Monopolies?

RE: Monopolies?

Anthony Todd — Mon, 23 Jul 2018 13:59:05 GMT

[quote user="Kate Richardson"]Anthony, with respect, you must be able to see your hypocrisy here- you have many times in previous posts advocated the 'giving of a jab of something' to a sick animal brought to you because the owner expects some treatment even if it is deemed not clinically necessary. [/quote]

True, and you're quite right and I was, or am and my argument was not really worthy of respect either.

The difference is only that now it is disguised as something ancillary, definitely non therapeutic, and much more expensive.

RE: Monopolies?

Kate Richardson — Mon, 23 Jul 2018 13:47:04 GMT

[quote user="Anthony Todd"]Back in the day all the vets I knew [with some exceptions!!] only did what they thought was necessary, not what the client imagined might be.[/quote]

Anthony, with respect, you must be able to see your hypocrisy here- you have many times in previous posts advocated the 'giving of a jab of something' to a sick animal brought to you because the owner expects some treatment even if it is deemed not clinically necessary.

Apologies Bob, if anyone wants to discuss this further, we should tangent it

RE: Monopolies?

Francisco Gomez — Mon, 23 Jul 2018 13:41:13 GMT

[quote user="Julie Innes"]

[quote user="Francisco Gomez"]

I'm not either against or for these sorts of prices. But my other half will not return to vet practice because she says no other job is paid so little for the amount of work it demanded of her.

When we complain about other people charges, we surely should take into account how we pay staff and how much is involved in the care. Some practices have a dedicated kennel nurse for example.

[/quote]

I don't think getting a higher wage would compensate most veterinary workers for having to euthanase animals that they could have helped. I know I would find it soul destroying. We all know that veterinary work doesn't pay as well as other careers and yet still choose to do it. Noone forced us

[/quote]

Using that logic we should pay our workers the legal minimum to ensure people disposable incomes can reach care.

RE: Monopolies?

Robin Grimmer — Mon, 23 Jul 2018 13:09:38 GMT

"5yo diabetic entire bitch with a mammary tumour who was quoted £1000 or euthanasia"

That doesn't seem unreasonable particularly if the diabetes was unstable. And of course both conditions would have been prevented if they had had the bitch spayed when she was younger.

RE: Monopolies?

Anthony Todd — Mon, 23 Jul 2018 13:01:54 GMT

[quote user="Kate Richardson"]Not quite sure what you are getting at? I am very happy to advise owners that pre op bloods aren't necessary if I don't feel they are necessary, however, if the owner would like them and is happy to pay for them AND I can obtain a sample with minimal stress to the animal, then I see no harm.[/quote]

So where do you stop? What about an x-ray, even if not necessary, or the classic, and back in the day mandatory, "injection"?

I would expect owners would always take your advice anyway?

Back in the day all the vets I knew [with some exceptions!!] only did what they thought was necessary, not what the client imagined might be.

I can't escape the feeling that these days sometimes some things are done for reasons other than veterinary medical necessity.

RE: Monopolies?

Julie Innes — Mon, 23 Jul 2018 12:34:53 GMT

[quote user="Francisco Gomez"]

I'm not either against or for these sorts of prices. But my other half will not return to vet practice because she says no other job is paid so little for the amount of work it demanded of her.

When we complain about other people charges, we surely should take into account how we pay staff and how much is involved in the care. Some practices have a dedicated kennel nurse for example.

[/quote]

RE: Monopolies?

Francisco Gomez — Mon, 23 Jul 2018 12:15:37 GMT

[quote user="Julie Innes"]

It didnt cost £1000

[/quote]

I'm not either against or for these sorts of prices. But my other half will not return to vet practice because she says no other job is paid so little for the amount of work it demanded of her.

When we complain about other people charges, we surely should take into account how we pay staff and how much is involved in the care. Some practices have a dedicated kennel nurse for example.

RE: Monopolies?

Kate Richardson — Mon, 23 Jul 2018 10:35:45 GMT

[quote user="Anthony Todd"]

[quote user="Kate Richardson"]Totally agree with questioning why bloods were necessary, but I don't know enough about the cat or the owner. [/quote]

Please tell me how "the owner" should have any influence on your, or any vet's clinical and therapeutic decisions.

