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Debunking myths about “rip off veterinary fees”

"Rip-off veterinary fees" were the subject of a recent poll on a vets-only website. In answer to the question "How often does your practice receive complaints about the prices it charges?", the results were:
  • All the time - 16%
  • Fairly often - 53%
  • Hardly ever - 30%
  • Never - 1%
So around 69% of vet clinics get regular complaints about their fees, and given that many people may feel irritated about fees without vocalising their concern to the vet, the true level of discontent is likely to be even higher. This is clearly an aspect of veterinary care that pet owners feel strongly about. I always find this a difficult topic to discuss: as a vet, I can't help feeling defensive, and it's all too easy to write a self-justifying commentary. Sceptical readers may then brush off any of my explanations: "well, he would say that, wouldn't he?". The challenge is that only vets know about the detailed financial background to running a veterinary practice; we're the only ones in a position to be able to explain why vets seem to charge so much. So please bear with me while I do my best to address some of the main myths about veterinary fees. 1. "Veterinary fees are so expensive that they must be a rip off" The reason why vets' fees are so costly is that vets' costs are high. For every £10 you give the vet, around £7.50 to £8 goes towards the running costs of the vet clinic, with the remaining £2 to £2.50 going to the vet. For a pie-chart that shows the breakdown of costs in a typical vet clinic, see here. Outgoings include drugs, utilities, building costs, staff wages, office supplies, continuing education, and, of course, VAT. Like any business people, vets try to keep these costs to a minimum, but they do need to be covered, and vet clinics only have one income source: pet owners. Human medical costs are perhaps the nearest equivalent to veterinary costs, but free medical care in the NHS means that the public in the UK have no appreciation of what's involved. As an example, a bitch spay may seem pricey at £300, while the standard cost of a human hysterectomy is around £5000 when done by a private human surgeon. Such comparisons make veterinary fees seem like ridiculously good value. 2. "Vets are loaded: you never see a poor vet" Look at the facts. The most recent survey of vets' earnings in the UK is carried out by the Society of Practising Veterinary Surgeons showed that the median salary of vets who have been qualified for a year is £32000. This rises to £41232 after five years of experience in practice, but it doesn't shift much higher than this subsequently. The median salary of a vet qualified between 10 and 20 years is between £45000 and £52000. The hourly rate for vets ranges from £15 for new graduates to around £25 for vets with many years experience. So vets are paid well enough, but nobody could call them "loaded". When you compare these rates of pay with other professions, it's clear that if a young person is motivated primarily by earning money, the veterinary profession is the wrong one to choose. 3. "Vets clean up with pet insurance. The first question they ask is: do you have your pet insured?" Why do people presume that vets ask this question with pound signs in their eyes? Yes, we do often ask the question, but people misunderstand the reason for it. If a pet is not insured, the owner will have to cover the costs themselves, and rather than shocking owners afterwards, vets prefer to give a detailed estimate, perhaps with different options, in advance. When a pet is insured, there's no need to go over such detail beforehand with the owner: the focus can immediately be to attend to the animal, in the knowledge that appropriate costs will be covered without the owner having to worry about them. 4. "When a pet has a serious injury or accident, if you can't afford to pay for it, vets often suggest that the animal should be put down. A genuine animal loving vet would never do that. If vets cared about animals, they'd do it for free" The problem here is that there is no such thing as "zero cost" treatment. Given that vets receive 20 to 25% of the fees charged, simple arithmetic shows that 75 - 80% of vets' fees are needed to cover the non-vet costs of treating an animal. If a vet gave you a 10 - 12.5% discount, they are effectively taking a 50% reduction in their take-home pay. If you are given a 20 - 25% reduction, the vet is doing it for free. And if the vet does the work at no charge, then he or she is actually giving you money for the benefit of treating your pet. Much as vets may feel a desire to do this from time to time, they do need to earn a salary so that they can pay for their own living costs. Vets operate in an open market: competition means that people are free to shop around to choose the best value vet in their area. If you feel that vets' fees are still "too expensive", ask yourself what corners you would like your vet to cut. Do you want less time with your vet? Do you want him to pay his nurses less? Do you want him to use cheaper surgical and medical products? Would you like him to move to a part of town where property is cheaper? Do you want him to decorate his clinic less often? Should he undertake less continuing education so that he isn't as up to date with treatments? Please don't just assume that vets are "ripping you off": if money was our main motivation in life, we'd all have left our profession many years ago.
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A vet visits a Delhi slum: day two – educating young people about animal welfare

