant will make. Sometimes, the techs are making as much or more per hour than the veterinarian.

Just like with people, going to the ER is an expensive proposition. It is cheaper to see your primary care provider during the daytime, as long as you or the animal, will survive and be unharmed by the wait.

This is why you pay so much for ER’s…they are simply set up to allow for emergencies, unlike your regular clinic.

For example, dog came in late Friday night with sudden collapse. ER admitted dog, started on fluids ran IN HOUSE bloodwork an blood gasses (something most regular vets cant do). Put in O2 cannula. Within 30 min, Had board certified radiologist come do an echo on the heart - found a small mass in right oracle. Needed surgery. Within 1 hour from admittance Got board certified surgon in, and VERY qualified surgery techs. Auto transfused dog and piled him up on packed RBCs (another thing your local vet wouldnt likely do). Went to surgery. Dog recovered with multiple ICU techs transfusing dog, changing up pain and sedative CRI’s and dopamine rates depending on what the dog needed. Dog was intubated for 14 hours post surgery and watched like a hawk. Dog went home 4 days later ALIVE. Would have been dead if it went to its regular vet. And yes, this cost them and arm and a leg, but their dog is alive.

Bloodgasses were checked every 4 hours and important decisions were based on these results, I dont know ANY regular practice that has a blood gas analyzer.

Not to mention, HBC’s came in, vomiting dogs, anemic cats, and a spleenectomy.

You pay for quality, not all ER’s are great but a lot of them are far superior in medical emergencies than your regular vet clinic that cant even run bloodwork in house, do an ultrasound or even a fast digital xray. Pay for quality.

Not necessarily… 6 years ago I took my JR into a big after hours/ speciality clinic and the care was neither emergent nor all that good. There were more major things wrong at that clinic than I have fingers on my hand and we paid through the nose. I will never EVER go back there. It may be different now but the clinic was obviously strictly being run on a business model, and one that was inconsiderate to the patients’ owners. I will go to NC State instead.

[QUOTE=mvp;5627137]
A serious question about this: Why do you all need to repeat a test done elsewhere within a reasonable time frame?

Truly, I never understand this and therefore get paranoid or huffy. Are you padding the bill? Do you not believe me or the other vet when I hand you the results of the last version of the test done? I’m more honest and intelligent than I look, but I do need to be educated. I’m good with motivations I can understand. Because this doesn’t work like human medicine where it’s “treat now, ask about cost later” I also want to have some part in deciding how “gentlemen… we can rebuild him” or “meh, he’s livestock” our treatment will be.

Sometimes I think it’s that I bring a “large animal” perspective to my relationship with small animal vets and it’s unwelcome. IME, horse vets dispense a lot of education along with treatment, so I expect that of all doctors. Woe be to the MD who ever has to treat me as the patient![/QUOTE]

It depends on the test and the patient’s signs. Some things change very slowly so results a week ago aren’t going to be much different (as a rule). Other things like kidney levels, electrolytes, CBC’s can actually change of the course of a few hours!! I routinely see patients that have normal albumin levels the day before a a major abdominal surgery and often even normal after the surgery. BTW, “normal” is high 2’s to in the 3’s. Not uncommon for patients with “bad belly disease” for these patients to have their albumin levels drop to less than 1 in less than 12 hours. I also see alot of patients that the initial interpretation was that it was all “normal” then when I look closer there are things that are not.

And in the hosital with critically ill patients, things can change very quickly as we start trying to “fix” things. We need to know if our therapy is working well enough, not well enough, if we are overshooting or if we have now uncovered another problem (that happens alot!!).

While I can’t speak for all veterinarians I can say that very few of us “pad bills” with unnecessary tests. A blood test only tells you what was happening at that exact moment in time the blood was taken. Here is an example: your dog has a severe infection and may even be septic (blood poisoining). Initially its WBC count was high. As the WBCs are used up and can’t be replaced as quickly as needed, the count drops. Depending on when I have taken the blood, it may have dropped to “normal”. Then a day later (for example), it may be exceeding low as the WBC have been used up. Blood sugar levels fluctuate tremendously in ill patients. I have a kidney patient right now whose values were improving so we decreased its fluid rate somewhat. Labs were done yesterday morning. I did them again this morning, not to “pad the bill” but to see what happened after 24 hrs of a lower fluid rate. Dog LOOKS great. Kidney values had all increased. Guess what? This 1) means I need to increase my fluid rate again and 2) changes the plan and prognosis for the patient.

