Dear Second Opinion,
Over the past several years, my clinic has acquired an increasingly large number of new patients. We have even expanded services to include urgent care appointments. As our clientele grows, I routinely have to balance optimal patient care with clients’ financial needs.
For example, I recently diagnosed a patient with a urethral obstruction. I initially recommended the gold standard of care, which included urinary catheterization and hospitalization to monitor renal values, electrolytes, and fluid balances; however, the estimated cost exceeded the financial capabilities of the client. I offered several variations of the above treatment plan and worked extensively with the client until we ultimately decided to proceed with outpatient care. I felt anxious about the outcome of the case, guilty about not providing the best standard of care, and worried the client would blame me and the clinic if the patient did not improve.
I sometimes feel like I spend more time discussing finances and altering patient care estimates than practicing medicine. How can I successfully navigate client financial limitations and still maintain a high quality of care?
—Constrained by financial constraints
Dear Constrained by Financial Constraints,
These guilt-inducing financial conversations are a common concern for those in private practice and can drain your energy, time, and joy.
First, try to let go of the guilt and worry. It doesn’t help to mentally berate yourself for somebody else’s financial constraints. You deserve to feel at peace when you have provided the best care possible within the client’s budget (even if that is just relieving the patient’s suffering).
Second, embrace the spectrum of care. We’re taught that the gold standard is best and everything else falls short, but that is simply not the reality of private practice, nor does it account for the client’s limitations or desires. Offer the gold standard first, but have a backup plan for big estimates. If you are bothered when a client elects care that is less than the gold standard, practice letting go of your attachment to the outcome. This is easier said than done, but it can bring peace of mind. Make it your goal to do your best within the constraints of any situation so you will have achieved your goal regardless of the outcome. Also consider having a technician or customer service representative present estimates to free up your time.
Third, ask the practice manager to look into client financing options. Medical lines of credit can be difficult to secure. A payment service (eg, Rectangle Health) that approves credit lines for most clients can lower the access to care barrier. Payment services charge the clinic a small fee but can help save lives, save time, and reduce stress for the staff.
Last, empathize with the client when money is an issue. Many people are embarrassed when they aren’t financially prepared. Let them know you care and understand and will do what you can for their pet. Then breathe…and let it go.
Sarah Wooten, DVM, CVJ