Gauging Clientele Knowledge on Alternative Methods of Payment for Veterinary Services in Relation to Client Satisfaction

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Honors College Theses Student Works

Spring 5-9-2023

Gauging Clientele Knowledge on Alternative Methods of Payment Gauging Clientele Knowledge on Alternative Methods of Payment

for Veterinary Services in Relation to Client Satisfaction for Veterinary Services in Relation to Client Satisfaction

Olivia Hritzkowin

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Recommended Citation Recommended Citation

Hritzkowin, Olivia, "Gauging Clientele Knowledge on Alternative Methods of Payment for Veterinary

Services in Relation to Client Satisfaction" (2023).

Honors College Theses

. 178.

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Introduction

As of 2023, 86.9 million homes in the United States house at least one pet. This leaves

the 78,717 clinical practice veterinarians in the U.S. to provide care for each and every one of

these pets that are brought to them. In an ideal world, every one of these U.S. pets would be

brought to their veterinarian at least once a year; unfortunately, that is not the case. A survey by

the American Veterinary Medical Association (AVMA) details that the reasoning behind not

taking a pet to the veterinarian is first “not sick or injured” (48.6%) and second “couldn’t afford”

(29.3%). (Burns, 2013) The reasoning behind clients stating “not sick or injured” can be

attributed to lack of knowledge on the importance of preventative care like annual exams,

vaccinations, and dental care. The second reason, however, is a point that many veterinary

professionals hear on a daily basis. Veterinary clients criticizing the pricing of veterinary services

is one of the first aspects of clinical practice that a new professional will learn how to handle. In

2020, the average dog owner spent $326 on veterinary services alone, and 42% of dog owners

stated that a vet bill of $999 would put them in financial debt. (Megna, Tilford, 2023) This data

demonstrates that a large percentage of pet owners are one medical emergency away from

putting themselves in debt. 1 in 3 pets will need emergency care each year, with the average cost

of an emergency hospital visit ranging from $800-$1,500 depending on the treatment plan.

(Reinicke, 2018) Putting these statistics together, less than half of U.S. pet owners are financially

prepared for emergencies, and many are still financially unprepared for the annual cost of

veterinary care.

Unexpected financial strain can cause someone to be more prone to “yelling, cursing,

threatening others, pushing, shoving, hitting, hostility, resentment, rage…” (Marter, 2021) While

extreme violence is not a daily occurrence for veterinary professionals, general anger and distrust

towards them is. Many times, these feelings are derived from unexpected costs. Human medical

care seems less expensive to many people due to the use of medical insurance, which is a seldom

used financial resource for veterinary clients. Human medical practitioners also have the

advantage of their clients being billed months after services are provided, as well as having direct

channels to their patients. Alternative methods of payment (pet insurance, CareCredit, payment

plans, etc.) may be a solution to increasing client satisfaction in regards to pricing of veterinary

services. However, these alternative methods of payment (AMP’s) are not being used by a

majority of clients. The purpose of this study is to examine how much veterinary clients know

about AMP’s and if their satisfaction levels may be higher if AMP’s were used to decrease

financial strain.

Another point that this study will focus on is the increase of mental health issues in

veterinary professionals. There are numerous reasons for this increase, but this study will dive

deeper into how client complaints affect the mental health of those who work with the pets of the

U.S.

The end of this study aims to show that clientele knowledge of alternative methods of

payment has a positive correlation with client satisfaction. Therefore, allowing veterinary

professionals to advertise these services to their clients will likely be beneficial in decreasing the

amount of professionals leaving the veterinary profession due to mental health decline. In order

to obtain recent and relevant information, I will be conducting a survey of pet owners who have

paid for veterinary care in the past 12 months. Another survey will be conducted of veterinary

professionals to obtain information on their thoughts of AMP’s and how they believe it would

impact client satisfaction. This will investigate the correlation between client satisfaction, use of

alternative methods of payment, and the mental health of veterinary professionals by gaining

information from surveys and literature.

Background

In order to further investigate the usage and influence of alternative payment methods, it

is important to first understand the pricing of veterinary services, details of AMP’s, client

complaints surrounding pricing, and how this issue negatively affects veterinary professionals.

The average cost of a routine veterinary visit (including an annual physical examination)

will cost pet owners anywhere from $40-$250 depending on the veterinarian and geographical

location. While a routine visit is the most common circumstance for visiting the vet, the reality of

owning a pet comes with possible emergencies, illness, and euthanasia when time. Each of these

come with costs that may seem unreasonable to clients. Although the pricing may seem steep, it

is necessary to inflate pricing on medical equipment, drugs, and more to ensure a veterinary

hospital can keep its doors open. Not only does a hospital have to make money off of their sales,

the employees need to be compensated. Licensed employees (doctors, technicians, technologists)

all undergo years of schooling and training to be able to successfully treat and care for their

patients. Degrees and licensing takes time, a great amount of money, and come with a large debt

load as well. Veterinary technicians on average are left with $25,000 of debt after schooling, and

the average veterinarian is left with a whopping $188,853. (Lau, 2021) There are also more

individuals than veterinarians and technicians in a clinic who need to be compensated. Kennel

technicians, veterinary assistants, receptionists, and hospital managers also require fair

compensation for the work they do each day. Utility bills, employee benefits, medical waste fees,

building maintenance, and insurance are major costs to veterinary hospitals as well. Each of

these services need to be paid for using the money made from services provided. The public

often forgets that while a veterinary practice is a legitimate medical setting, it is also a business.

This is what drives the pricing that clients pay for their pets' care.

In order to pay for the medical care of a pet, a client has many options. The focus of this

study surrounds the option of alternative payment methods. Alternative payment methods can be

defined as a payment made with anything other than cash or readily available money through a

credit or debit card. For the purposes of this study, a focus on pet insurance, payment plans, and

CareCredit will be applied. The study that was conducted showed that these are the top three

methods that are used by the pet owners that were surveyed.