If blood was “just” done, and the vet wants to repeat it, simply ask them why and what tests they are worried about changing. I wouldn’t encourage the “what if” question right at that point as that can be a very long discussion. But a general question of why they feel the MEDICAL need to re-do them based on what they are seeing is a valid question. I get it all the time. Same with x-rays for that matter.

I hope that makes sense.

[QUOTE=mvp;5627137]
A serious question about this: Why do you all need to repeat a test done elsewhere within a reasonable time frame?

Truly, I never understand this and therefore get paranoid or huffy. Are you padding the bill? Do you not believe me or the other vet when I hand you the results of the last version of the test done? I’m more honest and intelligent than I look, but I do need to be educated. I’m good with motivations I can understand. Because this doesn’t work like human medicine where it’s “treat now, ask about cost later” I also want to have some part in deciding how “gentlemen… we can rebuild him” or “meh, he’s livestock” our treatment will be.

Sometimes I think it’s that I bring a “large animal” perspective to my relationship with small animal vets and it’s unwelcome. IME, horse vets dispense a lot of education along with treatment, so I expect that of all doctors. Woe be to the MD who ever has to treat me as the patient![/QUOTE]

It depends on the test and the patient’s signs. Some things change very slowly so results a week ago aren’t going to be much different (as a rule). Other things like kidney levels, electrolytes, CBC’s can actually change of the course of a few hours!! I routinely see patients that have normal albumin levels the day before a a major abdominal surgery and often even normal after the surgery. BTW, “normal” is high 2’s to in the 3’s. Not uncommon for patients with “bad belly disease” for these patients to have their albumin levels drop to less than 1 in less than 12 hours. I also see alot of patients that the initial interpretation was that it was all “normal” then when I look closer there are things that are not.

And in the hosital with critically ill patients, things can change very quickly as we start trying to “fix” things. We need to know if our therapy is working well enough, not well enough, if we are overshooting or if we have now uncovered another problem (that happens alot!!).

While I can’t speak for all veterinarians I can say that very few of us “pad bills” with unnecessary tests. A blood test only tells you what was happening at that exact moment in time the blood was taken. Here is an example: your dog has a severe infection and may even be septic (blood poisoining). Initially its WBC count was high. As the WBCs are used up and can’t be replaced as quickly as needed, the count drops. Depending on when I have taken the blood, it may have dropped to “normal”. Then a day later (for example), it may be exceeding low as the WBC have been used up. Blood sugar levels fluctuate tremendously in ill patients. I have a kidney patient right now whose values were improving so we decreased its fluid rate somewhat. Labs were done yesterday morning. I did them again this morning, not to “pad the bill” but to see what happened after 24 hrs of a lower fluid rate. Dog LOOKS great. Kidney values had all increased. Guess what? This 1) means I need to increase my fluid rate again and 2) changes the plan and prognosis for the patient.

If blood was “just” done, and the vet wants to repeat it, simply ask them why and what tests they are worried about changing. I wouldn’t encourage the “what if” question right at that point as that can be a very long discussion. But a general question of why they feel the MEDICAL need to re-do them based on what they are seeing is a valid question. I get it all the time. Same with x-rays for that matter.

I hope that makes sense.

[QUOTE=JoZ;5626946]
May I ask a question that has always perplexed me? Who decides what “off hours” and regular hours are? Why are the regular hours the ones during which most people work? Is it impossible to find a vet who would like the night shift to be his/her normal shift?

I am a night person, and if my job allowed me to work 11 p.m. to 7 a.m. I’d do it in a heartbeat. Instead I’m a 9-5 worker (7 to 7 with commute) who tries to fit everything into Saturdays and vacations. So that’s my perspective in asking this.

I would gladly take my dog or cat to a 10:00 p.m. or 11:00 p.m. regular vet appointment. I’d bet that people who work swing shift would take their animals for appointments in the wee hours of the morning. I sure would like to talk to someone that isn’t half asleep when my foal is born at 2:00 a.m. and doesn’t nurse right away. Not begrudging the sleeping vet, btw, more wondering why there isn’t someone somewhere that is awake.

