The squeeze: What happens when owners can’t pay for veterinary care?

Tragedy in Michigan results in backlash against profession

May 2, 2014 (published)
By Tony Johnson

Dr. Tony Johnson

A recent tragedy put me in mind of this short phrase: Veterinarians are caring, trained professionals. 

All three words at the end of that sentence are important, but let’s look at each element individually. 

Caring: It is obvious to most that the majority of veterinarians’ work revolves around animals, so caring for and about animals is a vital piece of that. 

What may not be as obvious is that being a veterinarian is a people job, almost more so than it is an animal job. Nearly every pet also has a person attached to it, and good people skills are every bit as important as good diagnostic skills when it comes to being a veterinarian. And for many veterinarians, the person attached to the animal being cared for is why they do the job. 

Trained: Veterinary school is arduous and expensive. On average, veterinarians spend eight years in college while specialists — surgeons, oncologists, radiologists and the like — spend an additional three to five years honing their craft. My path was four years of undergraduate education, four years of veterinary school, one year of an internship and three years of a residency in emergency medicine.

The current student loan debt for a new graduate is around $160,000. Contrast that with the starting salary of around $67,000 for veterinarians in companion animal practice, and you start to see how financial pressures can creep into the picture. Seventeen years ago, I came out with about $80,000 in debt, and it took me close to 10 years to pay it off. These are individual pressures, but the economic woes of treating pets run deeper and wider than that.

Professionals: This may be where things get sticky. The bottom line is that this is a job.

It’s not just a job, but it’s a job. It’s how veterinarians feed themselves and their families, educate their kids and make their way through life. The problem is that the job involves asking people to part with their hard-earned money in exchange for providing medical treatment to the pets they love.

It's your money or your pet’s life in certain situations. We don’t do it to be cruel; we don’t do it to be greedy. It's how the system is set up. In human medicine, there are creative ways to avoid saying to a parent, "Your money or your kid’s life." There's medical insurance or socialized health care. But for pets, the burden is squarely on the shoulders of owners to pay veterinarians to make their pets better.

Veterinary medicine also is a business — and a business that doesn’t make money isn’t a business for long.

Why is this an issue right now? A recent case in Michigan highlights just what can go awry when this single-payer system breaks down.

At the risk of oversimplifying a nuanced and complex incident, consider this real-life scenario: A dog got sick after spay surgery performed at Hospital A. The night of the surgery, the owners took the dog to Hospital B (an emergency clinic) after Hospital A had closed for the day. At Hospital B, they were given an estimate for many times what the original surgery cost because the dog had lost a lot of blood and was gravely ill. The owners couldn’t afford care at the emergency clinic, so the dog was sent home and later died.

The owners, furious that the dog died after what they believed was a routine procedure (there's no such thing as a routine procedure when anesthesia is involved) took to social media, and the episode blossomed into a perfect storm of righteous consumer hatred. The staff at the emergency practice received death threats, including one from a caller who threatened to shoot a staff member.

The power and reach of social media to make one person’s story the banner that many carry in indignant protest was in full force that week, and the ripples reached far and wide. Thousands spread the story in a near-perfect logarithmic explosion within hours of the first post.

The dog owner, dismayed at the impact of her actions, later stated that violence and death threats were not the intended outcome of her message. 

During the crisis, I talked to the doctor who owned the emergency practice, and he expressed that this had been the worst week of his 20-some years in practice. The staff was afraid to go to work or answer the phone. He sounded hurt and beaten down and weary.

The implications of this incident go beyond one hospital’s fearful staff or the woes of a single practitioner. The recent suicide of a New York veterinarian facing aggressive pet-related activism and a public smear campaign shows just how high the stakes can go if the wheels of social media roll unchecked. Veterinarians are four times as likely to commit suicide than the general population, likely due to the financial pressures of the job, easy access to drugs that can be used for that purpose and emotional strain.

The sad truth is that incidents like what happened in Michigan play out in veterinary hospitals with shocking frequency. Every day and night, pets come in with injuries and illnesses that far outstrip the owner’s ability to pay for the care needed to heal them. Veterinarians are forced to juggle the holy trinity of veterinary medicine: the patient’s needs, the owner’s pocketbook and the doctor’s conscience. Many times, we can go with a medical plan that will suffice, perhaps cutting a few corners so our client can still feed his kids, we can get paid and sleep at night. 

But sometimes we can't, especially if the patient is too ill or the owner's finances are too limited. If a dog is in labor for 24 hours and needs a Caesarean section or a trauma victim comes in with a bleeding spleen, we close the doors and ask the pet owners, "What can we do?" Many times, owners will realize that treating their pet's illness will be far beyond what they're willing to pay and choose euthanasia. But for some, the squeeze of being caught between what is and what could be is not acceptable. They become angry, even enraged at the perceived unfairness of being asked to bankroll their pet's emergency care. 

This is what happened a few weeks ago in Michigan. It started with a spay and spiraled into a virtual, brutish cyber-mob, threatening to shoot people.

I liken it to the crisis in the Ukraine — murky, gray and unresolveable. What's "right" depends on your stance. Are you an angered and grieving pet owner or the veterinarian left feeling avaricious and whorish for charging money to do a job, which might include saving a life? Is the owner wrong for not carrying pet health insurance or saving in case of an emergency? 

About the only certainty is that the dog is not culpable. I think what's driving the vicious response to this incident is people wanting to find rationale for a needless death. They seek a villain and a hero; they want black or white, good or bad. The truth is usually much more subtle and complex.

It’s often easier to grab pitchforks and light torches to storm the castle than to consider this from all sides. The reality of many emergency cases is that each instance in the exam room must be negotiated, finessed and resolved based on the animal's medical condition and the owner's willingness or ability to pay for care.

The squeeze will always be there; there is no panacea as long as pet owners have to pay out of pocket. Every one of these situations has the potential to go nuclear and erase all subtlety and understanding with nothing more than the press of the ‘post’ button.

Veterinarians have the training, desire, dedication and care to make medical magic happen. But veterinarians can’t fix pets for free. Our job is to set fair prices, minimize suffering when we can and provide good service. A pet owner's job is to be prepared and pay for what they can, minimize suffering and not let things get financially out of hand. Owning an animal, whether it is a rabbit, a cat, a horse or an iguana, is a responsibility. 

Even if a pet is free, that doesn't mean it will stay that way. 

As a profession, we need to take stock that what we are doing is right, and that there is nothing wrong or immoral about making a living by treating pets. 

About the author: Dr. Tony Johnson received his veterinary degree from Washington State University in 1996 and obtained board certification in the specialty of emergency medicine and critical care in 2003 after completing a residency program in Portland, Oregon. He currently is minister of happiness and a consultant/editor for the Veterinary Information Network. He has lectured for several international veterinary conferences and is an active blogger and writer. He also is the recipient of the 2010 Small Animal Speaker of the Year award from the Western Veterinary Conference. He used to live in a converted one-room schoolhouse in the middle of a cornfield but has since taken occupancy of a normal house in a normal neighborhood with very little corn. He has two young sons, one daughter and a beautiful wife, Gretchen, who also is a veterinary emergency and critical care specialist. In his spare time he enjoys sleeping, eating and breathing with occasional forays into woodworking, cooking, drinking whisky, raising chickens, reading and writing (but not arithmetic).

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