[/quote]

Not quite sure what you are getting at? I am very happy to advise owners that pre op bloods aren't necessary if I don't feel they are necessary, however, if the owner would like them and is happy to pay for them AND I can obtain a sample with minimal stress to the animal, then I see no harm. Or it may be that they have had a previous bad experience and are very anxious and despite my reassurances that I have no concerns regarding the anaesthetic, if having a blood sample done helps alleviate some of the owner's anxiety and then allows me to perform a necesary procedure, then that's also fine as long as it is not detrimental to the cat. And in cats, the stress of getting a sample can sometimes/often be more detrimental pre GA then the info they give you.

[quote user="Julie Innes"]

Surely all the "add ons" should be optional, not pay all this or have your dog PTS?

It seems a strange business model to me, but it must work for them overall.

[/quote]

But it's not restricted to corporates! It comes down to you as an individual vet making decisions and choices based on what you think is the right thing to do. 'Add ons' are always optional, sometimes strongly advised, but not obligatory. At least that's the way I work, regardless of who pays my wages

RE: Monopolies?

Julie Innes — Mon, 23 Jul 2018 09:28:25 GMT

I don't get the rationale. We get a lot of patients as second opinion from the nearest big corporate, because they have been quoted ridiculous prices for fairly straightforward procedures. Obviously they must get enough people who just accept it and pay it to make it worthwhile. It makes me a bit cross sometimes- like the 5yo diabetic entire bitch with a mammary tumour who was quoted £1000 or euthanasia. She came to me, we spayed her and removed the mass, started her on insulin (although now she is neutered the amount required has decreased, naturally) It didnt cost £1000, and the lovely happy wee dog is still alive. Surely all the "add ons" should be optional, not pay all this or have your dog PTS?

It seems a strange business model to me, but it must work for them overall.

RE: Monopolies?

Anthony Todd — Sun, 22 Jul 2018 18:02:20 GMT

[quote user="Kate Richardson"]Totally agree with questioning why bloods were necessary, but I don't know enough about the cat or the owner. [/quote]

Please tell me how "the owner" should have any influence on your, or any vet's clinical and therapeutic decisions.

Cat dentals are a recurring thread on here and are becoming far more expensive, and "comprehensive", in terms of the add-ons.

Back in the day what would be regarded now as an inadequate cash gouge and therapeutic and diagnostic missed opportunity, always resulted in an obvious massive improvement in the cat's well-being with very few come-backs, repeats and/or failures.

RE: Monopolies?

Evelyn Barbour-Hill — Sun, 22 Jul 2018 16:40:26 GMT

[quote user="Laurence Webb"]Pre op bloods were about £140. Drip was around £100. £174 for the first x-ray and £100 for .two more. I think surgery time was about 30 minutes.[/quote]

Nearest thing we've got for "jaw hits floor" emoticon.

RE: Monopolies?

Kate Richardson — Sun, 22 Jul 2018 15:23:43 GMT

[quote user="Laurence Webb"]

Yes, I have a breakdown of the costs. It was a 3yo, apparently otherwise healthy cat with FORLs on both lower first premolars

Pre op bloods were about £140. Drip was around £100. £174 for the first x-ray and £100 for .two more. I think surgery time was about 30 minutes. No nerve blocks and done by a standard GP vet, much like myself.

Bizarrely, when I saw the cat and there were a couple of extra teeth that had developed FORLs since the elderly lady who owned the cat asked of she should go back to the other practice for treatment.

I have no problems with the standard of treatment (although I would question whether a young healthy cat needed such an extensive blood panel)

[/quote]

Totally agree with questioning why bloods were necessary, but I don't know enough about the cat or the owner. Price wise, again difficult to comment without knowing exactly what was tested, but I would be wanting a pretty comprehensive profile for that price! Fluids, a bit pricey maybe. But the price of the xrays- that is way OTT. We do full mouth xrays (6 films, specific dental xray machine) for about £70 then about £12 per extra plate from there. £274 for 3 films is a rip off. As a vet I would be questioning my superiors about that, as that is not valuing dentistry, that is ripping people off. Apologies if I seemed a little defensive, but a lot of my dental procedures do come in at the £6-700 mark because of the xrays and other extras, but I feel I do offer good value for money in that the cat has had a really comprehensive assessment and treatment, and I am happy to 'cut corners' where I can if this is not affordable.