So why is everything so firmly entrenched in the “workday” model? Does anyone have a vet (equine or small animal) that works, say, 4 p.m. to midnight as regular hours?[/QUOTE]

I used to work at a practice that was open until 10 pm some nights. We were very very slow those nights I know that some people do work swing and night shifts but unfortunately not many of you :frowning:
I used to, and still very occasional still do, work the overnight shifts. The vast majority of the time it gets very quiet somewhere between midnight and 2 and then you sit there for the rest of the night. Or go to sleep. Staying awake that hour when you are bored out of your mind is just not possible. So if something DOES come in at say 4am and I have been asleep, you are still waking up a sleepy vet. :wink:
Having a vet work a 4-midnight shift at a regular practice can’t be justified financially. The building overhead has be maintained, there has be a tech on duty too. And the amount of money (that evil word) generated those 8 hrs will just not sustain that.
That is why about 20+ yrs ago the concept of centralized emergency hospitals came about in SA medicine.

There is a practice in my area that is open 24-7. Yes, they see emergencies but you can also get a rabies vaccine at 2am. These are pretty few and far between though. (and they have a pretty high turn over in staff).

[QUOTE=mvp;5627356]
No, not too medical heavy! Thanks for taking the time to type that all out. You helped me and some future vets.

Reading down the list, the $$ meter in my head is going nuts. There are so many things about which I’d like to say, “Well, yeah, but can’t you tell some of that by looking at the outside of the cat?” Of course, cats are pretty stoic and look “not too bad”… until they look really bad![/QUOTE]

No. Just had a cat come in that has survived the recent tornados. Had been at another vet’s for 2 1/2 days but since a holiday weekend start tomorrow it is with us now. Vet pulled blood today and sent it out (rather than being able to do it in house and have the answers in 15 mins). Overall, cat looks pretty good, all things considered.
Until the lab faxed us the blood work:
BUN 199 (normal <30) Creat 14 (normal <1.3) Phos 16 (normal <7) Those are the kidney numbers.
Bilirubin 3 (normal < 0.7) another liver enzyme 354 (normal <67)
Potassium 5.7 (normal <4.8)
Diagnosis in this apparantly normal cat:
Acute kidney insult boardering on failure and liver failure (hepatitic lipidosis).
This cat needs: agressive IV fluids, antibiotics (for other problems), pain meds, GI protectants and a feeding tube.
And we WILL repeat many of those tests tomorrow morning. Even though blood work was “just done” we need to know if we are getting after both these life threatening problems before they really nose dive. They are already leaning that way now.
By 8am (15 hr from now) the bill will be at $400. Before we repeat lab work (about $100). Fortunately with the feeding tube alot of medications can be given “orally” instead of by injection, which helps with the bill alot. By Tuesday morning (given the holiday, and the fact the cat will prob be here that long anyway) the final bill will easily be $1,500.
But remember, this cat looks “fine”.
Oh, and it has a traumatic hernia that will need surgery and has pelvic fractures (that don’t need surgery, thankfully).

There is a saying in medicine: if you don’t look, you don’t find it. Sometimes looking at the patient is enough but alot of times you have to look deeper.

Does that make sense? (I can give alot more examples if you really need them.)

[QUOTE=grayarabpony;5627597]
Not necessarily… 6 years ago I took my JR into a big after hours/ speciality clinic and the care was neither emergent nor all that good. There were more major things wrong at that clinic than I have fingers on my hand and we paid through the nose. I will never EVER go back there. It may be different now but the clinic was obviously strictly being run on a business model, and one that was inconsiderate to the patients’ owners. I will go to NC State instead.[/QUOTE]

  1. we aren’t all perfect. My “bone pile” is pretty darned big after 30 yrs. I just try not to make the same mistake twice!
  2. not all veterinarians, ER or otherwise, are created equal. Some are better than others.

FWIW, “ER vets” can be any number of “things”:
Some, like me, do only that.
Others do it part time but only that.
Others work in regular practices and pick up a shift or 2 every now and then at the ER to make extra money.

Like anything else, the more of it you do, the better (I hope) you get at it.

It also depends on how the ER is staffed. I am lucky that our clinic is well staffed with vets during busy hours. I know many (first hand) however that only have one vet on a shift at a time. You cannot possibly do as detailed of a job in that situation as you can when there is more than one of you.