Pet insurance is a new alternative method of payment that has been increasing in

popularity in the past several years, partially due to the COVID-19 pandemic of 2020. As the

popularity of this method has grown, more and more insurance companies have adapted “pet

policies”, allowing clients to make monthly payments to cover up to 100% of veterinary fees.

Each company offering pet insurance policies has different terms, which allows pet owners to

make the decision as to which policy will be best for them and their pet. A large complaint about

pet insurance that clients possess is the tribulation that many pet insurance companies do not

allow their policies to cover pets with “pre-existing conditions.” Unfortunately, some insurance

companies often request to identify these conditions (for policy purposes) instead of the

veterinarian, which regularly leads to acute, one-time issues like allergies or a urinary blockage

being classified as a pre-existing condition. It is often difficult to obtain an insurance policy with

an animal that is not young, frequently deferring clients from using their services. Part of the

appeal of insurance companies is that a small fee once a month to cover 100% of veterinary costs

for the rest of a pet's life is attractive to owners. These insurance companies often work by

reimbursement, allowing the owner to first pay for their bill and then submit a copy to the

insurance company for reimbursement. This is easy on the veterinary professionals, as they do

not need to learn how to work a separate website or program as is the case with other AMP’s.

While this process is uncomplicated for veterinary professionals, it does deter some clients from

using pet insurance, as many of them do not have the funds readily available to pay for their

veterinary bills.

A more easily accessible AMP is a program called CareCredit. CareCredit can be used

“to pay for out-of-pocket expenses not covered by medical insurance, and special financing

options are available that you may not be able to get with other cards”. A CareCredit card can

also be used for human healthcare, which is a bonus for many clients. The pet CareCredit card

covers “Routine veterinary: Annual check-ups, Teeth cleaning, Parasites, Dermatology, Rehab,

Medication, Diagnostics, Care of chronic pet diseases and conditions, Dog chemotherapy,

Vaccinations, Microchipping, Pet food and nutrition Veterinary surgery & emergencies: , Spay

and neutering, Emergency services, Surgical procedures, Hip dysplasia surgery”(CareCredit) Not

only does it cover many veterinary services, it also covers almost every pet species. Over 25,000

veterinary practices accept CareCredit, making it one of the most easily accessible and

user-friendly AMP’s. There are very little stipulations surrounding this option: the largest one

being that credit approval is needed to gain a CareCredit card. It should be noted that CareCredit

also offers pet insurance, but that aspect of the company will not be grouped into the discussion

of the CareCredit AMP.

Practice managed payment plans are a final payment option that the conducted survey

found to be common. Payment plans allow clients to pay their bill over a period of time directly

to the veterinary practice. This option has steadily declined in popularity, mostly due to

veterinary practices halting the usage of these plans due to unpaid bills. Some clinics do still

utilize this method, but it should be recognized that this option is not widely available and is

noted as an AMP only due to it being recognized in the survey. Clients should be aware that

there are not many clinics using this method and clients should ask their veterinary staff prior to

presuming that a payment plan is able to be made.

Each AMP helps pet owners cope with the high prices that may come along with vet care,

which happens to be one of the biggest complaints amongst veterinary clients. Decreasing client

complaints is a goal of many veterinary practices, which provides reason for many practices

accepting AMP’s. According to a study conducted in 2022, “CC (client complaints) have

detrimental effects on VSS (veterinary support staff) career satisfaction, mental health and

hospital practices.” (Rogers et. al, 2022) Declining mental health continues to be a problem in

the veterinary field, with the suicide rates being 3.5 times higher than that of the general

population. Mental health is not the only factor leading to a decline in personnel within the

veterinary field. Client complaints, rude actions, compassion fatigue, and burnout are also big

contributors. Client complaints seem to be the leading cause of many of these other issues,

meaning decreasing client complaints may ensure an overall healthier work environment for

veterinary staff. While CCs were relatively rare, the effect of CCs was pronounced, with more

than 70% of small animal veterinary internists reporting feeling depressed due to a CC, and more

than 40% considering changing their career because of CCs. (Rogers et. al, 2022)

To restate, the goal of this study is to gauge the knowledge that veterinary clientele hold

about AMP’s in an effort to show that as clients who utilize or are knowledgeable about AMP’s

lodge less complaints and are more satisfied with their veterinarian and staff. Once proven, this

study should be used as a resource to help both clients and veterinary professionals, hopefully

decreasing mental health concerns and increasing knowledge of AMP’s for each party.

Methodology

This study consisted of two main components, both of which were essential to gain a

further understanding of my topic. The first component was finding articles that detailed the

background information needed to further investigate my topic. I needed to find articles that gave

me information such as average cost of veterinary visits, how financial strain affects individuals,

the cause behind the decline in mental health in the veterinary field, and more. This was done

through literary analysis of several resources. I was able to find past studies, articles from

veterinary journals, and online forums through search engines such as Google Scholar. I was also

able to obtain veterinary professional’s opinions from Facebook pages and word of mouth. Once

I had found enough information, I saved my articles and thoroughly annotated them to gather the

information I found useful. This helped me gain an overall understanding of the topic and narrow

down data that would back my hypothesis. This process also helped me to understand more

about the thoughts of average pet owners with no stake in veterinary medicine, as many of the

people I know personally are employed in or educated in veterinary medicine.

