Should we have individual choice over OOH? (Tangent to "Crisis in the Profession")

RE: Should we have individual choice over OOH? (Tangent to "Crisis in the Profession")

cairncross — Fri, 03 Sep 2021 14:59:40 GMT

In terms of ooh i feel if the online provider has said need to be seen, we cannot argue or contradict a fellow professional without further evidence so we are forced to see whilst they have collected fee and absolved responsibility.

On arrival if it is trivial and i try to collect ooh fee any ire is directed at me.

I also wonder how much data they harvest certainly feel anecdotally that clients who have cobtacted these then are more likely to ask for prescription next they need meds as they have now seen advert fir tgeir med at much less online

RE: Should we have individual choice over OOH? (Tangent to "Crisis in the Profession")

vetbl.locum — Fri, 03 Sep 2021 11:01:26 GMT

Still doing OOH work, recently I have had several clients stating that they have phoned their insurers helpline and this is what needs doing to their pet. Which seems even worse than Dr Google help.

Last night's was a Pug which had eaten corn on cob which need X ray, induction of vomiting, ivft and must be done within a 2 hour window of which 7/8ths had passed by the time the very worried client phoned me.

What is the experience of the forum on these services and the impact on the subsequent face to face consult

Rgds

RE: Should we have individual choice over OOH? (Tangent to "Crisis in the Profession")

Chris Milligan — Fri, 27 Aug 2021 16:38:51 GMT

[quote userid="3839" url="~/001/nonclinical/f/life-in-practice-discussions/29957/should-we-have-individual-choice-over-ooh-tangent-to-crisis-in-the-profession/232628#232628"]Without the legislation do you think the ER clinics would be present . What happens to those in Canada that can not afford or can not reach the ER clinics?[/quote]

Good question. The legislation is much younger and less well established than in the RCVS codes - a lot of issues have still yet to be brought up and legislated on in BC at least. As far as I know the current emergency system here has been around since the early 80s, predating much of the current legislative standards. Canadian (and American) provinces/states each have their own regulatory bodies and each is independent of the other - there's no nationwide standard; but OOH care is broadly similar across the country. Generally if you can't afford care you don't get it, certainly not from a private general practice - sounds brutal but it actually puts the onus back onto owners not to take on pets they can't afford and, in some regard, it is somewhat successful at this. Of course there are many exceptions - most provinces have legislation requiring compassionate euthanasia at no charge for patients in critical distress. The biggest difference here is that the SPCA and animal welfare organisations have a lot more teeth and as a government organisation rather than a charity their duties are, in BC at least, enforced in law. If clients turn up with a suffering pet and refuse/can't afford care their options are strictly one of three - treat it at the GP if you can find the finances (preferable); surrender care to local SPCA who will treat it and then rehome it or euthanase it dependent on severity; euthanasia. This legal requirement for the involvement of the SPCA gets private clinics out of a lot of jams and is incredibly useful.

with respect to your other questions - Canada is generally slightly cheaper cost of living than the UK. BC is very expensive compared to rest of country (avg house price outside of Vancouver is about $500k, inside of Vancouver you're talking $1M plus) Martin's figures for the other jobs is about right. Most people rent, in BC rents are very expensive too (more than UK in a lot of places), but food, petrol, tax and public services quite a bit less than the UK. Plus healthcare is free here versus the US. Not sure about HK - I hear its mega expensive there and very long work hours?

RE: Should we have individual choice over OOH? (Tangent to "Crisis in the Profession")

Chris Milligan — Fri, 27 Aug 2021 16:00:40 GMT

not too sure to be honest - my understanding from talking to the local colleagues is that large animal is much more like the UK system just out of necessity to maintain good relations with farmers, but I haven't touched a cow since final year. They're the ones that go moo right? Horses the same as small animal I believe, but at least in BC and Alberta horse care is decidedly more rough and ready than in the UK

RE: Should we have individual choice over OOH? (Tangent to "Crisis in the Profession")

cairncross — Thu, 26 Aug 2021 02:08:17 GMT

Hi Hamish , farm here was effectively subsidised by TB testing this allowed practises enough income and vets to improve rotas.Just now that has flipped and practises who can't get vets can't get the testing done and are stuck in contracts obliging them to provide testing.