Oh, I forgot. The cat I was referring to earlier?
Well the money grubbing vet that I am…I didn’t even ask them for a deposit. OMG!!!

[QUOTE=MeghanDACVA;5628974]

  1. we aren’t all perfect. My “bone pile” is pretty darned big after 30 yrs. I just try not to make the same mistake twice!
  2. not all veterinarians, ER or otherwise, are created equal. Some are better than others.

FWIW, “ER vets” can be any number of “things”:
Some, like me, do only that.
Others do it part time but only that.
Others work in regular practices and pick up a shift or 2 every now and then at the ER to make extra money.

Like anything else, the more of it you do, the better (I hope) you get at it.

It also depends on how the ER is staffed. I am lucky that our clinic is well staffed with vets during busy hours. I know many (first hand) however that only have one vet on a shift at a time. You cannot possibly do as detailed of a job in that situation as you can when there is more than one of you.[/QUOTE]

The clinic was well staffed. The priorities just weren’t right. I felt bad for the dog more than anything else and still feel guilty about the whole episode. But she did pull through, albeit with spinal cord damage. Damage may very well have been inevitable but I always wonder if they’d acted more quickly she’d have had less. Being the upstoppable force that she was she kept on going and enjoyed life.

Copying because I still can’t “quote”. :frowning: Can’t wait until the computer is actually fixed.

“Rowdy would’ve been a less expensive cat if you’d had her spayed…”

Oh, I know that. I consider it a hard lesson learned. I didn’t have the money to have it done, the last year having to toe the line to get bills paid, so what would have cost me probably $200 instead cost me $1000, (had to max out my credit line and borrow money from a friend). Smarter move would have been a. to refuse taking the cat to begin with, or b. having her euthanized. She’s a good cat though and I’ll manage to get everything paid back. You live, you learn.

“As for payment plans, do you ask the grocery store to take payment plans? Veterinary offices are not financial institutions, and while it’s fantastic that some clinics are kind enough to offer them, I certainly don’t think it should be expected”

My Dr. takes payments. My chiropracter takes payments. Our regular vets, (large and small animal) take payments. My dentist takes payments. I guess I’m just used to being able to make payments on a large bill for medical services. I can’t remember ever going to the grocery store and spending $1000, but I imagine if I did, they would not take payments. :wink: I understand that many businesses do not take payments and unfortunately for me, this clinic was one of them.

“PS - Parvo doesn’t require contact with new dogs or people. It can live in the soil for months.”

The puppies were never on the soil. They were raised in the house. They had no contact with other animals, new people, etc. We’d lived here for 8 years and never had a sick dog on the property. The opthamologist’s clinic is a vet clinic and on the eye-exam days is filled with dozens of puppies, in and out of the examining room. The incubation period was right and as far as I can guess the clinic would have been the only exposure they had.

“And PPS - Your vet likely LOST money by treating your 8 puppies for only $1200 and missed his vacation. I’m glad you appreciate him – you should.”

I know this and I am extremely grateful to our vet.

Just an update on the kitty I had mentioned earlier. In part cuz I am am guessing some of you (even if only 1) are wondering how she is doing, and in part to demonstrate why we do what we do.

Blood work was repeated this morning. After a night of being on aggressive fluids, her kidney numbers almost doubled!! And her potassium is now 8. And she didn’t urinate all night while being on 3 times her maintanance amount of fluids. So they xrayed her this morning (I would have ultrasounded her but the vet on today is not yet comfortable with ultrasound). Her belly is full of fluid.

Now, to REALLY know for sure what the fluid it we really need a sample of it and to test it. However, 1)I bet it is urine and 2) no matter what it is she needs to surgery to fix it. So I could “pad the bill” and take a sample and test it. Esp since the owner’s home owners insurance is covering all of the bill. But we won’t. Rather the vet is calling the owner to say that she needs to go to surgery today. Soon.

Again, to make a point and not to be a smart as*, this is why we do repeat testing, etc. If we went on just by how the cat looked it would be easy to say she doesn’t look that bad (and she looks about like she did yesterday afternoon) and she is a cat and cats alot of times won’t urinate in their cage until they absolutely positively have to. And even then they often just lay there and go on their bedding, which drains thru the mat to the papers below. So in a typical day time practice, esp on a holiday weekend, it is unlikely any of this would be noticed. Until the cat was found dead in a day or so.

