What Can We Learn From Equine Veterinarians?

Mike Pownall, DVM, MBA, practice owner, consultant, and fellow podcaster, joined Central Line to talk about what veterinary professionals in any corner of the field can take away from Synchrony’s 2023 Equine Lifetime of Care study.

By Katie Berlin

A Conversation With Mike Pownall, DVM, MBA

Here at AAHA, we stay mainly in the small animal realm, but that doesn’t mean we can’t learn from our colleagues in equine practice. Mike Pownall, DVM, MBA, practice owner, consultant, and fellow podcaster, joined Central Line to talk about what veterinary professionals in any corner of the field can take away from Synchrony’s 2023 Equine Lifetime of Care study.

From the recommendation many of us “grew up” with—to keep veterinarians out of cost conversations—to the question of where insurance and financial planning should first be discussed, Pownall, who co-founded McKee-Pownall Equine Services with his wife, reminds us that we have more in common than we have differences. In the end, we all came here for the same reasons, and we can and should help each other grow and learn.

Katie Berlin: I’m really excited to get your take on a lot of challenges that the veterinary profession faces. I’m one of those people that wanted to be an equine vet, and I went into vet school for about five minutes, then I realized that it just wasn’t going to work out. And it’s probably good because my back would’ve given out after like year two.

Mike Pownall: You know what, when everybody says that equine practice is so tough, I’m like: Yes, but we don’t have scratchy, bitey cats.

KB: Truth, truth. So, Synchrony did a study, the Equine Lifetime of Care study, not too long ago. And we are coming together to talk about what was found in that study and what we can learn from it. So, can you give us a little bit of background on what that study talked about, and the big findings you think are relevant?

MP: They talked to about 1,200 US horse owners, ages 18–79, and what they were trying to do was really understand the financial, emotional, and psychological effects of the cost of equine care. That’s one thing that really makes our professions different—equine care is much more expensive on an annual basis. So, they really want to understand what is the average horse owner involved with, what industries are they involved with, and what do they spend?

Their actual expenses in this report are often three to four times higher than what they were thinking of spending. So even though they’ve saved some money or they have a little nest egg put aside for that rainy day or something that’s gonna happen, it’s often not enough. And when something happens, they’re ill-prepared.

Approximate Annual Cost of Horse Ownership

Backyard/pastured horse . . . $11,538

Recreational . . . $16,460

Competitive . . . $36,851

Source: Synchrony Equine Lifetime of Care study

KB: When I was working in the vet clinic, it seemed like everybody here in Colorado hikes with their dog, takes them paddleboarding, or bikes with the dog running alongside. Those dogs are going to get hurt more than your average house dog like my chihuahua.

And many of them are totally unprepared for how much it costs to like, say, do a TPLO or hospitalize the dog when he eats poisonous mushrooms or something like that.

MP: I think people realize that the ongoing care of horses is expensive because you’ve got to stable them, you’ve got to pay for a farrier. But it’s always that surprise.

KB: I don’t remember ever getting an estimate or a treatment plan to look at. The equine vet would just say, it’s going to cost about this much to do this injection or to do this treatment. I just said yes because the horse is standing there and it needs it.

And that seems to me to be very different from the plan that a lot of veterinary hospitals have now, which is to present a treatment plan, a paper estimate in front of the client, and go through it item by item so that the client sees that total before they’re at checkout. Whereas with the equine vet, I often just got a bill in the mail and that was very scary. Is that changing now or is that still what happens?

MP: That’s starting to change. People want estimates; people just want to be informed. I think a key competency of being a vet now is your ability to communicate, and this is a big part of it.

KB: Do you think people are more likely to say yes to a large estimate if they know they don’t have to pay it right away?

MP: One of our vets told us something once a while ago, and I thought it was really a great insight. When you’re presenting a couple of options, you say if money was no object, I would do this. But a different treatment plan may be a good alternative—still great medicine—but an alternative.

And when they get silent, they’re not thinking, I don’t want to pay for this. They’re often thinking, okay, what do I have to give up to afford this? They want to do what’s best for their horse, so they just need to think about it.

KB: So what about the advice that we are given? I don’t know about you, but I graduated vet school in ‘09 and we were told that vets should stay out of the cost conversation. We should send a technician in or another staff member to go over the estimate and itemize the cost for the client. In my experience, that wasn’t always the best solution, and it left me feeling a little bit powerless, especially if the client said no to stuff. What do you think about that advice, for equine vets, who probably have to go over the costs themselves most of the time?

MP: I think cost is so related to care that when you delegate the discussion about cost, you’re not part of the conversation about care. As a veterinarian, if you remove yourself from this conversation, you lose a lot of control. And I think you lose a lot of that relationship with the client, that trusting relationship. So, yeah, I think that that needs to be part of that conversation.

