Referring down

Re: Referring down

Edward Jones — Thu, 29 Jul 2010 09:44:08 GMT

[quote user="Bob Russell"]The price conscious ones shop around, the loyal ones take the rough with the smooth.[/quote]

One benefit of reasonably high (/realistic) cost of non-elective procedures - We had a client who was obviously phoning round the local practices getting estimates for a caesarian - there's two ways of saying, 'P*ss off back to your own practice', but only one doesn't get you a complaint with the college

Re: Referring down

Bob Russell — Thu, 29 Jul 2010 09:11:16 GMT

[quote user="Colin Cameron"]

[quote user="Bob Russell"]I know I should not single out the corporates (I include some of the big chains of practices in this) but they seem to be the main ones offering at cost or loss-leaders. [/quote]

That was some loss leader bill we all saw on Panorama, wasn't it ?

[/quote]

Very briefly Panorama showed the price list - I had to rewind and pause sky+ - cat vacc £14.50 (or £14.99 poss can't remember) incl Leukaemia £19 - can't remember others but they were extremely low - We charged around £13 for a cat booster in my first practice 26 years ago.

The large bill shown was the other side of the story - we do not charge for monitoring blood pressure during ops (not that we do routinely) but at £80 a go perhaps we should! It is the extremes - bring clients in with cheap offers and 'hammer them' when things go wrong (not saying this was the case with Medivet as I do not know enough detail of that particular procedure.

I realise this is the way the world works now but owners are not daft and they realise this. The price conscious ones shop around, the loyal ones take the rough with the smooth.

Re: Referring down

Colin Cameron — Thu, 29 Jul 2010 01:57:53 GMT

That was some loss leader bill we all saw on Panorama, wasn't it ?

Re: Referring down

Bob Russell — Wed, 28 Jul 2010 13:52:35 GMT

[quote user="Julian Earl"]

[quote user="Mark Holmes"]

[quote user="Evelyn Barbour-Hill"]

[quote user="Bob Russell"]We have seen a few clients for the first time with the story 'we went to XYZ corporate for the £5 booster and £1.50 microchip but now the pet is sick we want to be seen by a proper vet'.[/quote]

[/quote]

So... do you invite people to shop around before amputation or euthanasia on the basis of costs, I only use this as an example but it could equally apply to pyometra or foreign body retrieval.

[/quote]

Or indeed every single thing that we do.

[/quote]

I don't invite people to shop around - not my place. We charge what we need to, it lets us earn a crust.

If an owner cannot pay our prices (hopefully not extortionate) I will offer all the options that I feel are in the animals interest. I will 'refer down' if appropriate.

It is just interesting how some clients view the special deals that seem to be out there. Cheap seems to equate with not good on occasions with some owners!!!

I know I should not single out the corporates (I include some of the big chains of practices in this) but they seem to be the main ones offering at cost or loss-leaders. The world is changing and competition is increasing but I am not sure it is particularly good for the profession - probably showing my age now.

Spoke to my optician yesterday - he used to work for a corporate apparently from a turnover of millions for contact lenses they make a few thousand in profit. Seems a mad world and getting madder!

Re: Referring down

Mark Holmes — Wed, 28 Jul 2010 09:19:34 GMT

One last thought, if performing euthanasia on the grounds of costs, can you cliam to have informed consent unless you have informed the owner that there may be options else where? Another practice may be cheaper or just have a different credit policy etc both of which obviously affects the affrodability of the proceedure.

Re: Referring down

Julian Earl — Tue, 27 Jul 2010 22:51:29 GMT

[quote user="Mark Holmes"]

Yes but not everything we do has such stark consequences. I once locumed for a practice that charged around £800 for a pyo when a local other practice used to do one for £200, what do you do if someone cannot afford £800 but can afford £200? Surely offering euthanasia as the only alternative to surgery is a very uncomfortable option when you are aware of the other local practice being affordable. At the time I used to refer them to the managing partner who used to try and thrash something out and if that was not possible he would send them down the road. They probably wouldn't get bloods or fluids and the op facilities were basic but one could argue adequate for a pyo. The risks greater admitedly, hypovolaemic animal under ga... increased risks of renal failure etc etc but at an alternative to euthanasia better.