THAT is why ER and CC (critical care) costs more. Overhead aside.

[QUOTE=mvp;5627137]
A serious question about this: Why do you all need to repeat a test done elsewhere within a reasonable time frame?

Truly, I never understand this and therefore get paranoid or huffy. Are you padding the bill? Do you not believe me or the other vet when I hand you the results of the last version of the test done? I’m more honest and intelligent than I look, but I do need to be educated. I’m good with motivations I can understand. Because this doesn’t work like human medicine where it’s “treat now, ask about cost later” I also want to have some part in deciding how “gentlemen… we can rebuild him” or “meh, he’s livestock” our treatment will be.

Sometimes I think it’s that I bring a “large animal” perspective to my relationship with small animal vets and it’s unwelcome. IME, horse vets dispense a lot of education along with treatment, so I expect that of all doctors. Woe be to the MD who ever has to treat me as the patient![/QUOTE]

The other reason so many times we need to repeat it? Because 99% of the time we don’t have access to the results from the regular vet. We just have the owner of a cat standing there saying “They said everything was normal” While the cat practically SCREAMS renal failure…

If you can hand us actual bloodwork results there would be a lot less we would feel the need to repeat, just as an FYI to anyone who didn’t know, or wants to Bi*^% about us “padding” the bill.

And i’m not even going to respond to the poster earlier, because I can’t even begin to think of something top say that wouldn’t have me kicked off this forum in the next 5 min! But what I will tell you, is that I worked overnights, 7on 7 off schedule, minimum of 76 SCHEDULED hours in a week for signifigantly less than what I’m making now working “normal” daytime hours at a regular practice.

And even so, I if I didn’t have a toddler I would like to spend time with I would go back to ICU/Critical care in a heartbeat! I can still tell you the name of the first patient I lost, and I’ve lost count of the many hours I sat by cage racks in isolatin watching parvo puppies get sicker and sicker. It takes a really long time to get that burning smell out of you nostrils, and even longer to quit blaming yourself for the one that died while you had to pee. :cry: I LOVE my job, and while I know thousands of people would quit their jobs the minute the won the Mega Millions lottery I’m not one of them.

I thank each and every one of you who understand the care standards are higher at an emergency clinic, and therefor the overhead and costs. I also appreciate those of you who understand that not all vets/techs/clinics were created equal, and do not hold the misdeeds of one against the whole.

Katherine
Vet Tech

I would add to this whole conversation…as an overnight ER DVM…that contrary to the implications of some, we do not make a boat load of money. Most people go to vet school with the understanding that this career is for the love of making a difference, not for making much of an income. Overnight care is very costly to provide, especially on the nights when nothing walks through the doors. The staff, the overhead and the more advanced diagnostic equipment still have to be paid for. This costs money that has to be made up in higher ER fees.
The other thorny issue is the question of payment plans. We used to take payment plans at the hospital where I work. We had to stop 5 years ago when we wrote off $95,000. Yes, $95,000 in unpaid medical bills that the hospital had to absorb. The government doesn’t cover that as in human medicine. Sorry, but the number of bill slackers has become painfully high while the cost of medical supplies and everything else has risen too. So now we do require deposits and payment in full. Nobody likes it, including the doctors and staff, but reality intrudes on the ideal world.

We’ve got a fabulous ER vet clinic nearby - I think they (Cobb Emergency Vet Clinic - they were the subject of a “People” photo essay several years ago) were one of the earliest around.

I used them twice when I had my cocker spaniel. Once when he was HBC - my sister saw it happen while I was at work and took him in. They called me to give me a brief synopsis and to get Tx authorization. NOTHING was mentioned with regards to paying before treating. Thankfully it was minor injuries - some cracked ribs and bruises. I don’t remember how much it cost, but it wasn’t outrageous - not much more than I’d have paid the regular doc. The second time was when he nearly tore off a whole cornea. Costs discussed upfront and I think I did have to pay the $85 initial consult fee up front. Again, I don’t remember what was charged, but that means it probably wasn’t anything stupendous. And they saved his eye. :slight_smile:

Yeah - that equipment is not free, nor is the maintenance on it. For example, the same clinic kept my then-BF’s new puppy on supportive care overnight after diagnosing the pup with a patent ductus. The options were to do the surgery to close the PDA that night, or keep the puppy on O2 and various other means of support until the regular vet opened the next day. He opted to wait, authorizing surgery if things got critical/dog appeared in danger of crashing. Pup made it through the night (and had the surgery at regular vet the next day and is still kickin’).

