How to discount associates right out of practice

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How to discount associates right out of practice

Dr. Codger wants to help, so he cuts prices for his veterinary clients. Dr. Greenskin wants to do top-quality medicine and charge appropriately. Are the two medical cases in this story going to be the straw that breaks the camel's back?
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Feb 07, 2018

Give it away, give it away, give it away now .... Wait, no, don't do that. (Illustration by Ryan Ostrander)Editors' note: The problems here started last month in "How judgy is too judgy?" Get caught up here.

Practice owner Dr. Codger and his young female associate, Dr. Greenskin, are keeping up with a busy day of appointments, but two sick patients are straining the technical staff. Doornail is in dire straits, and his owner, Ms. Ded, isn't sure she wants to pay for diagnostics. They've been moved to the grieving room while the client deliberates—and because euthanasia looks likely. Drippy needs surgery, but her owner, Mr. Sepsis, isn't sure he can pay for the procedure. See the problem?

Drippy's situation is easier to resolve: The team has orders from Dr. Codger to get Mr. Sepsis' dog on the surgery table no matter what. After some generous price-slashing, including senior, service-member and loyal-client discounts—plus a quick approval for the in-clinic interest-free payment plan—Mr. Sepsis grants Dr. Codger a chance to save the champion show dog. Twenty minutes, a few signatures and a $300 deposit later, Drippy is on fluids, antibiotics and pain control, and team members are hurriedly prepping the OR and deciding who gets to stay late via a high-energy "rock, paper, scissors" tournament.

The $80 euthanasia option is still on the table, and Ms. Ded's keen business sense is in direct conflict with love for her loyal canine.

Doornail's case is less straightforward. There's no clear diagnosis or owner commitment, so there can be no expectation for treatment or prognosis. Dr. Greenskin does her best to piece together her most conservative treatment plan yet. For a mere $2,200, Ms. Ded will get the peace of mind of knowing the clinic is doing everything it can. For 48 hours. Unless something goes wrong. Without anyone watching the dog overnight. Without confirming a diagnosis. With no guarantee that Doornail will survive. The $80 euthanasia option is still on the table, and Ms. Ded's keen business sense is in direct conflict with love for her loyal canine.

As can be expected, when things get tense between Dr. Greenskin and Ms. Ded, Dr. Codger manages to worm his way into the conversation. He demands a complete recap of the case as Dr. Greenskin rushes off to manage her 25 other cases. She does her best to stay in multitask mode while giving Dr. Codger the information he demands.

"Look, the dog is critical, and I'm not sure what's wrong—the owner has no money and won't let us run bloodwork," Dr. Greenskin explains. "But she wants us to save the dog, and I think she ought to just put him to sleep!"

Alarmed, Dr. Codger decides he needs to rush in and save the day: "I'll go take a look at Doornail and have a talk with Ms. Ded." Without looking for agreement, Dr. Codger heads toward the treatment area before Dr. Greenskin can muster a response. The young doctor guesses that another round of big discounts is on its way. Noble as the old doc's efforts may be, Dr. Greenskin shudders at the thought of discounting services. However, she's all too happy to get something off of her plate. Dr. Greenskin eventually heads home, exhausted, figuring she'll get the update when everyone returns nice and fresh to the clinic in the morning.

You know this isn't going to end well, right? Turn the page ...

The following day Dr. Greenskin heads straight to the sick ward to see what happened overnight. Dr. Codger has apparently been hard at it: Drippy is still recovering from her spay, on fluids and looking comfortable. In the next run, Dr. Greenskin is surprised and elated to see the cute and cuddly Doornail standing next to his empty food bowl and wagging his tail, eager to see any human who might offer some friendly pats.

Dr. Greenskin's joy deflates when Dr. Codger enters looking like he hasn't slept all night and spoiling for a confrontation.

"You quoted her for all this unnecessary stuff—lab tests and ultrasound and radiographs. Better to start conservative and see how the patient does, I say."

"Well, Dr. Greenskin, looks like old Doornail here just had a simple tummyache," he says. "I wanted to talk with you about your estimate. Poor Ms. Ded was distraught, and I think your huge estimate made the situation worse. I got her bill down to around $250. A couple of fluid bags, some injectable Flagyl and some Reglan—that cost us maybe $60, so the clinic still comes out ahead. You quoted her for all this unnecessary stuff—lab tests and ultrasound and radiographs. Better to start conservative and see how the patient does, I say. Plus, this'll be one happy client. She may even give us a great Yelp review!"

Dr. Greenskin, nervous about getting an online reputation for "cheapest vet in town" is quick to respond: "I'm very glad the poor dog looks so much better. I'm sorry, Dr. Codger, but I don't think the clinic wins on this case. It looks like you were here very late, and I bet there's some staff overtime to pay out. I also don't love the idea of Ms. Ded telling everyone in town that we saved her dog for pennies on the dollar. You may not have massive student loans to pay off, but I do, and neither giving away services nor practicing subpar medicine make me feel professionally fulfilled. And you don't actually know the dog just had a tummyache. There was no history of dietary indescretion, vomiting or diarrhea. How are we going to handle this if the dog is just as sick again in a couple of days?"

Dr. Codger is ready to defend the Codger legacy!

"We can't know everything for sure," he says. "You need to get comfortable with that, Dr. Greenskin. I know your fancy vet school had fancy CT scans and all those laboratories, but our clients around here aren't ready for all that. Plus, they can't afford it! This dog is all patched up now, ready to go home tonight. Isn't that better than putting him to sleep just because you didn't get to run your tests and you need to pay back a bunch of money to the government?"

Dr. Greenskin blinks back tears and heads to her office. Dr. Codger feels a twinge of regret for being so hard on his protégé, but he knows she needed to hear it.

"I'm going to take a couple of days off. I'll give you a call next Monday to discuss when I might return. In the meantime, feel free to call in a relief vet."

Later, Dr. Greenskin finds Dr. Codger back in the office. She's carrying her purse and coffee mug, which slightly worries Dr. Codger.

"This whole situation is really bothering me, Dr. Codger," she says. "I don't think I can focus on my job today. I'm going to take a couple of days off. I'll give you a call next Monday to discuss when I might return. In the meantime, feel free to call in a relief vet."

Dr. Greenskin leaves no room for response as she fishes her keys out of her purse and heads toward the door. Dr. Codger feels a sinking feeling that he hasn't experienced in many years, and he wonders what will become of his relationship with the younger, valuable and very capable Dr. Greenskin.

Editors' note: Who's right in this scenario? Email us at [email protected] to let us know your thoughts—and tell us how you've dealt with these kinds of conflicts in your own practice life.

Dr. Jeremy Campfield works in general practice in California's Sacramento Valley. He is an avid kiteboarder.

Discount ass. right out...

Extreme example however disturbing. Is the purpose to insinuate that the patient should have been euthanized because the owner couldn't afford the extreme estimate of $2,200? All because Dr. G has student loans? So the moral (or immoral) of this story is price gouge clients or kill pets? Dr. C went to the other extreme with the discounts. Dr. G could have handled this properly by having a discussion with the owners about money... clearly they had more than $80. Couldn't Dr. G find a treatment plan for reasonable fees, instead of all-or-none? I think Dr. G mishandle the situation first, then Dr. C screwed it up afterwards. I bet the clients could have come up with $400 - $500 to work with; some conservative treatment accomplished without Dr. C stepping on Dr. G toes and neither staying up all night, and, most importantly, the patient lives. Some new grads have unreasonable expectations about practice. We successful experienced doctors have learned that not every client has thousands to spend and we don't get to run all the diagnostics we'd like but we still treat the pet as best as we, and the clients, can.