Which diagnostics have little or no value?

RE: Which diagnostics have little or no value?

Marni Miller — Tue, 02 May 2023 20:52:02 GMT

We had a positive case for Neospora 2 years ago! This was a first for us and for the neurologist we referred to.

RE: Which diagnostics have little or no value?

Alasdair Hotston Moore — Thu, 20 Apr 2023 08:44:24 GMT

[quote userid="4181" url="~/001/nonclinical/f/life-in-practice-discussions/30519/which-diagnostics-have-little-or-no-value/241362#241362"]If the direct evidence for an intervention is not there, then is it not appropriate to use the evidence we have and our veterinary training and knowledge to inform our treatment?[/quote]

I think it is reasonable to use indirect evidence (for example from other species, in this case humans to cats) but only if we do with circumspection: honesty to ourselves, our clients and to those we teach (in whatever context). The problem is often that these interventions based on extrapolation are presented as 'truth' when they are no more than 'expert opinion'

(I may be guilty as charged!)

RE: Which diagnostics have little or no value?

cairncross — Thu, 20 Apr 2023 03:11:18 GMT

It's still a rcvs obligation we must provide 24 7 care for our clients . We now know from surveys that most of our clients can't afford what we have chosen to offer. The obligation drove the creation of specialist ooh centres to meet the regulation and very clearly removed ooh from the very animals it was designed to protect. Surely there should be some reflection of this.

RE: Which diagnostics have little or no value?

cairncross — Thu, 20 Apr 2023 03:03:47 GMT

If you agree that ooh are not generally in reach of most of the public the dogs trust and bva surveys suggest similar. We are knowingly not meeting our RCGS duty by refering ooh to a centre that charges these prices. We are knowingly not providing an ooh service to our clients

RE: Which diagnostics have little or no value?

Rob Loxley — Tue, 18 Apr 2023 07:14:44 GMT

[quote userid="8991" url="~/001/nonclinical/f/life-in-practice-discussions/30519/which-diagnostics-have-little-or-no-value/241330#241330"]

Yes possibly - but the question begs, how would it change your decision making?

Clopidogrel has been studied in prevent recurrence of ATE, but not first incidence. No apsirin evidence to speak of.

[/quote]

If the direct evidence for an intervention is not there, then is it not appropriate to use the evidence we have and our veterinary training and knowledge to inform our treatment? Given the poor prognosis of ATE, shouldn't we try to prevent it, while being aware of the evidence base; is this bad medicine?

RE: Which diagnostics have little or no value?

Alastair Welch — Mon, 17 Apr 2023 11:39:12 GMT

David,

I'm interested to understand how you know that OOH arm of the Corps have all made 'significant profits' in the last few years. AFAIK the majority of this data is not publicly available. The one exception is of course CVS who being listed are required to publish their results. I couldn't see any specific figures relating to the OOH arm in their latest annual report (I admit that I did just skim the bulk of it) but looking at the overall financial performance it is hard to imagine their OOH arm making 'significant profits. In FY22 they made £25.7M profit from £554.2M turnover. This must have been considered good performance as their executive team achieved 98.4% of their possible bonus and their share price has been doing fairly well, but it is hardly amazing. Do you have actual available data which demonstrates the 'significant profits' with particular reference to OOH work you describe or is this just your assumption?

It is clear that fees (and OOH fees in particular) have risen significantly in excess of inflation over the past few years but I believe that the main driver for this rise is the increased cost of labour. VS wage inflation was in double digits before CPI was, and staff costs are the largest line entry by some way. Rising wages for dedicated OOH staff have pushed the cost of OOH provision up across the industry: even in the traditional 'subsidised' model wages have had to rise to retain staff who remain willing (at a price) to do OOH work.

I maintain that anyone who relies upon another provider for OOH work bears some of the responsibility for the cost of that provision. I don't mean that you directly set the prices but by removing your labour from the traditional model of day work/on call you push the value of OOH labour (the bulk of the cost of OOH provision) and hence the fees up. If tomorrow, by some magic wand we returned to the situation where the bulk of the profession physically contributed to OOH work the cost would go down.

