Unpacking the Crisis: navigating the challenges of modern veterinary care

😲 Are you concerned about the rising costs of vet care? You're not alone and this episode dives deep into the issues plaguing the pet health care space, affecting your pets, you, and those within the veterinary industry.

It's easy to vilify veterinary professionals as money grabbing (and many do) but the truth is very different - Did you know that in the last 12 months, 25% of veterinary staff in the UK received absolutely NO pay raise? The preconception that vets are "only in it for the money" couldn't be more misplaced!

📉 Yet this is on the back of record vet bill rises. We're facing serious global challenges in pet healthcare:

- Inflation is skyrocketing, yet vet pay isn't keeping up, making it tougher for veterinary professionals worldwide.

- Costs are on the rise, not just for pet owners but for the clinics too, due to increased prices for drugs and necessary medical equipment.

- There's a trend of corporatization where shareholder returns are driving business decisions and the staff in your clinic may have zero say in pricing and service provisions.

🧐 Importantly, we need to consider the advanced level of care provided today compared to decades ago. Practices now are equipped with state-of-the-art technology to offer the best care, which significantly drives up the costs.

But is this also part of the problem?

This episode covers so much more, and while I don't claim to have all the answers these topics are vital for you to be aware of so we can work towards a future that works for everyone.

Learn more over in the show notes at: https://ourpetshealth.com/podcast/broken-pet-healthcare

Love the show? Sharing this episode or leaving a review helps others know it's worth a listen! - https://ourpetshealth.com/review

Transcript

Dr. Alex:
There are some seriously big problems within the pet health care space that affect your pet. They affect you as the pet parent, and they also affect everyone who actually works in the veterinary industry. And it's going to be easy for you to leave comments below that are vet bashing, are blaming, but that actually, as you'll hear later, is in a way part of the problem. And we all have a responsibility to fix this. So grab a cuppa and let's jump in. And while what I'm going to discuss are a lot of the the the data and the figures that I'm going to discuss with you today are based from the UK. I mean, that's where I train, that's where I'm from. Although, currently living and practicing in New Zealand, these issues are global.

Dr. Alex:
They're worldwide. I see them time and again in comments from frustrated, from upset pet parents on these YouTube videos. I see it in the press from different countries. It's just a global issue. But what really, I guess, triggered this video, me making this video was reading a report that in the UK in the last 12 months, a third oh, sorry. A 25% of vet staff have received absolutely no pay rise. And then a third again have received a pay rise between 1 5%. Now that really doesn't fit into the narrative that is also going on at the moment about vets being only in it for the money, being greedy, charging ridiculous fees to line their own pockets.

Dr. Alex:
Added to this report was the fact that actually half of all veterinary professionals, so that's going to be vets, but also nurses and other people working in the industry in the UK were open to moving abroad, moving overseas, leaving the veterinary industry in the UK. Again, that doesn't fit into a narrative of vets just raking it in, being in it for the money and fleecing pet parents at every opportunity. Now that's not to say that costs haven't increased, and that's not to say that there aren't issues. And I'm going to discuss some of those issues in just a little bit. But when you read posts, when you hear stories and they are attacking individual vets, you know, maybe we need to think that the comp that the situation is a little bit more complicated the UK veterinary industry for exorbitant prices effectively, and they received a record number of submissions from concerned pet parents about the increase in the cost of veterinary care over recent years. There's a big corporatization, issue going on issue. Is it an issue? Well, I discussed that in a little bit as well, but I think it was found that about 36% of, clients of corporate practices felt that the costs had climbed significantly in the last year or so compared with, a 26% of clients of more traditionally owned veterinary practices. But that's still a fairly significant increase in prices that people are absolutely feeling.

