PET TALK: A 40-year perspective: The state of the profession

By Dr. Daniel Eubanks
   Editor’s note: As readers will see below, this is Dr. Daniel Eubanks’ last column. We — Mae Rhine (former managing editor) and I, Ruth Luse — will miss it. It provided us and our readers with many things — among them facts we needed to know, written in an interesting way we could understand, and entertainment. The Beacon truly will miss “Pet Talk.”
   This week’s article is my final installment of Pet Talk after nearly 10 years . I feel privileged to have been given the opportunity to provide you with hopefully some useful information and perhaps even a few laughs. I hope you have enjoyed reading it as much as I have writing it
   .Finally! After 40 years of veterinary practice I have achieved the status of being fully qualified to assess and comment on the state of my profession. This may become a little long-winded, but please bear with me — it’s my last gasp! I feel proud and gratified to have participated and hopefully contributed to the immense progress that has taken place in veterinary medicine over the past four decades.
   In 1975, my wife and I moved to Lambertville, having purchased a very small veterinary practice. It was located in the ground floor of a very old duplex home at One Feeder Street. There was no number Two. We were the only building on Feeder Street.
   The living room converted into our clinic waiting room. The exam room was the dining room. The kitchen became the surgery and the business office was a bedroom.
   My wife, my sons and I lived in the second and third floors.
   We ran a genuine “Ma and Pa” practice. This was the norm in the 70s. Practices were almost exclusively solo veterinarians. Services provided were minimal, including wellness exams, vaccinations and routine surgeries. Any complicated diagnostic or surgical procedures either weren’t performed or were referred to the nearest university with a veterinary school.
   After-hours emergency services were provided by the solo practitioner. This nearly drove me into becoming an auto mechanic. If a surgical procedure was required late at night such as a C-section, my wife would assist me and we might retire to bed at 3 a.m., only to begin the next day a few hours later.
   I had one full-time employee, who served as receptionist, assistant, bookkeeper, janitor, etc.
   My after-dinner activities included reassembling and sterilizing the surgery packs, performing rudimentary in-house lab tests (there were no commercial outside labs), clean the kennel, mop floors, etc.
   Most solo practices couldn’t make ends meet providing exclusively professional services and so ancillary, non-professional services were offered. I never bought into this policy because, quite frankly, it was beneath my dignity. I did not attend an Ivy League graduate school to board and bathe dogs. I felt shame and disgrace for my professional image to see many veterinary billboards advertising “Boarding, Bathing, Grooming, Medicine and Surgery,” in that order!
   Enough, you get the picture. Relative to today’s veterinary practice, things were primitive and a bit rough. Let’s skip the intervening evolutionary steps and describe veterinary practices as they exist today.
   Ma and Pa, one-man practices are extinct. Large, multi-doctor practices are the norm. Even our own small practice as it exists today has three veterinarians providing extensive services, including full laboratory testing with less than 24 hour turnaround, X-ray, ultrasound capability and most surgical procedures, including some orthopedics, performed on site. Anesthesia services and anesthesia monitoring are state-of-the-art.
   Many “mega” practices exist that are usually specialty referral and emergency/critical-care facilities. During the normal workday, they are staffed with board-certified specialists providing advanced services in surgery, internal medicine, radiology, oncology, cardiology, ophthalmology etc. Procedures such as MRI, CAT scan and endoscopy are almost routine. Staff will include certified technicians, assistants, office managers, maintenance personnel and sometimes even a bereavement counselor.
   Twenty-four hour emergency services and intensive care is always provided at these larger facilities, which have become logistically located for convenient access. They are there for the night shift only. They’re up and running and providing far better emergency care than we could have ever possibly approached in the old days.
   The goal in all of this technology is to provide the best possible healthcare for your pet. An inevitable consequence of that goal however, is that it all costs money.
   It offends me to hear snide remarks insinuating that all of this “progress” is designed to make veterinarians rich. Believe me, I’ve been around enough vets for enough years to know that that simply is not true. My profession is nobler than that and in fact, I have never known a “rich” veterinarian.
   But are veterinary bills higher now than ever before? Yes! Are the services provided more numerous, sophisticated and expensive? Yes!
   In human medicine, money is no object. Anything that CAN be done WILL be done. If the surgeon bills you $45,000 for a procedure, Medicare and/or Aetna may allow for $7,500, of which you have a $40 co-pay.
   In veterinary medicine it’s COD. Unless you have pet insurance, which is becoming more and more inviting, the bills are yours alone and it’s cash out of pocket.