I'm not sure that increased fees (both OOH and through the day) are necessarily a bad thing. For decades the public have enjoyed cheap access to VS care on the back of a long hours culture. The true cost of seeing a professional in the middle of the night in expensive, and perhaps the public will just need to alter their expectations. I often hear junior colleagues/our nursing staff concerned about their own financial position (in particular their inability to buy a house), if by charging clients more we transition to a higher wage sector then perhaps it is no bad thing.

I would agree with removing the 24hr requirement and replacing it with a market driven solution, likewise requiring new graduates to do some OOH work but I can't see it happening anytime soon.

Your 'moral' argument sound a lot like the standard 'you're a vet and you must love animals, why can't you do it for free'. I/we do on occasion provide discounts for 'hard luck' cases but this is very much the exception and not the rule. Providing cheap OOH care for a significant number of clients is a thing of the past.

RE: Which diagnostics have little or no value?

David Mills — Sat, 15 Apr 2023 22:23:59 GMT

[quote userid="11308" url="~/001/nonclinical/f/life-in-practice-discussions/30519/which-diagnostics-have-little-or-no-value/241327#241327"]I think there is scope for this - so many cats with a murmur that appear clinically normal but have severe HCM, a huge left atrium and sometimes a giant thrombus floating about there. More often than that spontaneous echo contrast.[/quote]

Yes possibly - but the question begs, how would it change your decision making?

Clopidogrel has been studied in prevent recurrence of ATE, but not first incidence. No apsirin evidence to speak of.

Cats almost always go into CHF suddenly - they are sedentary unlike dogs. However it doesn't change the optics of there is nothing you can do, as far as we know, to stop, slow, retard a HCM cat from going into CHF medically. So, for me, it doesn't progress the case meaningfully other than knowing what CM is there - which doesn't help the cat, disease, but may have some value in preparing the owner.

[quote userid="11308" url="~/001/nonclinical/f/life-in-practice-discussions/30519/which-diagnostics-have-little-or-no-value/241327#241327"]NTproBNP.[/quote]

I forgot this one! Completely pointless test.

RE: Which diagnostics have little or no value?

David Mills — Sat, 15 Apr 2023 22:16:14 GMT

[quote userid="12375" url="~/001/nonclinical/f/life-in-practice-discussions/30519/which-diagnostics-have-little-or-no-value/241322#241322"]

I was really commenting on your assertion that OOH fees are unsustainable and that £800 (according to you 1/2 a nights stay at an IVC practice) was unaffordable to many, and that the Corps are pricing many people out of the market.

I don't know if £800 for 1/2 a night stay is an accurate number but I agree that OOH fees are beyond the easy financial reach of much of the population.

[/quote]

There are two aspects to this.

1. Yes it can be £800 for half a night's stay - say a trauma case with symptomatic care, no definitive rads or ultrasound, it can easily be this. For a routine case (e.g. post op, blocked bladder) the overnight fees (without consult - £150-£300 not including any meds) will start in the region of £300-£600 for the night. The £800 was a touchpoint for me. The survey I was referring to was an American one of pet owners to see where the pinch point lied in terms of would an unexpected vet bill cause financial difficulty.

https://www.forbes.com/advisor/pet-insurance/pet-cost-inflation/

2. Given that most OOH is now run by one of big corps - IVC, CVS, V4P, Medivet, VetPartners - they are responsible for pricing. These aren't specialist OOH providers anymore, as all are part of groups that have daytime practices.

[quote userid="12375" url="~/001/nonclinical/f/life-in-practice-discussions/30519/which-diagnostics-have-little-or-no-value/241322#241322"]Where I don't agree with you is that it is somehow 'The Corps' fault. We (the profession) have, in our droves, opted to move away from the traditional day work/on call system to one where the day and OOH sides are largely supplied by different teams. The Corps have merely taken advantage of our collective desire not to work both through the day and at night as well, and organised us into providing dedicated OOH services (in truth the largest OOH provider was, until relatively recently, privately owned by one individual so this really pre-dates 'The Corps'). If this describes how you work then you are partly responsible for the 'unsustainable' OOH fees.[/quote]

I agree that people don't want to do OOH (although some still do), and the tradiitional model was cross-subsidy. No different to the same with vaccines, preventative treatments, neutering. Yes it didn't necessarily make sense for multiple practices to be open OOH in the same urban or rural centre, but that was the broad model.

