Vet Client Relationships In The Clinic: Cost vs Care

How do we build better vet client relationships?

Did you know.. Pet owners’ expectations that animal care considerations should come before cost considerations, combined with data that suggest provision of cost information is often lacking or not discussed early during a visit, create a paradox for veterinarians when confronting the topic of costs of care. If too much emphasis is placed on costs and compensation, the veterinarian may be accused of being mercenary (ie,“in it for the money”), which may impair the veterinarian client relationship. Conversely, if too little information regarding costs and compensation is provided, clients may feel unprepared, uninformed, and vulnerable, which can result in detrimental consequences for animal care…*.

Would you like to find out more? This October 15th-17th is the Navigating Difficult Clinical Encounters Workshop. Join specialists in Ethics, Oncology and Well Being as we discuss the research and techniques which contribute to the most difficult situations we face. Options are available to attend one, two or the full three days! Register here or please check out the brochure for more information.

*Factors that influence small animal veterinarians’ opinions and actions regarding cost of care and effects of economic limitations on patient care and outcome

Rehabilitation: A Lifeline to Your Patients, Practice and Career

After 12 years in the daily grind of practice ownership and being a solo veterinarian performing general medicine and surgery, I was burned out. If I had to have the flea life cycle discussion, look at an ear cytology, or discuss the puppy vaccine series one more time, I might just lose my mind.  I was ready to leave veterinary medicine all together and look for something new. The possibility of being a greeter at Walmart crossed my mind.

Thankfully, I decided to head to Las Vegas for a much needed “vacation” disguised as a veterinary conference. I perused the options of lectures to attend –  Internal Medicine, Critical Care, Dermatology – nothing jumped out me. Then I saw a lecture track on Rehabilitation for pets and thought to myself “hmm, that might be interesting – at least it’s something new”. What I didn’t know is that decision would change the trajectory of my career and quite frankly, my life.

Listening to the speakers, I discovered there was an entire method of evaluating and treating patients that I had never been exposed to in my veterinary medical training.  I learned about exciting therapeutics, pain management options, and incredible patient outcomes on pets that I honestly would have given up on.  I was intrigued and excited on one hand, but also felt a bit guilty as I was running through all the patients in my mind that could have benefitted from this therapy. I decided that if I was to stay in veterinary medicine, I must pursue this knowledge. As Maya Angelou once said “When you know better, you do better”.  I made it my goal to do better.

After completing my certification in rehabilitation through Canine Rehabilitation Institute, I set out to help as many of patients as I could. I slowly built my rehabilitation service within my general practice, first working out of an 8×10 room and focusing mainly on manual therapy and therapeutic exercises.  Then as the rehabilitation portion of my practice grew, I made the decision to hire additional associates to take over my general medicine duties which allowed me to focus my efforts on pain management and rehabilitation.  In 2014, I built a new hospital with a dedicated rehabilitation gym space, fully outfitted with all the bells and whistles. I now see patient referrals from as far as 2 hours away from my practice.

I have been pleasantly surprised over and over again at the level of care and dedication my rehabilitation clients provide for their pets.  I work with A+ clients, all day, every day.  They want to learn how to best care for their pets and are anxious to be a part of “the team”.  We all cheer on these patients and feel such a sense of accomplishment when we see them living a pain free and functional life.  What a joy this is!

Adding rehabilitation to my practice has provided a financial reward as well.  The vast majority of my patients are not a “one and done”. They come to my practice twice weekly for several weeks, and then taper down as they improve.  We provide complementary services such as Acupuncture, Regenerative Medicine, Hyperbaric Oxygen Therapy, and Musculoskeletal Ultrasound that benefit the bottom line.   The income gained from rehabilitation allowed us to make the decision to eliminate boarding from our hospital, which freed up our staff, animal holding areas, not to mention our weekends!  As the economics of veterinary medicine shifts to the likes of online pharmacy, vaccine clinics, and low cost spay/neuter facilities, adding services only the Certified Canine Rehabilitation Therapist can provide makes total sense to improve your financial security.

Finally, and most importantly for my sanity, this journey has brought back my passion for veterinary medicine. I have to use the creative side of my brain on a daily basis to solve the challenges my patients face. I couple this with my knowledge of clinical anatomy, physiology, and general medicine to provide comfort to my patients and peace of mind to my owners.  I am enjoying practice again and I know that I am “doing better” for my patients, clients, practice, and myself.

Written by
Kara L. Amstutz, DVM, CCRT, CVPP
Resident –  American College of Veterinary Sports Medicine and Rehabilitation. Hometown Veterinary Hospital & River Canine Rehabilitation
Springfield, Missouri


AVA Conference Fashion Show 2018

Who needs the Mercedes Benz Fashion Show when you have the AVA Conference! It’s not the sort of place you’d think to find to showcase some of industries’ most fashionable, but the wonderful Dr Anne Fawcett spotted and captured many wonderful snaps.  Unbeknown to many, veterinarians can be damn fashionable too.


