The Economics and Quality of Quantity
The following is a copy of a statement by Dr. W. Marvin Mackie, owner/director of Animal Birth Control. Dr. Mackie's clinic is located at 450 Arcadia Drive in San Pedro, California. We have made this excerpt available to show the changes that need to be made in the current mindset of the veterinary community when dealing with spay/neuters.
The most common problem people around the world seem to have when they contact the Feral Cat Coalition is finding a vet, or group of vets that will perform low cost or free surgeries. We have been fortunate in San Diego to have a large group of vets willing to donate their time and talents to our cause. This is not the norm. We are not suggesting that vets should always perform alters pro-bono. We are however suggesting that there are ways to bring the costs down to a level where the general population would not see it as a financial burden.
The argument is often made that most people CAN afford to pay for alters. This is not the problem. The problem is WILL they pay. We need to create a situation where is it financially attractive to have your animal altered ( this applies to both pets and ferals ). At the same time, the vets need to be able to keep the doors open.
Dr. Mackie's Statement
To clarify our philosophy:
- I emphasize results over form: at least as you will first observe our system.
Results: We expect excellence and strive for perfection in the results of each and every patient's surgical encounter with us.
Examples:
- The pet's stay is as stress-free as possible. Dogs receive an anti-anxiety drug. Cats are placed in their restraint bag and back into their familiar carrier.
- Anesthetic agents used are rapidly removed from the patient following surgery.
- The shorter the surgical time the better - safer for the patient and an economic imperative.
- Exit the patient the same day anticipating no return.
- Economics are always a factor in services we provide. Remember: Time and Motion, Supply and Demand.
Example: Surgery room fee with veterinarian is $200/hr. If your team completes three queens in one hour, the price must be $67/cat. However, if the team does eight queens in that same hour, the price can be $25/cat to cover that same $200/hr. Clearly, efficient production is important. - Surgery has a mystique about it because so few can do it well. Plus, our profession, at the teaching schools, are focused on form and go to great lengths to ingrain that into our consciousness. It is never suggested that form may be altered. Schools must teach classic form in the traditional manner simply because it teaches the basics and provides a fail-safe outline to keep the student from inadvertent errors that could be disastrous. However, once the basics are understood, some of the form then becomes burdensome, unnecessary, and does not improve on the results.
- The duration of routine surgery can be shortened since it is a learned mechanical skill using all available senses, especially eye/hand coordination. Just as the pianist moves from one rapidly moving complex piece to the next, each in its turn taking hours of concentrated effort to master from those first slow, methodical attempts to a faster, more appropriate tempo with perfect execution, then so too can the veterinary surgeon improve his speed and skill. The basic spay or castration is the most common owner-requested surgery. It then becomes your job to do it with increasing mechanical ease (in handling of tissue and instruments) and shortening the time taken from cut to close. In addition, turn-around time must also improve; i.e., from cut of one patient to cut of the next. (Given an average 8-minute cut-to-close, if it takes another 4 minutes before you begin the next cut, then you have a poor 12 minute turn-around time.)
The following is taken from a "Letter to the Editor" in Veterinary Economics. It typifies the utter disregard for the concept of economics in medicine. The author is patently insulting and denigrating of anyone who has skills beyond hers. The elitism of the comments causes me to be embarrassed for her. The letter is complete except for changing the doctor's name.
"Dr. Quick-Knife can spay a cat "skin to skin" in 10 minutes (Letters to the Editor, February)? An average dog in 15? Talk about warp speed! I guess I'm not an "average veterinarian worth my salt". After six years, my average surgical time is 20 to 25 minutes for a cat and 30 to 40 minutes for a dog - longer if the animal is obese, pregnant, or in estrus.
I routinely keep animals open 45 to 60 minutes during abdominal procedures, yet my infection and complication rate is less than 1 percent. I believe that proper presurgical preparation, sterile technique, gentle tissue handling, and appropriate postoperative care are more important in preventing complications than the length of the procedure.
When I first began interviewing for an association position, I met many veterinarians whose first question was, "How fast can you spay a dog?" My standard answer quickly became: "I prefer to do a safe, thorough, complete ovariohysterectomy, removing the entire reproductive tract and doing a three-layer closure, rather than hustle to see how fast I can get in and out of the abdomen."
Luckily, I found a practice where the doctors prefer quality and skill to speed and quantity. I'd like to thank these doctors for stressing the importance of quality medicine."
Dr. W. Marvin Mackie, Animal Birth Control, 450 Arcadia Drive, San Pedro CA 90731
Dr. Mackie is obviously convinced that you do not have to sacrifice quality when you increase quantity. We have seen the same thing at our monthly clinics where we alter upwards of 150 cats in an afternoon. Our complication rate is exceedingly low. We need to get the word out to others in an attempt to eliminate the negative outlook that many seem to have regarding mass spay/neuter.
[Page updated November 2009]