Equine is an example of where small is heading . Stripped down to a specialist gold standard only service affordable to a tiny few . Afaik corporates are in the process of stripping equine out of mixed into a standalone service .

RE: Should we have individual choice over OOH? (Tangent to "Crisis in the Profession")

cairncross — Thu, 26 Aug 2021 01:39:06 GMT

would they have had free access for the euthanasia of they phoned and said no money or would it only be if already their having paid a fee.

Do the municipality provide a free ooh service or would their involvement only be a 9 to 5 thing..

Google reveals 58 percent of UK households on some form of benefit . (Welfare) significant regional variation in this 34 percent in London where most of the population is so much higher elsewhere.

Average UK wage in UK has risen 40 percent scince I qualified in 99 . Ooh fee to get seen at my first job 60 pounds now 200 .at same practise I asked yesterday. Most ooh cases would be dealt with for under 100 pounds GDV in the region 3 to 4 hundred .remember hastle with a bill and old boss explaing to owner they had 2 vets up most of the night for 300 pounds . An overnight bill reaching £1000 pounds unheard of anywhere at that time . Equipement staffing specialist expertise has expanded massively but affordability hasnt . Average ooh bills must have risen 500 percent at least in the period wages have increased 40 percent.

Vet times 11/01/2017 insurance premiums and claim costs rising by 10 percent per annum. .would equate to similar 4 or 500 percent increase over the 20 year period when wages rose 40 percent.

UK house price average in 2000 8ok now 200 k

Heating oil in 2000 15p litre now 40p

Petrol in 2000 36p now 132.

Summary households disposable income in ,20 years must have risen by less than 40 percent vet fees increased by 400 to 500 percent in same period. .Now we have a big expansion in pet numbers to factor in that reduced affordability/ disposable income has to spread over more pets.

RE: Should we have individual choice over OOH? (Tangent to "Crisis in the Profession")

Hamish Denham — Wed, 25 Aug 2021 22:54:09 GMT

So we having been mainly discussing small animal out of hours. How is the large animal out of hours provided. C section for cattle and colic for horses?

RE: Should we have individual choice over OOH? (Tangent to "Crisis in the Profession")

Martin Hamilton — Wed, 25 Aug 2021 22:48:01 GMT

What happens to clients who can't afford a practices out of hours fee in the UK? "Unofficially" our ER will do free euthanasia's if the alternative is the client taking a pet home to suffer. The legal onus is also on the owner, so if they cannot afford treatment and the pet needs immediate care and refuses euthanasia, legally the municipality can possess the animal from the owner to relieve suffering.

[quote userid="3839" url="~/001/nonclinical/f/life-in-practice-discussions/29957/should-we-have-individual-choice-over-ooh-tangent-to-crisis-in-the-profession/232628#232628"]I understand vets wages are higher but as all things are relative, what are wages like for the general population ie what is the average wage, what does a teacher or HGV driver earn, what do city bankers earn? May have been touched on but what does a 3 bed room house cost , and what are rents like. How much is a L of petrol.[/quote]

Avg wage in Ontario - $50k (£28k)

Avg teacher salary in Ontario - $108k (£62k)

Avg HGV salary in Ontario - $59k (£34k)

Avg banker salary (this is hard to find as depends on the definition of a banker) - $48k (£27k) for a teller as far as I can tell. If we mean investment bankers then it's $105k (£61k)

Avg 3 bedroom house in Ontario - $594k (£342) - I'd like to note the avg size in the UK is approx 1087sq ft and in Ontario it is approx 2000sq ft. In Ottawa I bought my first home for $524, 3 bedrooms, so a little cheaper than the avg.

Rent - $1347/month (£700/month).

