Thursday, October 25, 2007

Good Medicine Is Not Negotiable

Veterinary medicine is a business to be sure. Just like any other businesses, veterinary hospitals need a healthy bottom line in order to afford payroll, inventory, mortgages, and all the other expenses that maintaining a hospital incurs. Unlike other businesses, however, veterinary medicine is held to a higher ethical standard that is predicated upon establishing the best quality diagnostics and treatments to help patients.

Despite this standard, some pet owners try to treat veterinary hospitals as other businesses, calling clinic to clinic to find the cheapest rate for a surgery for their pets. Sometimes when we offer our price, they will tell us that a clinic down the road offers it for less as if we are going to be so desperate for their business that we will agree to match the price. Other times, they will take the itemized estimate we give them for a given procedure, and ask about moving forward with the procedure, but omitting certain services - sometimes even pain management injections, intra-operative cardiac monitors - in order to save on cost. Still others will even low ball our estimate, as if we were haggling over a car.

In order to appease these types of clients, some vet hospitals play into this and offer their services at a lower cost by cutting corners. One less pain injection here, a cheaper lower quality anesthetic there, omit a little of this, then a little of that, and there you have it, a procedure that costs less. The patient may have a stormier, more painful, perhaps even more dangerous recovery, but that procedure will be cheaper. My hospital is not one of these types..

I will not compromise my level of medicine by cutting what I deem essential top of the line anesthetics, pain management medications, and vital sign monitoring equipment. At the same time, I do not have any obligation to give away valuable services and medications to clients that do not want to pay for them. I would rather not perform a given procedure rather than perform it with one hand tied behind my back under these circumstances.

Some of my peers think that my stance is too rigid, and that I sacrifice revenue by refusing to compromise the gold standard. My answer to that is that I would rather not have those that value a bargain in higher regard than good medicine and what is best for their pet. I prefer a smaller client base comprised of people that not only accept my standard, but enjoy that I offer only the best for their pets and nothing less.

A few weeks ago, a client brought a pitbull in that had a tumor on the bottom jaw that I deemed should be surgically removed ASAP. My technician gave her the estimate for the procedure, and after that, we did not hear from her for a while. This week, the client finally made the appointment to have the procedure performed. She told me that the delay was that she had gone to another vet hospital to see if it would be cheaper to have it done there. When she received her estimate, she had found that it was 30% cheaper than our estimate. A human anesthesia nurse herself, my client told me that her decision as to where to have the procedure performed was an easy one. Where the other hospital's estimate would have indeed saved money, it did not include what she deemed essential items that were present on our estimate: an anti-inflammatory pain injection to complement a narcotic pain injection, a fentanyl patch (a morphine derivative pain patch) to go home, and 7 days of oral anti-inflammatory medication to go home.

Now, one may think, "Well, this client was an anesthesia nurse that understood what everything on the estimate means. Maybe the people that go with the lower cost procedures just don't understand that lower cost often sacrifices quality." My rebuttal to this would be that the client is never just handed an estimate for a procedure. As the client receives the estimate, a technician fully explains each item line by line. We even advise the client that if considering other estimates, that lower cost may mean that some of the important services and medications may not be included.

I would take one client of the mind of the anesthesia nurse over any number of those who value bargain over good medicine.

To pet owners: always keep in mind that, just as in all other industries, in medicine, you get what you pay for.

Roger L. Welton, DVM
Founder, WebDVM

Friday, October 5, 2007

The Dirty Truth About Online Pet Med Companies

Several months ago, our drug rep for Merial, a very prominent animal health care pharmaceutical, was in my hospital giving the staff a learning seminar about their flea and tick product, Frontline. What prompted Rob to come in educate the staff about Frontline, was the fact that I had mentioned to him on one of his visits that I was seeing an increased number of patients that were having flea and tick troubles despite having Frontline applied as directed.

The first premise that he discussed is that the first question that we should ask the client when Frontline fails, is where he or she is purchasing the product. The reason Rob brought this up is that Merial does not sell to online pharmacies, but deal only directly with veterinarians. Since they refuse to stock these pharmacies, the pet medications they sell must come from overseas.

These overseas products do not undergo the scrutiny of the USDA as a result lack quality control. This leads to products that are not what they claim to be, and are even found to be outright counterfeits. Merial is legally powerless to stop this, since apparently our government does not care about the health of its citizens' pets (overseas prescription medication is expressly forbidden in human medicine). As a result, Merial, as well as many other animal health pharmaceuticals, refuse to guarantee the safety and effectiveness of their medications and preventives that are purchased online.

Frontline is an excellent product with a great reputation, and for it to fail is unusual and usually because the pets' environment is heavily saturated with fleas and/or ticks. As my staff and I began to examine cases of failure of Frontline effectiveness, we found the a large percentage of Frontline failures were from Frontline that was purchased from online pharmacies.

Once we came to this realization, we became concerned about how potentially dangerous it would be for for a patient to be on an ineffective or counterfeit heartoworm preventive, especially here in Florida where the disease is so prevalent. In the three years that I have practiced in Florida, there have been a handful of cases where dogs have gotten heartworm disease despite being on a reputable brand name preventive. I can only wonder if any of these cases were the result of patients being treated with preventive purchased from online pharmacies. I certainly plan to keep track of this in such future cases.

As a result of all this, I found a company called vetcentric that has set up an online pharmacy for my hospital (Maybeck Animal Hospital VetStore). Pet medication pharmaceuticals readily sell to Vetcentric, since they represent animal clinics directly. Not having to pay inventory costs to offer the items, I can offer the pet meds at a discounted price, often competitive with online pharmacies. Also, the clients still get the benefit of home delivery, but the product they recieve comes from the USA based manufacturers, complete with the manufacturer guarantee of safety and effectiveness.

Roger L. Welton, DVM