It seems we have been left with the worst of both worlds. When OOH provision was by companies that did only or mainly that then you could justify the fees to an extent - it had to be sustainable. I'm no bleeding heart liberal or anti-capitalist but a lot of profit was also made. However now we are back in the realms of providers no longer just providing that - so we have high cost, no subsidy, fewer centres, and more people excluded from access.

[quote userid="12375" url="~/001/nonclinical/f/life-in-practice-discussions/30519/which-diagnostics-have-little-or-no-value/241322#241322"]If this describes how you work then you are partly responsible for the 'unsustainable' OOH fees.[/quote]

Non-sequitur. I am not responsible for the pricing of OOH providers or their behaviour by virtue of the fact we don't cover our own overnight OOH provision. Aside, we are in a rather different position as a charity qnd our relationship with our OOH provider.

[quote userid="12375" url="~/001/nonclinical/f/life-in-practice-discussions/30519/which-diagnostics-have-little-or-no-value/241322#241322"]If we are unwilling to provide 'subsidised' OOH cover then we should not complain that the cost of the dedicated service is punchy.[/quote]

Disagree - just because you can't fit your neighbours windows does not preclude you from expressing an opinion that the £2k they paid to someone was too high in terms of the marketplace value. And the latter is the nub. On a subjective level, OOH fees either price a majority out of accessing them or drain insurance. This isn't isolated to OOH - we and I'm sure many daytime practitioners see the effects of animals that should have been seen OOH putting additional pressure on daytime practice.

[quote userid="12375" url="~/001/nonclinical/f/life-in-practice-discussions/30519/which-diagnostics-have-little-or-no-value/241322#241322"]What is your solution? I don't see a lot of VS willing to do the traditional model so we become reliant on these willing to work (for a premium) through the night. Assuming you believe that 'affordable' OOH is desirable how would you provide it? [/quote]

There are several possibilities. Reducing fees now that subsidy can exist again. Creative insurance policies that cover OOH - corps could provide these themselves in conjunction with day time practices. Requirement of new/recent grads to spend time in OOH - where they learn a huge amount - helping to subsidise the staffing aspect. A re-iteration of the true requirement to attend to an animal's immediate welfare needs (as per the code) where finances are an issue - that means OOH providers offering a triage service FOC and provision of analgesia or euthanasia - if you think this is done in reality, it isn't.

I personally would remove the requirement for 24h cover - this would allow market forces to dictate the sweet spot in terms of pricing; currently it is a completely unlevel/monopolised playing field in that it is a requirement so therefore a premium can be attached to its provision (all the corps OOH arms made significant profits in the last 1-5 years) - let owners decide what price point they are able or willing to pay but keep the 'under care' provision for the OOH centres if an owner contacts them. Practices are being squeezed to outsource; OOH centres are riding on the wave of necessity; the owner is getting increasingly squeezed.

I've left the moral argument to last. I read a book by a police officer recently and they made the observation that whilst we criticise and demonise 'bureaucracy' we do naturally drift towards it because it shelters us from the real and present of someone (MOP), stood in front of you, with a real and difficult problem. It is far more comforting for us to turn to dehumanised figures, charts, facts, observations about the cost and profit and how people should pay, and expect to. To quote M in Spectre - "a licence to kill is also a licence not to kill...and sometimes you need a person to make that decision". We can prevaricate about what the true 'cost' of OOH is, and how it is the owner's responsibility to pay and to hang with the rest. But we are not dealing with cars, bridges, light bulbs, plumbing. I'm sure most (not all) of us got into this profession because of some vague notion that animals' lives matter, and, by extension, those of their owners who share an emotional bond or financial interdependency. Do we really want to work in a profession where we are pricing out the majority of these owners from accessing veterinary care in an emergency? Can we, as many do on here, attack the RCVS on animal welfare grounds when we are complicit in not providing for the majority whilst hiding behind the finances and dry arguments on 'true cost'? We have all knocked off charges to people in our careers - the motivation for that is no different to the above.

