Dr. Angie Krause (00:00)
Welcome back to Tails of Truth, where we tell the truth about veterinary medicine. I'm Dr. Angie, and this is my co-host JoJo veterinary nurse extraordinaire. And today we are talking about accessibility in veterinary

JoJo (00:16)
Yes, I wanted to talk about this topic because I see it coming at us from a lot of aspects. So I think there's a lot of ways we can talk about accessibility and lack of accessibility really is what we're talking about. And when I think of accessibility, I think most of us think about financial accessibility to start. And that is definitely a thing. And I would say even more so as we are where we are in this day and time, which is

know, 2025, things are changing economically for a lot of people. And with that comes, I think we keep talking about shame and guilt. think but with that come shame and guilt, I don't have the financial means to do the endoscopy that's being recommended or I think it's hard for people to go into an appointment to be given diagnostic recommendations and have to decline those.

for financial reasons. And I think that feels bad on a number of levels. One, I'm not providing for my pet, what needs to be provided for my pet. That feels really bad. I wonder what the veterinary team thinks about me, that I'm not saying yes to this because of financial means that I'm not deserving of my pet, or what kind of judgment are they making about me? So there's the layer of shame again. And

Yeah, I just wonder, and I wonder if you see this in practice. I know we hear about it a lot. We receive emails about, can't afford to do this. What is the lowest cost option that I can provide? And I think as a veterinarian, I think that I would like to hear you speak to this because I hear you say it in appointments in a way that can take down the threshold of shame in terms of this is what I would do.

what are your financial means? What is the best option we can offer? I think that's the conversation that is most kind. yeah, so I mean, are you seeing more of it or what do you see?

Dr. Angie Krause (02:10)
Absolutely.

Yeah, I do see more of it and it really depends on where I'm practicing. So if I'm practicing in Boulder, I see a little bit less of it, of course, because economically, it's a more well-off county. When I'm in a low-cost clinic or in a different city, then I see more and it's really difficult. A really skilled veterinarian that's been practicing for a long time can usually offer you

Kind of tiers Like ideally we would do X, Y, and Z. Here's how much it's going to cost. Here's what it's going to tell us. If that's too much money, then you know, here are our choices. We can try some empirical treatment, meaning that we think it's this, so we're going to treat it as if and see if it gets better. I think newer graduates, newer veterinarians struggle with this a little bit more, and I probably did too, because you're so used to just recommending the best all the time.

And there is some practicality that comes with practicing for a long time. For example, if I had a cat that I suspected had inflammatory bowel disease and my client had no money for diagnostics, they didn't have $500 for the ultrasound and probably certainly don't have $2,000 $5,000 for the endoscopy. Then, you know, we can just start with steroids and it's no big deal.

some veterinarians might feel like, I really want all of these things because they probably haven't seen enough cases of inflammatory bowel disease. Usually we do that ultrasound, we see thickened bowel loops, then we of course want the endoscopy. Most people don't do the endoscopy no matter how much money you have. And so kind of all roads lead to steroids. And so I think most veterinarians will have that skill, but if you are in a situation where your veterinarian doesn't have that skill or doesn't have the experience,

It can be really shaming. And I always tell people, they're like, well, what would you do? And I'll usually tell them what I would do with the means I have now. And then I would also tell them like, you know, I'm the clinician, so I'm greedy with the information that of course I'll spend your money. And so I say things like that to give people permission to say no. Like I actually don't have that money. I don't want to spend that money on this. Or, you know, I have a kid going to college or, you know, there's all kinds of things happening.

JoJo (04:22)
Mm-hmm.

Dr. Angie Krause (04:34)
And so, yes, I see that all the time. And I think in these financial times, any recession I've been practicing through, although I don't think we're quite in a recession yet, but we're headed there. Any recession I've seen, like people definitely change their spending habits with their pets as well. And it's hard to, it's hard to not be able to afford treatment. I see it tear people up. The guilt is high.

JoJo (05:01)
Mmm.