KB: Even $1,000, that’s a lot of money, especially to somebody sitting in a vet clinic with a cat. They’re not expecting to spend $1,000 on their cat. So you could say, “this might come a surprise, but let’s see if there’s anything that we can do to keep the costs down.” There’s something about that that makes us a little bit vulnerable, and that vulnerability on our part creates more trust with the client.

“I think cost is so related to care that when you delegate the discussion about cost, you’re not part of the conversation about care.”

Mike Pownall, DVM, MBA

MP: We have to have that conversation of the expense versus the value. You can say, well, this is expensive, but this is the reality of the cost of care. And as you said, you break it down and here are the components. I would say the one thing I have found in my travels is that Americans are better with those discussions than Canadians because of our government-funded health care. We have no idea what medicine costs. It’s free, but it’s not. So when you start talking about pet health care, that’s a harder discussion.

KB: What about insurance? As long as I’ve known horse people and had horses in my life I’ve known about equine insurance. I showed horses growing up, and we always had insurance. But pet insurance has been pretty slow to catch on, in this country anyway.

MP: One of the reasons why equine insurance is slow to pick up is just the cost of the horses. When you have a high-end show horse, it’s quite valuable, and you ask the owner, well, is it insured? They’re like, no. And you’re like, why? They say, well, we have four like this, and we just can’t afford the insurance on them. So, I think the rate of insured horses is below 10% in North America. It’s pretty low.

KB: Yeah, that really surprises me. If I had a backyard horse, I probably wouldn’t insure that horse. I insured the show horse because if he colicked, I wanted to be able to do surgery on him.

MP: I think these are where we have to have these proactive conversations with clients. An unexpected expense will happen at some point in the animal’s life. We need to have discussions with clients, maybe in how we onboard new clients, our welcome package, or our discussions about the value of insurance.

KB: This profession, I’ve never met a group of people who like talking about money less. We all got into this because of our hearts and not because we wanted to get rich. So we really just hate talking about it. My first boss wouldn’t let us say “expensive” and “cheap.” He would say “it costs more” or “it’s more cost-effective.” I feel like the big reluctance on the part of vet teams is that we don’t want to seem focused on the money.

We don’t want to be like, hey, just so you know, we’re going to be asking you for a lot of money, pretty much every year, forever. Do you have tricks or tips for how we can approach that conversation?

MP: I think the best practice is to train as many people in your organization other than vets about money, so you can have these discussions. Often the client will be there with a technician while the doctor’s out of the room. So they need to be able to have some comfort talking about money. We just say, we want what’s best for your horse, dog, cat, hamster, whatever, but the cost of the diagnostics and treatments would be a challenge for everyone. So let’s think about options that can make this affordable.

I think we can always come back to the fact that health care is expensive. Let’s not skirt that. We’re going to talk about money, but we’re talking about it in context of what is optimal for the health care of your particular animal.

“I think we can always come back to the fact that health care is expensive. Let’s not skirt that. We’re going to talk about money, but we’re talking about it in context of what is optimal for the health care of your particular animal.”

Mike Pownall, DVM, MBA

KB: That follows the trend of authenticity and supporting brands that you feel are telling the truth to you, that I think Millennials and younger generations seem to really identify with. They’re willing to pay more for something if they really believe that it’s for a good cause or for the right cause.

You had said that a lot of times, the equine vet is the last one to see the horse. After the client has exhausted all the other options, so they’ve been on their online forums and they’ve had the chiropractor out who may or may not be a vet. They will talk to everyone they can before they have you out, and then you come out and the treatment that you’re offering is the right treatment, but things are more advanced now.

Do you feel like the best medicine for that is to try to get around it and say, okay, we’re gonna try to educate clients so that they don’t do this? Or do you feel like that’s just the behavior in the society we live in now? And so now, our goal is really to focus our energy on having those transparent cost conversations about what you’re getting for that value and why it’s important to be prepared? Sort of like, do you fight a bad review with just a bunch of good reviews, or do you respond to it?

MP: You know, I think the right answer for everything is always, it depends. You have to wonder, why do they not want to come to us first? That’s really the first question. Is it a general perception of veterinarians? Is this a person who is never going to spend the money anyhow?

What we do in our own practice is develop that reputation of trust, of providing a thorough diagnosis. I think you need to develop a reputation as a practice with transparency—that you’re providing the best care for the animal, but there’s a price associated with that. You can’t be embarrassed, or ashamed, or dismissive of it. It’s part and parcel. We want to pay people well, you know. We want to give people time off. We want to have great diagnostics. All of this costs money, so we can’t be skirting it.