So... is it justifiable to suggest euthanasia as the alternative to surgery without suggesting the client shop around? Obviously you could drop the trimmings yourself and proceed but that still doesn't always reduce the charges to a sufficiently low level.

Its uncomfortable but I am intersted in what people think

[/quote]

Just recently I had to do a caesarean on a bitch where I was informed that these puppies were to be sold at £750 each, followed minutes later by being was asked if I could offer a discount for... well, for no reason at all really. I was sorely tempted to answer, "Yes, and which corner would you like me to cut? The stitching up maybe? The anaesthetic? Something else?" I didn't voice this though, and just responded with a quick-witted "Errm, no, sorry".

However, it is indeed a very challenging question that you raise here and I for one don't know the proper answer. As with so many things it probably depends on the individual case and circumstances. Surgery without a drip and, say, no hospitalisation for several days is better than death as long as the lack of fluids doesn't lead to renal failure three months later. Maybe.

Re: Referring down

Mark Holmes — Tue, 27 Jul 2010 17:29:07 GMT

[quote user="Julian Earl"]

[quote user="Mark Holmes"]

[quote user="Evelyn Barbour-Hill"]

[/quote]

So... do you invite people to shop around before amputation or euthanasia on the basis of costs, I only use this as an example but it could equally apply to pyometra or foreign body retrieval.

[/quote]

Or indeed every single thing that we do.

[/quote]

Its uncomfortable but I am intersted in what people think

Re: Referring down

Julian Earl — Tue, 27 Jul 2010 17:01:13 GMT

[quote user="Mark Holmes"]

[quote user="Evelyn Barbour-Hill"]

[/quote]

So... do you invite people to shop around before amputation or euthanasia on the basis of costs, I only use this as an example but it could equally apply to pyometra or foreign body retrieval.

[/quote]

Or indeed every single thing that we do.

Re: Referring down

Rudolph — Tue, 27 Jul 2010 16:01:11 GMT

I never have referred down, possibly because I'm pretty much bottom rung anyway with a small, basic practice. I've certainly never had someone come to me because I've been the cheapest vet, nor is that an image I'd wish to cultivate. I've been in the referral/amputation situation for fractures and have done amputations. I don't think I'm a bad surgeon but I have limited orthopaedic experience and don't like to "have a go" at these things for a reduced cost because I don't think that owners can really accept that it might fail - potential for great upset in these situations. Also, if they spend their little bit of cash then there's nothing left in the pot for amputation, should the need arise.

I think that it would also put the practice to which you've "referred down" under some pressure as they will be aware from the outset that there aren't funds to cover complications if they arise, be it orthopaedic failure, or post-op infections or peritonitis. I'm not sure that I'm entirely comfortable with the idea.

Re: Referring down

Mark Holmes — Tue, 27 Jul 2010 15:17:32 GMT

[quote user="Evelyn Barbour-Hill"]

[/quote]

So... do you invite people to shop around before amputation or euthanasia on the basis of costs, I only use this as an example but it could equally apply to pyometra or foreign body retrieval.

Re: Referring down

Evelyn Barbour-Hill — Tue, 27 Jul 2010 15:00:26 GMT

Re: Referring down

Bob Russell — Tue, 27 Jul 2010 14:10:40 GMT

True but size of practice, charity links and industrial scale practices.

People are not daft - they understand how it works. We have seen a few clients for the first time with the story 'we went to XYZ corporate for the £5 booster and £1.50 microchip but now the pet is sick we want to be seen by a proper vet'.

Oh what a wonderful world we live in!!!

Re: Referring down

Mark Holmes — Tue, 27 Jul 2010 13:59:28 GMT

[quote user="Bob Russell"]

We already do. There is a practice that does work for a number of charities. They will sometimes do things at a lower rate than we can - it may be a little conveyor belt compared to the service that we try to give but it is an option we offer to owners not able to benefit from PDSA / RSPCA subsidised treatment. Nothing wrong with that.

[/quote]

Nothing wrong with it at all, in fact I think we are obligated to do it and I don't think enough prctices do. It certainly makes you really ahve to be able to justify your fees explaining why someone else can do it cheaper.

Re: Referring down

Bob Russell — Tue, 27 Jul 2010 13:55:50 GMT