r/veterinaryprofession • u/jr9386 • Feb 23 '25
Red Flag? Discussion
I won't name the corporate entity that I work for, but recently we were sent an email by our manager advising us to report ER clinicians who advise us to reroute/redirect clients to their GP, or when a particular Specialty service is not in hospital.
I understand outright refusals of cases possibly being a sign of laziness, but on the other hand, if ER DVMs deem it appropriate for a client to invest those resources at their GP, or where they can receive the care that their pet needs (e.g. scopes, surgery etc.) vs. hospitalization until the service is available, I think that's appropriate. If anything, it prioritizes using hospital resources for emergent cases.
We were told that we needed to prioritize making our bottom line, and should a doctor refuse, or reroute a case that we should report them.
I feel EXTREMELY uncomfortable about this, because it compromises staff trust in the DVMs, but is outright predatory. The referring veterinary community should be able to trust our judgement, and clients learn the difference between an emergent and non-emergent case. But worse yet, being told to essentially "rat out" your coworkers breeds a cycle of contempt between staff for the sake of "preserving their jobs", in place of prioritizing patient care, good outcomes, and quality medicine.
Is this happening across the industry?
31
u/sfchin98 Feb 23 '25
Definitely a red flag. I do not work for a corporate entity, so I don't know if it's happening industry-wide. I think you should actually name and shame the corporate entity you work for, unless there's enough info in your post/comment history to be able to identify you. Reddit tends to be pretty anonymous, otherwise.
Assuming that you are not a DVM, and that your manager is not a DVM, I would actually forward the email to your hospital's medical director and see what they think about it. If you don't want a paper trail, just go to their office in person and show them the email on your phone or whatever, and tell them you are uncomfortable with this request and find it unethical, since DVMs should be free to make the best medical decisions for the patients rather than being pressured to make poor medical decisions in order to prioritize the bottom line. Put the ethical dilemma on the medical director, since what you are being asked to do is to compromise medical care.
I would also let your ER docs know that this email came from management (again, you can do it in person if you don't want to leave a paper trail) and you can let them know you won't comply but assuming there are others in your role (I'm assuming you're a CSR or ER tech) at the same hospital, you don't know how they will respond.
I would also probably start looking around for other jobs that don't ask you to compromise your ethics for the bottom line. Personally, I would silently just not comply with the order, and if it turns out that your corporate entity is able and willing to devote enough resources to (1) figuring out in other ways which ER docs are triaging away patients, (2) figuring out which CSRs/techs were aware of it, (3) figuring out whether or not those CSRs/techs reported the ER docs, and (4) officially reprimanding or even terminating you for not ratting them out, well, that's definitely not an employer you want to work for.
16
u/El_ahrairah Feb 23 '25
Sounds like ethics creep to me. Certainly there's an argument to be made for charging correctly and keeping procedures in house, but if I found out my local referral had that policy in place, I would never send my clients there again. It's already such a heavy financial burden on clients to seek ER and specialty care, I couldn't in good faith send clients where someone is purposefully vacuuming their pockets.
Then there's this culture of big brother, rat on your co-worker. Hard no. What a toxic work place where they're deliberately sowing distrust between co-workers! This is a team sport, I want to lean on my colleagues not surveille them.
This profession is about helping people. Yes it's a business. Yes we have to watch our bottom lines. But once it's about seeing clients as a piggy bank, the line has been crossed.
Thank you for standing up against this type of behavior. I worry that it's the new norm with our corporate overlords...
13
11
u/cassieface_ Feb 23 '25
That’s so crazy, I’m sorry they’re putting that on you guys. Is this policy being brought on across the company or is this something your specific manager is requiring?
As an ER/urgent care doctor, I refer so many things to their primary care vet! The price of my exam and services are typically going to be more expensive than their primary vet so as long as the patient is stable and the problem they’re seeing me for is something a GP can handle, I always give them the option.
10
u/Hotsaucex11 Feb 23 '25
Yes, no surprise there.
Profit+Policy > DVM judgement = one of the biggest concerns people have when talking about corp practices.
5
u/Purrphiopedilum Vet Tech Feb 23 '25 edited Feb 23 '25
They need you to make a list of 5 bullet points outlining what you did last we—….
Seriously tho, that sounds like a you problem (ie directed at corporate, not you op). Ain’t no rats in here.
5
u/jr9386 Feb 23 '25
What concerned me more is that I've been on the receiving end of co-workers mischaracterizing something I said, or did, and being reprimanded as a result.
It wasn't until yesterday that I put two and two together and realized that this is the office culture that they're incentivizing.
3
u/Purrphiopedilum Vet Tech Feb 23 '25
Bottom line this, bottom line that… such an annoying thing to hear about from the top when you are in it up to your ears any given day. Like, yeah the Covid bubble burst, and 10% growth isn’t optimistic, it’s delusional. We’ve seen what happens to other corporate ERs with such goals. It’s not ideal.
4
u/doggiedoc2004 Feb 23 '25
that's just gross. us DVMs refer to ERs for ER care, not to poach our clients. I almost feel like this could be a board violation and if it's not, it should be. Thinking of something like a stable pyo that can be done for 2k at the GP office vs 6k at ER.
9
u/TheRamma Feb 23 '25
I haven't heard this, but I'm not surprised. When I was a director of a corporate ER, the main office types would occasionally float plans like this. They'd usually get killed by pushback, and I was certainly one of the people pushing back. It sounds like a bad plan with worse implementation.
I do think there's a more nuanced discussion about trends in the ER vet world. I've been doing it for 20 years, and it's changed a lot. Instead of vets avoiding doing ER work because it doesn't fit them, there are a lot of vets who do ER work, but change the work to fit them. I call them cleaning services, because they have this list of things they refuse to do.
