Recently, I had my own appointment with an otolaryngologist (aka ear-nose-throat or “ENT” physician). I was diagnosed with otitis externa (an ear infection) and the doctor prescribed some medicated ear drops which I picked up at a local pharmacy. This experience struck me as one similar to a scenario I see all the time at Levittown Animal Hospital. I see at least one (if not four) ear infections on any given day. So I decided to compare the services we provide our patients (and their associated costs) with my own human appointment. Here’s the breakdown.
1) Making the appointment: If you suspect that your dog or cat has an ear infection, we can usually get you an appointment the same day. At most, you would have to wait one day to come in. When I suspected my own ear infection, I first spoke with another personal physician to get a name of an ENT doctor he trusted. I called the ENT office for an appointment, and the earliest available slot for a new patient was 10 days away. That particular day was one I couldn’t take off from work, so I made an appointment 14 days after the call.
2) The examination: If your dog or cat comes in with the chief concern of an ear infection, he/she still gets a complete nose-to-tail physical examination. Ears are examined with an otoscope. If there is any abnormal discharge, a sample is examined microscopically. My ENT doctor looked at my ears, my nose and my throat. He did not wear or carry a stethoscope (there’s no H or C in ENT!). Abnormal discharge was found deep in my ear canals, but none was collected for further investigation. Cost: At my hospital the exam is $62 and in-house ear cytology is approximately $30. My ENT exam cost me a $40 copay, although without insurance I would have been charged $275. Speaking of insurance, I pay about $450/month for my plan. Assuming one doctor visit a month (not sure if I’ve ever gone to the doctor that often!), that averages out to a cost of $490 for my examination, including the copay. Yes, I know that’s an oversimplification, but you get my point.
3) Cleaning: If there is excessive or abnormal discharge found in your dog or cat’s ears, my technicians or assistants will gently and thoroughly clean it out with a liquid ear cleaner (chosen based on my assessment of the ears and the nature of the discharge). It is usually a two person job -one person restraining and the other cleaning. My ENT doctor cleaned my ears himself as I did not require restraint. Or a muzzle. Cost: About $30 at my hospital. No additional charge by my ENT doc.
4) Medications: If an ear infection is confirmed by microscopic exam, an appropriate medication is chosen based on my interpretation of that cytologic exam. This is all done while the patient’s ears are being cleaned. The first dose is typically applied at the hospital by my staff. The medication is dispensed from our own in-house pharmacy. Most of the time, we will also dispense an appropriate ear cleaning solution for at-home use. My ENT doctor diagnosed an ear infection and prescribed an antibiotic-containing (a “big gun,” ciprofloxacin, no less!) drop without the supportive evidence of a cytology or culture. I had the prescription filled at my local pharmacy. Cost: Ear drops and ointments sold at my hospital range from about $20 to $45, depending on what the patient needs. Ear cleaning solutions range from $5 to 20. My CiproDex otic drops cost me a $30 pharmacy copay since it is not available in a generic form. The same drops sell at a discount internet pharmacy for over $135.
5) Additional testing: Often times, ear infections in dogs and cats are just one part of an overall dermatologic problem. Sometimes we will run additional tests if we find skin lesions or other evidence of infection outside of the ears. There are also times when we will suspect an underlying endocrine problem, so we may submit a blood sample to our reference laboratory. My ENT doc had one of his assistants/nurses perform a hearing test and “ear function test” on me. Cost: Skin impression smear and cytology will cost about $30 at my hospital. General blood screens range in cost from $60 to $160 depending on what tests are of interest for a particular patient. My ENT doctor charged me an additional $40 on top of my copay for the hearing and ear function tests. Without insurance, I would have been charged $330.
6) Other observations: While waiting in one of my exam rooms, you may peek out the windows and spot my car parked next to the hospital. It’s a 2006 BMW X5 which I bought used last year for $25,000. While waiting for my ENT doctor in his lobby, I looked out the window and saw his car parked outside. It was a 2009 Maserati GranTurismo. Base MSRP $117,500. Just saying…
So let’s add all this up: Appointment right away at my hospital, ear cytology, ear cleaning, meds and flush will run you about $160. If I have to look at a skin smear and submit a senior blood profile, the total goes up to about $350. Let’s say your dogs is overdue for his 3-year Rabies vaccine, needs a nail trim and you brought a stool sample for us to check out also. Now we’re at $420 for all of the above.
Appointment in 10-14 days wth my ENT physician, cleaning, testing, and meds would have cost me $740 if I did not have insurance. Luckily, I have insurance so my out of pocket costs that day were limited to $110. But if you factor in just one month of my insurance premium (which I pay for since I am self-employed), that figure gets bolstered to about $560. And nothing below my neck was even looked at.
Still think veterinarians charge too much?