A Discussion About Different
Levels of Veterinary Care ...Quality vs Fees
Using Dentistry as an Example
General Introduction: I think you'll find this eye opening.

You may have noticed that veterinary fees for the "same" procedure vary widely. 

As an example, if you were to call 20 or so different veterinary practices around the country and asked what you might expect to pay if your dog had a "bad" tooth, you would get estimates that range from about $200 to $1200.  Or more.  Occasionally much more.

At least a small part of the variation is due to the veterinarian's high or low opinion of his or her self worth.  And the relatively high costs of everything in big urban areas versus rural America is a big factor.

But the biggest factor of all is what this page is about and that is the huge difference in the quality of care performed from one clinic to another.  And as you'll soon read, I'm not really saying bad vs good ... just different.  And it applies to almost every service we offer.  I'm going to use dentistry as an example:

A quick introduction about Dental Health:

Thanks to decades of human dentists “educating the public” about the importance of gum health and dental hygiene, everyone knows that unless they brush, floss, routinely go in for a dental check up and cleaning, that they are going to start loosing their teeth in early adulthood, and they won’t be getting many French kisses. 

And we also know from human studies that inflamed gums are the number one port of entry for bacteria into our blood stream leading to septicemia, liver disease, kidney disease, and especially cardiovascular disease.

Well, everything I just wrote about human beings (except for the French kissing part) applies to dogs and cats too. 
In fact, due to differences in salivary pH, our veterinary patients accumulate plaque and calculus 5 times faster than people!

Not only do pets accumulate plaque and calculus 5 times faster than people, don’t forget that pets age about 7 times faster than people.
(And 7 x 5 = 35.  Therefore, since it’s recommended that people go to a dentist for professional cleaning every 6 months, that means you should bring your pet in for professional cleaning 35 times more often or about 70 times a year.) Sorry... just screwing around)

Mathematical kidding aside, dental disease can seriously reduce your pet’s quality of life.  More to the point, a little effort and attention taking care of your pet's mouth will likely improve your pet's life span, prevent numerous diseases, prevent the pain and irritation of inflamed gums, and help a lot with bad breath. 

Introduction over; Here's the quality difference between really inexpensive vets, middle level vets, and really expensive vets ... lets call them level 1 thru level 4 and remember that I'm using dentistry as an example but this often applies to other services in the clinic as well.

Level One Veterinarians:  If a pet has obvious mouth pain, discomfort, obvious gum inflammation, heavy tarter, or bad breath typical of gum disease then the vet will offer  "dentistry" under anesthesia. Using basic dental tools and an ultra-sonic scaler, the vet and/or assistant will extract any teeth that are rotten or loose, inspect the mouth for lesions, growths, and other problems, and remove the tarter from all the remaining teeth.  He or she will give an antibiotic injection if appropriate and send home pain medications and antibiotics if needed.

Your pet will probably do great, look better, feel better, and smell better.  And you will have spent a minimum of effort and money.  If you have a tight, tight budget, you should be grateful that there are still quite a few level one vets around willing to keep things basic.

Level one doesn’t mean bad…such basic, inexpensive, and practical care.

Level Two:  Here's what level 2 vets do differently:
They will probably spend a lot more time in the exam room ... every time a pet is in the exam room... talking about the importance of oral hygiene, point out early signs of periodontal disease, and discuss all the things you could be doing to keep your pet's gums and teeth healthy.  He or she will probably recommend dental prophylactic cleaning long before the tarter and gum inflammation is so bad that the pet is in discomfort.

And when it's time to put your pet under anesthesia and do the dentistry, the vet will recommend or automatically do quite a few things, in the interest of maximizing the safety and comfort of your pet, that the level one vet may not have included.  Let me make a quick list:

1.  Laboratory screening tests prior to dentistry to make sure the liver and kidneys are healthy (critical for metabolizing injectable anesthestics), and that your pet doesn't have diabetes or anemia. This vet may recommend just a few basic screening tests costing $30-50 total... or a full panel and urinalysis costing up to $200.  Especially if the patient is old, weak, or dealing with multiple problems.

2.  A level 2 vet may use an inexpensive injectable anesthetic agent like the level 1 vet, but he or she will be quick to recommend more expensive gas anesthesia in older patients and other pets at higher risk.
There will be an iv catheter in place ready for emergency medications in the advent of anesthetic problems.
There will be iv fluids running to minimize the dehydration and electrolyte imbalances that are associated with anesthesia.  The I.V. fluids will also help flush out the anesthetic from the body after the procedure so recovery is smoother and safer.

3.  A level 2 vet may have an EKG and other monitors on the patient during anesthesia as an added safety measure.

4.  A level 2 vet will have more sophisticated dental machines and equipment in addition to an ultra sound scaler.  He or she will not just clean your pet's teeth, but also polish and seal.  This level of vet will be equipped and trained to do gum surgery, perhaps with a surgical cutting/cauterizing laser.
And this is fairly new, but a level 2 vet may also offer laser therapy (a different type of laser than a surgical laser) of the gums to reduce post dental swelling, inflammation, and discomfort.