Dr. Alex:
Clearly, this is then kind of factored into the fact that we are record inflation. Certainly things hopefully seem to be coming down at the moment, but there's been record inflation levels. So the cost of living for everyone is being pushed right up, but that's actually doesn't fit in with the fact that vets have not been in vets and their staff have not received the pay rises to match inflation. So it could be argued and certainly very easily argued that veterinary industry professionals are being paid less than they were a few years back in relative terms because they've either had no pay rise in the last 12 months or that pay rise at 1 to 5% hasn't matched the rate of inflation. So when we then need to think about when we see the prices of veterinary healthcare go up over and above this rate of inflation. Where are those prices going now? Of course, there have been huge issues with just something like the provision of power in the UK. And I've heard the the the power bills of some practices have have doubled. They've gone up to astronomical levels to to such a degree where actually they were worried about being able to pay their power bills.

Dr. Alex:
Cost of supplies, costs of all of the goodies that are needed to provide advanced levels of veterinary care have gone up. Cost of drugs have gone up as well. Where the competition commission or where the report is investigating at the moment is partly in the cost of drugs because the cost of drugs from your veterinary clinic is likely significantly higher than maybe you can get in an online pharmacy. And that report, I mean, it doesn't surprise me. It reminds me of a couple of situations really just around the time when I graduated. And I can't remember whether it was just before or just after, there was another competition report into the provision of veterinary medicines effectively saying that veterinarians had a monopoly and were overcharging for the medications. The nuance of that report though said that actually they were undercharging for their professional fees. So the, the cost of the surgery, the actual time that was charged out was undervalued.

Dr. Alex:
And actually that the cost to the client should pretty much remain the same, but that balance should be redressed. So the cost of of drugs should come down and the cost of the the professional fees should go up. And I think we're still actually in a situation where that is the case. We are or practices are potentially over reliant on the sale of medications or pharmaceuticals, subsidizing professional fees. I certainly know that we have, a situation in a lots of cases where our nursing team, for example, are providing hours of hospital care and and their time is actually not being charged. It's being, kind of wrapped up in a hospitalization fee and that will be a daily or an overnight hospitalization fee. You know? And You know, and that's just one example where the traditional pricing model is maybe quite broken. The other thing that this report reminds me of is I remember not soon out of, vet school, someone came to me and said, look, I can buy this bottle of medication for for this price.

Dr. Alex:
And at that point in time, I could actually see what, we as a clinic bought that bottle for. And we couldn't even buy it for as cheap as our client was able to buy it from an online, pharmacy. And, you know, it'll be no surprise that we've got economies of of scale here. If you've got a faceless warehouse that employs skeleton staff and is stacked high, they can buy in in huge bulk and their overheads are really low. So it's no surprise then that they can provide that medication cheaper for your veterinary clinic to stock, a pharmacy, to have a well stocked pharmacy with all of the potential drugs that might be needed. You know, that is expensive. Things will go out of date because they're not used and those costs have to be recouped, you know, and it's important that a vet clinic has a well stocked pharmacy because you can't always wait 2, 3 days, even 24 hours, even 12 hours might be too much of a wait for a critical drug. But there's clearly a balance to be struck here, and you're well within your right to to shop around and look for cheaper, medication.

Dr. Alex:
There's there's absolutely no problem with that. Clearly, it needs to be from a reliable pharmacy as well. There are, lots of unreliable pharmacies. There's kind of a black market in pet pharmaceuticals, and you may actually not be getting what you believe you are and the safety and the storage and all that kind of thing. You know, you need to be sure that you're going to a reputable place. And there are various schemes across the world that that will will allow you to be sure that that is the case. And then I guess this discussion of, you know, the nursing care that I've just mentioned actually leads really nicely into just thinking about how much veterinary care, how much modern veterinary care takes in terms of personnel and in terms of equipment. You know, we, I often hear harking back to the good old days or, you know, 20 years ago, my, you know, my vet did X, Y or Zed on a shoestring.

Dr. Alex:
It didn't cost me very much. And we put our rose tinted glasses on. We think back to the, the kind of the halcyon days where, you know, your vet would jump out of bed in the middle of the night and, you know, provide care to your pet for, you know, no money at all. But really the old the old ways of veterinary medicine, steroids, antibiotics, you know, and and and not very much else. There was, you know, very little anesthetic monitoring and and clearly I'm doing I don't mean to be doing a disservice to all of the excellent work that was done, but but it bears no relation to today. When I was a vet student and seeing practice, you know, I saw practice in a clinic that had no qualified nursing staff. The vet was, monitoring their own anesthetic while they were doing the surgery. They were using much older, less reliable, less safe equipment.