The second part of my study was surveying the public and veterinary professionals. I

decided to create two surveys, one for pet owners and another for veterinary professionals. Due

to my surveys being an online format and my subjects being human, I had to first obtain IRB

(Institutional Review Board) Certification. The training allowed me to gain skills needed to

safely and effectively collect data from human subjects. The training program was easily found

through Murray State’s website. The training took less than a day to complete and I was able to

receive certification quickly. After that was completed, I was required to submit an IRB

application to the representative for Murray State. The application process with detailed

instructions was given to me by my advisor. In order to complete the application, I needed to

create a document of all survey questions, recruitment emails, social media posts, advertising

posters, and a consent form. I started with creating the survey questions document. I had two

surveys to conduct, so both started with an informed consent page and an option to agree to the

terms of the study. I then compiled a list of 10 questions for the public and 10 for veterinary

professionals. For my survey for pet owners, I required the participants to be a pet owner who

had paid for veterinary services in the past 12 months. I then started with basic information such

as what kind of service they paid for, how much the visit cost, satisfaction levels of care and

pricing, and what geographical area they live in (rural, suburban, urban). All of these questions

had very simple answers. The “public” survey was administered via Facebook with my approved

social media blurb, as well as via email with my approved email blurb. The blurbs included a

description of my goals of the study and what I am looking to accomplish with the information I

gained. Within the survey was an informed consent form that I was easily able to draft by using

resources provided by my advisor. This form allowed all participants to understand their rights as

well as give their consent so I could use the data for my study. The same went for the “veterinary

professionals” survey. The questions included in this survey asked about the amount of clients

that use AMP’s, if the surveyee thought satisfaction was related to pricing, and a few questions

about their knowledge of AMP’s. This survey was posted on Facebook as well as sent via email

to 5 veterinary clinics within the western Kentucky area.

The platform in which my survey was made was Google Forms. I decided on this

platform due to its simplicity and accessibility for anyone on any device. This program also

creates graphics using AI which allows me to easily interpret data quickly. I was also able to see

individual responses which was especially helpful in the “veterinary professionals” survey, as I

left an open response section for surveyees to give feedback.

Once I received an adequate number of responses from each survey, I was able to begin

data analysis. I started with the “public” survey. To do this I reviewed the responses to the

questions regarding what type of care surveyees paid for and how much it cost. This information

was key to furthering my literature review, as I knew what area of veterinary medicine to focus

on. I then analyzed the section of the survey regarding satisfaction of both quality of care

received and pricing for the visit.

I then analyzed the “veterinary professionals” survey after receiving the responses I

needed. I began with reviewing the questions regarding the number of clients that use AMP’s.

The next step was to review the responses to the questions asking about the surveyees' opinions

on client satisfaction as it relates to pricing. These questions were answered with a scale from

1-5. After gathering the information from the singular answer choice questions, I used the open

response section to gain further insight on the opinions of veterinary professionals.

After I compiled all of the data from the two surveys, I was able to look for trends. The

trends I found were essentially the same as what I was able to find in my literature reviews,

which allowed me to easily connect the lines between existing research and my own.

It is to be noted that I included a section in each survey for the surveyee to place their

email addresses. This was specifically for them to get a copy of any information I gained about

the AMP’s, as I have created a resource (located in the results section) for both pet owners and

veterinary professionals to learn more about the specifics of each type of AMP. My hope is that

this resource can help vets and their staff better understand the use of AMP’s as well as make it

easier for clients to understand the benefits of using an AMP.

Results:

Public Survey:

When pet owners were asked what type of care their pet received in the past 12 months,

the following options were listed: Annual Wellness, Sickness related visit, emergency care, and

other. The most common reason for visiting the vet was “Annual Wellness: exam, vaccines,

regular blood work” at 91.6%. This was followed by: Sickness related visit, emergency care, and

“other”. The reasons listed in the “others'' section included neuter, TPLO (cruciate ligament

repair) surgery, and orthopedic radiographs. Figure 1.0 provides a visual of the survey results.

Figure 1.0: Type of care received by pet in a clinical setting in the past 12 months

The survey then asked clients about their satisfaction with the care their pet received as

well as the satisfaction of the cost of their visit. Figure 2.0 and 3.0 show the results of these

questions. Answer choices were ranked on a scale of 1-5, with 1 being very dissatisfied and 5

being very satisfied. When asked about the care their pet received, clients were mostly very

satisfied or just satisfied. (Figure 2.0)

Figure 2.0: Client satisfaction regarding care received by their pet from veterinary staff

Despite care satisfaction levels being high, price satisfaction was lower. Satisfaction of pricing

was rated on the same 1-5 scale. Most clients stated that they were “OK” with the pricing of their

visit. Figure 3.0 provides a visual representation of the responses.

Figure 3.0: Client satisfaction regarding pricing of their veterinary visit in the past 12 months

It is to be noted that many of the surveyees may have a bias to higher satisfaction levels

due to their relation to myself. Many people who completed this survey were students of Murray

State University’s veterinary technology or pre-veterinary programs, or friends of these students.

This bias may skew results, generating results that show higher levels of satisfaction for both

care and satisfaction than are found in the general population.

The average price that those surveyed paid for their visit was $100-$200, followed by

$0-$100, $500+, $200-$300, $400-$500, and lastly $300-$400. This data follows the existing

data I researched and received from Pawlicy Advisor, who states that the average cost of a

routine checkup visit is between $50-$250 in Kentucky. (Pawlicy, 2023) Kentucky was chosen as

this is the state my study was conducted in.

Questions about AMP’s concluded that only 6.3% of those surveyed used an AMP. The

top method used was CareCredit, followed by pet insurance, then practice managed payment

plans. When asked about their knowledge of AMP’s, the majority answered they knew nothing

or a little bit about AMP’s. This question was also ranked on a 1-5 scale, with 1 being nothing

and 5 being expert, respectively. Figure 4.0 shows the results of this question.

Figure 4.0: Clientele knowledge on alternative methods of payment

Clients also provided insight into how often veterinary professionals teach clients about

AMP’s. They can be informed about the existence AMP’s in many ways, but one that the

veterinary community can make a difference in is word of mouth straight to the client. When

surveyed about this, the majority (60.6%) of clients reported that they had not been notified of

AMP’s by their veterinarian or veterinary support staff. A visual of these results is provided with

figure 5.0. Due to these results, another goal of this study was to create a resource for clients and

veterinary professionals alike to use for education on AMP’s. This resource is located at the end

of the “results” section and titled Table 1.0.

