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Pet insurance should be more affordable. Here’s why it’s so expensive in 2018.

Pet insurance has made a huge difference to many animals’ lives. The principle is simple: you pay a relatively small monthly sum to the insurance company, and if your pet is unfortunate enough to fall seriously ill or have an accident, the insurance covers the costs of the vets’ bills. Of course this is subject to the expected caveats of pre-existing conditions and excess contributions, but still, the principle is sufficient to make a huge difference to the affordability of vets’ bills for thousands of people. The benefits for animal health and welfare have been immense.
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BBC’s Today Programme asks a profound question: how much is a dog’s life worth?

Dogs and vets' fees took centre stage in the UK media yesterday when they featured on the BBC's Today programme, the most popular show on Radio 4, with over 7 million listeners every week. One of the presenters, Evan Davis, brought his whippet, Mr Whippy, into the studio, and a discussion on vets' fees followed. Mr Davis recounted how he'd spent £4000 on fixing Mr
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Do vets charge too much for bitch spays?

As part of my work as a "media vet", I'm a strong advocate for spaying and neutering pets as the best way to control the problem of pet overpopulation. Accidental pregnancies still account for a high number of unwanted puppies and kittens, and routine spaying/neutering of young adult pets is the best way to prevent these. This doesn't meant that every pet needs to be spayed/neutered when young (there are some good reasons to delay or even not to do the operation for some individual animals), but it does mean that every pet owner should at least discuss the options with their vet around the time of puberty.

Why do people refuse to have their pets spayed?

People have a variety of reasons for not having the operations done on their pets, and the cost is a major factor. In a recent social media discussion, the following comment came in. "Vets should reduce their fee to £120 for a female dog. A lot of people genuinely just can't afford it."

Why don't vets reduce their fees?

This is a good point. Why don't vets reduce the price of spaying? Let's look at how this could be done: what makes up the cost of an operation, and how can those items be reduced? To put this in perspective, what are the typical fees for spaying? The recent SPVS survey found that the median fee nationwide for an adult bitch spay was £204. There is significant regional variation on this, but the figure acts as a reasonable starting point for discussion. How could it be reduced to £120? If you look at the pie chart at the foot of this page, you can see that over half of the costs of vets' fees are made up of overheads that are difficult to reduce: rent, heat, light, phone, drugs, surgical supplies, cleaning, nurses' wages and administration costs. Vets already do as much as they can to keep these costs down: it's in their own interests to do so. So let's leave these alone for the sake of this discussion. So what about the obvious "top item" on the cost list for most people: the money that goes to the vet. Surely vets can manage with less? For every £10 you give the vet, typically only £2 to £2.50 goes to the vet. If a vet gives you a 20 to 25% discount, they are working for nothing. Vets are well enough paid, but their salaries are lower than most people expect. A typical new graduate vet earns around £30000, and a vet qualified for 20 years might earn £50000. Should vets work for less than that, with five years of tough training and high costs in getting through college? For the sake of this discussion, let's say yes, and agree that vets will operate for free on bitch spays: take 25% off £204, and you're left with £153. What next? What about VAT? The government charges 20% on all vet fees, making up £34 of the £204. If this was not charged, £153 minus £34 = £119. Bingo: it's less than £120. So if vets work for nothing, and the government agrees to stop charging VAT, the cost of a bitch spay would reach the desired target. Is this going to happen? Of course not.

In the real world, how can pet owners pay as little as possible for bitch spays?

So what can impoverished pet owners do? Here are three tips. First, plan in advance. You should budget for the spay/neuter surgery when you get a pet, just as you should think about how much it will cost you to feed your new animal. If you genuinely can't afford it, perhaps you should not get a pet. For the financially disadvantaged, there are some subsidised schemes to help, but charity resources are limited, and most of the working population will not qualify for these. Second, shop around, but don't do this on price alone. You should physically visit at least three vets, eyeballing the premises (are they clean?), talking to staff (do they seem to care?) and asking some specific questions: • Do they have qualified veterinary nurses? • Do they use up-to-date anaesthetic, pain relief and monitoring equipment? • Does they monitor all pets after anaesthesia until they are awake? You may not be fully aware of the "right answers" to these questions, but even just by asking the questions and judging the tone of the response, you will learn a lot about the practice. Third, ask for a discount. Some vets may just say "no" ( this is understandable - it directly eats into the 20 - 25% that they are paid), but as in any other consumer transaction, there is no harm in asking the question. If you think a bitch spay is expensive at £200, remember that it would cost around £5000 to have a similar operation carried out on a human. And if you want to help with the pet overpopulation problem, as well as benefitting your own pet's health, it's a price that's well worth paying.
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Are vets more interested in the health of their patients or the money in their pockets?