Dr. Alex:
There was no anesthetic monitoring involved at all. Clearly, a much cheaper way to provide a surgical experience, a surgical service for their patients. But times have moved on, and that's really not acceptable for the majority of pet parents and for the majority of veterinary professionals as well. We'd not be comfortable providing that level of care. You know, the the fact that there was no qualified staff, animals would be left in kennels unsupervised for long periods of time. There were x rays, but there was certainly no ultrasound. There was no CT scanner. There was very poor in house lab equipment, if any, you know, there might have been a microscope and nothing more than that.

Dr. Alex:
So everything had to be sent away, and it would take a week or so to get results back. Now a lot of clinics, I would say, probably most clinics, and, clearly, this is gonna depend on where you are in the world, will have a comprehensive practice laboratory where I can take a blood sample at the start of a consultation and 15 minutes later, I've got the results in front of me that I'm discussing with you, and we are making decisions based on those results. That is an amazing level of care if you think about it, but those machines are eye wateringly expensive. Their maintenance costs, their ongoing costs are huge. The training needed to, you know, provide that level of care is also huge. CT scanning is, I guess, a modern equivalent where that really is unusual, but more and more practices are putting CT scanners into their clinics because it can provide some incredibly valuable information when it comes to diagnosing problems. But again, the cost of those are eye watering. And I was on a, a forum the other day and and someone was saying that because of these changes, they've had to get new doors for their imaging suite so they need to be lead lined of a certain depth, and all that kind of thing to keep everybody safe and a single door was costing 10,000 pounds It kind of boggles your mind how much this, you know, this equipment costs and the ongoing cost of maintenance and everything like I save.

Dr. Alex:
And and that's not to mention the training that the staff need to to actually be able to use all of that kit. That aside, even providing for simple routine procedures. So I'm thinking our, castration, our spay, our lump removal, the amount of personnel required to provide the level of care that you quite rightly demand and expect is huge. For a simple procedure, you're going to have 1 vet and and probably 2 nursing nurse members of nursing team who are highly trained qualified individuals as well. It's going to be very unusual that there are unqualified staff providing, anesthetic monitoring, for example. That's something that you need to be aware of and that the the the title of vet nurse or vet technician isn't protected everywhere. So you can't take it for granted that they are qualified, but but most will be. So that's 3 members of highly trained veterinary staff that are required for a for a simple and inverted commas operation.

Dr. Alex:
The other day, even just yesterday, in fact, actually, I was, just walking past the theater and one of the other vets was, about to embark on a particular surgery. And there were 2 vets and 4 nurses in that room at one point in time. And that was the number of personnel that were required to make sure that the patient was kept as safe as possible, to actually make sure that the surgery was carried out as quickly and as safely as possible. And that is a huge input of man hours and clearly the costs involved with that are significant. So with all this in mind, would you be happy to go back to the days where you know, your vet probably didn't really have a chat about what the options were? They just gave you some medication, told you to get on with it. They didn't have any equipment. They weren't using trained staff to assist them. Would you be happy with that? Would you be liable to to complain if things went wrong? I suspect that that's probably the case and quite rightly, I don't think that's an acceptable level of care.

Dr. Alex:
We demand the the level of care that we can receive in the human health industry. And actually, in the veterinary industry, we are getting to a stage where we can absolutely provide that level of care. Now, my job as a vet, all that being said is to work with pet parents to, to be able to provide the best level of care within the means that are affordable for them because CT scanning, MRI scanning, you know, advanced surgery, really invasive diagnostics or a long diagnostic pathway, complicated treatment plan are going to be out of reach of of many people, but there is often a plan b or c or d, and that is my job to to come up with those to work with the resources that are available to me to to reach the best outcome for for that family and for that pet. And so that conversation with your vet, that trust that you have with your vet is is incredibly important, especially as the options increase, but the cost of those options also increase. And then the other factor that I wanted to discuss today, that I hinted at at the beginning is is this blame culture. So, you know, I say, would you be happy with that lower level of care or would you be, you know, quick to to complain and even launch an official complaint against, a vet or against a clinic if the the level of care was perceived to be substandard? And, you know, there are I'm not saying that don't complain if things go wrong, if things haven't been done properly, then absolutely it's your right to to to get the level of care that that you demand and that you expect to have all the options explained to you to know where those might lead, to know what the potential complications are, you know, and all of these other factors kind of around that. But I can tell you now that the morale in the veterinary industry is, is really low because there is so much vet bashing that goes on. And even for, you know, the vast majority of vets who aren't on social media, who aren't putting themselves on platforms like this, where, you know, I expect to get, a lots of negative comments because that's just what people do in the comments section, but it really does get people down and it also makes people very, very worried about having a complaint against them.