Figure 5.0: Clients notified about alternative methods of payment by a veterinary professional

Lastly, the client survey showed that the geographical location of most surveyees was

rural, which aligns with the region in which I conducted this study. Figure 6.0 shows a visual of

the geographical regions of the clients surveyed.

Figure 6.0: Geographical location of clients surveyed

Veterinary Professionals Survey

Most of the survey respondents indicated that they were veterinary assistants (61.9%) or

veterinary technicians with a license (33.3%). It is to be noted that many of the respondents are

students at Murray State University or have recently graduated from the university. A wider

network of veterinary professionals may yield better results in the future.

Of those surveyed, 81% work in a small animal general practice. Figure 7.0 shows the

breakdown of types of practice these professionals are employed at.

Figure 7.0: Description of place of employment of surveyed veterinary professionals

Veterinary professionals seem to witness more AMP usage than what the client survey

indicated, with 61.9% of professionals voting that they see AMP’s used “often”. This question

was rated with the answer choices being: Very often, often, not often, and never. Each response

received votes, and a visual breakdown of these results can be seen in figure 8.0.

Figure 8.0: Veterinary personnel results on how often they see alternative methods of payment used

The value of the veterinary professionals survey lies in the results of the following three

questions:

● Do you believe that clients would be more satisfied with your place of employment if

pricing was lower?

○ Results show 71.4% say “yes” (Figure 9.0)

● Do you believe that alternative methods of payment make paying for veterinary care

easier?

○ Results show that 90.5% say “yes” (Figure 9.1)

● Do you think that clients who use alternative methods of payment are more likely to be

satisfied with their visit?

○ Results show that 61.9% say “yes” (Figure 9.2)

The results from these three questions provide insight into the minds of veterinary professionals,

as well as telling us how we could improve client satisfaction. As has been previously

mentioned, an improvement of client satisfaction may lead to the betterment of mental health in

the field. The three questions of this portion of the survey may hold bias, as the IRB approval

required that this survey not be blind, so the respondents did know the purpose of this survey

which may have led to a slight bias from respondents. The results from these three questions are

provided with visual aids below, in figures 9.0, 9.1, and 9.2.

Figure 9.0

Figure 9.1

Figure 9.2

Analyzing these results show that many veterinary professionals are on the same page:

they believe that clientele who are more financially able to pay for veterinary services are

believed to be more satisfied. Those who are knowledgeable about AMP’s (while using one or

not) have higher satisfaction levels altogether. Included in the “veterinary professionals” survey

was an open response portion to gain further insight into thoughts of veterinary professionals on

this subject.

A few notable responses:

● “I think most people would be happier if we did our job for free; that being said when

equipped with accurate information and explanations on process, there is less pushback

on procedures.”

● “As much as I see CareCredit, which is great, I wish people would be more open to pet

insurance and be more knowledgeable about it! BUT I also wish pet insurance paid

upfront, because sometimes if O has to pay for things up front, they don’t have that money

even if they have insurance. I recommend getting pet insurance and care credit to revolve

payments (etc. you pay for your visit with care credit, submit claim on insurance, use the

money you get back from insurance to pay off care credit)”

Both of these responses provided value to my study, as they both support the thesis that owners

who are supplied with information of AMP’s would be less likely to push back veterinary

procedures due to high pricing. The second response also brings up an interesting point that was

unexpected: owners may not understand the reasoning behind veterinary pricing. This idea will

further be discussed in the “Discussion” portion of the study.

Finally, this resource may be able to provide more information to both veterinary

professionals and clients alike. While a much more detailed version of this chart could provide

more information, this is a simple starting point. Table 1.0 showcases the pros and cons of the

top three AMP’s from this study, as well as providing information on where specifics can be

found.

Pet Insurance

Pet CareCredit Card

Payment Plan

Pro

Financial preparation for

emergency care and any

other visit

Little to no interest, pays

bill upfront, covers almost

every expense

Allows clients to pay veterinary

hospitals directly, no interest

Con

Many do not cover

pre-existing conditions or

senior care, requires a

monthly fee, most require

payment upfront and

reimburse the client

Prior credit approval

needed

Many practices do not use this

method, clients cannot be held

accountable

Where to find

information

ForbesAdvisor: Best Pet

Insurance of 2023

Pet CareCredit Card and

Financing- CareCredit

website

Contact your veterinarian for

practice specific plans

Table 1.0: Resource for AMP’s for both veterinary personnel and clientele

Discussion

Veterinary Pricing

In order to successfully analyze the survey results, it is essential to understand the

reasoning behind the prices charged by veterinarians for their services. Like any other business,

veterinary practices have more than just merchandise to pay for. Fixed expenses like building

rent, utilities, property taxes, insurance, medical waste fees, disposal fees, maintenance and more

are often hidden and forgotten about by clients. Listed below are the average expenses that

veterinary clinics pay for their fixed expenses, this does not entail all expenses incurred by a

clinic and is just listed averages. (Hoeksema, 2022)

● Accounting/bookkeeping - $300 per month

● Advertising - $500 per month

● Insurance - $250 per month

● Professional Services (legal, marketing, etc) - $200 per month

● Rent - $3,000 per month

● Software subscriptions - $200 per month

● Supplies - $500 per month

● Utilities / Internet - $500 per month

Adding to these fixed expenses is staff wages. The average veterinarian salary in the U.S. is

$95,000, the average salary for a veterinary receptionist is $30,000, and the average salary for a

veterinary technician is $31,600. (Hoeksema, 2022) To put these wages into perspective, a

human medical doctor working in general family practice makes $299,769 a year. The difference

in wages of these two professions is astounding, especially when considering the schooling for

each is almost identical. However, clients are often more upset at their veterinarians for pricing

than their family doctor. The degree needed to become a veterinarian is a “Doctorate in