RE: Which diagnostics have little or no value?

Anthony Dennison — Sat, 15 Apr 2023 22:06:27 GMT

[quote userid="8991" url="~/001/nonclinical/f/life-in-practice-discussions/30519/which-diagnostics-have-little-or-no-value/241305#241305"]Heart scans for asymptomatic cats with murmurs[/quote]

I think there is scope for this - so many cats with a murmur that appear clinically normal but have severe HCM, a huge left atrium and sometimes a giant thrombus floating about there. More often than that spontaneous echo contrast.

It's not uncommon for cats to just suddenly present with FATE or with a pleural effusion and a heart with huge atria and ventricles just wibbling and not doing anything.

I would say a scan is more appropriate than taking a blood sample for NTproBNP.

RE: Which diagnostics have little or no value?

David Mills — Sat, 15 Apr 2023 21:12:08 GMT

[quote userid="8958" url="~/001/nonclinical/f/life-in-practice-discussions/30519/which-diagnostics-have-little-or-no-value/241323#241323"]

David Mills said:
Xrays for mets in dogs with mammary tumours

You may as well. I had one recently that showed metastatic disease, but I still removed the tumour. It's more about prognosis and would you remove again? I agree that a negative isn't necessarily a negative.

It takes minutes, the issue is the 'price' ,what's reasonable? I've seen prices of £220 for an x-ray, for me it's a classic case of if you said £30 everyone would do it, for £220, maybe 1 in 10, so who wins long term? This for me is becoming the problem with diagnostics.

[/quote]

Yes agree to an extent - it's the pricing. We do them but then it doesn't cost the client much (if anything). But given their lack of sensitivity for picking up mets, the spread of mets (lymphatics, through abdo, ending up in thorax via spleen/liver) they do seem a throwback and a poor use of money if it doesn't immediately change what you're going to do. It would be an interesting study to see their NNT; how many of these are radiographed, and how does it impact on decision making.

We see it a lot with older animals that are referred to us that need a GA for something. Not strictly diagnostics, but the addition of pre-GA blood fees and perioperative IVFT bumping the price up by £3-400. Given these are mostly animals needing something minor - e.g. infected lump, dental - I can't see the point of bloods because all you're possibly going to do different is put them on IVFT - so just do it anyway, it costs <£5 in consumables.

[quote userid="8958" url="~/001/nonclinical/f/life-in-practice-discussions/30519/which-diagnostics-have-little-or-no-value/241323#241323"]

David Mills said:
Running bloods on an old cat with sg isothenuric

Hyperthyroid cat

Can you always trust a single SG?

Thoughts?

[/quote]

As ever the devil is in the detail.

A hyperthyroid cat with isothenuric s.g. will on the balance of probabilities (more than the balance actually) be showing signs of hypert4 historically/on clinical exam.

A cysto in clinic will be reliable. Old cat bingo card - hypert4, CKD, DM, hypertension - can be somewhat whittled down by an experienced clinician with a urine sample, refractometer and dipstick wouldn't you say?

[quote userid="8958" url="~/001/nonclinical/f/life-in-practice-discussions/30519/which-diagnostics-have-little-or-no-value/241323#241323"]

David Mills said:
C and S on urine or ear samples

This one is interesting, a lecturer at LVS from America had unpublished data that suggested that if you sent multiple samples to different labs, the results didn't even match. I avoid them

[/quote]

It's also that the labs haven't a reliable way of determining sensitivity for topical treatments. A lot of apparent resistance is overcome in the presence of local concentrations >1000s that of serum or tissue concentraions - obviosuly this happens in ears, but also in urine - most abx are excreted via urine at very high concentrations.