1L petrol - $1.27 today (73p)

RE: Should we have individual choice over OOH? (Tangent to "Crisis in the Profession")

hilary warner — Wed, 25 Aug 2021 22:31:26 GMT

[quote userid="9179" url="~/001/nonclinical/f/life-in-practice-discussions/29957/should-we-have-individual-choice-over-ooh-tangent-to-crisis-in-the-profession/232586#232586"]In most provinces the legislation insists on cases requiring OOH care to be at hospitals that can monitor them properly overnight. Popping in to see a hospitalised dog on fluids a couple of times overnight is not an accepted standard of care here (having run one of said ER hospitals until recently I can say neither should it be[/quote]

Without the legislation do you think the ER clinics would be present . What happens to those in Canada that can not afford or can not reach the ER clinics?

I understand vets wages are higher but as all things are relative, what are wages like for the general population ie what is the average wage, what does a teacher or HGV driver earn, what do city bankers earn? May have been touched on but what does a 3 bed room house cost , and what are rents like. How much is a L of petrol.

Again asking as working in Hong Kong gives a better wage but it is only possible to afford a modest flat, also although you may work until 7 pm you can then go shopping usually 8-10 pm if I remember correctly and there are just loads of places to eat even until the early hours. It is also culturally unacceptable to loose face and leave a debt, this makes some things much easier. Because places are open later it is possible to meet with friends and have a social life but it is a different sort of life and expectation to living in a rural UK community.

RE: Should we have individual choice over OOH? (Tangent to "Crisis in the Profession")

Chris Milligan — Wed, 25 Aug 2021 07:57:31 GMT

Vets Now is not the same as the ER system in North America - typically they go into existing clinics to do a night shift. ER clinics are independent hospitals that don't do any regular work.

In most provinces the legislation insists on cases requiring OOH care to be at hospitals that can monitor them properly overnight. Popping in to see a hospitalised dog on fluids a couple of times overnight is not an accepted standard of care here (having run one of said ER hospitals until recently I can say neither should it be). I worked in the UK for 5 years before moving here and I think the biggest difference I've noticed is that in the UK there's almost this expectation from the public and colleagues alie that the vet will be pushed into doing everything for nothing, even when that is hopelessly unrealistic. I think the UK is starting to have to deal with the consequences of this now everyone went out and bought a dog during the pandemic - completely inadequate OOH coverage to provide the recommended standard, but vets try to offer it regardless. It's bad for your health to work like this, bad for the patient and wasted on an ungrateful or indifferent client (though not all are ungrateful of course).

In my hospital NCPO from choking incl hospitalisation, FAST, serial rads, STAT rad review with a radiologist, bloods/blood gas and meds for a dog that survives would have been around CAD$2000-2500 (about 1700 GBP). ER vet salaries (we never took anyone less than 2 years experience) are at least $120k and up depending on location and volume of cases at the clinic (volume of cases is typically somewhere between insane and ridiculously insane).

GP clinics in an urban area would have sent that straight to emerg - better level of care, less stress for staff and owners. In very rural areas where distance is a problem most vets would have at least stabilised it for a journey if not made an exception. stuff like this is pretty rare for each invidual GP clinic though - only at emerg where you're feeding cases from 80-100 clinics are you seeing high volumes of it. The 500mile journeys aren't really that common - I work on Vancouver Island, there are some very remote communities only reachable by boat. If no boat access, no emergency care. Some people fly, most "emergencies" can actually wait quite a bit, at least a 4-5 hour car journey. Only really resp stuff, GDVs and vascular accidents that die in that time frame. What can I say, it's a big country with not that many people in it!

