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It’s always about the money

It’s always about the money
Clients typically need only the understanding that it’s OK that they can’t afford the veterinary care gold standard.

Four or five months out of veterinary school, I wasn’t in the habit of talking about finances with pet owners. One day, however, a woman came in with her pet. I already had an educated guess as to what the problem was, but I wanted some diagnostics as confirmation. The estimate for diagnostics was $450, which she agreed to. I got a definitive answer about the problem, but when I told her the cost of treatment, she said, “I can’t afford that. I only had $500.”

That moment sticks with me to this day. I had a confident prediction of what was wrong before diagnostics, and I needed only diagnostics to prove I was right. However, if I had started with a conversation about finances, I might have had an opportunity to provide better care given her resources. Both sides made mistakes there, but it was my job as her veterinarian to guide her in her pet’s care at that moment. She trusted me to do that and I let her down.

Talking About Money

A huge part of learning about veterinary medicine is not just learning the facts of medicine, it’s about finding what’s important in the mass of knowledge you do have and then communicating it. Clients come in having done research about costs, but they don’t understand that what they researched isn’t always relevant.

Newer veterinarians are often inexperienced at client communication, and they get frustrated about why our profession can’t communicate more effectively. But the communication issues are often about money. We know it’s always on the client’s mind, so failing to give an estimate is a cardinal sin.

The most important thing is to communicate why we bring up finances in the first place. We’re not doing it because we care about the money, we’re doing it because we care about treating the animal effectively. If a client has financial concerns, we must know that upfront. If the client has only $1,000 to spend and isn’t covered by pet insurance, for example, we don’t want to expend all our resources on diagnostics when reasonable educated guesses might be appropriate. We could use the budgeted amount for treatment and continued care.

With all clients, you need to know when to ask, “Do you have financial limitations? I need to know because this can get really expensive.” At the end of the day, if I’ve spent all the money on diagnostics, I’ve messed up.

When the Price Isn’t Right

Veterinarians can be a bit judgmental about people because of their finances. We give them an estimate and tell them what should happen — the gold standard — but we sometimes lose heart. We care about getting an answer, but we also need to care about the path to getting that answer.

That said, there are certainly times when clients come in knowing full well that they don’t have enough money to pay for treatment. They’ll act as if they do, then wait until we’ve provided services before admitting that they don’t. It’s not uncommon in emergency hospitals, and it’s sad that a few untruthful clients have ruined the goodwill for everyone.

At the other end of the spectrum, some clients honestly believe they have enough money for treatment but, for various circumstances, the finances are not available at that moment. In these cases, I have a couple of recommendations.

First, suggest financing through credit offers or payment plans.

As a second line of defense, we know that some veterinary charges can be “forgotten” or zeroed out. For example, morphine is a cheap medication, whereas methadone is expensive. If I have a situation where I’m worried about the cost, I always choose what’s going to cost the hospital less.

Worse-case scenarios will require asking for the animal’s surrender or passing the bill to collections, but even these are better than unnecessary euthanasia.

Start With the Gold Standard

Different levels of veterinary care exist, but I always want to communicate what my best medical advice is regardless of price. I start with the gold standard — what we’d do if money were no object — which is an easier conversation when pet insurance is in play.

Then, it’s up to the owners to say whether they can afford the care. If they give any indication that they are hesitant about the price, I tell them I understand and that we have options. I make clear that for everything we don’t do, more question marks will emerge in the diagnosis, increasing the possibility that we get something wrong.

Once that door is opened, however, clients typically need only the understanding that it’s OK that they can’t afford the gold standard. I often tell them, “Honestly, I couldn’t afford that either!”

Fixing a broken leg is simple enough, but the cost of caring for complex medical issues can vary by thousands of dollars. That’s why it’s so important to communicate the costs early.

Dr. William Hodges is a Raleigh, North Carolina, relief veterinarian and an advocate of Pawlicy Advisor, a pet insurance comparison website.