[quote userid="8958" url="~/001/nonclinical/f/life-in-practice-discussions/30519/which-diagnostics-have-little-or-no-value/241323#241323"]

David Mills said:
SDMA

Oh yes, you need 2 increased values anyway and if the creatinine isn't up....

[/quote]

I imagine it will exit stage left at some point in the future, hopefully. Treatment of risk is never straightforward.

RE: Which diagnostics have little or no value?

Neil Wheadon — Sat, 15 Apr 2023 12:56:27 GMT

Most of these I agree with

[quote userid="8991" url="~/001/nonclinical/f/life-in-practice-discussions/30519/which-diagnostics-have-little-or-no-value/241305#241305"]C and S on urine or ear samples[/quote]

This one is interesting, a lecturer at LVS from America had unpublished data that suggested that if you sent multiple samples to different labs, the results didn't even match. I avoid them

[quote userid="8991" url="~/001/nonclinical/f/life-in-practice-discussions/30519/which-diagnostics-have-little-or-no-value/241305#241305"]SDMA[/quote]

Oh yes, you need 2 increased values anyway and if the creatinine isn't up....

[quote userid="8991" url="~/001/nonclinical/f/life-in-practice-discussions/30519/which-diagnostics-have-little-or-no-value/241305#241305"]Running histo on a lump removal without any chance of further treatment[/quote]

Agreed

A couple I would question

[quote userid="8991" url="~/001/nonclinical/f/life-in-practice-discussions/30519/which-diagnostics-have-little-or-no-value/241305#241305"]Xrays for mets in dogs with mammary tumours[/quote]

[quote userid="8991" url="~/001/nonclinical/f/life-in-practice-discussions/30519/which-diagnostics-have-little-or-no-value/241305#241305"]Running bloods on an old cat with sg isothenuric[/quote]

Hyperthyroid cat

Can you always trust a single SG?

Thoughts?

Neil

RE: Which diagnostics have little or no value?

Alastair Welch — Sat, 15 Apr 2023 12:41:12 GMT

David,

I don't know if £800 for 1/2 a night stay is an accurate number but I agree that OOH fees are beyond the easy financial reach of much of the population. Where I don't agree with you is that it is somehow 'The Corps' fault. We (the profession) have, in our droves, opted to move away from the traditional day work/on call system to one where the day and OOH sides are largely supplied by different teams. The Corps have merely taken advantage of our collective desire not to work both through the day and at night as well, and organised us into providing dedicated OOH services (in truth the largest OOH provider was, until relatively recently, privately owned by one individual so this really pre-dates 'The Corps'). If this describes how you work then you are partly responsible for the 'unsustainable' OOH fees.

Dedicated OOH care is expensive: salaries (unsurprisingly) are higher than the day time but case numbers are comparatively reduced therefore each case must generate enough fees to fund the operation. I can't see another way. If we are unwilling to provide 'subsidised' OOH cover then we should not complain that the cost of the dedicated service is punchy. What is your solution? I don't see a lot of VS willing to do the traditional model so we become reliant on these willing to work (for a premium) through the night. Assuming you believe that 'affordable' OOH is desirable how would you provide it?

RE: Which diagnostics have little or no value?

David Mills — Thu, 13 Apr 2023 22:48:30 GMT

[quote userid="12375" url="~/001/nonclinical/f/life-in-practice-discussions/30519/which-diagnostics-have-little-or-no-value/241140#241140"]I don’t recognise the £800 but suspect this is a London price[/quote]

It was from an American survey, just converted into GBP.

The answer to the original question is that diagnostics that have little or no value are those, according to pragmatic or contextualised care, that do not progress the case in any meaningful way. Ruling out diagnoses by fishing with other peoples money falls firmly within the purview of diagnostics without value.