[caption id="attachment_3744" align="aligncenter" width="717"]So-called "street dogs" often have a care-giver keeping an eye out for them So-called "street dogs" often have a care-giver keeping an eye out for them[/caption] After an overnight flight from London, I was delighted to be welcomed to Delhi this morning by a remarkable lady who works on the coal face of the street dogs/rabies issue. Bondana Dutta (or Bondi, as everyone calls her) is the founder of a small but rapidly growing NGO charity called Alliance of Animals and People (AAP). Bondana resigned as a regional director for CRY ( one of the major Childrens Rights NGO's) to pursue her work with AAP, and she has brought many skills and strengths to her new role. She believes that the way to improve animal welfare in the slums of Delhi is to start with the children: if she can convince young people of the importance of valuing animals, the rest will follow naturally. The children will pester their parents to do more for animals, and in due course, they will mature into a new generation of adults who are strongly pro-animal. [caption id="attachment_3743" align="aligncenter" width="614"]I found myself in front of an audience of children, talking about animal welfare I found myself in front of an audience of children, talking about animal welfare[/caption] As an introduction to the educational projects she's created, I travelled with Bondi to one of her projects, in a slum in South-West Delhi. The cross-city drive to the slum gave me a taste of the lunacy of Indian traffic: half a dozen lanes of a mad mix of vehicles (from cattle-drawn carts to tuktuks to cars to trucks) barging against each other to get ahead, beeping horns instead of using indicators, yet somehow, all keeping going and reaching their destinations. We pulled up outside the slum, and walked in through narrow laneways past people sitting outside their homes in small groups. The weather in Delhi at this time of year is pleasant: 20°C with crisp clear sunshine rather than the humid 30°C plus of mid-summer. For people and animals alike, it's a comfortable climate to be outdoors. [caption id="attachment_3745" align="aligncenter" width="717"]We walked a few hundred yards from where we'd parked the car We walked a few hundred yards from where we'd parked the car[/caption] After walking a few hundred yards, we came to a fenced off courtyard in the middle of an open area: around fifty children were waiting for us there. This was Bondi's community: children aged between five and fifteen who have signed up for regular classes in animal welfare. An AAP worker, a former teacher, was giving a class when we arrived. She acted as an interpreter (the children speak Hindu, with just a smattering of English) to allow me to talk to the children. [caption id="attachment_3742" align="aligncenter" width="717"]The children gathered in the courtyard, as if in an outdoor classroom The children gathered in the courtyard, as if in an outdoor classroom[/caption] I asked a few questions and learned a lot: most of the children cared for street dogs which they view as their “family dogs”. They feed them a mixed diet of scraps, and they make sure that they are vaccinated against rabies and where possible sterilised. I asked about what should be done if a person was bitten by a dog: the children knew all about washing a wound thoroughly then seeking post-exposure rabies vaccination. [caption id="attachment_3741" align="aligncenter" width="614"]A hamster, kept as a pet, was an unexpected critter to find in the middle of  the slum A hamster, kept as a pet, was an unexpected critter to find in the middle of the slum[/caption] I then asked the children if they kept any other animals as pets – cats are popular (but they aren't as visible as street dogs here), some children kept pet fish, and one girl disappeared for a few minutes, astonishing me when she returned cuddling her pet hamster, Pooni. I stayed for half an hour talking the the children, and the end, they sang a song to me about the importance of looking after animals well. I came away feeling full of hope and optimism: in the three years that she's been visiting this slum, Bondi has created a population of young people who care passionately about animals, and in the process, they are taking the necessary steps to ensure that they – and their pets - are protected against rabies. The AAP model is only being used on a small scale at the moment – Bondi would like to have more full time employees to visit more slums running classes like this, but funds are scarce. Bondi has great vision, and with the right support, her dream of all Indian children being taught about the importance of caring for animals will come true. [caption id="attachment_3740" align="aligncenter" width="614"]This slum-dwelling goat was dressed to cope with the cool February evenings This slum-dwelling goat was dressed to cope with the cool February evenings[/caption]
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A vet visits a Delhi slum: day one – an introduction to street dogs and rabies

