CBC/CHEM/T4/UA and 3 views of chest with exam...less than $500 at my practice. Which I agree is a lot. I don't do tests that won't change my treatment plan.
That's great that you only do tests that will change your plan. I have to say I'm surprised that you can do all of those for <$500! Labwork for sure can be affordable if packaged well, imaging is what inflates a lot of bills. Where is your practice located? Does your CXR charge include a DACVR radiologist review? At many practices that is a separate line item that can be multiples of the cost for just the X-ray, and some places don't let clients opt out (I see pros and cons to that).
I'm in Central NY. I am able to get DACVR readings at no cost (not typical I know). I think that performance based pay contributes to over testing. Which is why I've never offered it.
Ah, that makes sense. I grew up in the tiny town of Lockport, NY between Buffalo and Niagara Falls and went to undergrad in Central NY. It is a beautiful part of the country, definitely lower cost of living and there have been some economic struggles over the decades.
That's great that you can the addt'l DACVR review at no cost! The clinician in me says that should be the standard for best care, but then I put on my business hat and remember radiologists need to get paid too. Hopefully our industry can figure out a balance for both sides!
I have only worked jobs for salary (sometimes with an annual bonus tied to overall company performance), flat daily rate (relief), or fee-for-service with pathology case reading, although in the latter I am not the same person ordering the tests, so I don't determine volume. I feel like if I was on Pro-Sal or production-only I would always be paranoid it was coloring my decisions, but I know plenty of vets who are on it and say its fine, so I dunno, maybe it depends on the individual 🤷🏻♂️
Interesting read! Working in veterinary ER, I resonate with the fear of a liability risk. I’ve also been bitten in the a** a time or two for choosing imaging over bloodwork or vise versa when a pet owner asks me to choose which one I recommend most because they don’t have the budget for both.
I just removed two blankets from a dog’s stomach and intestines at the ER because when they visited their primary vet a few days before, they could only afford bloodwork and not X-rays at the time.
So if I see a dog with anorexia, vomiting, and not eating — they’ll often get an estimate for bloodwork, X-rays, fecal, and pancreatitis test. Now that’s obviously a lot. I offer to go stepwise, but that has pros and cons for animals too. Pet that needs sedation? It’s tough to do one test at a time. Cat that was almost impossible to get in a carrier and get to the vet? The owners usually very much don’t want to have a second vet visit. Owner doesn’t want to spend 4 hours at the vet either.
Anyway, I agree that a recommendation guide would be helpful like in human med.
Tricky topic! Thanks for sharing more on it. I love learning from human med too.
Great points! Thanks for sharing your perspective, Dr. Foster. I have also definitely been there too on ER and urgent care. One of the ones I felt the worst about was missing Stage V lymphoma / ALL in a CKCS dog that presented for collapse with a loud murmur and what I felt like fit best with heart disease from the rads and clinical picture. Lymph nodes were not appreciably large on intake (though the dog was quite overweight, maybe masked mild lymphadenopathy). So we managed it in O2 and with the standard cardiac meds overnight and did OK. When I emailed for follow-up the next week (relief practice during my residency), they said the patient was doing well, but they sent off a CBC path review and it had 50% blasts in circulation 😱 The quantitative in-house CBC results weren't crazy when I ran it so I felt like taking time to do a blood smear review would be just tunnel visioning my clin path background, yet that was the key test we needed. It's very hard to make decisions under uncertainty with partial information and limited funds :/
And these cases stick with us! We never forget. Medicine really is an art and a science. And choosing to practice in a way that helps you sleep at night.
I will have to check that one out. Malpractice lawsuits are less common and for smaller dollar amounts in vetmed compared to human healthcare. I have to admit I was *shocked* to see judgments of over half a BILLION dollars being awarded in some cases!!! 🤯 I understand that it is tragic when someone dies from a medical error, and it is impossible to truly put a dollar amount on someone's life, but our system is going to collapse if a mistake can result in such a catastrophic penalty
CBC/CHEM/T4/UA and 3 views of chest with exam...less than $500 at my practice. Which I agree is a lot. I don't do tests that won't change my treatment plan.
