Charging what we're worth

Money is always a hot topic in veterinary medicine. Since very few people have insurance (and those that do usually require the client pay up front & then they are reimbursed), they are left to bear the burden of the entire medical costs for their pets.

The other day, I was working solo. An older cat had come in the day prior, basically just not doing right, with abdominal pain. Blood was drawn & sent to the lab, and an abdominal radiograph was taken. The radiograph shows a marked lack of detail in the abdomen. The cat was hospitalized overnight with supportive care while we waited for the bloodwork to come back, and for me to be there to perform an abdominal ultrasound. Bloodwork came back normal but the ultrasound showed pockets of free fluid in the abdomen. Not a huge volume, so I was fairly uncomfortable blindly tapping the abdomen for fear of hitting intestines.

Communication at our place can be tricky sometimes, what with one doctor admitting the patient and the next day another doctor takes over their care. We try really hard though, for the sake of the clients, and so Dr. Old called the owners on his day off and told them the news, receiving permission to perform the abdominocentesis and for fluid analysis if we got anything useful.

The cat was sedated (he was too painful and became fractious during the ultrasound, there was no way he would sit nicely while I shoved a needle in his belly and have it all stay sterile) and surgically prepped. I picked a spot again using the ultrasound. I chose a 22 gauge catheter, and once I felt the stylet pop through the body wall, advanced only the catheter and removed the stylet, thereby basically eliminating the risk of puncturing intestines in my search for fluid.

We obtained a diagnostic sample and, sadly, the cat had cancer. The owners elected euthanasia instead of searching for the exact source.

I tell this story because that was a lot of work. Safely sedating an old & sick cat. Using the ultrasound to find the fluid, prepping the patient with a sterile field, using sterile technique and a little but of a different approach to reduce the risk of contamination or sepsis. Collecting and analyzing a sample. The knowledge needed to perform these tasks draws from many different portions of my veterinary education (which, believe you me, I paid dearly for. Am still paying dearly for!) When I talked to Dr. Old about the charges I put in, I was almost apologetic. I said I wasn't sure what he'd quoted them, so if he needed me to discount my fee, I could do that.

Turns out my charges, the ones I was almost embarrassed about, were a full $200 less than he'd quoted them. Which would be about $6-800 less than a larger "specialty" clinic further south.

Why can I not wrap my head around charging what I'm worth?