But yes, that pup got frequent blood gas analyses done, plus all the fluids, etc. Not to mention the techs who are trained to recognized subtle clues that things might be about to go south.

I have not read through all of the other posts, but this was my experience last Friday night after having to take my beloved dog to a 24 hour emergency veterinary hospital due to the long weekend (Canada’s long weekend was last weekend) and my regular vet being out of town.

I don’t have children, so my dog is my life!! :wink: 9 1/2 years old and never a sick day in her life. Started violently throwing up every hour on the hour, couldn’t keep food down, lethargic, not walking good, couldn’t get her up, excessive panting due to abdominal pain.

Took her into the ER at 3 am. I knew before we got there that I wanted to do bloodwork, IV fluids and 2 xrays of her abdomen. I had to pay $149 up front before the vet would even look at her as the exam charge. Not very nice there or very welcoming, but boy were they ever quick to run into the room with a printed out quote of $1,700 just for bloodwork, overnight hospitalization, 2 bags of IV fluids and a basic blood panel!! :eek: I was devastated and said absolutely not! Keeping her hospitalized until morning was $220 and just setting up the catheter for IV fluids was $120. Are you kidding me? :no:

The people in there were cold and distant, and when I said I could not afford $1,700 just for bloodwork, fluids and 2 x-rays, I was treated like an outcast. So I asked for just a simple blood panel, and again, a quote on paper got whisked in so fast it made your head spin. Ended up walking out of there with a $380 bill, managed my dog over the weekend and waited until Tuesday until my regular vet was back in the office.

My dog ended up having leukemia and we had to put her down yesterday :no: But it was done by a sympathetic vet who knew we tried to do all we could, charged us reasonable fees and had some empathy for us…which the emergency hospital didn’t seem to have the time for…even though we were the only emergency patients in there that night. I would NEVER go there again - because of the expense and because of the lack of respect, sympathy and understanding towards the animal owners!! :no:

Sigh.

See, I get hammered at the other end: When I’m at my regular practice and I want to see and have copies of the lab results. My vets will take the time to show me those and explain them to me… but only if I ask. It strikes them as unusual.

OK, I’ll stop posting now as I think further comments from my might help this thread degenerate into a full us vs. them discussion.

RE: Insurance: This was a very unusual circumstance. In 30 yrs, this is the first time I have ever heard of home owner’s insurance covering veterinary expenses.
To make it a bit clearer, these people lost their entire house in a tornado. One horse got impaled with a piece of wood and in an equine hospital (that is not going to be be a cheap one either!!). Of her other 4 equines, they are farmed out in pairs to friends. The other cat is ok. The 4 dogs are being boarded. The family is living in a hotel.

THAT is why the insurance company is picking up the tab.

Update on the kitty: She had a couple of hours of surgery yesterday to fix her bladder tear and her abdominal wall hernia. She is no where out of the woods but should make it, with more intensive care: feeding tube, urinary catheter (THAT is a trick in a female cat!), a blood transfusion, a synthetic protein called Hetastarch (oh, her albumin dropped to 1.4) and well as continuing her fluids, antibioitcs and pain meds.

Daventry: I am so sorry for your experience at your ER. That really sucks. I have to admit I have worked at some that you must pay the exam fee up front, etc. Just like you describe. Many of those are share holder owned though and the share holders, which are the other vets in the area!, want to be sure they get their return on their investment. Admitedly, your vet may not be one of the share holders. (And I have had shareholder vets gripe me/us out over “our” policies and fees. When they are the ones that set them!! Go figure.) I am fortunately we are privately owned, and by a veterinarian whose forte is NOT business management :wink: And we have a lot of lattitude when we feel it is warrented.
I don’t know the economic demographics of your area but if the exam fee is an indicator, you are in a higher cost of living than we are in Oklahoma. For that matter, MOST of the country/canada has a higher cost of living that us!
Our overnight ICU hospitalization (15 hr = overnight) is $90. IVC and starting fluids is about $100. Additional bags are $25 each. 2 xrays are about $150. Not knowing what lab work they were doing…our “routine” CBC/Chem/Lytes is about $150. I am sure these are more up there. What else was in the estimate? There had to be other things?