It is the absolute worst to just, there's something conceptually around. It's just this paper money that I need to somehow get to get to you to get my cat what it needs. I don't know. It's so hard to grasp sometimes. it goes further in terms of, emergencies hit on Friday afternoon or Saturday mornings. It's what happens. And I think a great resource that we have now is that we do have urgent cares.

Dr. Angie Krause (05:15)
Yes.

JoJo (05:31)
And so emergency can be the most expensive option, you know, and then there's urgent care and then there's the day practice or your general practitioners. So I think if our pets would just get sick and ideal timing, right? Right, come on now. But I think all of us have experienced that where the moment hits and you're like, do I have to do emergency? Because I know that that is going to be full of complex financial decisions.

Dr. Angie Krause (05:43)
Business hours Monday through Friday, 8 to 5. Yeah.

Oh yeah, it's like $1,000 to walk in.

JoJo (06:00)
And I'm sure emergency clean,

yeah, I'm sure emergency clinics see it a lot. ⁓ Where they are faced with, where guardians are faced with what we call, ⁓ what do we call them now? Financial euthanasia is basically somebody who has a lack of resources, cannot afford the treatment that their pet needs and elect to euthanize because they cannot financially afford the treatment. And I think those are devastating all the way around.

Dr. Angie Krause (06:27)
Absolutely, everyone involved in those is struggling.

JoJo (06:30)
again, devastating is the only word I can think of in that situation. So then we come to accessibility of insurance. And I've been thinking a lot about insurance because you and I have had the conversation and you know, we've been on opposite ends of the spectrum in terms of insurance. But I even think that insurance has its own accessibility issues. Right? I mean, because to ask someone to pay a monthly amount,

Dr. Angie Krause (06:49)
⁓ yeah.

JoJo (06:54)
is actually a privilege to have any kind of leftover money to spend on pet insurance. So I mean, I feel like we're always having to look at privilege and accessibility and just this dynamic concept of how do we meet it all? And I don't know that we can, but how can we make ourselves more accessible for people? So financially, how can we make ourselves more accessible? I know how you have done it.

Dr. Angie Krause (07:12)
Right.

JoJo (07:20)
and you put out a lot of free content I mean, there are blogs, there are videos, there's this podcast, and hoping that people can get some of the answers that they need that they may not get in their clinic or that is one way. We have offered scholarships before for our consultations and that actually didn't really fly, you know? Right, so that was interesting. But I think

Dr. Angie Krause (07:38)
No, we didn't have a lot of people apply for them. Yeah.

JoJo (07:42)
that that conversation is being had. And I would imagine in clinics is being had as well, in terms of payment plans or accepting the care plans, financial care plans. But yeah, it's complex.

Dr. Angie Krause (07:53)
Yes.

I think that

conversation is being had less and less in clinics. The longer I practice, I mean, I can't remember the last time I saw a payment plan. When I first got out of school, definitely the clinics I was working for, they were doing payment plans and now no one does a payment plan. And I think it really isolates people. Not that I think veterinarians should do payment plans because I think it was putting us underwater financially and just for anyone out there. ⁓

JoJo (07:59)
Mmm.

Dr. Angie Krause (08:21)
veterinary medicine doesn't have great margins and it's actually hard to run a clinic and be profitable. So when your veterinarian is like, absolutely can't do a payment plan, it's because they have to keep their doors open. And so, but I do see it a little bit less where you're like, you can get care credit and then if you can't do that, then we can't help you, which from our side, I understand, but I do think the experience for the average person is it probably feels

JoJo (08:32)
right.

Dr. Angie Krause (08:48)
less inviting than 30 years ago when it was your family veterinarian and you maybe in a small town or you had more personal relationships with this person. It's changed and out of necessity, but I think it's a culture shift.

JoJo (09:01)
right.

Right. I, it has changed even in we've talked about this before too, in terms of where your local veterinarian may have provided your medications or your prescription foods and had, you know, a little bit of a markup on that that helped keep the lights on. Now we're under sold by big companies where we can't even purchase medications for what they're selling it to you for.

