Tuesday, June 5, 2012

Dentists and Veternarians

Our country suffers from a surplus of Dentists and Veterinarians.   Yet more and more people go into the field every year - and still find jobs.   Stranger, still, there are areas of the country that suffer from a shortage of Dentists and Vets.  What is going on here?  Simple economics.

I related earlier about an interesting story that appeared a few years ago on NPR about Dentists.  We are awash in a sea of Dentists, it seems, unless you live in West Virginia.

All jokes about "summer teeth" (some are there, some are not!) aside, rural areas of the country are under-served, it seems, when it comes to Dentistry.   But newly minted Dentists don't gravitate to these areas of the country, where they would have a near monopoly for their practice.   Why?  Because it is more profitable to open a practice near a large city, where wealthy suburban residents will pay big bucks for expensive and esoteric teeth straightening, bite alignment, and teeth whitening procedures.

While you may be the only Dentist in town, in Bumfook, West Virginia, you would starve to death, as your practice would be largely pulled out rotted teeth from clients who don't pay.

And this is an interesting conundrum, as most people today don't have Dental plans, and yet are willing to spend thousands of dollars on procedures.  I related my experience with the "fancy Dentist" we once had, who office looked like the inside of a space ship.  She said she could break and reset my jaw to improve my bite and do a number of other things, for about $10,000.   When I said I didn't have that kind of money, she said, "don't worry, your insurance will cover it!"   When I told her I didn't have dental insurance, she said I didn't really need the work.

I found a new Dentist, shortly after that.  He charged $60 for a cleaning and exam, which is really all I needed.

But it illustrates how you can create demand for services (or products), where there was none.   And today, Dentists have an arsenal of new treatments and products to offer you, from fluoride treatments, to gum treatments, to bite adjustment, adult braces, teeth whitening, filling replacement, or whatever.  And a surprising number of people, laying back in that chair, feel vulnerable enough that they will go along with whatever the Dentist says they need, even it means thousands of dollars in services.

(X-rays are another area where Dentists over-prescribe, often recommending a "bitewing" X-ray every other visit, and a "full X-ray" annually or bi-annually.  I have found that when I push the issue, most Dentists tend to back down from such arbitrary timetables.   Frequent X-rays are quite profitable for Dentists, but often they are of little value in diagnostics of adult teeth.)

And while we bitch and moan about making a $40 co-pay at our Doctor's Office, we will gladly shell out hundreds, if not thousands of dollars for cosmetic dentistry at the Dentist's Office.

The same phenomenon is true with Veterinarians.  The treatment of animals is certainly less important than human life - and the risk involved is far less as well.   If you are a Doctor, and your patient dies due to your negligence, you may be sued out of existence.   If you are a Vet, the most you can be sued for is the cost of a dog.

Yet the cost of a visit to the Vet can often exceed that of a trip to the Doctor's Office.   And again, while we whine and moan about having to cough up a $10 co-pay for medicine for ourselves, we eagerly pay $150 for heartworm and flea medications for our dog.  What gives here?  Why the disconnect?

And speaking of heartworm and flea medications, when I was a kid, we didn't have these things.   You took the dog to the vet for a rabies shot, maybe once a year, if that.   There was no flea medications, no heartworm pills.   And things like Doggy Dentistry didn't exist.  Granted, our pets back then were probably in poor health and did not live as long.  But these new treatments illustrate how the practice of veterinary medicine has expanded - creating demand for these new services.

Like with Dentists, we are awash in a sea of Vets.   In any given town, there are probably several Veterinarian offices - almost as many as there are Doctor's, in some cases.   They are easier to find than a Bank of America or a McDonald's.

That is, until you get to some very rural "under-served" areas.   You may find a Vet there, but he likely will be a fellow with a pickup truck to visits farms to treat livestock, not your family pet.  So, ironically, we have this simultaneous surplus/shortage of professionals in this country, again largely due to the fact that you can make a lot more money practicing in areas where people have more disposable income.

You are not going to convince a rural farmer that their barn cat needs chemotherapy.   He likely will just shoot the cat and bury it.   But some emotionally involved elderly widow in the suburbs of New Jersey?  She'll spend $5,000 or more, trying to save "fluffy".   And she may even have her teeth whitened as well.   Hers, not the cat's.   Although I suppose that is the next frontier - pet cosmetic Dentistry.

