If you have a pet you’ve almost certainly been to an animal ER. Sure, a few veterinarians are still willing to see their own patients after hours, but in the case of a major medical calamity, we’re all grateful for the services of a fully staffed, well-equipped, 24/7 veterinary emergency facility.

But that doesn't always mean your veterinarian is 100% happy to see you go there. Indeed, every single veterinarian I know will cop to a love-hate relationship with their pet ERs.

My slumdog after his recent (and very scary) bout of acute renal failure.

As one of those veterinarians who needs to draw thick lines between private life and professional time (lest I keel over mid-spay), I rely heavily on after hours facilities. As do the vast majority of companion animal veterinarians in the US.

Think about it: The heavy demands of modern veterinary practice makes it extremely challenging for veterinarians to handle their own emergencies at the high standard of care our clients demand. After all, who can place an IV, run an anesthesia machine, and monitor a patient overnight –– at the level of care you’d expect during working hours –– without a full staff?

Hence, our high degree of reliance on ER facilities.

With that reliance comes a price, however. Not only do we abdicate the care of our patients to veterinarians whose clinical practices will almost certainly differ from ours, but we cede this control at the time of our clients’ greatest need.

Which brings me to a list I’ve compiled for your consideration. It details all the things “regular” veterinarians like me can’t stand about animal ERs. And they’re many.

Now, you might think it unfair of me to rail against pet ERs in this way, but maybe you’ll cut me some slack when I explain that I do see things both ways. In fact, I spent four years of my career working ERs (two years as an associate and two as an owner/clinical director).

I’ll also reiterate this: Non-ER veterinarians have a love-hate relationship with animal emergency facilities. We know we need them. But we often find it hard to square that need with the needs of our patients and their people. This list aims to offer you a glimpse of that uneasy balance.

#1 We’d rather see our own patients but we can’t.

As hard as I work during the day, I feel like a slacker knowing that my own clients are forced to go to a facility they’d prefer not to visit and see a veterinarian they probably don’t know. I especially hate knowing that I’m effectively electing to ignore them in their hour of greatest need.

#2 It’s hard to transfer control of our patients’ care to other veterinarians.

It’s really hard for some of us to lose control over our patients. Control freaks that we are, many of us are uncomfortable knowing that our patients will be in another veterinarian’s hands. That means that medications might be changed, orders altered and recommendations issued that we might not agree with.

#3 Pet ER visits usually mean more work for us on follow-ups than if we’d seen the patient ourselves.

The feeling of forgoing control of our patients is one thing. Knowing we might have to work double to explain why we’re changing things back to the way we like them, or trying to alter the ER’s orders to meet the needs of our clients (we know them better than the ER does so we have a leg up on these things) is yet another burden for us, post ER visit.

Note: Given that medical records are still not readily shared, ERs don’t have the benefit of the whole story. Which makes more work for everyone.

#4 Sometimes it smarts to have our clinical decisions examined by others.

Some of us hate the sensation of having others look over our shoulders (professionally speaking). The feeling of potentially being second-guessed (for example, after a spay incision comes undone) is not one most humans cherish and one doctors tend to detest more than most.

I’m not saying it’s a wholly defensible position on the part of non-ER vets. I’m just saying it’s an uncomfortable [and very human] one many veterinarians experience after their patients have been to the ER.

#5 Sometimes pet ERs make clinical decisions that step on non-ER vet's toes.

After receiving a text from one of my clients after hours (so much for that thick line), I learned that the ER was running a full battery of tests on one of my patients. Despite the fact that my patient was perfectly stable after having had a seizure, the ER wanted to perform X-rays and an ultrasound in the middle of the night.

That’s when I called the ER doc and let her have it. “If my patient needs these tests to be stabilized, that’s one thing. If she’s stable and you’re ‘working her up,’ then you’re out of line.” It’s true. This doctor was way out of line. Pet ER facilities are there to stabilize and treat emergencies until patients can be transferred to their regular veterinarian (or a specialist the regular veterinarian recommends).

ERs are not there to find answers to deeper problems or treat problems that can easily wait till morning. This is not only a transgression of a professional boundary effectively agreed upon between two veterinary facilities, it’s not appropriate because this is not the ER’s core competency. It’s simply not what they do best. (As happened last year when a nearby pet ER decided to inexpertly treat my patient’s non-critical ear hematoma.)

What’s more, pet ERs charge two to three times as much for performing the same diagnostic services after hours than your regular veterinarian would during working hours. Which is bad for clients too!

#6 Pet ERs cost a lot.

Animal ERs deserve to charge two or three times as much as your regular veterinarian. After all, it costs more to staff a fully-equipped place after hours. Most keep really fancy equipment on hand, too, in case of major crises. Others have specialists on call (critical care specialists, cardiologists and surgeons, for example).

Moreover, veterinary facilities aren’t busy all the time but they have to be ready to see you at a moment’s notice. That means that for a significant percentage of the time they’re paying staff and not seeing any income for it. They have to make up the difference by charging more per patient. It’s a business, after all.

Regular vets like me don’t begrudge pet ERs this premium. Not at all! It does, however, become a point of contention when … a) ERs perform tests or procedures we consider unnecessary or that can wait until we see them in the morning or b) our clients come back from the ER with no money left over to diagnose or treat a problem. Not that we can always blame the ER for b), but it’s stressful for everyone nonetheless.

Given points one through six, it should now be clear that the relationship between pet ERs and “regular” veterinarians isn’t always an easy one to manage. Knowing what we deal with as we work hard to bring your pets the best care possible will hopefully make it easier for you to advocate for your own pets in the face of an ER-worthy emergency.

- Dr. Patty Khuly