So we have to make that up in other ways. And it's just unfortunate. And I know it makes people angry. ⁓ I mean, I could write a book on how many times we've been told you obviously don't care about animals if you're not willing to treat them. It's the line that comes out when somebody is scared and can't financially afford something. And we also are working in the business of finances.

Dr. Angie Krause (09:43)
yeah.

JoJo (09:55)
Like it's a business.

Dr. Angie Krause (09:55)
Right. Yeah,

we can't stay open without it. Can't keep providing some.

JoJo (09:59)
I know it's

so hard. I don't know what the answer is here or there is, but I just want to acknowledge that there definitely is accessibility, financial accessibility issues, and I'm afraid that that gap is going to get wider and less people are going to be able to afford it.

Dr. Angie Krause (10:16)
Absolutely. Yeah.

JoJo (10:17)
Yeah.

And I don't know the answers. I'm just bringing attention to it that we are aware. And I have a lot of empathy for people in that position. And I would never want someone to feel shame or judgment because they couldn't financially afford something.

Dr. Angie Krause (10:21)
No.

Absolutely, they're just, they're doing, everyone's doing the best they can. And I think a hard part is that, you you might obtain an animal from a shelter, from a breeder, from your neighbor and be in one financial situation and your financial situation changes. No fault of your own, maybe fault of your own. It doesn't really matter that it changes. And so there you are. And so,

this idea that, well, you should only get animals if you have the means to take care of them. And I'm like, of course that's true, but that doesn't really solve it. And like you said, insurance doesn't solve it for everybody because not everyone can afford insurance. I pay $40 a month to insure both my kitties. And for a lot of people, that's probably just not accessible.

JoJo (11:15)
Well, and truth be told, we're about to be in a situation where our own human medical insurance is about to skyrocket our monthly premiums. So I would assume families are gonna have to look at what they have to set down. And so I'm just saying, I see you and I hope that you feel received in the veterinary place. Even it doesn't mean you'll be able to get all the treatments that you desire for free.

Dr. Angie Krause (11:28)
Yeah.

Right. Right.

JoJo (11:41)
I hope that you're treated with respect, regardless of. And that brings me to something that was brought to our attention. You and I recently recorded a podcast for a ⁓ TNR, Trap, Neuter, Release program. the spay and neuter of rescues, or rescues of ferals, if you will. I didn't like that word, feral. It was interesting. There was another...

Dr. Angie Krause (11:42)
Yes.

I know, so

she calls them community cats. Yeah.

JoJo (12:09)
Yeah, the community cats. ⁓

And something that I hadn't thought about in terms of accessibility because of where we live is she had mentioned that, and you know, we talked about spay and neuter your pets, spay and neuter your pets. Everybody knows to spay and neuter your pet, but I did not know for low cost clinics, for spay and neuter clinics, that there could be, did she say almost a year long wait list?

Dr. Angie Krause (12:33)
Yes. Yeah.

JoJo (12:34)
That's mind blowing to me. So I had no concept or understanding that some people may not be able to spay and neuter their pets due to accessibility.

Dr. Angie Krause (12:44)
Right? Like they want to, and they just can't. Yeah. Yeah.

JoJo (12:46)
Right. There's just nowhere to do it.

Because what do you charge in your clinic for a spay or neuter? I know those are different fees.

Dr. Angie Krause (12:53)
I mean, it really depends

on the weight of the animal. mean, but if you were to ask someone to pay a hundred pounds, Great Dane, six or $700, it's a lot. Yeah.

JoJo (13:04)
Yeah. And so a low

cost clinic might do it for half that maybe. Yeah, so wait, I can understand somebody wanting to wait for that. But had I just had no idea that other places in the country had waitlists for their

Dr. Angie Krause (13:10)
Or even less. Yeah. Yeah.

Yes.

No, I had no idea either. We're so sheltered in the front range and I'm in Boulder County and it's the most, we call it the Boulder bubble. And we even had a client that listened to a different podcast of ours about when to spay and neuter your dog and cat. And the conversation was mostly around dogs, but I made this comment that like no one wants to not spay or neuter their cat for a lot of different reasons. You can go back and listen to that episode.

