Internet Veterinary Pharmacies

"The same medication I get from my vet...for half the price!" The internet pharmacies LOVE to advertise this message on TV. It used to bother me, but now, not so much. Thanks to these pharmacies, the veterinary business model is changing, maybe even for the better. Let me explain...

In the not-so-distant past, veterinarians derived most of their profit from two sources: vaccines (marked-up 500-1000%) and pharmacy items (marked-up 100-1000%). Makes us look like scoundrels, doesn't it? The other side of that equation was that we lost money on almost everything else! We used to charge $35 for an X-Ray taken on a $20,000 machine, or repair a fracture or do a bowel resection for $300. We lost money on these things because: 1)We were afraid to charge what we needed to to make them profitable 2)We were subsidized by our vaccine/pharmacy income 3)That's the way it was always done.

The emergence of the internet pharmacies is changing everything. Our vaccine and pharmacy mark-up is now lower, so we can compete with the internet on price. They do have some competitive advantages here. They buy in bulk, and often pay much less than we do for the same products. They also lack the overhead expenses of a full-service veterinary hospital. We still have to pay for that X-Ray machine, continuing education for doctors and staff, surgical instruments, emergency drugs and equipment, ECG, blood pressure, and other diagnostic equipment.

As a rule, we now charge more for our medical and surgical services (although I submit that an $800 fracture repair is a bargain when you consider the cost at a human hospital), and less for vaccines and medicine. It is actually a more logical business model, but it's a little scary for clients who don't have an extra stash saved up for emergencies. (I'm hoping that more of you will purchase Pet Health Insurance, but that's for another blog!)

There are some other things to consider. Numerous state pharmacy boards have found internet pharmacies guilty of selling veterinary drugs illegally. The EPA has fined a major internet pharmacy $100,000 for selling Australian products (that look like US products) to US pet-owners. Most heartworm products are guaranteed by the manufacturer only if purchased from a veterinarian. Unlike products purchased from your vet, drugs sold through over-the-counter channels are not monitored or regulated by any federal or state agencies like the Board of Veterinary Examiners. These medications may have been stored in an unregulated warehouse for an extended period of time.

Lastly, these pharmacies don't care squat about your pets. If there's a problem, you are on your own. Veterinarians stand firmly behind what we sell, and many of us are available for your pets 24/7. Internet veterinary pharmacies make HUGE profits, and that's all they're about. Hopefully most of us in private practice are motivated by something more meaningful.

Teeth

One of my least favorite topics to discuss with pet owners is their pets' teeth. When the teeth need to be cleaned (actually to call it "cleaning" is an oversimplification of a very comprehensive and complicated procedure), there is often resistance on the part of the pet owner. The two most common reasons for resistance are, understandably, cost and anesthetic risks. Anesthetic risks can be mitigated with preanesthetic blood tests and ECG, anesthetic protocols tailored to the specific patient, IV fluids given during the procedure, comprehensive and dedicated patient monitoring (a dedicated anesthetist, ECG, blood pressure, oxygen levels, CO2 output, temperature, etc...), and careful post-anesthetic monitoring.

Sounds like a lot, doesn't it? It is a lot, which is why pet dentistry can be pretty expensive. I've talked to a number of my colleagues, and my informal survey reveals pet dental procedures to run between $200 and $1000, depending on X-rays, extractions, etc... The good news is that those who get their pets' teeth cleaned before things get too far along, usually see dental charges on the low end of the scale!

The other source of resistance is that pet owners sometimes don't percieve the necessity of dental health. It is the veterinarian's job to educate these folks. The truth is, we believe that chronic dental infections lead to deterioration and damage to numerous vital organs such as the kidneys, lungs, and heart. A recent study published in the AVMA Journal showed a six-fold increased risk of heart valve disease in dogs with periodontal disease. Chronic kidney failure and pulmonary disease have also been linked to bad teeth.

So...my best advice is that when your vet first tells you it's time to clean your pet's teeth, don't wait a few years to do it. You will pay for the delay from your wallet, and your pet may pay with a few years of his life.

The Scheduling Conundrum

I'm a bit frustrated today by a problem that I've never been able to solve completely, even in 25 years of trying. We are (fortunately) a very busy practice, and it is not unusual for all the doctors on duty to be completely booked up on appointments in any given day. In spite of this, we take pride in the fact that if a pet owner feels the need to get their pet in TODAY, we will accommodate them. We charge an additional $15 for these "squeeze-in" appointments to discourage people from taking advantage (if their pet isn't that sick) and because it seriously disrupts our scheduling and causes other clients to wait. We try to leave a little space in our schedules each day to accommodate some of these "squeeze-ins" (we call them Urgent Care Appointments), but they often cause us to run a bit late. OK, sometimes up to 45 minutes late.

Most people seem to appreciate that we will get them in on short notice, even when we don't have openings, and are willing to pay the additional fee. Likewise, those who are made to wait are usually gracious and state that they would be glad if we did the same for their pets in an emergency. However...I can't seem to please everyone on this issue. Yesterday, we had someone walk out after waiting 30 minutes to see the doctor. The doctor was running late because of two Urgent Care patients seen earlier which set her behind. Today, I had a lady (who I go to church with) who wanted to get her dog in to see me for his severely itchy skin. This lady was informed that all my appointments were filled for the next two days (and then some), but that we could get her squeezed in as an Urgent Care appointment and there would be the additional charge. She was quite upset by this, and informed the receptionist that she would just take the dog elsewhere.

Damned if you do, damned if you don't I guess.