RE: Should we have individual choice over OOH? (Tangent to "Crisis in the Profession")

Chris Milligan — Wed, 25 Aug 2021 07:39:18 GMT

sorry I should clarify emergency clinics in Canada are open 24/7 every day of the year - you send stuff to them whenever you like. virtually every major settlement has a large hospital serving this function, sometimes several in the bigger cities. The system works extremely well generally - ER clinics act as a walk in for anyone, any time so clients get seen,and GP vets don't get burned out (theoretically). Any staying late to deal with an emergency is entirely at the discretion of the vet, and usually poorly received by support staff. Clients expect to have to go up to emerg. Most hospitals stop seeing cases an hour before they close so there's a low risk of the scenario you describe above. I think it's a cultural thing - Canadians are very clear about their work/life boundaries in a way that Brits aren't generally

RE: Should we have individual choice over OOH? (Tangent to "Crisis in the Profession")

hilary warner — Wed, 25 Aug 2021 07:24:17 GMT

Dear Chris and Martin,

This sounds like what Vets now tried t set up in the UK but met with much resistance. Ironically we had a genuine emergency come in last night at 5.15 w close at 6.30 that was not going any where else once arrived, it had been a choking puppy and on arrival- cyanotic it had non cardiogenic pulmonary oedema and some inhalation pneumonia on top, the only other time we had a patient we could not really move was one that had been in a house fire, lungs similarly compromised.

To be honest although the owner would have liked constant monitoring it was felt moving to an emergency clinic may have undone all the good, once stabilised- ie O2 not required, whilst resting, so it had periodic monitoring and the client is to be charged appropriately for this time so staff can be compensated. NB I went to sleep and set an alarm to get up and check the puppy and give antibiotics. If the puppy developed/develops SARS it will do this regardless of where it is so minimising further stress seemed most appropriate. We are a small practice and this does not happen often, providing you can have a slightly flexible attitude it can work. What is an issue is trying to provide a Tesla for the cost of a Pinto, grumpy staff, grumpy boss and a client with unrealistic expectations the next time. NB we had three people work shifts to monitor so no one has done the whole night, as said I was happy to sleep and get up and check the patient periodically, not ideal but as the puppy is really well this morning the plan is good. n=1.

Could you give us some sort o idea of costs for work at the emergency clinics or for this case. Again if wages are 70-115 then it is useful to know and idea of fees.

Chris would reception have turned this pup away?

How long does it take to cove 500miles, do many people fly?

RE: Should we have individual choice over OOH? (Tangent to "Crisis in the Profession")

Dinu Catilina — Wed, 25 Aug 2021 07:22:18 GMT

[quote userid="9179" url="~/001/nonclinical/f/life-in-practice-discussions/29957/should-we-have-individual-choice-over-ooh-tangent-to-crisis-in-the-profession/232573#232573"]it doesn't get to arrive - the receptionists will send it up to emergency unless there are very extraneous circumstances.[/quote]

This is one of the main issues with the OOH providers in the UK. VetsNow can not provide this level of service which creates a rare but very difficult situation. If the day practice and the shop closes at 7 and the emergency arrives at 6:30, what then? When the genuine emergency called at 6PM there is no way to direct them straight to a VN clinic.

I understand there is no perfect system but this is an unfair system where some have to do the work of others.

RE: Should we have individual choice over OOH? (Tangent to "Crisis in the Profession")

Chris Milligan — Tue, 24 Aug 2021 22:23:27 GMT

[quote userid="16672" url="~/001/nonclinical/f/life-in-practice-discussions/29957/should-we-have-individual-choice-over-ooh-tangent-to-crisis-in-the-profession/232568#232568"]Hope you're doing well in BC! [/quote]

We're good thanks - hope you're enjoying Ontario still. Lots of forest fires here at the moment ,but otherwise enjoying summer on the island. We get cases from the Northwest Passage communities occasionally - about 800miles away - but that's about the furthest.

RE: Should we have individual choice over OOH? (Tangent to "Crisis in the Profession")

Chris Milligan — Tue, 24 Aug 2021 22:21:04 GMT

all the time - depends on the complexity of the case. if it needs overnight care it usually goes to emergency.

it doesn't get to arrive - the receptionists will send it up to emergency unless there are very extraneous circumstances. most clinics avoid the chaotic disruption of the chancers that aren't registered at your clinic marching into your reception at 6:45 on a friday evening with a pyo, as is so common in British practices. even if they do walk into the clinic they'll be turned around and sent to emergency.