Some examples

Running bloods on an old cat with sg isothenuric

Running histo on a lump removal without any chance of further treatment

Doing “monitoring bloods” on a stable epileptic on pheno

SDMA

Xrays for mets in dogs with mammary tumours

Bloods for pyos

Most leukaemia diagnostics

Heart scans for asymptomatic cats with murmurs

Staging of mast cell tumours

Sending away mast cell tumours for histo

CT or MRI scans in almost all orthopaedic conditions

Arthrotomy for cruciate disease / removal of torn menisci

Pre GA bloods in a healthy or even mildly morbid animal

Ang bloods for any localised condition (eg CBA, retrobulbar abscess, tumours)

C and S on urine or ear samples

Theres plenty more

RE: Which diagnostics have little or no value?

Anthony Dennison — Thu, 13 Apr 2023 16:35:58 GMT

[quote userid="2457" url="~/001/nonclinical/f/life-in-practice-discussions/30519/which-diagnostics-have-little-or-no-value/241104#241104"]I read a different figure on a FB forum of £450, but no idea if any rumours or numbers are true. I've never worked for Medivet anyway.[/quote]

IVC have implemented a policy that any locum fee of > £450/day needs to be approved by the Area Director, but if it can be justified they will still approve it. We had an excellent locum recently that charged more but we were happy to pay because he was charging an adequate amount of work to justify this.

RE: Which diagnostics have little or no value?

Richard Carter — Fri, 24 Mar 2023 10:21:44 GMT

Doesn’t help that ooh is painted to be the devil with RCVS looking over your shoulder should something die and something to be avoided at all cost in undergrad lectures and popular vet press. Think every vet student needs to go on a two month stint in a charity in India or Africa or similar to get a reality grip and lose the bs being fed and reinforced.

As a new grad, when did you gain the most experience? In practice which were the exciting or interesting cases?

Doesn’t change the fact we now cannot do a caesarean or pyo under £1000 but can spay for 1/4 of that (and don’t talk about loss leaders- in my practice still made money on neutering), anything more interesting is referred or priced out of the market

RE: Which diagnostics have little or no value?

Alastair Welch — Fri, 24 Mar 2023 08:46:38 GMT

David,

I don’t recognise the £800 but suspect this is a London price. The point however remains valid that OOH care is beyond the easy financial reach of much of the population.

It is not the ‘corps’ who are pricing people out of OOH care it is us the profession. The corps are only a symptom of our unwillingness to do OOH work. There is no third way: either we use a dedicated OOH workforce with all the costs to the client that entails or we use the daytime workforce to provide the OOH cover. VS have voted with their feet and chosen the former, but if one derives one’s income from providing clinical services in the day time but do not actually physically contribute to an OOH rota then uncomfortable as it may seem the £800 fee rests on your (by which I mean VS who rely on someone else to do their OOH work) shoulders.

Adverts for jobs with ‘on-call’ receive far fewer applicants than those without. Unless and until this changes I can’t see ‘affordable’ OOH care appearing any time soon.

RE: Which diagnostics have little or no value?

Alasdair Hotston Moore — Fri, 24 Mar 2023 08:43:52 GMT

I’m not in control of pricing policy. Although I do express opinions about it.

RE: Which diagnostics have little or no value?

David Mills — Fri, 24 Mar 2023 01:12:34 GMT

[quote userid="8663" url="~/001/nonclinical/f/life-in-practice-discussions/30519/which-diagnostics-have-little-or-no-value/241110#241110"]I am also uncomfortable with this, especially when the charges for care are very high but the care provided by these staff can be very variable[/quote]

Alasdair, this happens within your company. Maybe not the FB posts but at your 24h centres it does. I’m not having a go here but it’s a reflection of the times we work in.

This thread kind of reminds me of the lectures today at BSAVA “on a shoestring” where people were quoting 1-3k for a thyroidectomy in 1st opinion practice.

