What should vet bills cost?

Vets’ bills were in the headlines recently, with BBC presenters, Justin Webb and Evan Davis, discussing the costs of gastrointestinal and orthopaedic surgery for their dogs. Ethical issues around the charging and spending were discussed on Radio 4’s Today and I was interviewed for the Telegraph. The following 3 questions recurred:

1. Do vets charge too much?
2. Do vets do too much for individual animals?
3. Can high spending on pets be justified in the face of other worthy causes?

Why treat pets at all?

Few would argue that sentient animals should not be protected from pain and suffering, particularly those that are impacted on by people or are under human stewardship. Unlike inanimate objects, sentient animals can experience feelings (e.g. hunger, fear, contentment), which are morally relevant.

Moreover, it is illegal not to protect our pets from pain, suffering, injury and disease. This legal duty upon all pet owners is explicit in the UK animal welfare acts.

No NHS for animals

Vets are uniquely qualified to prevent and treat illness and injury in animals. The Veterinary Surgeons Act 1966 ensures that only veterinary surgeons - qualified professionals with a minimum 5 years scientific and practical training – are able to diagnose and treat ill health in animals as part of the practice of veterinary surgery.

Diagnosis and treatment incur costs and there is no NHS for animals. Some people are surprised when they receive a bill for their pet’s care - sometimes because they are not used to paying (directly) for human medical care; sometimes because they had considered very few essential costs when purchasing their pet on an impulse. Some owners do not prepare or provision for veterinary costs, for example by taking out pet insurance. Others are less surprised but feel the cost may be unreasonable.

All items and services sold in a veterinary practice must cover their costs as well as the costs of 'keeping the lights on' – for example, medicines, suture materials, rents (which are subject to geographical variation) and loan repayments for expensive diagnostic equipment. Unmet, the practice goes out of business.

Veterinary salaries

Staff must also be paid. If an owner feels a bill is unjustifiably high, but accepts that direct costs must be met and was satisfied with the clinical outcome, then by inference someone in the practice should be paid less. As stated in the Vet Futures report, veterinary salary packages range from £31,150 for newly qualified vets to £69,021 for vets qualified more than 20 years. This is surprising to some, who imagine veterinary and human medical earnings to be comparable. Hospital consultants earn a basic salary of £75,249 to £101,451, depending on length of service.

In addition to this, the BVA Voice of the Veterinary Profession survey reported that 40% of BVA members said they would not, or were unsure if they would, choose to be a vet again, citing long hours, stress and rates of pay. Pay reductions could divert skilled and compassionate would-be vets to better paid professions.

Prioritising patients’ interests

Any intervention that is not in a patient’s best interests is defined as overtreatment. Overtreatment would inflate veterinary bills, but vets are bound by their professional declaration, enforced by our Royal College regulator, to prioritise animal welfare in our decision-making. We have duties to our patients, their owners and the veterinary businesses we work for, but our overriding duty is to the welfare of our patients.

Owners may urge us to 'try everything' in a bid to extend their pet’s life, but a trusting relationship with their vet is essential for prioritising animal welfare. Our pets, unlike humans, cannot offset the pain of some treatments against predicted future benefits. This means that quality – not quantity – of life is what is most important for non-human animals. As vets, we provide owners with ethical, evidence-based options, without unreasonable expectation that they will opt for the most costly 'gold standard', and while remembering that euthanasia may best serve our patient’s interests. It is well recognised that vets receive more heartfelt thanks for sympathetic euthanasia than complex surgery.

Ethical spending

As pets become increasingly valued as family members, so owners become increasingly willing to fund their veterinary care which, in turn, stimulates further veterinary advances. Some question whether these funds would be better directed towards more deserving ends – Evan Davis, for example, questioned how he would weigh the expenditure on his dog’s orthopaedic surgery against “the life of a small child in a poor country”. It is for individuals to decide how best to use their limited resources to optimise the sum of animal, human and environmental wellbeing. The veterinary profession can only legitimately intervene on animal welfare grounds: to ensure all sentient pets are protected from pain, suffering, injury and disease, and to ensure diagnosis and treatment are always in a pet’s best interests.

Sean

What do you think about the discussion on vet bills? Share your views on our BVA community post, Defending vet fees.

You can also listen to Junior Vice President Gudrun Ravetz, put well-known 'shock jock' Jon Gaunt "in his place" about vet fees. The clip is between -45.45 and -31.00 minutes into the programme.

We have created further information about the cost of veterinary care which can be shared with your clients, including the following leaflets:

• The cost of veterinary care explained (133 KB PDF)
• The benefits of pet insurance (107 KB PDF)