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Tuesday, August 5, 2014

Expensive Vets - a letter to Carte Blanche prior to their one sided program.


After 41 one years in the profession I recently semi - retired as a veterinarian. Semi, because after adding together my investments and a recent inheritance from my parents, I need to earn at least half of my final monthly salary of R30 000 to survive financially. But I had really had enough off my boss complaining that the practice was not profitable and the clients complaining about being ripped off.
Admittedly, part of my problem was caused by my lack of time while being on call 24/7 and poor knowledge of investment strategies. Part was due to investing in poorly performing Professional Provident Fund annuities. But mostly, I never had much extra money to invest – not after paying first study loans, then household expenses, children’s expenses and education, etc.
It was never about the money. Yes, I needed some to sustain my practice and my life, which was definitely not extravagant. Heck, I drive a 17 year old car and live in a tiny apartment.
However, the world is my oyster and I have so much to be grateful for. For one, I am still best friends with some of my clients – especially those I met early in my career, when life in general was not all about the money – even though in relative terms I charged a lot more in those days. In my first year in practice in 1974, I made R600 a month, which was a lot more than the R360 per month my husband earned as a teacher. But then he had cruised through a BA and teacher’s diploma and I had been one of only 4 girls selected to attend Onderstepoort in 1968 and had studied ridiculously hard for 5 years.
I could have been wealthier if I had stayed in one of several of the places I practised in or worked at in the earlier years of my career. However, after initially moving where my husband’s career took us and starting practices in remote rural locations like Clanwilliam and Aberdeen, amongst others, I eventually worked as state veterinarian in Kuruman for 5 years – earning much more than I ever did in private practice. I even learnt to fly!  After my divorce, I loaned money and bought 50% of a very successful practice in Botswana. There I had some money to spare. Strangely enough, I remember very few complaints about money. Of course the tax rate in Botswana was also much kinder than in South Africa and many clients were expats accustomed to overseas charges.
However, after 5 years there, my children had finished school and were travelling the world and working in exotic locations, so the travel bug bit!  I went to England, but discovered that all I liked was the pound, the postal system and the strawberries. The pay was good enough and the pound was strong enough to enable me to work for only 5 months of the first year.  The following year I joined the London to Sydney air race as a paying passenger and support plane co-pilot.  All my pounds spent, I worked for DEFRA during the Foot and Mouth outbreak for most of the year. My next venture was being a Clinical Tutor in Grenada, West Indies for a term. From there Australia beckoned and I accepted a high paying but disastrously bad job in rural Queensland. My next job was with a now corporate practice on the coast – average salary but great hours and working conditions.
Eventually I missed good old SA too much and once again attempted to practice in Clanwilliam around 2005 . By now most livestock had disappeared from farms as labour issues became more challenging and other forms of agriculture more lucrative. The most profit I made in any month was R3000.  And yet clients were complaining. I specifically remember seeing a lovely young Labrador belonging to an upper middle class family. He had a severely dislocated hip.  I offered surgery which would cost R1800. The owner declined on financial grounds, requesting euthenasia instead.  He told his distraught young son that he would buy him a new dog. The tears I cried were definitely not about money. I had to end the life of a delightful young dog that could easily have continued to have a great quality of life after surgery. This is not why I became a vet – working hard at school to get into university, working even harder in my first year to get into Onderstepoort and suffering significant financial hardship to complete my studies and repay my loans.  And what values was this father teaching his child?
To add insult to injury, I had dinner with a friend at the local restaurant that evening.  The man in question was entertaining a group of friends with free flowing alcohol and lavish meals. His bill was over R2000. His beautiful dog was dead in my freezer.
However, life’s little setbacks aside, my career has allowed me to see and experience a large part of the world, meet many people and treat many species, and I helped and saved many, many more animals than I killed or failed to save.  And who needs bungy jumping to experience an adrenalin rush! It also exposed my children to many experiences they would not have had if I was a stay at home mom, as they often accompanied me on call outs – even at night or “helped” in the surgery. None of them became vets!
I remember being called out late one evening to a cow with a prolapsed uterus in the Sandveld near Graafwater.  My husband was away. The three todders were bundled into the car half asleep and driven 50 odd kilometers, from where we had to walk a  kilometer in the pitch dark to the cow. I carried the youngest on my back.  My friend’s children played with brainy blocks while mine had to work out how to open a horse proof gate latch.