Dr Sandra Steele and Emma

Dr Sandra Steele and Emma

Dr Mark Kelman and Dr Robert Johnson

Dr Mark Kelman and Dr Robert Johnson

Dr Kestrel Howard and Dr Ilana Mendels

Dr Kestrel Howard and Dr Ilana Mendels

Dr Anne Fawcett and Dr Karen Teasdale

Dr Anne Fawcett and Dr Karen Teasdale

Why Don’t More Female Vets Become Surgeons? Meet Dr Sue Gibbons

Have you ever thought about why, despite veterinary science being a female dominated profession, there are relatively few female veterinary surgical specialists, and even less female veterinary orthopaedic surgeons? Who better to discuss this with than Dr Sue Gibbons, who has been doing primarily orthopaedics since 2002, and became a small animal surgical specialist in 2006. Sue currently runs a mobile surgical business, Specialist Surgical Solutions, servicing Brisbane and surrounding areas.

Given that our profession is dominated by women in the workforce, why do you think so few seem to do orthopaedic surgery?

It can be scary when you first start out. It’s a numbers game; the more you do the better you get. It’s hard to find mentors who are prepared to hand over the tools and take the time to teach you. It’s traditionally a male dominated field so I guess women have to prove themselves a bit more to be accepted in this field. I used to be the butt of many jokes like how women can’t use power tools and have no sense of direction particularly when placing implants. I also get lots of comments about how strong you have to be to do orthopaedics, but it’s all about technique not strength.

What is the best part about performing orthopaedic surgery? Any benefits to being a woman?

It’s often challenging; no two dogs are the same. It’s satisfying to see your results on the post-op radiographs (i.e. instant gratification!).

What is your typical day like?

Running a mobile business means that my work day is somewhat unique. I usually drop the kids to school, do a few consults and two to three surgeries. My car is my office! I have awesome nurses that come to my house at night to pack and sterilize my kits.

Any advice for women considering a specialist career? Anything you wished you knew beforehand, honestly?

If you want to have kids, consider getting your Fellowship/Diploma out of the way first.

Write down your reasons for wanting to do Fellowship at the start of the journey because there are likely to be times when you question this decision along the way.

What do you think is the biggest barrier as a female veterinarian and/or specialist? How have you handled or overcome it?

Barriers to becoming a vet/specialist as a female include juggling family, long unpredictable work hours and getting back into the workforce after maternity leave. I have overcome this by running a mobile surgery service which allows me to work more flexible hours. It is helpful to have lots of back up (family, hired help) to assist with running a household and childcare if/when you get stuck at work.

General barriers to becoming a specialist include many years of low income, long hours, additional study and the examination process.

What do you think is the main causes of gender disparity?


Do you think the veterinary surgeons board, or the associations should take steps to benefit or hinder the gender bias?

Possibly. Many women have suggested that some kind of refresher course would be helpful for those re-entering the work force after prolonged maternity leave to ensure they are up to date. Equal pay regardless of gender would be another potential topic for discussion.

What do you think are the steps needed to attract more women to pursue further education or specialist positions in surgery?

Shared working weeks/fortnights, part-time/split shift rosters etc.

You have been in the veterinary industry for several years and have accomplished so much! Have you noticed any changes or shifts as time goes on?

There are more women involved in surgery in general and in orthopaedics.The greatest general change in my time is the shift to digital imaging.

If you’d like to meet this extremely accomplished surgeon, why not register for the VetPrac workshop in Perineal and Urogenital Surgery Workshop on August 24-25, 2018. Dr Sue Gibbons will be an educator at this workshop, alongside Dr James Simcock and Dr Peter Delisser. VetPrac is not biased with respect to gender roles – both male and females veterinarians are most welcome to attend our workshops!

Contact Details:
p 0407 645 886

Meet The Hip Dr John Punke

Meet Dr John Punke, who hails from the USA, but has fallen in love with his new home Adelaide. Luckily for VetPrac, John has agreed to join the education team this year, to share his knowledge and enthusiasm for all things surgery at the Hips and Hindlimb Surgery workshop in Gatton on 26 and 27 June 2018.

We recently got to know a little more about John and how his veterinary surgical career and lifestyle has flourished since moving to Australia.

What inspired you to become a veterinarian and then go on to specialise in surgery?

I’ve had a love for animals as long as I can remember.  My dad and I would watch National Geographic movies together.  When I was old enough, during my summer vacation, I would walk to the local library and read every book they had about animals and dinosaurs.  I was fascinated!  I excelled in science in school, then biology in high school.  It was a bit of a natural progression for me, I guess.  I feel that I am very fortunate to have naturally fallen into a career that I love so much and can be so emotionally rewarding.  I entered a small animal rotating internship after veterinary school with 6 other young veterinarians.  I was the only one of us who enjoyed surgery.  So, the other veterinarians would see my scheduled appointments so that I could do surgeries for them (stitch ups, aural hematomas, that sort of thing).  It was an early referral system and I really enjoyed the work.  I love being able to “fix” things.  I didn’t enjoy dermatology or cardiology much at all.  It was a natural progression for me to pursue surgery on a full-time basis and I wanted to practice at the highest level I could, so I accepted a surgical internship at the same practice the next year and pursued residency after that.

