By Dr Bob Encinosa
As a veterinarian, I have always been interested in parallels between my profession and the human health care profession. While veterinarians, on some levels, seem to try to model what we do after “how it’s done in human medicine”, there are some things that I hope we will always do differently.
We have been able to keep our fees for most procedures relatively low compared to the same procedures in human medicine. For example, in most areas of the country, a total hip replacement can be performed on a large breed dog by a veterinary surgery specialist for $3000 to $4000 . The hip prosthetics we use are made for humans and the anesthesia and monitoring procedures are the same. The total cost in human medicine for a total hip replacement is now over $110,000.
Another example, is the cost of an ovariohysterectomy, also known as a “spay”. The total cost to spay a 100 pound dog is still only around $400. The total cost to “spay” a 100 pound woman is about $40,000 or one-hundred times as much. That difference always comes to mind when I hear people complain about how much we as veterinarians charge for these procedures.
The reasons for this difference are numerous, but in my opinion come down to mostly two things. The first is that we, as human patients, have become so dependent on insurance to cover our medical bills that we have removed competition from the equation. When was the last time you heard of someone phone shopping for the price of their hysterectomy?
The second big reason for the difference in cost is the factor of liability claims in human health care. Malpractice insurance for doctors, while significant, is only a part of that cost. Doctors, more so than veterinarians, are forced to practice defensive medicine , which can mean more tests and more referrals to specialists. I found it very interesting that there was absolutely no mention of tort (legal) reform in the recently passed Health Care Reform Act.
Another major difference between veterinary medicine and human health care is the degree of specialization. Yes we do have a growing number of specialties in veterinary medicine, including surgeons, cardiologists, neurologists, dermatologists etc., etc., but for the most part, we as general practitioners, are still able to do what we feel we are capable and qualified to do. Therefore, we are able to treat most problems that arise in pets very efficiently and without having to refer our patients to a specialist for everything more severe than a cold or a splinter.
There are pros and cons to this level of specialization in human health care. For very complicated diseases, specialists are absolutely life saving. Take , for example, open heart surgery. I would want nothing less than a very experienced heart surgeon on the other end of the scalpel.
The down side of such a high level of specialization is that I often hear about cases (and have witnessed it with my own relatives) , where there are many specialists involved in different aspects of a patient’s care, but no one who is assimilating or overseeing what happens to the patient as a whole. This appears especially true with our senior citizens. One doctor takes care of Mary’s diabetes, while another takes care of her heart condition and yet another handles her dementia or her shingles. It becomes very easy to overlook the question “How is Mary?”
Fortunately, veterinarians are still able to take the holistic approach (which by definition means taking care of the whole patient). The human medical field has some amazingly gifted and caring professionals who try their best every day to deliver the very best in health care, while trapped in a system that is far from perfect. But, by any standards, I still believe that the human health care in this country is the best in the world.