Resumen de Factors that influence small animal veterinarians’ opinions and actions regarding cost of care and effects of economic limitations on patient care and outcome and professional career satisfaction and burnout
Barry S. Kipperman, Philip H Kass, Mark Rishniw
JECTIVE To determine small animal veterinarians’ opinions and actions regarding costs of care, obstacles to client education about veterinary care costs, and effects of economic limitations on patient care and outcome and professional career satisfaction and burnout.
DESIGN Cross-sectional survey.
SAMPLE 1,122 small animal practitioners in the United States and Canada.
PROCEDURES An online survey was sent to 37,036 veterinarians. Respondents provided information regarding perceived effects of client awareness of costs and pet health insurance coverage on various aspects of practice, the influence of client economic limitations on professional satisfaction and burnout, and proposals for addressing those effects.
RESULTS The majority (620/1,088 [57%]) of respondents indicated that client economic limitations affected their ability to provide the desired care for their patients on a daily basis. Approximately half (527/1,071 [49%]) of respondents reported a moderate-to-substantial level of burnout, and many cited client economic limitations as an important contributing factor to burnout. Only 31% and 23% of respondents routinely discussed veterinary costs and pet insurance, respectively, with clients before pets became ill, and lack of time was cited as a reason for forgoing those discussions. Most respondents felt improved client awareness of veterinary costs and pet health insurance would positively affect patient care and client and veterinarian satisfaction.
CONCLUSIONS AND CLINICAL RELEVANCE Results suggested most small animal practitioners believe the veterinary profession needs to take action at educational and organizational levels to inform pet owners and educate and train veterinary students and veterinarians about the costs of veterinary care.
Veterinarians are often faced with a conflict between a desire to improve animal welfare and relieve suffering and clients’ inability to meet the increasing costs of veterinary care. The cost of care is frequently a limiting factor in the quality of medicine a veterinarian can provide, and some reports1–3 suggest that decisions to end an animal's life on the basis of economic factors (ie, economic euthanasia) are becoming increasingly frequent. Consequences of economic limitations may include a decrease in the number of veterinary visits,1,4 decline in quality of patient care, economic euthanasia,3,5 moral stress for veterinarians and pet owners,6,7 professional income limitations, and reduced career fulfillment for veterinarians.
In a study8 of pet owners’ perceptions regarding the costs of veterinary care, pet owners indicated that veterinary medicine should not be a profession in which concern about the cost of care takes precedence over concern about the well-being of animals. However, results of that study8 indicate that pet owners expect veterinarians to discuss cost of care early during a visit, which suggests that most pet owners are uninformed about veterinary care costs. That supposition is supported by the results of the 2010 Bayer veterinary care usage study,9 in which 1,160 of 2,188 (53%) dog and cat owners completely or somewhat agreed with the statement that veterinary costs are much higher than expected. In a 2014 follow-up survey4 to the Bayer veterinary care usage study, 649 of 1,100 (59%) dog and cat owners agreed with the statement that costs of routine veterinary visits are higher than expected.
Results of another survey8 indicate that pet owners are generally not satisfied with the extent of discussions regarding costs provided by small animal veterinarians, and many stated that they received little or no information about pet health insurance from veterinarians. Results of yet another study10 indicate that only 58 of 200 (29%) companion animal veterinary visits included a discussion of actual costs, and it was the client who initiated that discussion in 19 (33%) of those 58 visits. Moreover, costs were discussed in only 35 of 84 (42%) visits during which diagnostic testing was recommended.10 Pet owners’ expectations that animal care considerations should come before cost considerations, combined with data that suggest provision of cost information is often lacking or not discussed early during a visit, create a paradox for veterinarians when confronting the topic of costs of care. If too much emphasis is placed on costs and compensation, the veterinarian may be accused of being mercenary (ie, “in it for the money”), which may impair the veterinarian-client relationship. Conversely, if too little information regarding costs and compensation is provided, clients may feel unprepared, uninformed, and vulnerable, which can result in detrimental consequences for animal care and veterinarian well-being. Results of a survey7 of 200 veterinary hospitals indicate that discussing and disputing fees is considered the third most common source of stress among veterinarians.
The purpose of the small animal practitioner survey reported here was to assess the frequency with which veterinarians, pet owners, and pets are affected by economic limitations; identify the most commonly used resources to address economic limitations and their effect on pet care; evaluate the extent to which veterinarians inform and educate pet owners regarding costs of care and payment options before patient illness occurs; identify the obstacles to veterinarians educating clients about veterinary care costs; assess veterinarians’ opinions regarding the value of addressing veterinary care costs with pet owners; determine how veterinary care costs affect professional medical recommendations and professional burnout or career dissatisfaction; and evaluate differences among veterinarians in terms of addressing veterinary care costs and pet health insurance with pet owners prior to patient illness on the basis of years of practice experience, practice role (owner vs nonowner), veterinarian gender, and practice type (GPs vs specialists). Our hypotheses were that small animal practitioners frequently encounter economic limitations in providing patient care; small animal practitioners seldom broach the topic of costs of care with clients prior to patient illness but frequently discuss costs associated with preventive health care, such as vaccinations and gonadectomy; small animal practitioners modify their medical advice to clients on the basis of prior declinations of care by those clients because of costs; small animal practitioners with > 15 years of experience discuss care costs with clients more frequently than do less experienced practitioners; the frequency with which veterinary care costs are discussed with clients by small animal practitioners does not differ on the basis of practitioner gender; small animal practitioners who are practice owners are more likely to discuss veterinary care costs with clients than practitioners who are not practice owners; economic limitations to patient care are an important cause of professional dissatisfaction or burnout (which was defined as an emotional state that includes disillusionment with one's career, depression, diminished professional motivation, an increase in resentment toward clients, or a decrease in veterinary-related interests and activities); experienced practitioners have a higher degree of burnout than less experienced practitioners; small animal practitioners believe that client awareness of pet health insurance and veterinary care costs will improve animal care and professional career satisfaction; and specialists’ career satisfaction is affected by client economic limitations to a greater extent than that of GPs.