JoJo (13:24)
Yeah.

Yeah.

Dr. Angie Krause (13:49)
⁓ but she is, ⁓ this woman who's been our client is she lives about an hour north of us. So like not in the front range, not in the Denver Metro. And she was like, Hey, ⁓ by the way, Angie and JoJo, we have this huge problem up here where there are not enough kind of openings in these low cost settings to spay or neuter. So like just drive an hour north and then you find it. But I didn't know.

that that was happening. assume like Fort Collins, like around the veterinary school, like I wouldn't have, I would have had no idea. So I'm glad she brought that to our attention that there was an accessibility problem just an hour, hour north of here.

JoJo (14:27)
Right?

Yeah, it changes the dialogue and I think my eyes are open of I need to be more sensitive and how I speak to that because my assumption would be, you didn't spay and neuter your pet out of a lack of responsibility rather than a lack of accessibility. And I feel really bad saying that out loud, but that is the truth because I just thought it was easily accessible.

Dr. Angie Krause (14:37)
Yes.

right?

Right, because we're super privileged here. We have other states shipping their animals to us because we don't have enough here. Right, like that's the situation we're in.

JoJo (14:57)
So, super. ⁓

That's crazy.

Right. Okay. And then the other area of accessibility that I thought about, just high level one that I see is, you know, as a house call, when we were doing house calls, I thought it was such a privilege on our end to be able to meet people where they were at, because we would go to homes for elderly. I mean, I think we had a woman in her 90s.

who we were caring for her cat. And so driving or getting her cat to a clinic becomes something that's more challenging and she still absolutely deserves to have that cat even if she can't get to a clinic. Or we have people with certain physical limitations that maybe couldn't bring their pet in. And I think as ⁓ an industry, we are doing better in this sense of, I think house call vets and home visits are becoming much more accessible. ⁓

there seem to be, I even think there are some more, not corporate, but chains or ones that, is it chains? Corporate? I don't know. Yeah, that have vans that are going around. I mean, I think I saw three in my neighborhood last week from three different companies. So people are getting that. And I think of that as an accessibility issue, not just for the human side, but also for the very scared animal side.

Dr. Angie Krause (16:06)
I they're corporate.

nice.

Yes.

JoJo (16:23)
Right, like

the fearful animals that are so hard to get into the vet then also puts a layer of shame and guilt on the owner because it's so hard to get them in that we just stop.

Dr. Angie Krause (16:36)
Definitely

and understandably. Understandably.

JoJo (16:38)
Yeah. And so I think

we can continue to serve our communities in that way. If we can continue to serve our communities in that way and having those resources for medicine in your own home. It's just a great option. And I bet a lot of rural places do not have this option. And again, this maybe is a big city privilege.

Dr. Angie Krause (16:53)
Mm-hmm.

Yes,

I think you're right. I think if, you know, people in rural areas watch our content, there would be something so out of touch about everything. Yeah. And I think as a veterinarian that spent, you know, the majority of my career in the front range in the Denver Metro, there are so many ways I'm privileged as a clinician. And there's a lot of things I actually don't know how to do because I

JoJo (17:09)
They're like, okay princess. Yeah. ⁓

Dr. Angie Krause (17:30)
never had to do them versus my classmates that maybe stayed in rural Texas, they can probably do so many more things than I can because I've always had a specialist down the street. And not only have I had a specialist down the street, I've had multiple specialists all around me. And ⁓ we just live in such a, it's just such different medicine here. So even

as a practitioner, the amount of accessibility I've had has made me really privileged. And of course, it elevates the level of care that my patients get because they have all, you know, they have accessibility to a dentist, a neurologist with an MRI, like a CT and like, yeah.

JoJo (18:10)
Mm-hmm.

Right. Yeah,

a teaching school an hour way that had, you know, yeah. It's right, the conversation. I don't know that we are even the ones who can have a conversation about what it is to live in rural areas. No idea. I mean, I've worked relief in some rural areas in Texas specifically. And it was eye opening. Right. It's just a different kind of medicine. It is very

Dr. Angie Krause (18:21)
Yeah.