We can blow hot air all we want but that is unsustainable as are ooh fees regardless of any moral argument. We - well the corps of Medivet, Goddards. IVC and CVS - are simply pricing a huge number of people out of the market. Half of people face with a bill of £800 (half a night stay at IVC) would be putting themselves in debt. The corps are *maybe* charging properly (MDB compulsory aside) but it is a shift away from the subsidised model of old (all these corps have daytime practices now) and they are absolving themselves of responsibility. Yet with websites full of how much they care for animals. Very very odd. And ultimately they are serving not animals but…

RE: The value, or not, of diagnostics

cairncross — Mon, 20 Mar 2023 23:35:44 GMT

Ooh was contributed to by everyone, salaried staff and practise owners what was seen and what level of care they received was fairly uniform As school kid as student and in my first ten years of practise almost everyone on general practise contributed to ooh. Nowhere truly provided a fully manned overnight service. Fees were pretty uniform 2 vast majority were seen patched up and sent home or dripped and put in a kennel till morning . Around 100 quid would be a decent bill for much of this ( presumably regional variation applied )

Nowadays of course we have advanced and moved on and with around 10% of vets now willing to contribute to ooh , with the public having much less money in real terms to spend and 40%more animals to spread this over We have carefully reduced standards and expections to reflect this reality, worked out carefully what can be minimised to be efficient and conserve our scant resources (money and staff) whilst still helping those most in need . Nah actually we have decided the exact opposite of what is achievable is the solution, more complexity more regulation more time demands more financial demands per case has been legislated for or expections of increased.

RE: The value, or not, of diagnostics

Alasdair Hotston Moore — Mon, 20 Mar 2023 19:30:05 GMT

I think you’re arguing that a salary was intended to pay for the employee to work until the work was done. Acceptable with a working week allowing give and take. But that’s not the modern world. We were too slow to catch up. Businesses allowed on call to require more and more time at work whilst taking away the give and take traditional of salaried professionals

RE: The value, or not, of diagnostics

Richard Carter — Mon, 20 Mar 2023 17:58:03 GMT

But it wasn’t ’unpaid’ - the vets received an annual salary which included some duties ooh. Most practices then had a four day working week for people who did weekend and ooh with leave calculations on an annual basis so the day off / in lieu was included in leave accumulation. Most were pretty flexible about swopping out.

The problem then started with all day consulting on weekends, days extending to 7-7.30 instead of sticking to a 7-8 hour day

RE: The value, or not, of diagnostics

Alasdair Hotston Moore — Mon, 20 Mar 2023 16:29:32 GMT

[quote userid="3169" url="~/001/nonclinical/f/life-in-practice-discussions/30519/the-value-or-not-of-diagnostics/241096#241096"]I think my biggest frustration is that I still get in my newsfeed on Facebook cries for help to staff OOH centres at short notice, the people working there are far from ECC specialists, they are anyone with MRCVS after their name......[/quote]

I am also uncomfortable with this, especially when the charges for care are very high but the care provided by these staff can be very variable

RE: The value, or not, of diagnostics

Alasdair Hotston Moore — Mon, 20 Mar 2023 16:28:10 GMT

[quote userid="3169" url="~/001/nonclinical/f/life-in-practice-discussions/30519/the-value-or-not-of-diagnostics/241096#241096"]Why "fortunately"?[/quote]

The 'fortunately' relates to salaried staff. Historically OOH care was provided by them as 'on call' but became increasingly unpaid unsocial working hours. I think this has led to where we are now: so many vets simply won't accept SA jobs with on call because they think they will end up working extra unpaid unsocial hours. In other words, as on call got busier and so many practices (and indeed the Uni's in my experience) ended up exploiting staff to essentially work at night/Sundays for nothing

RE: The value, or not, of diagnostics

Gillian Mostyn — Mon, 20 Mar 2023 09:12:19 GMT

[quote userid="8958" url="~/001/nonclinical/f/life-in-practice-discussions/30519/the-value-or-not-of-diagnostics/241103#241103"]£360/day apparently[/quote]

I read a different figure on a FB forum of £450, but no idea if any rumours or numbers are true. I've never worked for Medivet anyway.

RE: The value, or not, of diagnostics

Neil Wheadon — Sun, 19 Mar 2023 22:52:21 GMT

[quote userid="5012" url="~/001/nonclinical/f/life-in-practice-discussions/30519/the-value-or-not-of-diagnostics/241101#241101"]

Neil Wheadon said:
as they are the first corporate to cap locum fees

At what rate?

[/quote]

£360/day apparently

Neil