RE: Should we have individual choice over OOH? (Tangent to "Crisis in the Profession")

Martin Hamilton — Tue, 24 Aug 2021 21:59:25 GMT

At my last practice staff had to book an appointment like any other client, though sometimes would be squeezed into a lunch break. Up to the discretion of the vet working (though we were a three-man practice and I was the only one not a partner) so pretty manageable. Out of hours - maybe a vet would come in but generally they would go to emergency out of hours practice like any other client. Unsure about in BC where Chris is but in Ontario it's pretty common that vet staff get a discount at out of hours practices as a way to foster good will.

The clients are usually given three options:

- We stabilise at the regular practice and transfer the patient to an out of hours practice at closing time - transportation is the owners responsibility. If this extends past opening hours there will be additional fees to cover staff costs (for example, blocked cat which is recumbent).

- Pet goes straight to emergency provider - we may provide analgesia or first aid as is deemed appropriate.

- Emergency is dealt with in regular practice, owner is informed it will be cheaper but there will be no care overnight, if staff stay past closing there will be additional fees to cover staff costs. Given economies of scale, generally this is cheaper than emergency practice but not by an insane amount (unless the pet is hospitalised for a week or something).

Transfering patient to emergency provider involves us (the general practitioner) calling the emergency provider, getting a rough estimate, presenting it to the client and then they choose which option to go for. Once the client confirms they are going to emergency clinic we will call the emergency practice, GP vet talks to emergency vet about history to allow the emergency practice to triage/set up for procedures accordingly.

Edit: clients are also given the option of euthanasia should it be deemed appropriate

Also, as Chris said below, this situation doesn't even occur too often as the pets are often already diverted to an emergency facility when they call in advance and/or clients have been doing this for 30 years so head to an emergency practice intuitively.

RE: Should we have individual choice over OOH? (Tangent to "Crisis in the Profession")

hilary warner — Tue, 24 Aug 2021 21:40:26 GMT

Do staff ever try bending the rules for their own pets?

What do you do with the complicated case that arrives 60 minutes before closing? ie inpatients

This is trying to have an idea of how these things are managed. I am also assuming the culture is different. I am very aware in rural Scotland things/expectations are different to in the city and also what people are prepared to do themselves.

RE: Should we have individual choice over OOH? (Tangent to "Crisis in the Profession")

Martin Hamilton — Tue, 24 Aug 2021 19:39:54 GMT

[quote userid="9179" url="~/001/nonclinical/f/life-in-practice-discussions/29957/should-we-have-individual-choice-over-ooh-tangent-to-crisis-in-the-profession/232567#232567"]This is typically the closest emergency clinic - though in places this can be 500miles away. People deal with it.[/quote]

Hey Chris, I was hoping you'd be able to back up some of the Canadian aspect of things! Hope you're doing well in BC! We have clients flying dogs 2000km from Iqaluit to here, but that's a very rare exception.

[quote userid="9179" url="~/001/nonclinical/f/life-in-practice-discussions/29957/should-we-have-individual-choice-over-ooh-tangent-to-crisis-in-the-profession/232567#232567"]clinics simply have to designate an emergency provider, and even then only for clients registered at the clinic[/quote]

This is the case here in Ontario too.

RE: Should we have individual choice over OOH? (Tangent to "Crisis in the Profession")

Chris Milligan — Tue, 24 Aug 2021 19:20:33 GMT

In Canada, or at least British Columbia, clinics simply have to designate an emergency provider, and even then only for clients registered at the clinic. This is typically the closest emergency clinic - though in places this can be 500miles away. People deal with it. Almost no vets provide their own out of hours, nor do many work weekends. The difference in work/life balance and job satisfaction between Canadian and UK vets is predictably immense

RE: Should we have individual choice over OOH? (Tangent to "Crisis in the Profession")

cairncross — Sun, 22 Aug 2021 19:30:07 GMT

Thank you , again. If things are not progressed officially , wont econmics just drive the change ooh will just be priced out of reach for mostvanimals and owners. This makes the profession look even worse. How much consultation or trial is needed the rest of the world has been running without ooh obligations for ever.