Veterinary Medicine (D.V.M.)” or equivalent (V.M.D./ BVSc). This degree entails 4 years of

undergraduate studies, 4 years of veterinary medical school, and possible internships or

residencies. After this schooling, most students are left with an overwhelming debt load. It is also

worth noting that veterinarians are in high demand, which means many clinics are in competition

for new hires. On average, 90% of vet students will receive multiple job offers before graduating

veterinary school. (Fallenstein, 2010). Analyzing these statistics together, veterinary clinics must

offer sign-on bonuses or student loan forgiveness to employ new veterinarians and keep existing

ones. This only adds to the outgoing expenses. Many clients also believe that veterinary

practitioners inflate prices of medical supplies and medication greatly, which they often don’t see

with human medicine due to medical insurance. For example, a multi-use vial of the canine

rabies vaccine costs on average $28. This vial will vaccinate 10 animals, with each vaccine being

priced around $15. Putting this through the following formula:

(price owner pays x number of doses in vial) - price of vial = profit

Therefore the profit calculation for a vial of the rabies vaccination is as follows: (15x10) - 28 =

122. The profit from a vial of rabies vaccines is $122. While at first glance this seems like a lot

of profit, in reality $122 is trivial compared to the expenses spent everyday on payment for

employees, more medication and medical supplies, utilities, and everything else listed

previously. Add in x-ray machines, lab equipment, computers, phone lines, and more technology

as well, and that extra $122 on a rabies vial may not seem as outrageous. Please note that the

prices listed above and that of the calculated rabies vaccine are highly varied based on supplier,

geographical location, and clinic. The prices listed are a general average found online and should

not be believed to be the same at every veterinary practice. It is possible that transparency on

pricing to clients may change their thoughts surrounding the idea of unethical inflation from

veterinarians. Veterinary professionals also have the ability to explain what exactly the prices

mean. For example, an x-ray is not just $100, it is a diagnostic tool that could save an animal's

life. If owners better understand the meaning behind the service they pay for, they may have less

apprehensive about paying for services. Let it also be known that the conducted surveys show

that clients in rural areas paid less for veterinary visits, a factor that the public may not know

about. It can be inferred from the responses from the veterinary professionals survey, specifically

those from Figures 9.0, 9.1, and 9.2, that veterinary professionals believe that well informed

owners have high satisfaction levels, and therefore more compassion for the professionals who

provide medical care to their pets.

Client Satisfaction

The data collected from both the literary analysis and survey portion of this study

indicates that client satisfaction levels have a positive correlation with usage of alternative

methods of payment. Comprehensive client satisfaction is created by many factors: care

received, pricing, time of appointment, personal lives, stress about a sick pet, and more. All of

these factors contribute heavily to the overall satisfaction level of a client towards their

veterinarian. For the purposes of this study, client satisfaction levels will be evaluated using two

criteria: level of satisfaction of care and level of satisfaction of pricing. Both of these factors

contribute heavily to the overall satisfaction of clients. Based on the survey results, most

veterinary clients are highly satisfied with the care they received by their veterinarian and

support staff. Satisfaction of care received is case-by-case, as client and patient care is not

identical for every case. It is good practice to treat every patient and client with excellence, but

there are times that owners do not feel as though their pet received this level of care. Finding a

solution for care-based satisfaction would require specific examples and personalized plans,

which is why care-based satisfaction is not the primary focus of this study.

On the other hand, price-based satisfaction is the focus of this study. According to the

client surveys, most veterinary clients who paid between $100-$200 were satisfied or OK with

the pricing from their veterinarians. However, those who paid a higher amount did not have

satisfaction levels as high. After looking at the individual responses, it is important that most of

the respondents who answered “yes” to using an AMP had high satisfaction levels for both care

and pricing. Those who answered the question surrounding price-based satisfaction with

“dissatisfied” or lower had little to no knowledge about AMP’s. This set of individuals were also

shown to have not been told by their veterinarian or veterinary staff about AMP’s. The clients

who have lower satisfaction levels often tend to be those who become angry or aggressive with

their veterinary staff. This is one of the main reasons behind wanting to increase satisfaction in

this field, as many professionals are becoming less tolerant of aggression. Highly satisfied

customers often form better relationships with their veterinarians, which then further increases

satisfaction and trust between client and staff. Once a client builds that relationship, they are also

more likely to accept the prices that come along with pet care, to understand that veterinary care

is important, and to give their pet preventative care throughout the year. Pets who receive yearly

preventative care are less likely to experience sickness or emergencies, therefore resulting in less

financial strain on an owner.

Putting this together indicates to us that pet owners who have an AMP or who are

knowledgeable about them have higher overall satisfaction levels, which leads to a better

relationship with their veterinarian, which results in better pet care, and finally results in less

financial strain. Those who do not use or do not have a great deal of knowledge of AMP’s have

lower satisfaction levels, leading to a greater likelihood of aggressive behavior, which can lead

to backlash from veterinary professionals, and result in overall dissatisfaction of the veterinarian.

Not only do dissatisfied clients leave the veterinarian’s office feeling irritated, veterinary staff

often feel the same. Dissatisfied clients will often leave complaints that negatively affect the men

and women in the veterinary field. A 2022 study on the effects of client complaints on veterinary

support staff showed that one hundred and ninety (34.4%) VSS (veterinary support staff)

reported being subject to a CC (client complaint) in the previous 6 months, with cost of care the

most common reason (78.6%). (Rogers et. al, 2022) The study provides evidence that the cost of

care for pets is largely responsible for the frustration of clients. However, veterinarians cannot

lower pricing for every service they provide. AMP’s are a possible solution to this problem and

one that is supported by the above evidence taken from the conducted survey.

Veterinary Mental Health

1.6 times as many male veterinarians and 2.4 times as many female veterinarians died by

suicide than did members of the general population from the years 2004-2013. Mental health,

just like physical health, is ever changing based on the individual. While each veterinary

professional has a different story and a different reason behind declining mental health, trends

have been identified. The chart below, provided by VetX International, presents the common

reasons that veterinary professionals say are to blame for declining mental health status.