And I am very sorry to hear about the diagnosis. Has the type been defined and any treatment discussed? I don’t do oncology so I am pretty ignorant in that area; I refer to people who do oncology for that part.

mvp: If you understand the blood work results based on your vet’s explanation, no reason to ask for more detail. But when we are repeating your vet’s blood work I would not be surprised when an owner asks for an explanation. I do alot of mini-physiology with owners.
Medicine is expensive. I am sorry. I am not in control of the costs of the drugs, the electric/water bills, the techs’ salaries, cost of continuing education (required for license renewal), required license fees, property taxes, etc. As others have said, ER/CC units have more, and different, equipement. I don’t have the luxery of sending blood work out; I have to be able to do it in my hospital, now. We have 2 patient monitors; the newest one was $36K. We have high end ultrasound and digital xray that interface with one another. (My boss cringed when he put in the digital xray and said he had never bought a piece of equipment that cost more than his (one story ranch) house!!) 4 anesthesia machines. ALOT of stuff that your vet usually doesn’t have.

And yes, it does have to be paid for by the owners. That is unfortunate fact of life in our economic structure.

And yes, some folks do go to vet school to be “adequate” vets. Some don’t want to do the stuff I do. Likewise, I don’t want to the stuff they do. No one goes to school to be a crappy vet though!! But just like riders/trainers, there are all ranges of skill, quality, and fee structures.

For all of you who have had crappy experiences at ER’s, I sincerely apologize and do feel your pain. I have had owners get mad at me and ones that don’t like me too. So we aren’t all perfect. :frowning:

[QUOTE=Daventry;5631330]

I had to pay $149 up front before the vet would even look at her as the exam charge. [/QUOTE]

our local hospital for humans and the local medical group are doing this as well. The ER can’t and they are so in the hole, it caused the hospital to consider shutting down 2 years ago.

Don’t blame the vets, blame the patients who don’t pay their bills.

How about YOU go into work and when pay day comes around, your boss gives you a check that bounces. You wouldn’t want to go to work either! And it happens all the time to vets.

I have never figured out why people have such a hard time paying for services from a vet or farrier. Seems like those 2 professions are ones that get hit frequently.

I’d like to throw my support behind the vets and their staff right now. I started another thread dedicated to them but it has not gotten a lot of attention, so this is for them.

Thank you for what you do. Thank you to Dr. Imbur who saw my young dog with severe gastoenteritis yesterday even tho I am not a regular client of her practice. She was through, helpful, kind and honestly listened to what I had to say. This clinic was slammed full yesterday, as it is a holiday weekend and they are one of the few open. They had office hours until 1pm but I’d lay down my next paycheck that Dr. Imbur was at the clinic well past that!

Vets do a job I couldn’t and don’t want to. I am more than happy to pay for that service.

Daventry, I’m sorry for your loss. I don’t doubt you when you report on what you were quoted. But I can’t even fathom how they got to that high of a total Heck, I think $1700 would cover much of the tab of hospital care for an impaction colic (non-surgical) at a top notch equine facility in my area. Full foreign body surgery for a dog is going to run 1500-2000 where I do ER work depending on what exactly has to be done.

Regarding requiring the fee up front. I had to take on of my mom’s corgis to Tufts a few years ago. As I tried to get through to them, the message over and over again was that the admit/exam fee of $160 was due upon arrival. $3800 later her dog is still alive (and this was in 2005) after his red blood cell and platelet counts bottomed out due to Ehrlichia. Mom put it on her credit card, it was worth it to her. Care credit is another option.

As for why some places are so adamant about getting that initial fee, people routinely waltz in with no plans to pay. I had a women in with her cat last night, hysterical. The cat turned out to be fine. We evaluated and x-rayed with no estimate. She gladly paid. Meanwhile, out back is the chihuahua and her two puppies that now belong to the practice. Her owners allowed her to become pregnant without ever figuring out their responsibility in this plan. When she needed a c-section, they promised to return with money to pay, Deb did the surgery (not that she would have let the dog suffer) and the owners never returned. I saw a cat with an abscess, simple visit. Owner consented to care. Total bill around $150. Despite the banner out front which lists the exam fee, when it came time to check her out, her response was “Well, I have $25.00 in cash” she had no debit/credit card and wanted to give a post-dated check.