[caption id="attachment_3735" align="aligncenter" width="768"]street_dog_2 Street dogs are part of the urban ecosystem in India[/caption] I'm just a vet in small animal practice in Ireland, but for the next week, I'm going right out of my comfort zone: I am travelling to Delhi, to visit a slum, where I'll be taking a look at the issue of street dogs and rabies. Rabies is one of those diseases that just flits across the consciousness of most of us: we know it's a terrible disease, and we feel blessed that it doesn't exist in the UK and Ireland, but that's about as far as it goes. The truth is that for many people and animals, it's a daily curse.  Minor dog bites are common all over the world, especially in children. Most often minor first aid is all that's needed: rarely, a visit to the doctor may be called for. Yet in most countries of the world, the threat of rabies in an additional worry. If a child happens to live in India, that minor dog bite could have had desperately serious consequences. If he was lucky, he might be taken to a doctor to be given post-exposure anti-rabies vaccination. However, it'd be far more likely that this level of medical intervention would be unavailable to him. Nothing would be done other than basic cleaning of the wound. If the dog was carrying rabies, he would be infected, and in the following weeks, he would develop symptoms of rabies. He might have a fever or a headache at first, with an itching sensation at the site of bite. A few days later, he would develop anxiety, confusion and agitation. As the disease progressed, he would develop abnormal behaviour (such as fear of water), hallucinations, and insomnia. He would go on to suffer a terrifying death. The most shocking aspect of rabies is that it is completely preventable. Vaccination of dogs in bulk programmes is inexpensive and highly effective: it can cost as little as 50c per dog. In comparison,the cost of a human being treated for rabies after a dog bite is around €40, which is over a month's salary in the regions where rabies is common. The World Health Organisation believes that mass canine vaccination programmes are the most effective measure for controlling rabies, and that vaccinating 70% of the dogs in an area where rabies is prevalent is necessary to control the disease in both humans and dogs. Targets are in place to have rabies eliminated from the planet by 2030 but this won't happen unless we all start paying more attention to achieving this goal In the recent past, mass dog vaccination programmes have allowed some countries to become rabies-free: there are many examples in South America. In Sri Lanka, this type of programme has reduced rabies deaths from more than 350 in 1973 to just 50 in 2010. Yet in over 150 countries around the world, death by rabies continues to be a threat to humans and dogs. Over 60 000 people die of rabies every year, with over 95% of them in Asia and Africa. India is the country with the biggest rabies problem, with over 20000 people dying every year. So-called "street dogs" are part of the urban culture. They play an important role in the ecosystem by helping to deal with garbage: in areas where dogs have been forcibly removed, the local rat population has boomed, with bubonic plague then becoming a major public health problem. But street dogs also carry rabies. The size and scale of India makes this problem seem impossible to solve: it's the second most populous country in the world, with over 1.2 billion people (nearly 300 times the population of Ireland, or 20 times the UK). Despite the magnitude of the challenge, the answer is still simple: vaccination of 70% of street dogs against rabies, combined where possible, with sterilisation of dogs to prevent breeding. If you think of another comparison: 20000 people dying of rabies every year is the equivalent of  67 people dying in Ireland, or 1000 people dying in the UK. Can you imagine the public outcry if that was to happen? Why should we be any less outraged because the people dying happen to live in India? I'm being hosted in Delhi by a charity called ASHA, which is primarily focussed on human health and education in the slums.  I have persuaded them to help me to investigate the severity of the rabies and street dog issue in one of their slums, and they are providing me with an interpreter to carry out a questionnaire. And the kind and passionate people at Mission Rabies have drafted a questionnaire for me to use.  In the space of ten days, I am not going to make much of a difference to anything, except perhaps to my own understanding of the issue, and my own desire to do something about it. If you read this blog for the next while, perhaps you'll learn a bit too. Rabies isn't going to go away by itself: it will take the joint effort of many people with a wide range of skills from a variety of backgrounds. Could you be one of them? street_dog_6
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So You Want To Be A Vet? – Getting into vet school and beyond