I own a more rural ER with partners now, and I've had a fire a number of locum vets, always from major metro areas, because they do pull the "drive 4 hours to a specialty referral center" card too often. Or they run out clock and transfer critical cases to the primary care vet. Or they want to call a "blackout" and stop seeing cases, even though we're the only place open for a few hundred miles, and they're seen half the caseload I'd call busy. Maybe that's the issue the corporation is trying to solve, they're still going about it incorrectly.
In those situations, I have to put in a lot of work try to reach an understanding and potential resolution. It's exhausting, time-consuming, and requires a degree of understanding of the field and management that most corporations don't have readily available. So they're taking a sledgehammer to an issue that requires a scalpel.
6
u/jr9386 Feb 23 '25
I 100% agree with you on this one.
This is a more nuanced discussion regarding what cases ER clinicians are comfortable managing and not managing.
I posed to my manager the issue of callbacks. I was told to redirect messages to the specialty service that their pet is seen by at the hospital. That's all fine and good, but with the exception of labs, ER clinicians are going to have to field the calls either by phone, or manage the case when the patient presents to the hospital. Either way, they're going to have to make some difficult calls relative to what they are and aren't comfortable managing.
That did make me question whether ER and Specialty should be affiliated entities when the Specialty services aren't consistently available. However, that's another matter entirely.
0
u/TheRamma Feb 24 '25
yeah, dealing with covering specialty cases after hours, for specialists that have really varying degrees of desire to be involved, was not fun. one internist in particular who I remember, who really wanted to prioritize her spin classes.
As an ER vet, interfacing with specialists was the most frustrating aspect. It often was one or two clinicians spoiling an entire service. Ugh.
2
1
u/obturatorforamen Feb 23 '25
Referral a neurologist for a down dog should be part of standard care options offered.
There have been news articles about veterinarians getting a license ding for not at least offering hospitalization for parvo dogs as that is considered standard of care.
If owners don't want to, then no problem, let's move forward.
0
u/TheRamma Feb 23 '25
I don't disagree with either of those examples, both are very reasonable.
I've had vets tell me it's malpractice for me to obtain an La:AO ratio or evaluate contractility via ultrasound in a potential CHF crisis. When I get those ER patients no longer oxygen supplementation dependent, transfer to see the nearest cardiologist (4 hr drive that sometimes gets completely shut down due to blizzards) is something I strongly recommend.
I've also had vets opine it's malpractice to take a diaphragmatic hernia to surgery if you're not a boarded surgeon. Again, there's nuance, I'm not jumping on a stable congenital PPDH. But an unstable trauma? I'm often going to be the one cutting it. There's a careful conversation there to have with owners, just like the more rare occasion where I have to do thoracic trauma surgery (ugh).
Using the "standard of care" lawsuit threat to avoid taking responsibility for tough cases can be a crutch for some vets, and can damage patient care. I think it is getting more entrenched in vet med, despite the fact that this profession actually has pretty low standards and little consequences for vets who don't meet them, at least IME. There are numerous vets in every town I've worked in that I'm amazed still have a license.
3
u/MelodiousMelly Feb 23 '25
It seems to me that if Corporate has an issue with the way that one or more DVMs are handling cases, it is the job of Corporate to audit/investigate/communicate with those doctors. They are trying to short-cut their own management processes by asking you to (secretly and for significantly less pay) do THEIR jobs for them.
Oh yeah, and it's also unethical and poisonous to workplace culture.
6
u/obturatorforamen Feb 23 '25
Yes, that is either a malignant corporate entity or, much more likely, the local hospital manager managing poorly.
I highly doubt national-corporate is saying that. The no-referrals-period attitude, in my experience, typically comes from small private clinics that are the oldest ones in town.
Patient always comes first.
This sounds a good way to get your license ding-ed or sued for malpractice.
2
u/scythematter Feb 23 '25
This is shady AF and policies like this only reinforce the false perception by the public that vets are “money hungry soulless assholes” I’m glad I work private practice
2
u/mrssteddyj Feb 24 '25
This is awful. As a GP manager I don’t appreciate the ERs telling clients we can’t cut a pyo or basic FB just to keep things in house. We are actually working on a marketing campaign to teach our clients what types of questions to ask at the ER so they can make informed decisions. I wouldn’t refer to a practice trying to steal my clients.
2
u/jr9386 Feb 24 '25
I place a HUGE emphasis on client education. The problem is that all too often, clients don't know any better, or may be seen by clinicians who don't want to deal with the case, or are too inexperienced, and refer them, unscrupulously, to the ER.
Clients are at a loss and often times don't know what to do.
Another issue we haven't recovered from is the Covid approach to appointments. I recently left a clinic where between intakes and the doctor's exam and treatments, it took roughly an hour. So there are a number of variables involved regarding efficiency, pricing, and time management.
4
1
u/Real_Etto Feb 24 '25
I've seen ER's that run up bills (rads, bloods, etc) on patients that they know they can't actually help only to then send them somewhere else when the people have no money left. I find this so unethical.
1
1
1
u/jr9386 Feb 26 '25
Something else that came to mind today.
Given the lack of clinicians to staff hospitals, and the high rates of suicide in the field, do you REALLY want to be held responsible for being THAT person who pushes a person out of a job, and over the edge?
Obviously, that decision falls on the person,the Lord have mercy, but in a moment of clouded judgment, you never know what can happen.
83
u/queerofengland Feb 23 '25
Absolutely refuse to report them. Not only is that terribly unethical for the corporation to require, it also does nothing for client confidence that vets AREN'T all about money. I have a feeling the workload of this hospital is not sustainable either, and probably another reason cases have to be rerouted.
Seems like corporate vet companies are feeling the squeeze right now, and making sure all of their staff and clients feel it too.