Literature’s most enduring story of redemption — Charles Dickens’ “A Christmas Carol” — is a perfect framework for Dr. Zeke Zekoff’s concerns about how the veterinary profession can best deal with pets whose owners cannot afford to pay their medical care.

“The question that begs to be asked today is if our profession will be considered the pre-redemption Scrooge in the future when it comes to being unavailable to provide health care to a larger share of the animal population because we have priced ourselves out of the market?” asks Zekoff of Blue Ash, Ohio, in an unpublished editorial to a trade magazine.

Zekoff is concerned that veterinarians will be, or already are, unfairly perceived by the general public as the pre-transformation Scrooge — greedy and self-absorbed — even though almost all clinics do pro-bono work. As a veterinarian who believes in charity, Zekoff wonders how the profession can balance the medical needs of indigent pet owners while recognizing a practitioner's need to sustain a business and earn a living. He fears that "giving back" ranks second to a profession that's fixated on advanced medical technology, which increases the costs of veterinary care.

At the same time, many in the profession feel that veterinarians aren't recognized for the pro bono work that many perform on a regular basis. Examinations, treatments and surgeries take place behind the scenes, rather than in the public eye, where others can view such giving. "We don't blow our own horn," Zekoff says.

Still, the charitable needs of society are clashing with the business responsibilities of private practitioners, and Zekoff believes his colleagues aren't doing enough to find a solution.

“One shelter here in Cincinnati has 600 cats because it’s a no kill shelter. To me, that’s Auschwitz. They never get adopted," he says. "As a profession, we are ignoring this problem, and it will bite us in the rear end."

Zekoff believes that all elements of the veterinary profession — private practitioners, academicians, shelter veterinarians, animal welfare advocates, rescue workers and pet owners — should work to solve the dilemma.

But when it comes to public perception, veterinarians often get a raw deal, some in the profession suggest.

For example, the time and talent that veterinarians donate while performing spays and neuters at a shelter often is overlooked by the general public. The shelter is the public face, receiving the donations and adopting altered animals. The contribution of the veterinarian in the back performing surgeries often goes unnoticed.

So it’s no great surprise that some pet owners think veterinarians don’t do enough charitable work, or even worse, care only about making money.

That's unfortunate, considering that in addition to time, veterinarians often incur out-of-pocket expenses for materials to treat needy animals.

Having practiced for 40 years, Dr. Warren Kaplan of Merrick, N.Y., came to a conclusion long ago: “Everybody is all for helping out the poor pet owner with low-cost this and that. But it’s the veterinarian who is asked to bear almost the entire cost (or all the cost) of these programs.

"I realized if a procedure costs me $75, and I do it for the low-cost program for $25, I am personally financing $50 of every procedure I do right out of my own pocket!” Kaplan writes in a Veterinary Information Network (VIN) message board discussion.

Zekoff believes that negative public perceptions and attitudes contribute to the compassion fatigue felt by veterinarians .

“A little bit of recognition from shelters would be the juice that keeps us going," he says. "The ones that do are the ones we bend over backward for."

Zekoff also knows that too much charity performed in a private practice can lead to compassion fatigue and financially drain the business.

Veterinarians are unfairly expected to shoulder the financial burden of charitable works, Kaplan contends.

“My feeling is that these programs (such as low cost spay/neuter) are a community problem, they’re not ours,” Kaplan says. “That doesn’t mean we’re not a part of it. It shouldn’t be just the veterinarian reaching into his pocket every time. If the county or humane society wants to start a fund and say to the veterinarian, ‘You charge the client $25, and we’ll reimburse the $50,’ then at least it’s my cost, and it’s up to me.

"I’ve had clients who fell on hard times and that’s my choice (to help) and my charity," he adds. "I’ll donate some of my charity to do that, but that’s a lot different from a client expecting you to personally finance a spay.”

When Dr. Josephine Banyard tells people about the charitable work that veterinarians do, they often assume that she's exaggerating.

"(They think) we are not telling the whole story. It needs to be something from an association or based on a study to be believed," writes Banyard, of British Columbia, in the VIN discussion.

A lack of communication could feed public assumptions that veterinarians aren't charitable enough, considering clients have little true understanding about what it costs to practice veterinary medicine, some VIN members contend.

Many clients seem to believe that veterinarians overcharge for their services and fail to consider the huge costs associated with veterinary equipment, education, staff salaries and other elements of a practice's overhead. Kaplan suggests that the American Veterinary Medical Association run television commercials showing price tags on equipment so that the public might learn how expensive it is to practice veterinary medicine.

High costs for advanced equipment also concern Zekoff, who deems much of what some refer to as "toys" to be unnecessary in everyday general practice.

“No one wants to know what percent of the population can afford vet care. We can do a lot to help animals without going to bells and whistles," he says.

While new technology is meant to enhance medicine, it also saddles many practitioners with debt. Zekoff suggests that his colleagues can do more with less by getting to know clients and practicing a good bedside manner.

That's the "fun" part of the profession, he contends.

"Lots of good people need help," he says. "I don’t want government agency help, but a tax break would be nice. If an economically hurting person does an economic euthanasia (a term used to describe when a pet is euthanized for financial reasons), there is an emotional and social cost.”
 
While some believe in the adage that people should not own pets if they can't afford them, Zekoff deems that notion too simplistic. “If I followed that theory, I wouldn’t have three children.”

Rather, education is the key, he says. Owners should know about the need for charitable funds from the private practices they visit.

“Most practitioners have to be taught how to let clients know that there’s a need because we are poor marketers," he says.

Alternatively, savvy solicitors like the People for the Ethical Treatment of Animals (PETA) and the Humane Society of the United States (HSUS) know how to get a pet owner's donation.

"HSUS has a $250-million war chest that doesn’t help animals," Zekoff says. "It’s a war, and we’re in the trenches. No one is here to help us.

“We need to educate the public as to where charity comes from," he adds. “We should engage the pet animal industry to help us."

Zekoff proposes that companies that rely on veterinarians for profits set up charity accounts that veterinarians can dip into to help animals. He hopes that, like Scrooge, the veterinary profession will wake up to a new way of approaching those in need.

Asking clients, suppliers and associations to donate toward an individual clinic’s charitable fund is one way to maintain financial integrity for the clinic and take care of needy animals in the community. Veterinarians are more than willing to help, but they can’t do it by themselves, Zekoff says.

Kaplan agrees that the responsibility lies beyond practitioners of veterinary medicine. “If people really want to help out, everybody has got to kick in," he says.

By appealing to the right people, the undue financial burden on veterinarians can lift, Zekoff adds, thus alleviating anyone’s need to say, “Bah, humbug.”