RE: Monopolies?

Anthony Todd — Sun, 22 Jul 2018 11:53:43 GMT

[quote user="robloxley"]and the markup on the cost of, say, the in house bloods and a drip are pretty keen[/quote]

Not as "keen" as not doing them.....

RE: Monopolies?

Rob Loxley — Sun, 22 Jul 2018 09:57:27 GMT

[quote user="Laurence Webb"]I have no problems with the standard of treatment [/quote]

and the markup on the cost of, say, the in house bloods and a drip are pretty keen

RE: Monopolies?

Laurence Webb — Sat, 21 Jul 2018 21:06:50 GMT

[quote user="Kate Richardson"]

[quote user="Evelyn Barbour-Hill"]

[quote user="Laurence Webb"]although some of the pricing that I have seen from corporates can be eye watering - £720 to remove two first premolars in a cat with FORLS)[/quote]

If a corporate is in a position to dictate that, there is something wrong somewhere.

[/quote]

I feel compelled to defend this slightly- have you seen the breakdown of costs? It may be that it included pre operative bloods including electrolytes and blood pressure on a cat with known renal disease, intravenous fluids, the anaesthetic carefully monitored by an experienced feline nurse, full mouth xrays and assessment, nerve blocks, surgical extractions by a very experienced dental surgeon albeit not a specialist, post extraction xrays to ensure there were minimal post operative complications, suturing of the gingiva and post operative analgesia.

Maybe the corporate didn't 'dictate' the prices, but they reflect the knowledge and experience of the vet performing the procedure rather than just hoicking out 2 teeth.

[quote user="bevs2251"]!! That price should cover a full mouth extraction (minus canines) !! 2 premolars only ?? Only if it's the carnassials.[/quote]

Really? for 3 hours of surgery? Do you think that places value on dentistry?

[/quote] Yes, I have a breakdown of the costs. It was a 3yo, apparently otherwise healthy cat with FORLs on both lower first premolars

Bizarrely, when I saw the cat and there were a couple of extra teeth that had developed FORLs since the elderly lady who owned the cat asked of she should go back to the other practice for treatment.

I have no problems with the standard of treatment (although I would question whether a young healthy cat needed such an extensive blood panel)

RE: Monopolies?

Rob Loxley — Sat, 21 Jul 2018 12:55:53 GMT

[quote user="Bob Russell"]I am concerned that the 'rule book' is potentially being dictated by non-vets and clients may well not have much choice should this be misused[/quote]

Through RCVS council representation, now through fingers in new vet schools - is that a good thing?

RE: Monopolies?

Bob Russell — Sat, 21 Jul 2018 11:32:20 GMT

This has strayed away from the point of my original post.

I am not being critical of clinical standards. I am not having a go at the people involved in any of these practices.

I am concerned that the 'rule book' is potentially being dictated by non-vets and clients may well not have much choice should this be misused.

I was primarily interested in where a monopoly be considered to exist.

The Competitions Commission did untold damage to the profession (IMO) when it intervened before and I hate to think what would happen should they interfere again!

I consider myself guilty of poorer note taking than I would like! Not professionally isolated but could do with some help however we are well equipped!

RE: Monopolies?

Robin Grimmer — Sat, 21 Jul 2018 08:53:31 GMT

I've locumed in a lot of practices and the worst ones to work in have all been one man band, individually owned practices. Professionally isolated, idiosyncratic/eccentric practices, sometimes poorly equipped, poor clinical notes etc.

RE: Monopolies?

Kate Richardson — Sat, 21 Jul 2018 08:44:57 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Laurence Webb"]although some of the pricing that I have seen from corporates can be eye watering - £720 to remove two first premolars in a cat with FORLS)[/quote]

If a corporate is in a position to dictate that, there is something wrong somewhere.

