I got my first job out of veterinary school at a 24-hour, 13-doctor practice in Portland, Oregon. The job paid $33,000 a year, but I didn’t care. Truth be told, I would have paid $33,000 to work there. I was so excited to walk in each day, meet new clients, and have my own patients. A few years in, the company switched from salaried veterinarians to paying us based on our production. It was called ProSal, meaning part production and part salary. Management made a good case for it. If you worked hard, which I did, you made more money, which I needed.
Little did I know that ProSal would be my entry into the veterinary Hunger Games and the start of my mental health’s unraveling. I was 27.
Everything was fine as 13 doctors entered the arena. Our assortment of players included:
- The new mom trying to afford day care
- The outdoor enthusiast always planning for his next trip
- The MBA-turned-DVM gunning for the top
- The tentative new grad not sure he chose the right profession
- The mom with four kids who ran 3 miles before work every day
- The anxiety-ridden one barely hanging on
- The girlfriend trying to figure out how to get her alcoholic boyfriend to move out
- The one who found out she was going to have another baby
- The recently divorced mom
- The one whose home needed a new roof and whose car was making a funny sound
Let the Games Begin!
Patient charts were hung in the order of client arrival. Our task as doctors was to take the chart at the top and move on. When we were ready for the next case, we returned to the wall and reloaded. Each chart carried a missive — a rabies shot, a vomiting dog, or a lacerated cat, for example. Under salaried pay, you didn’t care what you got, but in the production system, you excelled at mental math. “What is 20% of a rabies shot fee?” “What is 20% of a euthanasia invoice?” “What is 20% of the charge for removing a foreign body?” “Ka-ching! Paying my rent will be so easy this month!”
I started seeing dollar signs on patients but knew I shouldn’t think that way. I tried to ignore the image and thought a good person wouldn’t have such feelings. I was becoming the veterinary version of Katniss Everdeen, the protagonist in “The Hunger Games.”
It turns out I wasn’t the only one. Each player cherry-picked. We found it easy to pass over a diarrhea case that had been waiting for an hour and rush the laceration patient to the back. We started having big, drawn-out doctor meetings over who got paid for the dental cleaning. Was the beneficiary the veterinarian who sold the Grade 4 dental — oops, I meant “recommended” it — or was it the doctor who did the procedure? We tried everything: The selling doctor gets the commission, the surgery doctor earns it, we’ll just split it. Unfortunately, nothing worked. Everyone felt slighted, regardless of our roles.
No matter how much you told yourself that what you did was best for the patient, you were also doing something to advance your financial interests. In fact, production-based pay is built on the premise that both those things can be true. And it burns a bit more than it should when a client who can’t afford to put gas in her car yells, “You are only in it for the money!” Maybe, just maybe, your subconscious hasn’t yet shared with you the small bit of truth buried in that statement.
Over time, you realize it’s called production for a reason, and you are the milk cow.
When I talk to an earlier generation of veterinarians, they confirm that burnout and workplace mental health didn’t become as big an issue until the mid-’90s and early 2000s. As we learned from James Harriott, clients unable to pay a pet’s medical bill and veterinarians working long hours are nothing new. While the causes of our profession’s high rates of burnout, anxiety, and suicide are complex, I’d argue as someone who’s been inside the ring that it’s time we take a serious look at ProSal as a contributing factor. We can’t ignore it any longer.
The pitfalls of ProSal for the veterinarian are fourfold.
1. ProSal Conflicts Our Core Purpose
The employer’s attraction to ProSal is that it keeps business costs aligned with revenue. And by chasing the dangling carrot, veterinarians are encouraged to work harder and are supposedly rewarded for recommending “the best care” all the time. But the reality is that being paid in a way that justifies higher fees constantly strains the most essential part of our job: the veterinarian-client-patient relationship.
Over my long career, I have met thousands of veterinarians. Never once have I met someone who chose the profession to strike it rich personally. Never. The key motivator for veterinarians has always been, and will always be, taking care of animals.
