Why does a trip to the vet ER cost so darned much?

I get this question (or a snide comment) at least once a shift. It occurred to me that people genuinely don't understand why it takes more money to run an ER clinic and why the bills are often 2-3 times higher when compared to the price of a general practitioner. So, here are some of the reasons you're going to shell out more money to see an ER doctor.

1) Staff. Unlike a day practice, we do not schedule appointments and surgeries. We are walk-in service only. As a result, we must keep a certain amount of staff on hand at all times. On a regular Wednesday night, I have 2 technicians early in the evening, as well as a receptionist. A third technician comes in later to do the overnight shift. Some nights, we all sit around and stare at each other. Other nights, I need a third and fourth hand to spontaneously grow out of my chest so we have more help. There is no way to tell how any given night is going to go. As a result, we have a higher number of staff. Since they work nights, weekends, and holidays, they are also better payed (generally) then your average, day-time technician. Especially when they are working the "graveyard/overnight shift" and holidays (or overtime, as frequently happens when we are slammed with gravely ill patients).

2) Drugs. Our ER clinic stocks pretty much every drug known to man/beast. This is necessary because we see and treat a wide range of medical conditions - ranging form the not very serious to the immediately life-threatening. If we need a drug at 3am, there are no other practices we can call to obtain it. If we need red blood cells or plasma at 3am, we must procure it ourselves (and is why we keep it on hand). As a a result, we keep a very large inventory. Believe it or not, even the test cartridges for our blood machines EXPIRE. Often, these drugs and tests expire before we can use them all (MANY of then). We still need them, and so we stock them.

3) Advanced testing capabilities. Unlike many practices, we have digital xray, ultrasound, machines that can check clotting times, cortisol levels, and all manner of other bloodwork. We are often able to find a diagnosis on the spot given the on-site capabilities of our practice. Many day practices send out bloodwork, which is less expensive for the client. It also leaves the clients waiting for an answer. In GP, where animals are usually less ill, this is ok. In ER,when we often need answers NOW, this is not ok. As a result, we must keep all these machines, keep them running and healthy, too!

4) Nights, weekends, holidays. Finding veterinarians who want to give up their nights, weekends, and holidays is a challenge. ER hours are long, demanding, and frequently exhausting. Burnout is common in ER veterinarians (see recent posts). It is hard to find veterinarians to do this, and as a result, salaries must be higher. Part of the reason I do ER is the fact that I can make a great deal more money than my GP counterparts. On the other hand, I cannot count how many times I have missed family get-togethers, important milestones, or weddings because I had to work. Sure, I get 9 days off every 12, which is great. Yet, everyone else is working normal hours, so I entertain myself much of that time.

5) Overhead is extremely high. Drugs and machines/diagnostics, as I've mentioned - but also supplies, building space, heating and air. Since we are ER, we need a minimum amount of cage space, working space. There's no way to tell how many clients we could have at any given time, and having room for all of them, as well as AC and heat to keep them comfortable (and us) is part of the expense.

6) Our clinic is small but currently provides us with a generous continuing education allowance per year. This is crucial for veterinarians who wish to keep up with current diagnostic and treatment options. Further, the clinic pays for health insurance out of pocket. We are a small clinic (less than 20 employees), and as a result, we don't get any great discounts on health care. Some people may complain that this shouldn't be part of the cost of seeing an ER veterinarian, but it IS the cost of running a business.

When it comes down to it, would I like to treat every animal I see with no restrictions? Absolutely, yes. My job would probably be a great deal more emotionally satisfying if I could help every pet I see. But it all boils down to the fact that, like it or not, a veterinary hospital is a BUSINESS. It must be run like a business, and it must be self-sustaining, like any business. If we aren't, the doors are closed, the drugs are gone, the veterinarians leave, and no animal gets help.

Does that mean that we are not compassionate? That we don't love animals or want to help? No, it means that I do what I can within the means owners give me, while trying to do my best for the pet. And sometimes doing the best I can for the pet is realizing that I've done what I can and I have to be satisfied with that. Just like everyone else out there who goes to work, I go to work to bring home a paycheck, to feed my growing family, and to make sure that I have a car that runs. Happily, I am also passionate about what I do and have a great moral obligation to do it well...