It is the hope of many researchers to provide solutions for each of these factors. The current lack

of mental health training is being mended by veterinary schools, as many schools are now

offering electives on the importance of mental health as well as in-house counseling for students.

High levels of debt are also being tackled by vet schools, with financial counselors helping

incoming and current students. The American Veterinary Medical Association (AVMA) as well

as the American Association of Veterinary Medical Colleges (AAVMC) are also providing more

resources on how to handle high debt load. Client communication and dissatisfaction, however,

are not capable of being fixed with training during school. Many veterinary schools are now

offering courses on perfecting client communication, which does help train the future generation

of veterinarians. Two hundred and sixty veterinary support staff members (VSS) (47.2%)

reported feeling depressed because of client complaints (CC) made against them, 295 VSS

(53.5%) stated CCs negatively affected their enjoyment of their job, and 146 (26.5%) have

considered changing their career because of CCs. (Rogers et. al, 2022) Many veterinary

professionals have left the field all together due to their declining mental state, which then leads

the same client load on a smaller population of veterinarians and support staff. Another issue

plaguing the field is lack of employees, which further puts stress on those currently working.

That stress is also reported to cause mental health decline. The conducted study provides

evidence that AMP’s may help the veterinary mental health crisis by providing financial

soundness to dissatisfied clients, allowing them to be more civil with veterinarians and their

staff.

Conclusion

In conclusion, alternative methods of payment provide financial stability to pet owners,

which directly correlates to their overall satisfaction levels. The literary analysis of multiple

sources provides factual evidence that clients are emotionally overwhelmed during times of

financial stress, and are mostly unprepared for veterinary emergencies. Many clients become

agitated when confused about pricing for services that they are paying for. The analysis also

presents documentation of the negative effects of client complaints on veterinary professionals,

and shows that the decline in mental health of veterinarians is due to several factors including

negative client interactions. Clientele satisfaction is a complex part of any business, and tackling

it gets harder when the satisfaction levels are based on the care of a dependent animal. Literary

analysis provides us with reasons why owners are aggravated with their vets, with the top reason

being pricing. It is evident that better client satisfaction may occur when clients' knowledge on

reasons for prices on veterinary services are the way that they are. The research done via IRB

approved survey concluded that clients who use alternative methods of payment do in fact have

higher satisfaction levels overall, including but not limited to satisfaction of pricing and that of

care their pet received. The data showed that those who did not have an existing knowledge of

AMP’s were less satisfied with the care their pet received as well as the price they paid for their

visit. This can be attributed to the stress surrounding financial strain. As the literature showed,

those who are under more financial stress tend to be more agitated and less satisfied with their

services. The conducted survey provides evidence that the clients who are more knowledgeable

about the pricing of veterinary services and of the ins and outs of AMP’s are more likely to have

higher satisfaction levels. From this, we can conclude that those who understand the financial

reasoning behind veterinary services as well as understand how to refrain from financial stress

are less likely to berate the veterinary professionals that service them.

The survey conducted by myself on veterinary professionals shows solid evidence that

the employees in this industry understand the reasoning behind angry or upset clients.

Unfortunately, they cannot change pricing or ensure that a client will not be in financial trouble

post veterinary care. As the literature suggests, this is a reason for the decline in mental health of

veterinary professionals. Connecting the literature allows a conclusion to be made that happier

clients mean happier and healthier veterinary professionals, which leads to a decrease in mental

health disorders. We can also conclude that those with better mental health are less likely to leave

the field, which in turn can help the stress load on the rest of their colleagues. In conclusion,

client satisfaction levels can lead to better mental health of the men and women who care for the

medical care of animals everyday. The survey also shows us that most professionals are ready to

increase their clients satisfaction levels by better informing their clients about AMP’s.

After conducting this study, it is evident that further research could be done to prove

points made about teaching clients more about AMP’s. If future studies are done, I would

suggest surveying a wider range of clients and veterinary professionals to ensure less bias. A

study could also be conducted showing that veterinary professionals who are treated with more

respect enjoy their job more than those treated with disrespect.

Finally, alternative methods of payment do help clients manage their veterinary bills. The

objective of this study was to further understand clientele knowledge of AMP’s and find any

trends that occur between knowledge of AMP’s and satisfaction levels of those who use them. As

the study progressed, it was evident that clientele knowledge of alternative methods of payment

is related to their satisfaction levels. It was also found that while the usage of AMP’s helps

clients, it also helps veterinary professionals. Specifically, it can help by decreasing the

animosity between veterinary professionals and clients, thereby increasing satisfaction levels to

both parties. Overall, alternative methods of payment are shown to increase the satisfaction of

veterinary clients, which leads to happier clients and healthier veterinary practitioners.

Materials

IRB Needed Material:

Consent Form

Online Research Participation Consent

Study title: Gauging Clientele Knowledge on Alternative Methods of Payment for Veterinary Service in Relation to Satisfaction

Primary investigator: Olivia Hritzkowin

Faculty Advisor: Dr. Laura Ken Hoffman

You are being invited to participate in this survey as part of research for a Senior Honors Thesis

conducted through Murray State University. This form contains information you will need to help you

decide whether to be in this research study or not. Please read the form carefully and ask the study

team member(s) questions about anything that is not clear.

Nature and Purpose of Project: This survey will be used to investigate the use and client understanding

of alternative methods of payment for veterinary services in relation to overall satisfaction.

Explanation of Procedures: This is a one-time online survey and should take no more than 10 minutes of your time.

Discomforts and Risks: There are no anticipated risks and/or discomforts for participants.

Benefits: Participation in this study may not benefit you directly, but it will help veterinary clients who are in need of financial

assistance for veterinary services. It also provides veterinary professionals with a resource to better understand dissatisfaction of

services because of pricing. Research aims to determine if knowledge of alternative payment methods will increase satisfaction of

veterinary clients.

