For some it's about haves and have-nots
Smith is clear about her motivation for shelter medicine. After she graduated from Tufts University, she did an intense internship
at Angell Memorial. "There I saw the dichotomy between the haves and the have-nots," she explains. "There were people who
came into Angell Memorial because of the reputation and the specialists and they were going to pursue care regardless of cost.
At the other end of the spectrum were people who loved their animals just as much but had to make harder choices over much
more simple diseases—fixable diseases. They had to walk away because they couldn't afford to fix that fixable thing. And they
were no less heartbroken."
In fact, the question of income qualification for low-cost services, or means testing, has been a trigger for tensions between
private practitioners and low-cost providers. "That's where the conversation gets sticky," Smith says. "No, we don't do means
testing. We have an outpatient clinic priced competitively with local veterinarians. We do have a fund for animals owned by
people with financial needs, and for that program we do means testing to assure ourselves we're helping the truly needy."
But means testing is not part of the mobile sterilization program she leads called the Spay Waggin'. In that program, she
says, the goal is simply to prevent unwanted pregnancies, no questions asked. "We're not going to pass judgment on why you
came to us over your regular veterinarian," she says. "The Spay Waggin' program breaks even. We can provide spay and neuter
surgeries for a low cost because we support ourselves in volume. I do 40 spays or neuters a day so I can pay my staff, pay
for supplies, pay for fuel, pay for the garage, pay for the autoclave and charge $75 a surgery. We need the volume to be sustainable.
"Yes, we spay cats in wealthy neighborhoods," she says. "People vary in terms of their sense of responsibility regarding cat
ownership, no matter their economic ability."
But when the Spay Waggin' pulls up in poor neighborhoods, she says, the reception is sometimes overwhelming. "We have scores
of people from the community lining up with their cats in carriers," she says. "People will stand in line for four or five
hours to be seen. Their pets mean that much to them."
Smith says her organization studied the areas of greatest need in the city, drawing maps of the ZIP codes where animal control
workers found the most sick and dead cats. It was no surprise, she says, that these were the same neighborhoods where people
were in the most economic need. "And it was also no surprise," she says, "that when we overlaid that map with a map of where
veterinary practices were located, there was a big circle of them outside the 'red zone.'"
Brian Forsgren, DVM, a private practitioner in Cleveland, Ohio, says he has seen the same rings around the poorest areas of
his city. His Gateway Animal Clinic is located in the center of those rings, in a poor neighborhood not served by other veterinary
practices. "Last Tuesday night," he says, "seventy people came in between five and seven o'clock. You get the picture."
The picture is that his inner-city practice now has nine veterinarians and is projected to gross $4.7 million this year. But
he claims his work has never been about gross revenue. "I've never looked at this as a business situation," he says. "I've
always looked at it as a doctor situation."
Fosgren's practice is closer to humane clinics and low-cost providers than most in his city, but he says it doesn't worry
him. "I don't look on vaccine clinics or spay-neuter clinics as a problem," he says. "A lot of poor people come to me because
I've developed a relationship with them. And when the spay-neuter clinics have a problem, they ship the dogs over to us and
we fix them. That's what doctors are supposed to do."
Fosgren thinks more veterinarians should establish practices in poor neighborhoods. "We need as a profession to accept the
fact that if general practitioners aren't going to provide services within these communities, somebody is going to," he says.
"If veterinarians are the leaders in providing care for animals, it can't be just individual animals with money."
One strategy he's employed is to establish a 501(c)3 not-for-profit tax-exempt arm of his practice. That status does allow
a practitioner to raise funds from donations, apply for grants and exist in a tax-exempt bubble. But, Fosgren explains, if
you use the funds to reimburse the for-profit side of the hospital, you need an independent board of directors and clear criteria
for eligibility. While such an arrangement is possible, it's difficult to maintain.
The real key to solving the tension between private practices and low-cost clinics is for veterinarians to adopt the notion
that "we're all in this together," Fosgren says. "Those of us in private practice, in humane societies, in universities, in
rescue groups—the whole litany of people who have emerged in our field—we're all part of a team effort.
"Animals are at risk and our job is to not let them be at risk," he continues. "We have to figure out a way. And the best
way is for private practices to collaborate with shelters and other humane organizations. We need to make sure they're doing
things correctly. Help them. Be the good guy. Put the white hat on again."