As vets we never had any financial education and in most cases minimal interest in the subject. I became a vet for one reason only – to help animals.  The great disconnect between animals’ financial value to their owners and their emotional value to the vet, plays a very significant role in the fact that worldwide the suicide rate in the veterinary profession in 4 times that of the average person and twice that of the medical profession. We HATE putting animals down. Some people even complain about the price of that.
The irony is that there are several EXCELLENT medical aid insurance schemes available for pets which would support expensive treatments, but most owners are too stingy too even consider putting aside a regular minimal amount to take care of their pet in an unplanned emergency.  Yet, although we bill clients we perceive as income earning, every vet alive treats hundreds of animals for free or at minimal cost for people who REALLY do not have the means.  We also save and rehome many strays at our own expense. This affects our bottom line quite significantly. And NO, we do not charge paying clients more to cover these cases. It comes out of our own pockets. Often seeing an animal recover and an otherwise unfortunate person happy, is reward enough, but we simply cannot afford to do it for all.
The Veterinary Council publishes a recommended fees list – not as a price fixing guideline – but as a guide for non – business trained vets to what fee is reasonable to charge depending on level of facilities and post graduate training or specialised skills. Most charge near the bottom of the range. City practices with superb facilities, trained support staff and specialists charge more. All practising vets need to work from registered facilities which comply with strict guidelines. In fact I have visited many doctor’s surgeries that are not nearly as neat and well organised as most veterinary practices. Of course there is no compulsion on any vet to charge within the guidelines, but if they exceed them without good reason they lay themselves open to complaints from clients. I do hope Carte Blanche will ask the SAVC how these fees are determined.
What many clients do not realise is that the majority of veterinary practices are in fact mini hospitals with loads of very expensive equipment, such as x-ray machines, ultrasound, anaesthetic machines, monitoring equipment, dental machines, accommodation facilities for animals, etc whereas medical practitioners have rooms with minimal instrumentation and use hospitals and equipment they do not personally have to own and staff they do not pay if they perform surgery or many procedures.  By the same token most people of moderate means have medical aid, or if poor, are treated at tax-payers expense. If you have a pet, you are responsible for payment.
Please also investigate the charity done by the CVC (Community Veterinary Clinics) in various part of the country. Many vets donate their time or work at a low rate for the CVC.
Vets are expensive compared to what? A few years ago I performed complicated intra-abdominal surgery lasting about 4 hours on a dog. A lot of supportive treatment was involved. Total cost R5000. Unhappy owner.  Soon after I had minor surgery to release a tendon in my thumb – cost about R15000. 
Last week a plumber sealed a leaking shower at my house with silicone, fixed a leaking kitchen outlet, and added a tap for a second washing machine – cost R2200. 
My income as full  time vet in South Africa equated to R100 per hour, baby sitters in Sydney charge R250 per hour!
My dog was smashed by a car a few years ago and needed extensive specialist orthopaedic surgery. Total cost came to just over R30 000. Considering that he had a dislocated hip which was fixed with a stainless steel toggle, a broken pelvis that was plated and a broken sacrum that was pinned, and made a full recovery after being hospitalised, medicated and nursed with care and kindness for a week, that is CHEAP. Yes, it is a load of money and without rainy day savings, available credit on a card or PETS HEALTH INSURANCE an average middle class family would have great difficulty finding the cash in an emergency.  But please remember your vet is in the same position as you are! He or she is NOT rolling in money and also has bills to pay.
So if you want a pet (a privilege, not a right), please, please plan for the unforeseen! It is not the vet’s fault if your dog escapes and gets hit by a car. It is not the vets fault if you cannot afford payment.  So stop the emotional blackmail. Be a RESPONSIBLE pet owner. Get adequate insurance, make sure all prophylactic treatments such as vaccines, worming, tick control etc is up to date. Keep your pet in a safe environment. Feed quality food. Work with your vet to ensure a healthy, happy, long lived pet. We really do care much more about your pet than we do about the money, but without an adequate income we cannot maintain and update our equipment, keep our knowledge up to date, train and pay our staff enough to keep them motivated (not everyone likes cleaning poo, urine, blood and other disgusting stuff with a smile  on their face) and support our own families. We would like nothing more than to work for free and never have to have the money conversations.
Anyone want to sponsor my free clinic and pay me a salary for working reasonable hours in a safe environment?  Running costs for a modest small animal clinic should come to about R300 000 per month, once the building has been purchased and modified and all equipment purchased – depending on location about 3 to 5 million rand .  My study loan has been repaid a long time ago. If you hire a young vet, they may be faced with paying back a study loan of about R1 million.

Kind regards
Dr. Joan Jordaan



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