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InFocus

“It lets these proto-vets see just what a diversity of approaches there are to small animal practice – and a diversity of prices too”

One of the things I really enjoy about my job is visiting so many different veterinary practices – I provide an ambulatory ophthalmology referral service to about 40 clinics and seeing how they all work is fascinating. It’s especially good when I have students with me – that’s just starting up again after a COVID-induced hiatus, as you can imagine. It lets these proto-vets see just what a diversity of approaches there are to small animal practice – and a diversity of prices too. Given the current furore about charges from some, it’s interesting to see how different clinics charge for my work.

A consultation with me can cost owners anything from £50 to £300. At the lower end of the spectrum, some clinics consider that having me to see a case for them is part of their service to the owner and animal and they don’t put any markup on my charge – in fact they get the owner to pay me direct and don’t take any “cut”, as it were. Others do charge the owner for the use of their facilities as well as my fee, and where I have to travel a long way to see the animal that is understandably higher than £50, especially if it’s only one animal I’m coming to see.

And I can understand why different clinics charge different amounts. One may work out of a small building – a glorified portacabin in one instance and the upgraded garage next to the vet’s house in another – with two vets, a nurse and a receptionist, while another clinic is 10 times the size, all chrome and glass with more vets, nurses, receptionists, kennel staff and so on – so their overheads are much much higher. The question is whether the standard of care is much much higher too – and I’ll leave you to ponder on that thought.

What they do clinically varies as well. One practice will do pre-op bloods on most cases, place a catheter in all animals having an anaesthetic, have a sterile theatre in which one has to wear scrubs and scrub yourself assiduously before operating. In another, hands are scrubbed and gloves worn but otherwise normal clothes kept on and pre-op bloods are a rarity, taken in cases where there is a suspicion of a clinical problem that warrants them. Understandably the costs for surgery in the former will be higher than the latter. Interestingly, in neither is an attempt made to wash and cleanse the animal coming in apart from the surgical site, so getting ourselves togged up in clean theatre gear for each operation may not reduce the bacterial load around the animal as much as we might hope!

I ask the students where we are as we start an operation – the answer of course is the operating theatre. And in pre-COVID days I ask them if they’ve been to the theatre recently – maybe as a student they’ve been involved in drama. And if they have acted, or watched others act in a play, what are they doing? Performing! The whole thing in a theatre is to perform, and that goes for an operating theatre quite as much as under a proscenium arch. The first one of these opinion pieces I wrote, and looking back on my laptop I see that was in 2013, was about this new sterilising agent, Sterilium, and how washing your hands for a minute and a half with that alcoholic solution was nothing like as much fun – not at all a performance – compared with orange bubbles and the harsh scrape of a rather well-used hand brush for five minutes that was the routine with povidone-iodine.

But, as often happens, I digress!

The problem we have is that some practices charge substantially higher fees than do others. And quite apart from the daily running costs of an individual clinic, larger practices and corporates need to cover their costs of offices and staff who aren’t directly making money by treating patients. Indeed, they might not see a cat or dog during their work day given that they are organising the drug purchasing or staff recruitment in a centre not necessarily attached to a veterinary practice. And then of course there are the venture capitalists who put money into the company in the first place. Their interest, as we see on Dragons’ Den, is fundamentally making money.

At the end of the day, there are owners who will feel happier taking their animal to a clinic which looks really swanky, if I can use such a word for a veterinary practice, and are happy to pay the price for that and all it has to offer. Others will be content to pay a fraction of that amount and come to a clinic with a couple of vets without the gleaming surfaces and pre-op bloods that others may offer as routine. The important thing is to have that choice across the country and ensure that there are practices who can offer a different sort of veterinary service at a different price in every town!

David Williams

FELLOW AND DIRECTOR OF STUDIES at UNIVERSITY OF CAMBRIDGE

David Williams, MA, VetMB, PhD, CertVOphthal, CertWEL, FHEA, FRCVS, graduated from Cambridge in 1988 and has worked in veterinary ophthalmology at the Animal Health Trust. He gained his Certificate in Veterinary Ophthalmology before undertaking a PhD at the RVC. David now teaches at the vet school in Cambridge.


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