Refusal/Withdrawal: Participation in this study is voluntary. You are free to leave questions blank or exit

the survey at any time with no fear of repercussions. Please answer the questions honestly, there will be

no judgment of answers perceived to be “right” or “wrong” by the investigator or involved parties.

Confidentiality: Your participation in this study is anonymous. Neither the researcher(s) nor anyone

else will know if you have participated or how you responded. However, we are unable to guarantee the

security of the computer on which you choose to enter your responses. Information (or data) you enter,

and websites you visit online can be tracked, captured, corrupted, lost, or otherwise misused. An option will be provided at the

end of the survey to optionally provide your email address to be put on a list to receive resources on alternative payment options

for veterinary services as well as results of this study. This option is completely voluntary and will not affect results of the survey.

This research is overseen by Dr. Laura Ken Hoffman and Honors College Executive Director, Dr. Warren

Edminster.

Any questions about the procedures or conduct of this research should be brought to the attention of

Faculty Advisor: Dr. Laura Ken Hoffman ([email protected])

This project has been reviewed and approved by the Murray State University Institutional Review Board

(IRB) for the Protection of Human Subjects. If you have any questions about your rights as a research

participant, you should contact the MSU IRB Coordinator at (270) 809-2916 or

[email protected].

By continuing with this survey, you are consenting to participate in this research. You may choose to exit the survey at any time

by exiting the survey page or by not hitting submit at the end.

Email and Social Media Blurb

This is what will be posted online along with the link to my survey and the graphic

Hello! My name is Olivia Hritzkowin and I am a senior Pre-Veterinary Medicine student at Murray State

University. This survey is a part of my Honors College Senior Thesis. This research aims to link client

satisfaction and knowledge on alternative payment methods for veterinary services. If you are the primary

owner of a pet(s) and have paid for any type of vet care in the past year, please consider completing this

survey. Please SHARE this survey to allow pet owners and vet staff to become better informed on easier

ways to pay for services. Please contact me at [email protected] with any questions about the

research: Gauging Clientele Knowledge on Alternative Methods of Payment for Veterinary Service in

Relation to Satisfaction.

This is what will be sent via email to vet clinics as well as posted on veterinary

professional facebook groups along with the link to my survey

To whom it may concern,

Hello! My name is and I am a senior pre-veterinary medicine major at Murray State

Olivia Hritzkowin

University in Murray, KY. As a part of my Honors senior thesis, I am surveying veterinary professionals

on their thoughts about alternative methods of payment for veterinary services (Pet insurance, CareCredit,

payment plans, etc). My research aims to link client satisfaction and knowledge on alternative methods of

payment. This quick survey will allow me to understand how many clients are using these methods, as

well as gain insight into your thoughts on client satisfaction related to pricing. Please consider filling out

this quick survey and sharing with any veterinary professionals to allow pet owners and vet staff to

become better informed on easier ways to pay for services. Please contact me at

[email protected] with any questions about the research: Gauging Clientele Knowledge on

Alternative Methods of Payment for Veterinary Service in Relation to Satisfaction. Thank you for your

participation.

Sincerely,

Olivia Hritzkowin

Veterinary Professionals Survey Questions

What kind of veterinary professional are you?

- DVM

- RVT/LVT

- Veterinary Assistant

- Receptionist

- Other

What best describes your place of employment?

- Small animal general practice

- Mixed animal general practice

- Large animal general practice

- Emergency

- Specialty (please specify)

How often do you see clients using alternative methods of payment (Pet insurance, CareCredit,

payment plans, etc)?

- Never

- Not often

- Sometimes

- Often

- Very Often

On a scale from 1-5, how much do you know about alternative methods of payment?

- 1-5 scale

Do you believe that clients would be more satisfied with your place of employment if pricing was

lower?

- Yes/No

Do you believe that alternative methods of payment make paying for veterinary care easier?

- Yes/No

Do you think that clients who use alternative methods of payment are more likely to be satisfied

with their visit?

- Yes/No

What type of alternative methods do you see used the most?

- Pet Insurance

- CareCredit

- Payment plans

- Other

What best describes the area surrounding your place of business?

- Rural

- Suburban

- Urban

Anything else you would like to add?

If you would like more information on alternative payment methods for veterinary services, please

leave your email below. This will only be used for a single email with information surrounding

alternative payment methods.

Client Survey Questions

Has your pet received veterinary care in the past 12 months?

- Yes/No

What type of care has your pet received?

- Annual Wellness (exam, vaccines, regular bloodwork)

- Emergency Care

- Sickness related visit

- Other

On a scale from 1-5, how satisfied with the CARE of your pets were you after your visit?

- 1-5 scale

On a scale from 1-5, how satisfied with the PRICE of your visit were you?

- 1-5 scale

Around how much did you spend at your last visit to the veterinarian?

- 1-100

- 100-200

- 200-300

- 300-400

- 400-500

- 500+

Did you use an alternative method of payment (Pet insurance, CareCredit, payment plan, etc.) to

pay for your visit?

- Yes/No

If you answered "Yes" to the question above, please specify what payment method was used.

On a scale from 1-5, how much do you know about alternative methods of payment?

- 1-5 scale

Have you ever been told by a veterinary professional about alternative payment methods?

- Yes/No

What best describes the area in which you reside?

- Rural

- Suburban

- urban

If you would like more information on alternative payment methods for veterinary services, please

leave your email below. This will only be used for a single email with information surrounding

alternative payment methods.

Thesis Prospectus

Senior Honors Thesis Prospectus -- Proposed Study Abstract

Author: Olivia Hritzkowin

Advisor: Dr. Laura Ken Hoffman

Department: Pre-Vet/Vet Tech/Animal Health

Projected Date of Completion: April 28th, 2023

(An abstract of the proposal should follow. This should be single spaced and is not to exceed 500

words.)