Now we have no idea.

JoJo (18:41)
practical driven is very, hmm. I don't know. was, mean, the first time I stepped in the clinic, I was just like, what is happening? Where are the tools for this or the diagnostic methods for this or, we're not going to x-ray to diagnose arthritis or, you know, just all the things. Oh, I mean, not even having equipment sometimes to do the things and they find another way.

Dr. Angie Krause (18:45)
Yeah.

Yeah.

they find another way or they don't or yeah, I definitely can relate to that. Where you just don't have everything you need in every clinic and you figure it out or you refer out but when you're in a rural area you just can't.

JoJo (19:10)
Yeah.

Yeah.

So I don't know where this conversation is. I don't think it ever ends. ⁓ I don't know how we meet all the needs of accessibility, but I feel in some avenues we're doing good and in other ones we might be getting a fail still.

Dr. Angie Krause (19:37)
Yes. Well, it'll be interesting to see as our economic status changes. I remember in the first recession, the first recession of my career, I was doing rehabilitation. I was doing like PT. And I got really clear that that was not that you can't make a career out of it. You can. But I got really clear that I wasn't going to because it wasn't recession.

And I mean, as a veterinarian, there are some ways we're kind of recession proof. Like you and I were busier than ever in COVID because people wanted us to come to their homes. Yeah. And so the wait list, hundreds on our wait list. ⁓ And I realized quickly as a, you know, rehabber that I'm going to be the first to get cut. Like, yeah, people are still going to do their dog's knee surgeries, but they're going to try to like PT them at home.

JoJo (20:11)
So busy. That wait list was so long. We could not meet the demands. Yeah.

Dr. Angie Krause (20:32)
probably works out most of time too. And so that's when I was like, and we're going back to general practice. And so it'll be interesting to see ⁓ as we enter in a different economic and political time, how it affects accessibility. And it's probably not going to affect it more positively, but I could be wrong. We'll see what happens.

JoJo (20:38)
Right.

Right. Yeah, I don't know. And let's test the theories that veterinary medicine really recession proof. ⁓ I hope so.

Dr. Angie Krause (21:02)
Yeah, I think it is. mean, I am happy right now to be aligned with a family practice, because I think those values will be important as we enter this next phase of the US. ⁓ I think that people are going to value those relationships more than ever. So

It's important to stay aligned for me with places where you can have relationships with people and figure it out together.

JoJo (21:35)
right that trust factor is top bar. Yeah. Okay, that's all I had for accessibility. I mean, I feel like it's an enormous depth of places we could go. But I just, I think I want to leave or end with, I hope my want is that people still feel accepted. People still feel respected and people feel that they can have.

Dr. Angie Krause (21:36)
Yeah.

Yeah.

JoJo (22:02)
the conversations about where they need more support and where it's being met.

Dr. Angie Krause (22:06)
I love that. And I would like to say from an accessibility perspective, if you need some help with your pet, we offer online consultations. So it's another way to be more accessible, whether you live in Colorado or you don't. I can look at your pet's medical records and help get you organized, help make some recommendations, help improve your communication with your veterinarian.

or recommend seeing a specialist. So you can go onto our website, boulderholisticvet.com and you can go to the consultations tab. I think that's where it is now, right? Is there a consultations tab? Yeah, okay. We just redid our website. So now sometimes I can't remember where everything is, but yeah, book a consultation. You can find some time on my calendar and we'll collect your records and get a plan for you. And you don't ever have to leave your

JoJo (22:44)
Yeah, and there's a little book a consultation button that will take you there.

Right, I love that that is an accessibility option, right? Because not everybody has a holistic veterinarian in their area.

Dr. Angie Krause (23:08)
Absolutely. I can come to you via Zoom.

JoJo (23:12)
Yep, telehealth is a great accessibility option. Okay, well, bye.

Dr. Angie Krause (23:15)
Yes, okay. Well, we'll see you next time.