That's great that you only do tests that will change your plan. I have to say I'm surprised that you can do all of those for <$500! Labwork for sure can be affordable if packaged well, imaging is what inflates a lot of bills. Where is your practice located? Does your CXR charge include a DACVR radiologist review? At many practices that is a separate line item that can be multiples of the cost for just the X-ray, and some places don't let clients opt out (I see pros and cons to that).
I'm in Central NY. I am able to get DACVR readings at no cost (not typical I know). I think that performance based pay contributes to over testing. Which is why I've never offered it.
Ah, that makes sense. I grew up in the tiny town of Lockport, NY between Buffalo and Niagara Falls and went to undergrad in Central NY. It is a beautiful part of the country, definitely lower cost of living and there have been some economic struggles over the decades.
That's great that you can the addt'l DACVR review at no cost! The clinician in me says that should be the standard for best care, but then I put on my business hat and remember radiologists need to get paid too. Hopefully our industry can figure out a balance for both sides!
I have only worked jobs for salary (sometimes with an annual bonus tied to overall company performance), flat daily rate (relief), or fee-for-service with pathology case reading, although in the latter I am not the same person ordering the tests, so I don't determine volume. I feel like if I was on Pro-Sal or production-only I would always be paranoid it was coloring my decisions, but I know plenty of vets who are on it and say its fine, so I dunno, maybe it depends on the individual 🤷🏻♂️
Interesting read! Working in veterinary ER, I resonate with the fear of a liability risk. I’ve also been bitten in the a** a time or two for choosing imaging over bloodwork or vise versa when a pet owner asks me to choose which one I recommend most because they don’t have the budget for both.
I just removed two blankets from a dog’s stomach and intestines at the ER because when they visited their primary vet a few days before, they could only afford bloodwork and not X-rays at the time.
So if I see a dog with anorexia, vomiting, and not eating — they’ll often get an estimate for bloodwork, X-rays, fecal, and pancreatitis test. Now that’s obviously a lot. I offer to go stepwise, but that has pros and cons for animals too. Pet that needs sedation? It’s tough to do one test at a time. Cat that was almost impossible to get in a carrier and get to the vet? The owners usually very much don’t want to have a second vet visit. Owner doesn’t want to spend 4 hours at the vet either.
Anyway, I agree that a recommendation guide would be helpful like in human med.
Tricky topic! Thanks for sharing more on it. I love learning from human med too.
Great points! Thanks for sharing your perspective, Dr. Foster. I have also definitely been there too on ER and urgent care. One of the ones I felt the worst about was missing Stage V lymphoma / ALL in a CKCS dog that presented for collapse with a loud murmur and what I felt like fit best with heart disease from the rads and clinical picture. Lymph nodes were not appreciably large on intake (though the dog was quite overweight, maybe masked mild lymphadenopathy). So we managed it in O2 and with the standard cardiac meds overnight and did OK. When I emailed for follow-up the next week (relief practice during my residency), they said the patient was doing well, but they sent off a CBC path review and it had 50% blasts in circulation 😱 The quantitative in-house CBC results weren't crazy when I ran it so I felt like taking time to do a blood smear review would be just tunnel visioning my clin path background, yet that was the key test we needed. It's very hard to make decisions under uncertainty with partial information and limited funds :/
And these cases stick with us! We never forget. Medicine really is an art and a science. And choosing to practice in a way that helps you sleep at night.
https://wisewords.blog/book-summaries/risk-savvy/
Great read by Gerd Gigerenzer
See "Lawyers vs Doctors" in book and at link.
I will have to check that one out. Malpractice lawsuits are less common and for smaller dollar amounts in vetmed compared to human healthcare. I have to admit I was *shocked* to see judgments of over half a BILLION dollars being awarded in some cases!!! 🤯 I understand that it is tragic when someone dies from a medical error, and it is impossible to truly put a dollar amount on someone's life, but our system is going to collapse if a mistake can result in such a catastrophic penalty