In attempting to change equine veterinary medicine to become a sustainable career, there are several key points that must be addressed. One is that veterinarians are not great at setting boundaries. They are passionate about horses and providing the best care they can. That often means veterinarians put the welfare of horses and horse owners ahead of their own welfare.
While this article is focused on a topic that falls under the “boundaries” heading, it is more about giving yourself permission to step back from an owner who is insistent that you provide quality care even when they can’t (or won’t) pay on time, completely, or at all!
Horse Ownership Is a Choice
Sometimes equine veterinarians need to remind themselves that horse ownership is a choice. If a person makes a choice to own a horse (or a dog or any animal), then he/she should have considered the minimal needs for that animal’s care. The owner also should have considered that any living creature is subject to illness or injury. Therefore, animal owners should be prepared to provide for that animal’s care during those circumstances.
Some people who feel entitled think, “I have an acre of yard, someone offered me a free horse, so now I’m a horse owner and you [the veterinarian] are ethically obligated to care for my horse!”
Owning a horse (or any animal) comes with responsibilities. And just because you are a compassionate veterinarian does not obligate you to foot the bill for the care of a client’s horse.
Being a licensed veterinarian does not obligate you to provide discounts or become a “bank” for your client and offer payments. Being a veterinarian also doesn’t mean you have to accept every client, or that you have to keep every client.
It might be good for you to refresh your memory about the veterinarian’s oath:
“Being admitted to the profession of veterinary medicine, I solemnly swear to use my scientific knowledge and skills for the benefit of society through the protection of animal health and welfare, the prevention and relief of animal suffering, the conservation of animal resources, the promotion of public health, and the advancement of medical knowledge.
“I will practice my profession conscientiously, with dignity, and in keeping with the principles of veterinary medical ethics.
“I accept as a lifelong obligation the continual improvement of my professional knowledge and competence.”1
Are You Subsidizing Your Clients’ Hobbies?
Kelly Zeytooonian, DVM, MBA, CERP, is the owner of Starwood Equine Veterinary Service and Starwood Veterinary Consulting in California. In a previous article, she had stated, “It’s not our job to subsidize somebody’s hobby.”2
For this article, we asked Zeytoonian to expand on that thought.
“As veterinarians and horse lovers, we have a tendency to become very invested in our patients, which vests us in our clients’ lives,” explained Zeytoonian. “I think the lines become blurred because we find ourselves wanting to help regardless of whether we are paid on time, whether the client treats us with respect, whether we are giving up our own personal time to do it, etc.
“There is nothing wrong with giving 110% to our clients, but it’s also important to remember that at the end of the day, we need to take care of ourselves and put our needs before those of our clients,” she stated.
“Horse ownership is a luxury not a necessity; so if someone can’t pay for my care, I do not feel guilty for saying ‘No!’ ” Zeytoonian stressed.
We discussed with Zeytoonian whether it is unusual for veterinarians to be asked for discounts, freebies, payment plans, or rate decreases.
“It’s common!” she stated. “So is the assumption that we are making a ton of money. I don’t know how many times I’ve heard someone say: ‘I bought your new work car with my vet bills,’ or ‘I’m covering your kids’ college fund.’
“A better statement from clients would be: ‘Thank you for caring for my horse with compassion and completeness. I appreciate the value you bring. Here is your timely payment!’ ” Zeytoonian said.
She said clients also need to remember that “the practice of veterinary medicine is just that—practice. Sometimes we don’t have a resolution for a problem on the first visit. That doesn’t mean the next one should be free.”
The difference, according to Zeytoonian, is that equine veterinarians are “naturally ‘fixers,’ and not coming to a meaningful solution is tough.”
Veterinarian/Client/Patient Relationship
We asked Zeytoonian why clients feel like they can ask for discounts, free services or payment plans from their equine veterinarians when they would never ask for those from a dentist, a mechanic, or even their small animal veterinarian.