I did and I still do! Being a vet is a brilliant job; every day is different. I get to work with great people and use the skills I worked hard to gain to help animals and solve their problems. However, it is also involves long hours, regular challenges, with both pets and people, and it can be very stressful. The first hurdle to being a vet is actually getting into vet school and with an average of nine applicants for every place, it is one of the most competitive university courses there is. The standard of students is always extremely high and I know the selectors face a very difficult task in picking out those best suited for a career in veterinary medicine. First and foremost, you must get the right grades at both GCSE and A Level. Without these you won’t even be considered and rightly so; academically the vet course is tough. However, as well as being a geek (!), you also need to have excellent people skills, good practical skills and, I believe, bags of common sense. You can help to show you have these by ensuring your extracurricular activities are relevant and varied; music, sports, volunteering and Duke of Edinburgh all regularly appear on successful candidates applications. The other vital piece of the puzzle is completing a diverse range of work experience to demonstrate you really understand the veterinary industry. Trust me, it’s not all cuddling cute animals! The most obvious place to start is in a vet clinic but this can be difficult. Most practices receive a large number of requests but do persevere. You should also spend some time on farms getting your hands dirty. Helping out at milking time and lambing is not glamorous but will be rewarding & very useful. To stand out from the crowd you could also consider seeing other aspects of veterinary work such as zoos and exotic pets, abattoirs (all of which need a vet on the premises while they are operating) and scientific laboratories. Many vets are involved in research and during the course you will spend quite a bit of time in the lab! Wanting to be a vet for most people is a passion and very few probably give much thought to what working as a vet is actually like. It is a cliche to say it is more a way of life than a job but veterinary is certainly not 9-5! Many positions will include on call, meaning you will be working in the night and often the next day as well. A great deal of veterinary medicine, particularly for the farm and horse vets, is done alone, which can be stressful and even the small animal vets in a clinic will be expected to make their own decisions from day one and perform surgery single handedly. This is difficult when you first start and although it gets easier, it is always a challenge! It is also important to consider the salary you are likely to earn. This is often something students don’t consider important but it soon becomes so when you have a mortgage to pay and a family to support! As a vet you will always be paid a good wage but it is very much less than similarly qualified professionals. Trust me, you soon get tired of clients thinking you earn as much as a doctor when it is more likely to be a third of that! Being a vet is wonderful and I feel very fortunate to be in my dream job. However, I confess when I set my heart on it I gave very little thought to the practicalities of life with long hours, on-call, demanding owners and difficult cases. Although, to be honest, even if I had it wouldn’t have changed my mind! If you are sure you want to be a vet; have the drive, intelligence and I haven’t put you off (!), then my advice is work hard, go for it and maybe one day, I’ll see you in theatre! Cat Henstridge BVSc MRCVS - Read more of her blogs at catthevet.com
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High graduate debt, falling demand for pet health care & corporatisation. The veterinary profession is changing: is it for better or worse?

There's a lot of debate going on right now about the future of the veterinary profession. Many vets are worried about the current trend which basically follows this path:

1) Huge demand to study veterinary, especially among young females (80% vet students are female)

2) Not enough places at vet schools: traditionally, the number of student places has been capped in order to avoid flooding the market with far more vets than jobs

3) The realisation by universities that there's money to be made in teaching vet students, and that there's a strong demand from students who don't make it into the established vet schools. The first new vet school in over 50 years opened recently in the UK, and at least one more is planned. Meanwhile, in Eastern Europe, veterinary courses are taught in English, offering entry to the vet profession with a lower academic barrier if students are prepared to pay the fees

4) This is linked to the rising cost of veterinary education, with students in England paying £9000 per year x 5 years plus living costs

5) The result is that new vet graduates are qualifying with large debts, in higher numbers than ever before

6) Meanwhile the veterinary market is contracting, with people spending less money on pets, and so there are fewer jobs for vets available

7) Result: increasing numbers of underemployed young female vets with large debts

8.) Next part of jigsaw: there are fewer young vets to buy into established vet partnerships, and an increasing trend for chains of vet clinics to go "corporate", owned by shareholders whose main aim may be profit rather than the traditional broader professional view of a vet fulfilling a calling to earn a living

9) Result: vets become pawns in the animal care field, with young female vets desperate to pay back loans by working for corporations. As employees rather than part owners, they become subject to pressures common in other walks of life ("For your bonus, you need to sell so much food, book in so many dentals, see so many people every hour")

10) The long term potential result: erosion of trust in vets as pet owners question whether something is recommended because it is really needed, or because the vet needs to reach a target. This erosion of trust has already begun in recent years, with consumers questioning everything that professionals do: the sequence that I've outlined above will exacerbate this trend.

This trend in the veterinary professions seems to be a global one, and as ever, the USA seems to be further down the path than the rest of us. An excellent article has just been published on this in the New York Times - read it here: http://www.nytimes.com/2013/02/24/business/high-debt-and-falling-demand-trap-new-veterinarians.html?pagewanted=all&_r=2&

Vets are worried about these changes: our profession is heading down a new path with unpredictable consequences. It's hard to know what can be done to change the path: it feels like we're being nudged this way by unstoppable market forces.

What do you think? Should anything be done? Or do we just need to accept that this is the way it's going?

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