Now of course, we are presently also awash in a sea of Lawyers as well, and as a result, the profession is not as lucrative as it once was.   And Lawyers can create demand for their services, out of whole cloth sometimes.  And unfortunately, billboard advertising does just that.   But in small towns, again, life for a lawyer might not be so lucrative.

There is an old joke that a Lawyer set up a practice in a small town.  He was the only Lawyer in town, and nearly starved to death.   That is, until another Lawyer set up shop in the same town.

But I think part of the decline in the legal profession might be that people are wising up to the fact that the Lawyers always win every case - by raking in huge legal fees.   At least at the Corporate level, many folks are realizing that lawsuits are rarely "won" by anyone.  They just become a huge distraction to the underlying business, and a huge drain of resources as well.  And maybe right there is why the law business has taken a bit of a nosedive as of late.

Perhaps we Lawyers need to take a lesson from the Veterinarians and Dentists, and offer new, exciting types of Cosmetic Legal Services - akin to tooth whitening and adult braces.   Or perhaps pointless expensive services akin to Feline Chemotherapy.

Who knows?  It..... Just.... Might..... Work!

UPDATE  April 13, 2013:   Here is a tip for saving money with your vet.

We were traveling with our dog and realized her rabies vaccine was about to expire.  Florida State Parks require a current rabies vaccine certificate.  I located a nearby vet via GPS, and for $35 they gave our dog a 3-year rabies shot - likely the last she will ever need.

No office visit charge.  No hassle or fuss.   In and out in about 20 minutes.

The latter is really key, as our dog gets very anxious at the Vet.  It smells like other dogs in there - and cats - and there is a constant cacophony of barking and yelping in the background.  She hates it, and starts panting and freaking out.   My previous vet made me wait nearly an hour in the waiting room, all the time while the "techs" stood around the office and gossiped and chatted.  Finally I had enough.   Why should I wait an hour when these folks were doing nothing and my dog was freaking out.  I was hot, tired, and covered with fur, and my dog was unhappy.  I left.

And then I realized, on this trip, that there is no need for this hour-long wait and "exam" by the vet and the high charges.   I can just get a shot from a technician in a matter of minutes.   Well......Duh!

Many vets schedule vaccinations along with an "exam" which in most cases is prefunctory - a feeling of the dog's glands, a weigh-in, and a look at her teeth (and a pitch for $450 "dental cleaning").  The cost of this exam?  Often $50 to $100, for the office visit charge.

If you have several shots done (rabies, distemper, bordetella) and then buy flea treatment, heartworm medication, and (if they are good salesmen) some of that Science Diet food, you can leave the vet with a bill well into the hundreds of dollars - with a follow-up appointment for teeth cleaning that will run $500 or more.

It is, to say the least, a racket.  And as a vet, you make money selling more and more services, just like Dentists are prone to do.

If your dog is in good general health, and you know your dog's vaccination schedule, you can call, shop around, and schedule vaccinations with a veterinary tech, often for far less.   For example, Distemper shots might run $16, and Bordetella (required for boarding your dog in many boarding places) about $18.

(A friend of mine, with 6 dogs and 20 cats, administers her own vaccinations, to save even more money.  I am not sure I am ready to go that far to save a buck!  But I have only one dog).

As for heartworm medication and flea treatment, we buy this online, either at Amazon.com or on 1-800-PETMEDS (they rock!) which often charge half what a vet will.

BEAR IN MIND that a dog may live to be 15 years or so, and a cat, maybe 20, at the outside (we had one live to 22, but that is not the norm).   Taking extreme measures to keep your pet alive longer than that (and spending more money on your pet's health than your own) makes no sense at all.

Make your pet comfortable, happy and give them a good home.   But throwing money at them is never a worthwhile proposition.  Many pet illnesses, such as heartworm, are basically untreatable (but preventable).  Chemotherapy for a dog or a cat really doesn't make much sense.   Yet many people will spend thousands trying to keep an animal, near the end of its natural life, alive for a few more years.

Love your Pet, not your Vet!


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