Dr. Alex:
And this leads to something called defensive medicine. We practice defensive medicine which is where I am so concerned that someone is going to complain because of something that I didn't do. Even if we had the discussion about why that wasn't appropriate, that I am going to literally recommend every single thing that we can do to rule out the really unlikely possibility that there's this really rare problem going on. And this comes back to trust with your, with your veterinary team, to, to knowing, to knowing your vet clinic, to getting a relationship with your vets. Because if, for example, I have a young Labrador that comes in to see me, they've vomited once, owner's a little bit concerned but the dog is otherwise bright, they're happy, they have not got any diarrhea. On examination, they're not dehydrated, they're not sore in their abdomen, they don't have any lumps or bumps that I can feel. There's a couple of options here. We could say, well, in all likelihood, you know, your dog's eaten something, it's disagreed with them.

Dr. Alex:
You know, let's maybe try some anti nausea medication and see how we go over the next 24, 48 hours. If there's, if there's more vomiting, if your dog becomes unwell, then come back and see me and we can do some more investigations. In my mind, that is probably the most acceptable option, but it's a Labrador. It's a young Labrador. Maybe, it's been known to eat things in the past. So there is the possibility that there is something big that's been eaten, a stone. I had a dog with a stone the other day that he had eaten a big massive stone. I don't know why dogs do that, but hey ho.

Dr. Alex:
It could have eaten a stone, it could have chewed up a toy and it could have something in its stomach or in its intestine that could cause an obstruction. And that is why that dog has vomited. Many vets or some vets may actually recommend in spite of that clinical exam that doesn't suggest that may suggest an x-ray or may suggest a blood test because, well, it could be they've eaten something and that's causing problem with the kidneys and we want to get onto that really early. It's not very likely. In fact, it's very, very unlikely, but why don't we do a blood test and an x-ray just to rule that out so that we can then give medication safe in the knowledge that we're not in inverted commas, missing anything. So you can see how that I hope you can see how that train of thought goes and I can present that to you in a way that makes it seem really necessary because I'm so worried about to complain that I feel that this is necessary. So it's not it's not over selling. It's not upselling from a financial benefit point of view.

Dr. Alex:
It's me trying to cover all basis so that there is no way that I can have a complaint against the level of care that I'm providing. But clearly that blood test, that x-ray comes at a significant cost. So rather than a consultation and a few medications, you've probably looking at 2, 3, 4 times the cost with having all of these other bases covered. And then this also potentially leads on to the of the veterinary industry. We have gone from a situation where most practices were owned by kind of owner operated run if you like. They were owned by veterinarians. It was only veterinarians who could actually own and run a veterinary clinic. And maybe they owned 1 clinic, maybe they had 10 or 20 clinics, but ultimately they were run by vets.

Dr. Alex:
And there were issues with that. Why not vet nurses? Why not, practice managers? And that certainly changed as well. But we've gone from an issue where we were lots of small independent clinics to some really big corporations, and that's, you know, in the UK, I think there are maybe 6 big, corporate practices and it can be very hard to know whether an individual vet clinic is part of a particular group or if they're independent, you can certainly ask them and they'll let you know. But from an their online presence, it might be very hard to know that that's the case. Same situation in, you know, in other parts of the world. Venture capital groups are buying up vet clinics because they see them as a good way to make money through quantity. But that also leads to pressure on members of staff to, to meet certain targets that are maybe not based on health, but are more based on the bottom line. There's also issues with maybe where are the profits going because if the staff members are not seeing an increase in their pay to match inflation, but the the the costs of the bill to you, the pet parent, have gone up by significantly more than that cost of inflation, then, you know, where are those funds being redistributed to? You know, I I don't know for sure.