Do you have a favourite surgery or procedure that you like to perform?

I really enjoy the problem-solving aspect of fracture repair.  It’s a good combination of veterinary medical care with “shop” work using tools and implants.  Seeing a dog healed two months post-surgery and able to return to full function is very satisfying to me.

In your own words, what is it about hip and hindlimb surgery that you find interesting and that you believe general practitioners would benefit from learning from and performing better?

Hip and hindlimb diseases are very common in dogs; there are a lot of subtleties to their diagnosis and treatment.  I often diagnose ‘grade 2.5 medial patella luxations’ and ‘stable CCL disease’.  I find these subtle findings interesting and I think they enable me to continually improve my surgical skills. These aren’t things that are taught in veterinary school or text books.  I think being able to illustrate and teach these and other subtle findings and differences to general practitioners will help me add an extra level of quality to their clinical practice for their benefit and to the benefit of their patients as well.

Would you like to share any horror or hero stories from any of the procedures we will be addressing to inspire readers to assess and grow their skills?

Some of the most difficult surgeries I have ever had to perform were revision surgeries from failed tibial osteotomies performed in general practice.  To date, I have been able to save the leg in every case.  But, I often warn the owners that I will do my best but can’t guarantee that their dog will have their leg at the end of it.  These cases illustrate to me the importance of education, skill and attention to detail when performing this kind of surgery.  And even though I have been successful so far, I am always nervous that I won’t be able to help.

What practical surgical tips that you learned from experience would you share with general practitioners?

I would stress the importance of gentle soft tissue handling and accuracy with suturing and implant placement.  I think we all enjoy bones and joints, but the success or failure of orthopaedic surgery sometimes hinges on the health of those bones and joints as tissues.  We can’t forget that bones, joint capsule, and cartilage are living cells and need to be cared for like we would muscle, a spleen or the pancreas.

Thinking from a practice standpoint, be careful to always practice within the scope of your expertise.  For example, I do not perform total hip replacements and would not hesitate to refer to the surgery specialist across town with the skills and expertise to perform a total hip replacement well.  Never be afraid to admit and refer to someone who you know can do a better job than you.

What brought you to Australia? Has your lifestyle changed since moving to Australia?

I came to Australia at the end of my surgical residency to interview for a position in a place called Adelaide.  I had to Google it to learn that it’s in South Australia.  I thought it was worth taking a look.  I fell in love almost immediately.  I’ve always had a fascination with the animals of Australia. To see black cockatoos and dolphins on my first day in Oz convinced me to move here more than any job opportunity ever could.  I moved here 6 months later and hope to get citizenship later this year.  My wife and I love living in Adelaide.  It is only a short drive to many different wine regions, the hills for hikes, the beach, and we have many friends in town.  We couldn’t be happier here!

What do you like to do for fun? How do you spend your days off?

My wife and I enjoy hiking, trail running, camping, sailing, and taking our dogs on walks in the woods and to the beach.  There are many fantastic wineries and restaurants to try in Adelaide as well.

Are you working on any projects at the moment?

I’m working on a few projects at the moment.  I have developed a program to organise and teach general practice veterinarians in Adelaide how to screen dogs for hip dysplasia from a young age and what steps to take to treat them along the way.  The program is called the Adelaide Canine Hip Improvement Program (ACHIP).  We are still in the early stages of training our partner clinics, but the uptake has been very good!

I’m also developing a method to use CT and CAD modelling and custom implant design to treat angular limb deformities in dogs much more accurately.  So far, we have used the system to treat common antebrachial deformities, but I can see the system being used for other abnormalities in other bones and even with fracture repair.

We are also doing an experimental study to illustrate how much better our modelling and implant design will be in achieving accurate results and to test if our technique can make ALD surgery more accessible to less experienced surgeons.

What do you enjoy about teaching?

As a surgery specialist in practice, I can only treat and improve the quality of life for the patient in front of me.  But, as a teacher, I can help other veterinarians improve the quality of their care and utilise the skills and lessons I have learned to help many more patients than I could with my own hands.  I find that very satisfying.  Additionally, I really enjoy seeing the “ah ha!” moment on peoples’ faces when I can get them over a mental block they have been having with a concept or principle.  To me, veterinary medicine is about learning principles that we can apply and transfer to multiple cases to help us practice the highest quality of medicine and surgery possible.

For an opportunity to share in some of John’s surgical prowess and his love of his new home town, register for the Hips and Hindlimb workshop at Gatton on June 26-27, 2018.

Dr John Punke can be contacted on

Written by Alison Caiafa