What should I have charged?

Re: What should I have charged?

Martin Atkinson — Wed, 09 Apr 2014 10:20:03 GMT

[quote user="Emily Herskind Nightingale"]The nurses OOH fee is £46.00/hr + VAT [/quote] I presume the nurses don't get all that so there is an additional profit for the practice already on top of the other fees.

As I'm sole charge I tend to be flexible charge depending on circumstances and this one would have not received the 'sympathetic' end of my charging structure I have to say. I do very little OOH work now but for the record I charge my normal £8.50/min. surgery time to which all materials and drugs would have been added plus an £80 OOH surcharge and £50 hospitalisation fee and nurses overtime at double their normal rate.

Re: What should I have charged?

Braden Collins — Wed, 09 Apr 2014 09:59:45 GMT

Total bill about right I reckon. As a comparison we charge our vets out at $198/hour for monitoring animals, etc, so around 120 pounds/hour. The rest is about on par.

Re: What should I have charged?

Mark Holmes — Tue, 08 Apr 2014 22:10:55 GMT

I would have done it for free to avoid a 4yo's birthday party. You got paid ... Win win!

Re: What should I have charged?

Emily Nightingale — Tue, 08 Apr 2014 21:56:51 GMT

Hi. Thanks for all the input- Very encouraged to hear your thoughts.

I had outlined the potential costs (and had offered a detailed estimate which she declined ..twice.. )

The full bill included initial consult, Domitor sedation and reversal, 2 abdo rads (lat & DV), medication (injected buscopan, cerenia and synulox)

on the Friday. Saturday was rpt consult, inhouse bloods (haem and bioch), rpt injections as before, rpt lateral abdo xray, fluids, anaesthetic, surgical time, OOH surcharge (charged at 20% of the surgical time), my fee (which I am free to decide what I feel is appropriate), the nurses fee (fixed at £46/hour +vat for OOH ), consumables for op (drapes/gown/gloves/ 2L saline for flushing abdomen etc etc) and rpt post op lateral abdo rad..and meds to go home with.. all that came to just shy of £1900 incl VAT.

Very pleased to hear the majority feel this is reasonable.. and for the extra sympathy vote.. I missed out on going to a 4 year olds birthday party that my 2 y.o. son had been invited to... and was very excited about it. But the patient is fine.. Hurrah =)

Re: What should I have charged?

Stephen Courtney — Tue, 08 Apr 2014 21:04:02 GMT

How much did you estimate potential costs could be to the client before the surgery?

I find these a nightmare. And human nurses can be a huge part of that. but to be fair a lot of the people who call themselves nurses are really more along the lines of carers/ nursing assistants/ bed pan emptiers.

Re: What should I have charged?

Linda Filshie — Tue, 08 Apr 2014 19:48:35 GMT

Recent exlap and gastrotomy/multiple enterotomies to remove a linear FB in a young cat came to about £1450 including aftercare, all meds, hospitalisation etc. That was during the normal working week, no Saturday overtime. £1900 sounds reasonable to me.

Re: What should I have charged?

John Flynn — Tue, 08 Apr 2014 19:13:07 GMT

I appreciate costs don't compare well amongst geopgraphic areas, but I assume the pre-op chat of whether to remove a bleeding spleen or euthanase the dog goes similar wherever you work, so... how do you put it to the owner?

I tend to advise about a 50% chance that a bleeding spleen is "cancer", and that half of those will be a nasty cancer that will not be cured by removing the spleen and will generally mean that the dog will not survive for long (perhaps 2-3 months) after surgery. I further advise that we won't *know* whether it is a nasty cancer or not for a week or two after removing the spleen (should H/P be elected). Lastly, I advise that there is a 10%-20% risk of death either during the procedure or within the fortnight after having the spleen removed. I offer 3-view chest radiographs for metastases, but in practice I tend to either take a single "survey" chest radiograph or indeed none.

So overall that's about a 60%-65% chance of a decent outcome should you choose surgery, with an average cost per case of £xxx (based on average of the total bill for the previous 3 to 5 cases).

Re: What should I have charged?

Evelyn Barbour-Hill — Tue, 08 Apr 2014 19:07:41 GMT

[quote user="Emily Herskind Nightingale"]My family are horrified I only charged that, citing lawyers fees and private medical fees (My dad examines private pilots who fly as a hobby and his fees for a healthcheck are £200+ for an hour..)[/quote]

Have your family considered the possibility that lawyers and your father overcharge? (Please note, before everybody jumps down my throat, that I am not arguing that they do so.

Re: What should I have charged?

Francisco Gomez — Tue, 08 Apr 2014 18:54:27 GMT

[quote user="Michael Woodhouse"]

We'd charge somewhere around the £240 mark to spay this bitch - t

[/quote]

I believe that unfortunately 'bitch spay' is grossly undercharged in veterinary practice, because it is what people phone around about. The less you charge for it, the more likely to gain a client. Therefore everyone has a 'set' price for it.

I.e. mid-line cat spay is about £60-£70, but an ex-lap...

I'm not saying it is right... it's just the way everyone does it.

Re: What should I have charged?