Dr. Alex:
I've not read reports, you know, shareholder reports and things that will probably outline that maybe, but, you know, there's certainly issues there. Now corporate practice isn't all bad for the people who work within the the industry. There are potentially some benefits. One benefit for example, and I say about pay, but actually our nursing staff have traditionally been paid incredibly poorly. But one group, and I'm not sure if others have followed, have recently, you know, announced that their minimum pay for vet nurses is going to go up by quite a significant degree. So that, you know, that's wonderful news, but really they're only getting paid, you know, what they're worth, If that, and I'd say probably not even that there's definite room when we think of the the when I think of the caliber of vet nurses out there in the UK, the, the, the minimum requirements requirements just to become a vet nurse and then the standard of care that they provide, you know, they're definitely underappreciated, I think generally, but also in terms of financial remuneration as well. But all this leads to problems with affordability of vet care and insurance is definitely one way to afford vet care, but there are issues within the insurance industry as well. Know, the problem with having insurance is that you generally need to actually pay for that care at the time it's provided and then claim those costs back, which is all very well and good if you've got, you know, 1,000 of pounds, 1,000 of dollars in the bank.

Dr. Alex:
But if you don't, then how do you actually get that money to pay the bill in the 1st place to then be able to claim back? And here it's very easy to say, well, that's, you know, they just need to, you know, accept direct payment from the insurance company because insurance companies provide that. And yes, they do provide that. And yes, some vet clinics will allow that the bill to be paid by the insurance company. But this is a situation where the majority ruin it for the minority and the eye of literally had situations where we have submitted a claim form. It was going to be paid, agreed to be paid directly to the vet clinic, but the owner has then called up the insurance company and said, oh, actually can you pay me instead, because I paid the vet bill myself, they didn't. They've then been paid the money for the insurance claim, have done a runner never to be seen again. And so effectively the vet clinic has paid for the treatment of their animal and they've made money. Now that's an extreme example, but it happens.

Dr. Alex:
Or it will be that, you know, it's felt that insurance cover should cover a certain procedure, but actually they get declined because there's an unknown preexisting condition that that vet clinic wasn't aware of. And then the owner is not able to to afford the care that was provided after the event. You know, this is a real big issue. But it's a really, I guess I would be hopeful that in the near future that there's going to be some disruption to this industry because I can see a situation where something like AI is used to assess insurance claims. They're able to do that virtually instantly. And so from submitting a invoice with an insurance claim to the vet clinic being paid could be a matter of 5, 10 minutes, even faster. It could be almost instant. And if that's the case, then that will be wonderful because then the pet parent will just have to pay their premium and they won't have to worry about paying for any other costs other than excesses and all that kind of thing.

Dr. Alex:
So watch this space. I hope that things will change. I'd love to hear your thoughts of how insurance could change, of the vet industry, how that can change, maybe how, you've felt you've been you've you've had options discussed with you. You know, what is your relationship with your vet clinic? Don't just leave vet bashing comments. If you've come this far, then you probably won't. They probably all came a minute in if people even watched a minute. But I'd love to hear your comments, constructive comments. I'd love have a discussion with you about this because the situation is not perfect.

Dr. Alex:
It's not perfect for our pets. It's not perfect for you, the pet parent, and it's not perfect for for people who are working within the industry. There's a lot of rhetoric. There's a lot of us and them from from all industry. There's a lot of rhetoric. There's a lot of us and them from from all sides, and that's really not very helpful. And this is why I say that having a trusting relationship with your vet is absolutely key to your pet getting the best care that you would want for them. And I discuss that more in this video linked on screen.

Dr. Alex:
So tap on that video. I look forward to reading your thoughts on this one and until the next time, I'm veterinarian Doctor Alex. This is Our Pet's Health because they're family.