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- Author or Editor: Barry Kipperman x
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Abstract
OBJECTIVE To determine small animal veterinarians’ opinions and actions regarding costs of care, obstacles to client education about veterinary care costs, and effects of economic limitations on patient care and outcome and professional career satisfaction and burnout.
DESIGN Cross-sectional survey.
SAMPLE 1,122 small animal practitioners in the United States and Canada.
PROCEDURES An online survey was sent to 37,036 veterinarians. Respondents provided information regarding perceived effects of client awareness of costs and pet health insurance coverage on various aspects of practice, the influence of client economic limitations on professional satisfaction and burnout, and proposals for addressing those effects.
RESULTS The majority (620/1,088 [57%]) of respondents indicated that client economic limitations affected their ability to provide the desired care for their patients on a daily basis. Approximately half (527/1,071 [49%]) of respondents reported a moderate-to-substantial level of burnout, and many cited client economic limitations as an important contributing factor to burnout. Only 31% and 23% of respondents routinely discussed veterinary costs and pet insurance, respectively, with clients before pets became ill, and lack of time was cited as a reason for forgoing those discussions. Most respondents felt improved client awareness of veterinary costs and pet health insurance would positively affect patient care and client and veterinarian satisfaction.
CONCLUSIONS AND CLINICAL RELEVANCE Results suggested most small animal practitioners believe the veterinary profession needs to take action at educational and organizational levels to inform pet owners and educate and train veterinary students and veterinarians about the costs of veterinary care.
Summary
Pituitary neoplasm was identified in 43 dogs with pituitary-dependent hyperadrenocorticism via necropsy (n = 33), diagnostic imaging with computerized tomography or magnetic resonance imaging (n = 5), or diagnostic imaging and necropsy (n = 5). All dogs had clinical signs and clinicopathologic test results typical of hyperadrenocorticism. Thirty-seven dogs had grossly visible pituitary tumors, and 6 dogs had microscopic pituitary tumors. Fifteen dogs had developed neurologic signs typical of those resulting from an enlarging pituitary mass. Twenty-three dogs had pituitary tumors ≥ 1 cm in diameter. Provocative testing of the pituitary-adrenocortical axis was performed on all dogs.
Dogs with grossly visible pituitary tumors and dogs with neurologic signs had Significantly (P < 0.05) higher mean plasma endogenous acth concentrations, compared with values from dogs with microscopic tumors and dogs without neurologic signs, respectively. Dogs with grossly visible pituitary tumors and dogs with tumors ≥ 1 cm in diameter had Significantly (P < 0.05) lower adrenocortical responsiveness to exogenous acth, compared with dogs with microscopic pituitary tumors and dogs with tumors < 1 cm in diameter, respectively. Despite these differences, there was overlap between test results among dogs. On the basis of endocrine test results, it would appear difficult to distinguish dogs with pituitary-dependent hyperadrenocorticism and large pituitary tumors from those with pituitary-dependent hyperadrenocorticism and microscopic pituitary tumors prior to onset of neurologic signs.