“I think the relationship between equine vets and clients is more intimate than other career paths,” said Zeytoonian. “We spend a lot of time with these people. We are in their homes or at their barns, so they already have the upper hand in a sense. We often befriend our clients and lines become blurred.”
How Veterinarians Can Respond
If equine veterinarians are commonly asked to provide discounts or free services, then they need to be prepared for how they will deal with those requests.
We asked Zeytoonian how she thinks equine veterinarians should respond. She suggested using this phrase: “Our fees are a reflection of the time and expertise we provided you, and we will not be providing a discount.”
As she noted, “Providing education on the value our team brings to a case can really help defuse clients” who are trying to find lower-cost or free solutions to a problem.
In Zeytoonian’s practice, payment at time of service is a policy—“and I’m a stickler to it,” she said. That means payment must be arranged before a veterinarian will go out on a weekend or see a new client. “They say, ‘Once I see that email [about payment] come through with the paperwork, then we can get something on the schedule,’ ” she said. “That has been super helpful for our team.”2
Zeytoonian added that veterinarians need to be proactive not only in their policies but also in education. “Where we really need help is shifting the mindset of our clients, to change their expectations so that it’s not a surprise when we want to be paid at time of service,” she said.2
She added, “My job is to provide you [the client] with all of the options for care and give you a path to health and wellness for your horse. And my job is to also educate you on insurance opportunities, coverage opportunities, payment options—none of which involves putting somebody on a payment plan or subsidizing the care of the animals.”2
Some practices allow veterinarians to have a specific line item in the budget for charity services or discounts each year. Each veterinarian is allowed to determine whether that budget amount is used all for one case or is distributed across several clients or patients.
Dealing with Guilt
Unfortunately, veterinarians sometimes feel guilty from the act of just handing clients bills for needed or requested services. Do you think your plumber or mechanic feels guilty handing you an invoice?
Sometimes veterinarians feel like it is their “ethical” obligation to attend any horse in need. But they also feel put-upon, angry, upset or even depressed when their personal lives and well-being are repeatedly and constantly shoved aside.
How can equine practitioners deal with that guilt?
“Focus time and energy toward clients and cases where funding is available and allows you to provide the level of medicine you want,” said Zeytoonian. “You can’t help every horse, and that’s OK!”
In other words, you don’t have to be available 24/7/365. Let clients know when you are or are not available. Encourage them to have an alternative veterinary solution when they can’t reach you. That might be another veterinarian with which you have an emergency arrangement, a different practice in your coverage area, a local veterinary school, or an emergency-only practice.
She reminded her colleagues: “We do not have to be everything to everyone. We do not have to accept all clients!”
Preparing Staff for Requests
Zeytoonian noted that sometimes it is the staff—a receptionist or vet tech/assistant—who gets the questions or comments about services and payments because clients are ashamed that they can’t afford the gold standard of care.
She said, “We try to not make it a guilt thing, as there are some clients who just don’t have the funds to pay for more advanced therapies.”
Zeytoonian said sometimes she will have the office staff offer an estimate for services and have the clients “let us know when they are ready to schedule a visit.”
Take-Home Message
Equine veterinarians are becoming an endangered species. If we want to make the profession viable and sustainable, equine veterinarians must maintain boundaries that keep them from burning out and leaving the profession.
In order to prepare for the inevitable requests from clients, you might try practicing what you will say when clients ask you for discounts or free services, or even admonish you for not being “ethical” or “caring” concerning their needs and horses.
Remember that not only are you a professional, but you are a professional who runs a business. The great part is that you can be passionate about what you do and also be professional about how you do it.
You did not take a vow of poverty, and you did not agree to take—or keep—every horse owner as a client.
With appropriate boundaries, equine veterinarians can stop feeling abused or guilty because of horse owners’ actions. As a result, they can experience more complete satisfaction in their profession and be glad they stuck by their calling of being a horse doctor.
References
2. The Balance of Passion and Practice in Equine Veterinary Life
This article originally appeared in the 2024 Special Issue: Help Horse Owners Prepare for Care, brought to you by CareCredit. You can download and read the entire issue here.