   The perception that I would hope you would get from this is that you have choices. For those whose philosophy and finances permit, almost anything is possible. I recently had a patient with lymphoma who enjoyed two years of quality life, because of skillfully administered and monitored chemotherapy.
   Granted, this may not have been every pet owner’s choice. Some folks may have opted for humane euthanasia at the time of the diagnosis.
   But the proper perspective is that you have more choices. Do not allow yourself to feel compelled, shamed or guilt-ridden into buying into the “anything that can be done should be done” mentality. Communicate your wishes and needs with your veterinarian to create a treatment plan that’s right for you.
   A common example to illustrate this would be a more routinely encountered procedure — a 6-month old cat spay. In the 70s, a routine cat spay involved an injectible anesthetic, basic sterile technique, an ovariohysterectomy and go home. Rate of success (in the right hands) – 99.5 percent. Total cost — $50.
   Today, veterinarians are under pressure from the academia, peers, the media, potential litigation, professional associations, etc. A routine cat spay today involves pre-anesthetic blood work to rule-out any sub-clinical problems, such as diabetes or kidney disease; inhalation (gas) anesthesia, which is unarguably the safest but requires sophisticated equipment; ultimate sterile technique (cap, gown, mask, gloves sometimes boots — most of which is disposable); disposable anesthesia equipment; sophisticated anesthesia monitoring equipment, measuring ECG, heart rate, respiratory oxygen and C02 levels, blood pressure; precautionary I.V. catheter fluid line to maintain hydration and provide rapid I.V. access in case of emergency; certified technicians monitoring and recording vital parameters, such as body temperature, blood pressure, etc. during anesthesia and recovery. Oh yeah, and somewhere in there is an ovariohysterectomy performed by a professional with at least eight years of higher education.
   Rate of success – 99.6 percent. Total cost – $400.00 (which quite honestly is a bargain at twice the price, considering all of the above).
   Now, kick it up a notch and consider a sophisticated orthopedic procedure performed by a board-certified specialist at a specialty referral center with a final bill of $10,000 or more!
   There are no laws or regulatory agencies compelling veterinarians to provide this level of excellence. But should quality veterinary practices be offering the best service available? Of course they should.
   Can everyone afford this? No. And here is where the choice-making process begins.
   Some procedures can be described as “recommended and precautionary, but optional.” Examples would be pre-anesthetic blood work and I.V. fluids for a 6-month old dog or cat spay. Any good veterinary practice should be willing to accept your informed consent to omit these from the plan. They will not likely to be willing, however, to compromise their standards of anesthesia, monitoring, sterility, etc.
   And be advised that these “optional” procedures become more “essential” when dealing with an older pet presented for any anesthetic procedure.
   And there are more choices. You can opt-out of chemotherapy and/or radiation to treat cancer. It’s OK to do that! You can elect humane euthanasia rather than “last-ditch heroics” to prolong the life of an aged pet in kidney failure. You can take your pet to a low-cost spay/neuter facility. You can work with your veterinarian to create a one step-at-a-time, sequential diagnostic approach to a complicated, challenging case rather than running every test in the books right out of the gate. That way you can hopefully see where all of this is heading and get a feel for whether you want to pursue any of the unfolding possible outcomes or not.
   It’s like the current Citizens Bank TV commercial featuring the Founding Fathers. They say “People want choices — a good bank gets that!” As they push their trays through the cafeteria line, one guy gets “lasagna and sushi with mayo and sprinkles.” Go for it! But nobody is making him also pick-up the “meatloaf with triple gravy.”
   It’s all about an informed consumer having choices. But remember that the old adage is still true — you usually get what you pay for.
   If I ever do completely retire, there are certain aspects of this profession that will be sorely missed. I love surgery, I love animals and am totally sold on the value of the companion animal bond.
   And I know I’ll miss — but always remember — the crazy-funny things some of my clients have said. I’ve told many of these tales in the column through the years, but here’s one that happened just last week.
   Mr. and Mrs. Anonymous placed “Daisy” on the exam table and Mr. A. said: “Doc, I think she has tapeworm. She’s been scooting her butt along the carpet all week.”
   I replied that tapeworm was a possibility, but “more than likely she’s having trouble with her anal sacs,”
   Mr. A. looked at me in total shock. Then he said, in all innocence and sincerity, “Doc, that’s not possible! She was spayed when she was 6 months old and she’s never even had sex!”