I recently wrote a blog here titled "Debunking myths about “rip off" veterinary fees”, and since then, the subject of money has continued to be one of the banes of my life as a vet in practice. My aim in life is to do a job that I enjoy, and to be paid a reasonable salary: for most people, that just means that you go to work, do your stuff, and come home at the end of each day. For vets, it's different: every day, as part of our job, we need to ask people to give us money. Most of us would be delighted if this discomfitting task was taken away from us, but unfortunately, it's an unavoidable part of our job description. One recent case provided a good example of the type of daily dilemma that faces vets. An elderly terrier, Sam, had a small benign tumour on his flank. He was fourteen years of age, and his owner had been hoping that we might be able to leave the tumour alone: it'd be better to avoid a general anaesthetic unless it was absolutely necessary. When the tumour began to ooze blood, and Sam began to lick it a lot, we couldn't leave it any longer so he was booked in for surgery. When booking the operation, I mentioned to his owner that it would be wise to take the opportunity to clean up his teeth, which were caked in tartar. And I gave a detailed estimate of the expected costs. We took all the usual precautions to ensure Sam's safety. He had a detailed clinical examination and pre-anaesthetic blood tests to ensure that he had no underlying illnesses that could make an anaesthetic risky. An intravenous line was set up to give him continual fluids during the procedure and to give us instant access to a vein if any emergency treatment became necessary. And a vet nurse was designated to hold his paw and to monitor him for every second of his time under anaesthesia, from induction until he was sitting up at the end. Everything went well: the tumour shelled out quickly and easily, and a line of sutures closed the wound. I carried out a thorough descale and polish of his teeth, as planned. But it was then that the dilemma arose: beneath the tartar covering his teeth, it turned out that two of his molar teeth had large diseased areas. The gum margins had recessed, exposing large parts of the tooth roots. One of the teeth had serious infection, causing the tooth to be loose: it was easily removed. The other molar tooth was more complicated: one root was seriously diseased, but the other two roots were healthy. The tooth needed to be extracted, but it would be a tedious, time consuming surgical extraction, taking over half an hour, and requiring follow up x-rays to ensure that it had been done properly. This would involve an extra cost to the owner of well over £100. I had already given an estimate, and I didn't feel that I could go ahead with this without permission. While Sam was still anaesthetised, I asked a nurse to phone his owner to explain the situation. There was no answer on the home line, and the mobile number wasn't working. What should I do now? If I went ahead, I'd be carrying out unauthorised work on someone's pet. If there were any unexpected complications, the owner could hold me liable. And as for the extra cost? Could the owner justifiably refuse to pay? The safest legal approach would be to make a note of what needed to be done, and then to inform Sam's owner that he needed a follow up anaesthetic in a few weeks, during which we'd tackle his dental issues. But I knew that it would be far safer for Sam to have the entire procedure completed during this first anaesthetic, and I knew that his owner would be unlikely to agree to pay for a second anaesthetic on top of this first one. So Sam's dental issues would probably not be treated, and he would suffer as a consequence. I made an "on the hoof" decision to go ahead with the dental procedure. It took even longer than I had anticipated, and I had to take a series of x-rays rather than just one. By the end, I was happy that Sam had been given the best treatment, but I was nervous about the owner's response. Would she think that I had done this just as a way of extracting more money from her? What if she genuinely couldn't afford more than the estimate that I had given her? I felt so uncomfortable about the situation that I gave a significant discount on the extra work that I had done. Effectively, I ended up working my lunch hour for nothing because I felt so awkward about it. But what else could I have done? In the interest of the dog, I could not have left painful, diseased teeth untreated. What would pet owners feel if the vet presented them with a situation like this? Should you pay the full amount of justifiable extra work if it is unauthorised?  Do you trust your vet? Or do you feel that we are working more for our own interests than for the benefit of your pet?  
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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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