Money matters: how to discuss cost of treatments with owners

Discussing the cost of health care provision can be a sensitive issue. But why, given that people pay for almost everything else?

The fact that human health services in the UK are free (at the point of service) may well be a distorting factor in how people view the associated expense of other forms of medical expertise, but can this still be the primary reason at a time when NHS budgets are frequently under review in the light of increasing costs of provision, medical staff strike over pay and almost all dentistry is privately funded?

The current cost of living crisis is forcing people to make decisions about where they can reduce spending and, for many, veterinary care may now be one possible area.

However, regardless of the economic climate, veterinary professionals will always need to discuss the financial costs of their services and frequently offer treatment options that are beyond their clients’ budgets.

But why can these discussions potentially cause problems? This article will cover some of the reasons and solutions, starting with the two main protagonists:

Vets

Vets have varying perceptions of, and approaches to, their profession. However, the following can frequently be factors:

  • “Imposter syndrome”. This relates to professionals questioning their own relative capabilities and lack of experience (Hill and Hill, 2023). This is particularly prevalent in new or just-qualified graduates who are less comfortable about having knowledge gaps, will question how and why they can charge the same as more experienced colleagues and query whether the price of a service overestimates their “worth”.
  • A primary driver of veterinary professionals is animal welfare. Inherent in this basic feeling of care is a potential guilt complex where the possible course(s) of treatment are tempered by their relative associated costs and may lead to a range of responses, including omitting – whether openly or discreetly – to charge for an element of the treatment or showing embarrassment when explaining the appropriate professional fee involved.

Clients

Interacting with the general public exposes vets to clients from all walks of life.

Consequently, it can be difficult to always predict how people will react, but it always pays to be able to look at situations through a different lens.

Challenging financial discussions often originate from the need to treat or diagnose non-routine medical or surgical cases.

These conditions are often sudden and unexpected. In such scenarios, clients have to process the needs of their animal, understand unfamiliar medical terms and frequently prepare for life-changing decisions for both themselves and their pet.

In addition, it involves discussions with a professional about associated costs when few clients understand how complex veterinary businesses are and how much they cost to run.

Making it better

No single approach exists. Discussing with other vets how they manage complex decisions and situations helps create a library of skills and alternative approaches, which can be honed and improved over time.

The following are some of the things to consider:

Preparation

  • Prepare yourself for conversations that you know will occur. The consulting room is frequently full of curve balls, but common things, by definition, occur often. Many practices have a list of frequently repeated procedures and their associated price (for example, diagnostic imaging, blood tests and frequently performed surgical procedures). If these don’t exist then consider creating one. When discussing treatment options with owners give them as much information as you can at the time and, if appropriate, consider emailing estimates to clients after the consultation to remove ambiguity and miscommunication.
  • Be prepared for a mix of human responses and try to understand the client’s perspective. This does not give clients a carte blanche to behave how they wish, but time spent in preparation is seldom wasted.

Insights

  • Discuss all the reasonable and ethical treatment options with owners, regardless of insurance status and perceived ability to pay – looks can be deceiving.
  • Don’t avoid financial conversations or set other members of your team up to fail by not discussing elements of a procedure that you are most knowledgeable about.
  • Understand your worth – you have extensive knowledge about animal health. If you have to ask a colleague for clinical advice, then the patient is receiving the benefit of two insights. Similarly, where researching a case is required then all will benefit.
  • Don’t apologise for the price of procedures, but remain empathetic to people who say they can’t afford treatment (almost everyone has a limit, regardless of whether their animal is insured). Remember, you are only responsible for your own life choices, not those of others. How they choose to spend money or the things they value.
  • Help those who are struggling financially by understanding what payment options exist in your company/practice and whether charity help is a possibility.
  • Understand the basic (at least) finances of a veterinary practice. The price of care can appear substantial, but vets are the primary earners and these fees cover the wages of all the staff who support owners and their animals, the purchasing and maintenance or hi-tech equipment, rent, rates and other bills. Most practices make 5% to 15% profit, so this is not an industry fuelled by making money employing individuals with large salaries. The median veterinarian salary is ÂŁ48,062 (Office for National Statistics, 2023), which, although respectable, is less than many other professional services such as lawyers, doctors and dentists and also less than paramedics, train operatives and drivers.

Client management is based around a simple concept – “set and manage customers’ expectations and then deliver what has been promised” (Hill and Hill, 2023).

The majority of financially based complaints originate when costs are much greater than expected.

These can be avoided by creating accurate estimates, being honest about unknown outcomes and costs, recording your discussions in clinical notes and whenever possible communicating with clients if situations change before they are performed and billed.

Difficult conversations will remain an inherent part of a vet’s role, but this is true in any profession that makes a meaningful contribution to society. Being proactive and well prepared for these conversations is not a magic pill, but is part of “making it better”.

References

Joe Hill

Joe Hill

Joe Hill has been a practising vet for more than 20 years and has helped manage and improve many practices in different countries. He holds visiting positions at multiple UK universities, where he teaches and conducts research, on a wide range of programmes.

Joe has published a book entitled Vets In Business, which covers multiple aspects of practice management.