Michael Woodhouse — Tue, 08 Apr 2014 17:09:55 GMT

[quote user="Gillian Mostyn"]

Funnily enough we had a similar case approx 4 weeks ago... collpased lab presented at 6pm so most of work done OOH. Our final bill was approx £1300 (Including histopath - why would you not need to know???!!!) Insured animal. And I know we're quite cheap!!!!!!

All I can say Michael is that your overheads are obviously an awful lot less than ours if you can make a profit charging that!

[/quote]

We'd charge somewhere around the £240 mark to spay this bitch - this surgery took maybe 10 minutes longer and there is extra to allow for the longer time extra clamps, swabs, suction. Technically I think I'd rather take spleens out than uterus's if you have enough clamps!

I'd say 75% of the care this dog received was exactly the same as if I'd spayed her. I'd have sent her home the next day if the owner wasn't on holiday and unsure how he'd cope with her. I'm quite happy with an extra £400 for some salty water, a cartridge for the istat and 48 hour use of the kennel.

I appreciate some practices have to charge less for the spay and make it up elsewhere. If I charged what you did most of the people around here would go for PTS rather than Tx.

I always offer histology, the owner declined in this case. Their money, their choice. It's a flatty - it will be cancer.

Re: What should I have charged?

Hannah Wynne Richards — Tue, 08 Apr 2014 16:42:10 GMT

£7.30 per hour for veterinary time OOH! Far too cheap. The op cost itself seems reasonable, but overtime in virtually every field is expected to be time and a half, so I would calculate your normal rate would be £4.86 per hour, which would be illegal for an unskilled person! The fact that your overtime is a quarter of your nurses' shows you it should have been more!

I would have taken your annual salary, calculated your hourely rate based on a normal week and 52 weeks, multiplied by 1.5, then by the number of hours you spent on this case.

Wynne

Re: What should I have charged?

Mark Holmes — Tue, 08 Apr 2014 16:14:05 GMT

[quote user="Michael Woodhouse"]

For a similar case I would expect our final bill to be around half what you are charging. It is exceptional if a small animal bill breaks the four figure mark.

We had a flatcoat retriever in last week - ruptured splenic tumour. Removed OOH, scan, bloods, fluids, 2 days hospitalisation - cost the owner, £650 including the VAT. To be fair that only had 40 mins surgical time. Mass not sent off.

[/quote] I would quote at least double that. Last one was a good £1500 and surgical time was similar.

Re: What should I have charged?

Anthony Dennison — Tue, 08 Apr 2014 15:57:48 GMT

[quote user="Gillian Mostyn"]Funnily enough we had a similar case approx 4 weeks ago... collpased lab presented at 6pm so most of work done OOH. Our final bill was approx £1300 (Including histopath - why would you not need to know???!!!) Insured animal. And I know we're quite cheap!!!!!![/quote]

Just priced a similar thing on our system; would be about the same (similar area geographically I guess)

Re: What should I have charged?

David Shepherd — Tue, 08 Apr 2014 15:47:53 GMT

Did she pay?

Re: What should I have charged?

Gillian Mostyn — Tue, 08 Apr 2014 15:22:50 GMT

Emily: We all charge differently (as we all have different overheads) but I would say the final bill sounds about right. Unfortunately we are restricted by the economics of our owners, so just because a doctor can manage to charge £200+vat per hour doesn't mean we can. Everyone is paid according to what the person paying is willing to pay, not necessarily what we are worth! (Compare to Cit of London bankers......)

[quote user="Michael Woodhouse"]We had a flatcoat retriever in last week - ruptured splenic tumour. Removed OOH, scan, bloods, fluids, 2 days hospitalisation - cost the owner, £650 including the VAT. To be fair that only had 40 mins surgical time. Mass not sent off.[/quote]

All I can say Michael is that your overheads are obviously an awful lot less than ours if you can make a profit charging that!

Re: What should I have charged?

Thomas Johnson — Tue, 08 Apr 2014 15:19:40 GMT

I think your charging sounds very reasonable to me. If you were only at the practice because of that case, then you should be charging for your time. As for how much you charge, very dificult, because if there had been other animals in you would have had time to monitor and treat them as well, so the animal needed you there for all that time, but didn't need your undivided attention. I would say you've probably got it about right.

Re: What should I have charged?

Anthony Dennison — Tue, 08 Apr 2014 15:13:37 GMT

That's incredibly cheap! Are you not worried you are undercharging, even devaluing the importance of your services?

Sorry if that sounds offensive, it's just how it was put across to me by management when I first started working and wasn't charging fully.

Re: What should I have charged?

Andrew Kent — Tue, 08 Apr 2014 15:00:58 GMT

Hi Emily,

I would say the cost sounds reasonable, but then vets have chronically under charged for their time for years which makes direct comparison with other professions difficult. Equally the charging structure differs so much between different practices that direct comparison on here is impossible.

Andy

Re: What should I have charged?

Michael Woodhouse — Tue, 08 Apr 2014 14:54:57 GMT

For a similar case I would expect our final bill to be around half what you are charging. It is exceptional if a small animal bill breaks the four figure mark.