We’ve all been there: the big vet bill. It feels excessive. It feels mean. It feels frustrating. It feels like that piece of paper is pitting you and your pet’s illness against the vet who holds the keys to curing it. We know that vets have dedicated their lives to helping sick pets, so why are they gating it off behind such steep costs? There’s good reason why modern healthcare (veterinary and human alike) is so expensive, but the answer is complicated and we’re going to need to explore the business of providing healthcare first in order to understand it.
Is it the hospitals?
The first logical place to assume where that large bill is going is towards the profitability of the veterinary hospital. However, this is not the case. The average profitability of veterinary practices falls around 10-12% with many veterinary practices below even those slim margins Pet owners often feel confused or frustrated when they discover that their pet's prescription medications can often be found at lower prices online or at big-box stores. However, that discrepancy in price isn't because your local vet is taking advantage of you. Instead, it is because they can't afford to stock and sell those medications at the same price as larger retailers. Those online pharmacies are actually much more profitable than your vet’s business, mostly due to economies of scale and the fact that they don’t have the large overhead (see below) of providing medical care as part of their business. For comparison, many large online pet pharmacies run profit margins of 20% or higher, roughly double that of the average veterinary practice. Most veterinary hospitals are small businesses and as such they struggle to compete with the prices that larger businesses offer, especially ones that don’t have all of the costs associated with operating a physical business for their customers. Even if all veterinary hospitals operated as non-profit organizations rather than as businesses your vet bill would still be about 85-95% the same size as it is now because nearly all of your veterinary bill contributes directly to the cost of your pet's care rather than being kept as profit.
Is it the vets?
If the veterinary hospital isn’t getting rich off of that large bill, the next place to look to see where the money could be going is to look at the veterinarians themselves. Unfortunately, you’re not going to find anyone getting rich there either. Becoming a veterinarian in the United States requires a similar 8 year path of higher education as a physician including 4 years of veterinary medical school, with the average cost of veterinary medical school being above $200,000. However, the average primary care physician makes about 2.5 times the salary of the average veterinarian, making managing student loan debt much more difficult for veterinarians than physicians.
To be clear, this isn’t meant to be a “woe is me” complaint coming from a veterinarian. I love what I do for a living and I wouldn’t trade this profession for the world. Providing compassionate care to animals and pet parents isn’t just a job, it’s a vocation. Becoming a veterinarian represents a commitment to putting the welfare of animals ahead of the pursuit of personal financial gain. Still, just like veterinary hospitals I also have basic expenses like rent, food, and utilities so working for free isn’t an option. Ensuring that your pet has a well-trained doctor to care for them requires vets to have sacrificed nearly a decade of their working years and taken on a large amount of educational debt. That debt means that veterinarians cannot afford to work for less pay than the sum of their student loan payments and basic expenses. We don't want cost to be an obstacle for your pet to get medical care, but veterinarians simply don't have the option not to be paid for their time and work (and by extension, the cost of their training that enables them to do their job).
The financial situation is even worse for veterinary support staff. Despite doing skilled work comparable to nurses and medical clerical staff, most veterinary support staff get paid in the range of $10-20 per hour. Their work is exhausting, sometimes dangerous, often thankless, and they do not get paid even a fraction of their worth. To all of the veterinary technicians, assistants, client care representatives, and all other veterinary support staff from this veterinarian whose butt has been saved many times by the amazing safety net behind me: thank you for what you do.
The real answer is in the cost of the care itself:
So if the vets and their businesses aren’t getting rich, where is all of the money going? The answer is that modern healthcare is fundamentally expensive, both for people and pets. Vets and veterinary practice owners simply don’t have the power to make something that is expensive to provide into something that isn’t expensive to receive.
Modern healthcare has grown more expensive over time, but the quality of healthcare has grown with it. The days of “give him antibiotic and steroid injections and if he doesn’t get better then it was his time” are fading and increasingly being replaced by vets equipped with better science, better tools, and (most importantly) better outcomes. Hunches, blind treatment, and guesswork have been replaced by evidence based medicine, a systematic approach to medical practice where diseases are diagnosed and then treated with specific, targeted treatment that is supported by scientific evidence. Antibiotics, steroids, and euthanasia solution (“three bottle medicine”) are inexpensive compared to diagnostic tests and modern treatments, but usually fail to live up to the expectations of the modern pet parent. When you bring your sick pet to the vet the expectation is that they’re going to be able to figure out what is wrong with them and make them better, just as you would expect from a visit to your own physician. Veterinarians have better tools than ever to achieve those goals, but they come with a cost. A digital x-ray unit can cost upwards of $100,000. A portable ultrasound unit can run upwards of $50,000. Keeping the pharmacy and treatment rooms stocked with medications that have to be discarded and replaced if they are not used up before expiration is a constant drain. The list of expensive equipment (in-house blood analysis, anesthesia machines, anesthetic monitoring equipment, dentistry equipment, surgical tools, etc.), medications, and upkeep seems endless to a veterinary practice owner. Not only do all of these tools of modern medicine have up-front cost, but they cost money to maintain and eventually replace when they become worn out or obsolete. No matter how much veterinarians want to make veterinary healthcare affordable, nearly all of the cost of providing modern medical care exists outside of our control.
Since we can’t make good medical care cost less, what can pet parents do?
- Keep up with your pet’s preventative care: Vaccines and preventatives are much more affordable than dealing with the expensive diseases that they keep away. This also ensures that your pet gets examined at least once yearly by your veterinarian (at least every 6 months for senior pets) so that they can detect and address health concerns before they spiral into larger, more expensive issues to address.
- Be proactive in seeking medical care: Problems are always less expensive to fix when they’re still small. Waiting until a small problem becomes a big one is never a good idea.
- Get pet health insurance: Insuring your pet means turning large, unexpected medical expenses into a smaller, predictable monthly cost.
- If you have the financial freedom to do so, set aside money for unexpected pet healthcare costs: Setting up a savings account for your pet that you contribute a set amount to monthly can be an alternative to pet health insurance if you have the financial freedom to absorb an unexpected cost in the short term before the savings build.
- When times are good, be charitable: There are many non-profit organizations that assist people with unexpected pet healthcare costs or that provide subsidized low-cost healthcare. By purchasing Doc Wags products you’re making a small contribution to some of these organizations, but actively giving of your time and money when you’re able is even more impactful.
- Communicate your financial concerns to your veterinarian: We can’t help if we don’t know. Veterinarians default to offering “gold standard” care, but there are often less-ideal fallback treatment plans that we can come up with in scenarios where money is tight. There is often a spectrum of options for care that exist in the space between “gold standard care” and “minimum standard of care” that can be considered. We can’t guarantee the same chance of a good outcome with a fallback treatment plan as with a gold standard treatment plan, but at least communicating your financial concerns gives your veterinarian a chance to offer options that fit your budget along with an explanation of how that plan may be different from the gold standard approach. In situations where we can’t figure out a way to make the size of the problem and your budget line up, we may be able to direct you to low cost/subsidized care in your area.
- Be kind to the veterinarians and veterinary staff who care for your pets and understand that the decisions about what good medicine costs to provide are not in their hands.