The largest complaint from pet owners regarding veterinary care for their pets is pricing of

services provided by veterinary professionals. Annual wellness exams, vaccinations, bloodwork,

radiographs, sterilization surgeries, and other services are some of the most common services

provided by veterinary staff; they are also the most complained about by pet owners. Like any

other business, veterinary clinics need to charge for services to create revenue to continue to run

their business. Many veterinary professionals debate that clients have no right to be upset

regarding pricing of said services. As veterinary professionals, we often blame owners for lack of

preparation when they have trouble affording care for their pets. This has created animosity

between the clients and employees, oftentimes resulting in negative feelings surrounding

veterinary medicine from both clients and staff.

As a pet owner who has been in the unfortunate situation of paying for a medical

emergency, as well as being a member of staff at several animal hospitals, I have seen both sides

of the argument. Slowly, I have begun to realize that the solution to this problem may be found if

clients were more knowledgeable about alternative methods of payment for veterinary services.

Therefore, I will be conducting research to gauge clientele knowledge of alternative methods of

payment for veterinary services, as well as gauging how often these methods are used in

veterinary hospitals. Another goal of this research is to gauge what types of areas (urban,

suburban, rural) clients are more knowledgeable about alternative payment methods, as I have

seen a decline in knowledge when moving from a large city practice to a small rural practice.

The surveys will be sent out to pet owners who have paid for veterinary services within

the past year, as well as veterinary professionals who currently work in a general practice setting.

The overall goal of this study is to figure out if customer satisfaction is directly related to their

knowledge of alternative methods of payment. By the end of this thesis, I hope to create a

resource accessible to pet owners with results of this study as well as a guide to alternative

methods of payment. This will allow pet owners to be better prepared for the costs associated

with owning a pet, as well as providing veterinary staff with a resource to educate their clients on

how to pay for services. Hopefully resulting in decreased levels of animosity between clients and

staff as well as increased satisfaction with veterinary services.

References

Vital statistics. American Veterinary Medical Association. (n.d.). Retrieved April 15, 2023, from

https://www.avma.org/javma-news/2013-02-01/vital-statistics

Megna, M. (2023, April 13). Pet ownership statistics 2023. Forbes. Retrieved April 15, 2023, from

https://www.forbes.com/advisor/pet-insurance/pet-ownership-statistics/#:~:text=at%20a%20Glance-,66%25

%20of%20U.S.%20households%20(86.9%20million%20homes)%20own%20a,fish%20(11.1%20million%20

households).

Csreinicke. (2018, June 14). Are you prepared for a pet emergency? most Americans are not. CNBC.

Retrieved April 15, 2023, from

https://www.cnbc.com/2018/06/14/are-you-prepared-for-a-pet-emergency-most-americans-are-not.html

Sussex Publishers. (n.d.). How to manage anger resulting from financial stress. Psychology Today. Retrieved

April 15, 2023, from

https://www.psychologytoday.com/us/blog/mental-wealth/202111/how-manage-anger-resulting-financial-stre

ss#:~:text=In%20addition%2C%20people%20who%20endure,abuse%20of%20alcohol%20or%20drugs.

Chan, Melissa. “Here's Why Suicide among Veterinarians Is a Growing Problem.” Time, Time, 12 Sept. 2019,

https://time.com/5670965/veterinarian-suicide-help/.

“U.S. Veterinarians.” American Veterinary Medical Association,

https://www.avma.org/resources-tools/reports-statistics/market-research-statistics-us-veterinarians.

An Analysis of Client Complaints and Their ... - Wiley Online Library.

https://onlinelibrary.wiley.com/doi/full/10.1002/vms3.725.

Average Cost of a Vet Visit for Dogs: Must-Know Facts and Figures.

https://www.thezebra.com/resources/personal-finance/average-cost-of-vet-visit-for-dog/.

Altman, Nathaniel. “Student Loan Forgiveness for Veterinary Technicians.” Debt Strategists, 15 Dec. 2021,

debtstrategists.com/student-loan-forgiveness-for-veterinary-technicians/.

Average Cost of a Vet Visit for Dogs: Must-Know Facts and Figures,

www.thezebra.com/resources/personal-finance/average-cost-of-vet-visit-for-dog/. Accessed 3 May 2023.

“Still Broken, Five Years after Fix the Debt Veterinary Summit.” News,

news.vin.com/default.aspx?pid=210&Id=10324698&f5=1. Accessed 3 May 2023.

Carecredit vs General Purpose Credit Cards | Carecredit,

www.carecredit.com/howcarecreditworks/prospective/. Accessed 3 May 2023.

Fabregas, Krista. “Best Pet Insurance of 2023.” Forbes,

www.forbes.com/advisor/l/best-pet-insurance/?utm_content=TP_Pet_Insurance_Exact&utm_term=pet+insur

ance+&gad=1&gclid=CjwKCAjwrpOiBhBVEiwA_473dM2oQnnn3rEwbp1ZpKEjbyvbGyiRIjVSa6p049SM

KdEMxjssPowI-xoCoNkQAvD_BwE. Accessed 3 May 2023.

Hoeksema, Adam. “Opening a Profitable Vet Clinic - Numbers You Need to Know.” Financial Projection

Templates, 5 Jan. 2022,

www.projectionhub.com/post/opening-a-profitable-vet-clinic-numbers-you-need-to-know.

Fellenstein, Stephanie. “Job Offers down at Graduation, but Veterinary Market Still Growing.” DVM 360, 27

Apr. 2020, www.dvm360.com/view/job-offers-down-graduation-veterinary-market-still-growing.

“Special Report: Auburn-CDC Study Examines Frequency and Means of Suicide among Veterinary

Professionals.” American Veterinary Medical Association,

www.avma.org/news/press-releases/special-report-auburn-cdc-study-examines-frequency-and-means-suicide-

among. Accessed 3 May 2023.

Admin. “These Veterinary Mental Health Statistics Will Change the Way You See the Profession.” VetX

International, 18 Nov. 2021,

www.vetxinternational.com/these-veterinary-mental-health-statistics-will-change-the-way-you-see-the-profes

sion/.