5.  Level 2 vets are constantly reading, going to continuing education courses, and interacting with other vets and mentors trying to improve their knowledge, skills, and expertise.  We're always learning to do things better.

All these extra steps are great, and rapidly becoming "the standard of medicine" in the United States for pets. Not doing them exposes a veterinarian to censure, fines, and possible law suits in the event something goes wrong.  But guess what; it adds another $100-200 to the bill.  Especially when you realize that you will need an extra person... a trained extra person... helping you with the anesthesia, the I.V. line, the monitoring machine, the blood work, and so forth.

Level Three:  Veterinary clinics offering level three dental services for your pet will have spent a lot of time, money, and effort to be able to offer you this very high level of medical care.  And you can expect such care to cost several hundred dollars extra each time you bring your pet in for dentistry. 

They aren’t “ripping you off”, though, they are simply doing the job at a very high standard and that costs money.  So what’s different?  Well, a level three clinic will include everything a level 2 practice does but also

1.  A level 3 vet is likely to have advanced training and equipment in diseases of the gums, palette, and jaw.

2.  A level 3 vet will have certified dental techs aiding in much of the work.

3.  He or she will have a dental radiograph machine like a human dentist designed to highlight any disease or defect hidden under the gums.  As the professors teach us.... " the battle for gum health is hidden where you can't see it".  Dental radiographic machines are wonderful, but they cost $20,000-40,000 in addition to the costly yearly government inspections, insurance, worker safety regulation, and radiation badges that are required.

4. A level 3 vet will probably take digital pictures and make notes about every single tooth in the medical record.

5. And finally, this vet will probably dispense the very best and latest in pain management, antibiotics, and after care products, because at this point, who cares about another $50-100?  Your bill will probably be over $1000 anyways.

Level Four: 

Yes, some clinics offer even more.  Level four clinics will have a veterinarian skilled as a board certified dental surgeon supervising the techs during routine cleanings and, of course, performing the extractions, gum surgery, capping, bridging, cavity repair, and root canals should they need doing.  Some vets are even skilled at orthodontics.

Hopefully this article highlights why it is so difficult to compare vets based on prices. 

When someone phones to ask "how much for a spay?" I'm pretty much forced to say "just $60" plus $60-200 more depending on whether you want it as cheap as possible or if you want to do a few recommended things like pre-anesthetic blood work, I.V. fluids, anesthetic monitoring, and so forth.

Thank goodness level 1 veterinary medicine exists, or even fewer people would vaccinate, spay, and neuter their pets.  Or offer at least basic care when their pets were sick or injured. 

Where do people with almost no money go if their pet is in agony with a bad tooth? 

But also thank goodness there are level 2,3, and 4 veterinary practices always striving to bring our professional standard of care to a higher level. 

Yes, there are a lot of people with pets who really can't afford much, but there are even more people who have earned enough financial stability and comfort to offer their pet companions better and safer care.

One last comment.  With very few exceptions, the people in our profession, no matter at which level they practice, tend to be exceptionally honest. In every sense of the word. Including the honesty of telling you that your pet might need, or be better off, going to a colleague that practices at a different level.

“ Hey, I can treat this problem with minimal expense, but this case is a little more serious than you might realize and it would be better if you went to see Dr. Fancy Pants who's set up and experienced in tough cases like yours." 

What's On This Page:

A discussion about the wide variation in veterinary fees which is mostly because the quality of medicine is so different from clinic to clinic. 

What's involved in "doing a spay" or "a dentistry" might be wildly different from one clinic to the next.

Please read about it on your right.  It will give you some interesting insight about the financial realities of our profession.

Other Topics on this web site that you might find interesting:
There's a complete directory of links
at the bottom of the page


History of Veterinary Medicine; lots of interesting stuff    

A tribute to Dr Harvey Cushing

Where does your pet food come from?

History of the Discovery of Antibiotics

The Human-Animal Bond
Comments & Stories about this topic close to my heart

Cats: Fun or interesting stuff about cats and a discussion about the diseases common in our feline companions to include Leukemia, Feline AIDS, & Cat Scratch Fever.

Dogs:  a hodge podge page of stuff about dogs.

Pet Insurance:
Why I like and recommend Pet Insurance

Zoonotics: Diseases People get from Pets, Worms & other Parasites People get from Pets.


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Veterinary Pet Insurance

Which veterinary clinic would you go to?  Which offers low fees?  Where is the highest level of medical care offered?  There's certainly a wide deversity of care and fees in our profession.  And as I discuss on your right... this is a good thing.
Are pets allowed in here?