[/quote]

Maybe the corporate didn't 'dictate' the prices, but they reflect the knowledge and experience of the vet performing the procedure rather than just hoicking out 2 teeth.

[quote user="bevs2251"]!! That price should cover a full mouth extraction (minus canines) !! 2 premolars only ?? Only if it's the carnassials.[/quote]

Really? for 3 hours of surgery? Do you think that places value on dentistry?

RE: Monopolies?

bevs2251 — Sat, 21 Jul 2018 02:58:07 GMT

[quote user="Laurence Webb"]although some of the pricing that I have seen from corporates can be eye watering - £720 to remove two first premolars in a cat with FORLS)[/quote]

!! That price should cover a full mouth extraction (minus canines) !! 2 premolars only ?? Only if it's the carnassials.

RE: Monopolies?

Evelyn Barbour-Hill — Fri, 20 Jul 2018 23:58:14 GMT

[quote user="Laurence Webb"]although some of the pricing that I have seen from corporates can be eye watering - £720 to remove two first premolars in a cat with FORLS)[/quote]

If a corporate is in a position to dictate that, there is something wrong somewhere.

RE: Monopolies?

grumpyoldman — Fri, 20 Jul 2018 23:54:01 GMT

Where it bothers me slightly ,and its only slightly. is when they start to own suppliers e.g. Veterinary Instrumentation and Vetisco, and they then give their own practices preferential discounts on consumables . They can also abuse their position by adversely affecting none corporate practices credit ratings. On a day to day basis we have done very well out of them so far.

RE: Monopolies?

Martin McDowell — Fri, 20 Jul 2018 20:24:07 GMT

I would agree with the Bob on this. Some areas have only one single corporate having a monopoly in certain areas. They can influence the bulk order prices and also things like who they will accept as a locum or not. There is not enough transparency to show they are in fact part of a corporate. This not in any way visible on trademarks and clinic logos. At least the other large corporate often operated from pet stores has their complete own branding that is clearly showing they are part of a group.

Of course you could argue that independents have the option of joining buying groups but I am not sure of they can be as powerful as a corporate who can dictate to its clinics exactly which drugs they can and which they cannot order.

RE: Monopolies?

Dinu Catilina — Fri, 20 Jul 2018 17:28:28 GMT

[quote user="Wren"]I probably speak for some others on here, but I do find the ongoing onslaught against corporate practices and those who work in them rather tiresome and ever-so-slightly offensive.[/quote]

Wren, I don't think anyone has anything against the vets working for a corporate, as you said, their morals, clinical standards, etc will be the same regardless who their boss is. I do understand the defensiveness though, I worked for 2 different corporations, and who knows I might work again for one in the future!

The issue with corporations and monopoly is related to how how the whole profession will be regulated in the future. With more and more corporate people getting on the RCVS panel it can become easier to target small independent practice. I am not saying it will happen but it can happen.

This has happened in other industries as well. Set certain targets very high under the mask of protecting the consumer/ client/ patient leading to only certain players being able to conform. Example: RCVS may in the future decide what level of OOH cover should be offered by all practices, a minimum of one staff on site overnight to monitor inpatients, emergencies, etc. In theory great for the patient, no more animals left in cages on fluid pumps for 8 hours. Then, the local OOH (corporate) decides that they can only provide cover for their own practices. The 3 man small practice will have no option but to sell or close down.

This is my concern regarding corporatisation and monopoly. The bigger they are the easier it becomes to control the market and there will be little choice left for clients.

RE: Monopolies?

Bob Russell — Fri, 20 Jul 2018 16:44:16 GMT

I am not really concerned about clinical standards in any of the practices. We have had some grumbles that medication has become more expensive after the take over.

The concerns regarding a near monopoly situation is that large areas may only have practices owned by one corporate and this could lead to abuse.

Around here I would guess 60-70% of practices are now owned by one corporate.

I have a particular dislike of practices/groups using terminology such as My Vet, My Family Vet etc. In the old days the RCVS would have had quite a lot to say about terms like this.

Perhaps if someone makes me an offer I cannot refuse then I will join the rest of the profession in becoming part of the sell out.

Thankfully we are busier than we have ever been!