Can Dr. Greenskin convince her scrimping superior that investing in an ultrasound machine is prudent for both their patients and their pocketbooks?
Illustration by Ryan Ostrander
Late one evening, Dr. Greenskin had just finished up an emergency abdominal explore for a hemoabdomen and coordinated her patient's transfer to the emergency facility for overnight care when she gingerly stepped into Dr. Codger's office. As usual, Codger was poring over a lofty stack of bills and receipts that blocked most of his face from her view, but she could picture his disgruntled frown. With more than a little hesitation, Greenskin finally managed to utter the words she had been holding in for so long.
“I think our practice should invest in an ultrasound machine.”
Greenskin immediately knew she had really done it this time. At the word “invest,” she sensed the old man tightening every muscle fiber in his body. At the mention of “ultrasound,” Dr. Codger's complexion changed to an odd melange of red and blue hues.
“You seriously think we should shell out 40 grand just so you can feel a little better about collecting urine?” he bellowed.
No vexation without explanation
Dr. Greenskin stared at the ceiling and gave the old vet a few minutes to collect himself. She had spent enough time with Codger to know that it wouldn't take him long to suppress his initial fight-or-flight response and have a listen. When the dust settled, Dr. Greenskin was able to deliver her points.
“Do you remember that pyometra we missed last week? It wasn't all that obvious on our hand-dipped x-ray, but an ultrasound could have led to a fast and easy diagnosis,” she said. “I also wish I could have told my client tonight that there were multiple liver nodules in addition to the bleeding splenic mass before performing the abdominal explore. I think they might have made a different decision.”
Dr. Codger pondered his young associate's points. Though still a little wet behind the ears, the new grad had progressed quickly and was becoming a more confident and competent practitioner every day. Codger knew she had a passion for providing her patients with the best possible care. But still: This was a lot of money they were talking about.
“I understand an ultrasound would be a fun toy to have in the clinic,” Dr. Codger finally stated. “I just don't think it makes financial sense for our practice. I'm sure you got to see all of the latest equipment at your vet school teaching college. But those costly contraptions aren't for everyone. We have a business to run here!”
A plan even a penny-pincher could love
Greenskin had seen this coming, and now she had her superior right where she wanted him. She plucked a piece of paper from the notebook she'd been clutching close to her chest and placed it on the old man's crowded desk. As his weary eyes scanned the page, Dr. Codger was flabbergasted by what he saw.
Greenskin had typed up a concise but thorough cost analysis for acquiring and implementing ultrasonography in the practice. She outlined the cost of leasing vs. purchasing three different models as well as the cost of training either one or both doctors. Not neglecting Dr. Codger's main area of interest, the paper also included a monthly income projection. Dr. Greenskin had been keeping a log for the past two months, noting the number of cases in which she would have recommended ultrasound. She also provided her own estimate of the rate of compliance based on the clients' financial histories.
Even more impressive, Greenskin listed the cost of an ultrasound at competing hospitals that offered the service, as well as the nearest referral hospitals (Greenskin's sister had done some undercover calling to get the information she needed). Finally, Greenskin proposed a competitive price that was well below the cost of a radiologist's ultrasound, as she felt that would be most fair to clients. The price was also within the competitive range for their area, and only two other hospitals within 60 miles even offered ultrasounds.
Codger lifted his jaw off the rickety, receipt-laden desk just in time to watch his associate stride out of the silent office. Before disappearing from view, she called over her shoulder: “And yes, I'll use it to poke bladders, too.”
Dr. Jeremy Campfield works in emergency and critical care private practice in Southern California. This series originally appeared in Pulse, the publication of the Southern California Veterinary Medical Association.