I am not comfortable either abandoning , which why i put a compromise out there r of care within 24 hour .

RE: Should we have individual choice over OOH? (Tangent to "Crisis in the Profession")

cairncross — Sun, 22 Aug 2021 19:18:32 GMT

I guess we fall into that bracket, but we were lucky too. I wouldnt swap my 5 years at vet school for anthing in the world. Nowadays it seems to be a minefield of massaging the egos of teaching staff,.asking difficult questions or mentioning affordable options rather than the proscribed gold standard is an abomination. Seeing practise can be endless hours in a designated area of floorspace with hands in pockets or clasped behind back is proscribed touching a surface let alone an animal or medicine doest happen for some

I still love being a vet pretty much every day , I want to continue , i want to deliver it to the local community not a select few who can afford it from a much wider catchment. Itvshouldnt be asking that much for a system that facilitates as many as possible of the local animal population to receive some care. Its either that or we decide what percentage gets high end care and which get non.

RE: Should we have individual choice over OOH? (Tangent to "Crisis in the Profession")

Gillian Mostyn — Sun, 22 Aug 2021 19:11:45 GMT

Absolutely. I'm not one of the people who look back with rose tinted specs ... those days are best left in the past ... but it is much harder to be a practice owner/manager now ... hence why I sold

RE: Should we have individual choice over OOH? (Tangent to "Crisis in the Profession")

hilary warner — Sun, 22 Aug 2021 16:57:27 GMT

Thank you Chris,

I used to consider OOH service to be at first a telemedicine service as things are triaged, weather specifically trained receptionist, nurse or vet. Sometimes advice is given over the phone, sometime it is necessary for the patient to be seen. This has been going on for absolutely years, in fact as many years as I have been a vet I believe. The only reason I can see that anyone would wish to pick it off is to make money or to eliminate the competition. Did the competition commission not insist we had to provide scripts FOC for several years, maybe those providing telemedicine should have to provide free for 2-3 years to keep the playing field a little more even.

RE: Should we have individual choice over OOH? (Tangent to "Crisis in the Profession")

hilary warner — Sun, 22 Aug 2021 16:34:46 GMT

[quote userid="2457" url="~/001/nonclinical/f/life-in-practice-discussions/29957/should-we-have-individual-choice-over-ooh-tangent-to-crisis-in-the-profession/232513#232513"]In my first 2 jobs the assistants did all the holiday and sickness cover[/quote]

[quote userid="2457" url="~/001/nonclinical/f/life-in-practice-discussions/29957/should-we-have-individual-choice-over-ooh-tangent-to-crisis-in-the-profession/232513#232513"]when I was a partner ... The assistants generally refused to do any extra cover so holiday and sickness was really tough[/quote]

Kind of feel liked the squeezed middle era of vets.

RE: Should we have individual choice over OOH? (Tangent to "Crisis in the Profession")

Anthony Todd — Sun, 22 Aug 2021 15:17:13 GMT

Ironically there are no responses from "clients", or [better], pet-owners, who ring at unsocial hours with a chronic minor problem "'cos vets are supposed always to provide care."

Surely there are some vets on good terms with some clients who can ask the miscreants for an explanation as to why they waited until 1130pm for XXXX

It may be that the "non-client" rang at 2-0pm and was brushed off, or told to ring back if it got worse.

It may be that the neighbour [a revered "dog breeder"] [one litter 10 years ago] said "they all do that"

It may be that the animal "not right" was told "let us know" it may be etc.etc.

As usual and always,, data gives a much better perception and perspective!

PS Can someone ,anyone ask the next 10 OOH callers "Why are you only ringing now? "as your pet has been xxxxing for YYYY days/hours/weeks!!"

The results, after 100 might surprise us all! and 200 even more!

Is there any data of the problem? Ie how often, how many, what for, seriousless on a scale of 10....

It WILL be that the problem needs some accurate assessment??

And I don't mean the occasional and exceptional [I've been to the Royal Mint, yes, that one, at 11pm,something, for a not very ill dog. [*iss poor security! ].