When I finally left the Hunger Games practice and took a job in Durango, Colorado, one of my primary requests was a salary only rather than ProSal. I wanted an honest wage for an honest day’s work — and to restore some of my faith in humanity and in myself. It’s hard to describe the peaceful feeling that came with being back in tune with who I was again. It was like fixing a car tire that had been dangerously out of alignment for years.
2. The Cost Is Client Trust
In 2003, around the same time the internet and smartphones were taking hold, Consumer Reports magazine broke the news that veterinarians were paid commissions. We all hoped none of our clients would read the article or see it on the 5 o’clock news.
They did.
The article advised that savvy consumers shouldn’t buy medications from veterinarians and should shop around for the best prices on spays and neuters. This was the period when clients started telling me I only cared about the money.
The client relationship suffers when most of us are paid in ways that call our authenticity and integrity into question. Those two core values build trust.
3. ProSal Promotes a Workaholic Lifestyle
Employers will remind you that you have built-in time off and that you just need to take it. The problem is that instead of enjoying your time off and feeling like you earned it, you know that every shift you work is money in the bank for you and your family. Instead of sitting on the beach and enjoying the view, you think, “This is a $3,000 sunset.”
Over the years, my paycheck suffered when I had personal challenges to navigate, like getting divorced unexpectedly or taking six weeks off for a hysterectomy. I realized the job I held cared about only one thing: my ability to produce. It didn’t care if I was tired from staying up all night with a gastric dilatation-volvulus patient. It didn’t care if I had mentored the new doctor over a beer after work. It didn’t care if I helped the receptionists count the cash drawer when the books wouldn’t balance at the end of the night.
You start to believe that your primary function is to generate revenue. Nonbillable features that make you a well-rounded employee/human (like participating in team meetings or helping a colleague in a difficult surgery) are not nearly as important as the dollars you can generate in the exam room.
Not long ago, I spoke with a veterinarian who works for a corporation. She is the managing DVM. She would like to take her crew on a three-day off-site retreat for team building and CE, like most professional jobs do. The last one they did was never. It was completely out of the question because it would cost the mothership, her, and all the associates too much money.
4. Everyone Is Out for Themselves
I recently visited a Scheels sporting goods store for the first time. Every employee, from the greeter to the dressing room attendant, was so unbelievably friendly that I told the cashier, “Wow, everyone is so nice here!” She responded: “I’m so glad you feel that way. We are employee-owned, and we know you can choose where to shop and can buy most of this stuff online, so we go out of our way to be helpful. We appreciate you.”
Seriously.
The dream team at Scheels got me thinking about why veterinarians don’t think and talk like that. Maybe it’s because the ProSal model doesn’t reward important business drivers like marketing, reputation management, and teamwork. The only lever ProSal veterinarians can pull to increase their paycheck is to be on the floor for more hours or drive up the average client transaction by offering more services and products.
You become a gun-for-hire rather than a true stakeholder in the business.
What Is the Answer?
It’s time to ditch ProSal and move to a compensation model that rewards:
- Working hard
- Helping the business grow and succeed
- Mentoring other employees
- Taking care of clients and patients
Paying veterinarians by salary, not commission, would be a crucial step toward restoring their mental health. The salary should be based on a portfolio of contributions that includes revenue generation, mentoring, being a positive person, helping others, and demonstrating leadership to the lay staff. What I’m proposing is that every veterinarian be compensated as a professional, not as a revenue-generating machine.
I don’t claim to have all the answers, but we could come up with something better than today’s veterinary version of “The Hunger Games” if we, as a profession, put our heads together and start talking about what is really happening inside our practices.
BY THE NUMBERS
If you earn production pay or are considering a job with that compensation model, check out Student Loan Planner’s ProSal Calculator.
HAVE IT YOUR WAY
The veterinary industry firm Mahan Law defines three types of doctor compensation.
- Straight salary: A fixed annual income with no bonuses or commissions.
- ProSal hybrid: A base salary plus production bonuses after meeting a certain threshold.
- Straight production: No base pay. Income is entirely based on production.
COUNTERPOINT
The late Practice Smarter columnist Mark Opperman, writing in 2019, had this to say about ProSal: “Production-based compensation, when implemented correctly, is a win-win for the veterinarian and the practice owner.” Read “Pro on ProSal.”