KB: The honesty and forthrightness that you’re talking about really appeals to me. It works when we’re talking about any type of conversation with clients. Not skirting the truth, but trying to be direct with them as early as possible, as often as possible. And at least at the end of the day, if things didn’t go the way that you wish they would have, you can sleep well at night knowing that you did everything you could to communicate well and clearly to them.

MP: Yep. And that’s what I say. There’s the cost, and then there’s the value. The value is what a person thinks of with the result minus the cost. In our profession, we don’t always get great patient outcomes. It’s just the nature of our business. But we always talk about client outcomes versus patient outcomes.

You could have the best patient outcome—you’ve done the most current surgery with the newest technology—but if you haven’t discussed the pricing and aftercare and all that with the client, and they’re upset, that’s a bad client outcome. It’s like going to a restaurant, you can have the best meal, but when the service is surly, you’re never going back there. You can have a mediocre meal, but when they’re fawning over you and you feel like you’re special, you’re going to go back.

“I think you need to develop a reputation as a practice with transparency—that you’re providing the best care for the animal, but there’s a price associated with that.”

Mike Pownall, DVM, MBA

KB: Last question before I let you go. There’s just so many factors in horse aftercare when something happens. A lot of the outcome depends on the horse owner. Is that a conversation that you have too?

MP: I think there’s two approaches to that. We talked earlier about the older horse that might go for surgery. There could be complications, which may require another visit back to the surgical facility. But when you’re talking about things like laminitis, or founder, or wounds, you have lots of bandage changes, lots of cold hosing. The success in the outcome is dependent on how much time the client has. You’ve got to have that frank conversation.

KB: Yeah, that’s a really good point. Surgery’s not the end game. And that’s the case with a TPLO too, or a foreign body surgery. There’s so many things that have to happen after that for the outcome to be good. I do think that we, in small animal, do sometimes let that slide, because we’re just so focused on getting the client to say yes to the treatment that we want to do at that moment. It’s like the blocked cat, right? If you use all the client’s money to unblock the cat one time, there’s a very good chance that cat’s going to block again. And then what? Then the client’s mad, because you used all of their money. You hope for the best, but if you haven’t had that conversation, that sets you up for failure.

KB: Do you see a role for telemedicine being employed to have some of these conversations? If you’re in a time crunch and you say, I don’t have the staff to have a long conversation about this right now, but I will have somebody call you. We’ll set up a video call and we’ll have this conversation face-to-face at another time. Is that something that you do or have done or seen done?

MP: We don’t do it. I would love to do it. I think with the shortages that we’re having of not just veterinarians, but support staff, it could be an essential tool. But like anything, we need to know the limitations of it.

I remember once somebody called me from a horse show saying their horse had a laceration over a joint. I said, send me a picture. It looked superficial. I said one of my colleagues will be at the horse show there tomorrow. They can have a look at it, save you money, don’t worry about it. Well, he called me the next day and said this was a deep penetrating wound that just nearly missed a joint. And that could have been catastrophic.

But I’ve talked to behaviorists and they say, I can do my best consults with telemedicine, because I’m seeing them at home.

KB: That’s a really good point. I’m thinking of it in a slightly different light, which is where you’ve already seen the patient, you’ve already established the recommended treatment.

MP: I think this is where telemedicine, I think, has a great opportunity, in follow-ups. I just need to see how this dog is moving or how this horse is moving. I can see that on video. Don’t present an open wound and ask me, does it need to see a vet?

One of the things we’ve been looking at is building that into the price of the initial exam. So let’s say you come in for a lameness exam. We’re gonna charge you X dollars, but now our new price is gonna be X plus. And that includes two free telemedicine consults at regular times.

KB: I think that’s a fantastic idea. And it makes that initial vet exam seem like a better value. It’s all about that perception and we are definitely trained to see a package deal as being a better value.

Central Line: The AAHA Podcast is generously sponsored by CareCredit.

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Catch the full episode, and every other episode of Central Line: The AAHA Podcast, on major podcast platforms, YouTube, and at aaha.org/podcast.

Mike Pownall, DVM, MBA, owns McKee-Pownall Equine Services, which has three locations in the Greater Toronto area. He has consulted with veterinarians all over the world, focusing on human resources and marketing.
Katie Berlin, DVM, CVA, is the host of Central Line: The AAHA Podcast.

Photo credits: Abramova_Kseniya/iStock via Getty Images Plus, Joko Sutrisno/iStock via Getty Images Plus, monkeybusinessimages/iStock via Getty Images Plus, Evrymmnt/iStock via Getty Images Plus, Magnifical Productions/iStock via Getty Images Plus



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