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\u2019t 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.<\/p>\n
Little did I know that ProSal would be my entry into the veterinary Hunger Games and the start of my mental health\u2019s unraveling. I was 27.<\/p>\n
Everything was fine as 13 doctors entered the arena. Our assortment of players included:<\/p>\n
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 \u2014 a rabies shot, a vomiting dog, or a lacerated cat, for example. Under salaried pay, you didn\u2019t care what you got, but in the production system, you excelled at mental math. \u201cWhat is 20% of a rabies shot fee?\u201d \u201cWhat is 20% of a euthanasia invoice?\u201d \u201cWhat is 20% of the charge for removing a foreign body?\u201d \u201cKa-ching! Paying my rent will be so easy this month!\u201d<\/p>\n
I started seeing dollar signs on patients but knew I shouldn\u2019t think that way. I tried to ignore the image and thought a good person wouldn\u2019t have such feelings. I was becoming the veterinary version of Katniss Everdeen, the protagonist in \u201cThe Hunger Games.\u201d<\/p>\n
It turns out I wasn\u2019t 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 \u2014 oops, I meant \u201crecommended\u201d it \u2014 or was it the doctor who did the procedure? We tried everything: The selling doctor gets the commission, the surgery doctor earns it, we\u2019ll just split it. Unfortunately, nothing worked. Everyone felt slighted, regardless of our roles.<\/p>\n
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\u2019t afford to put gas in her car yells, \u201cYou are only in it for the money!\u201d Maybe, just maybe, your subconscious hasn\u2019t yet shared with you the small bit of truth buried in that statement.<\/p>\n
Over time, you realize it\u2019s called production for a reason, and you are the milk cow.<\/p>\n
When I talk to an earlier generation of veterinarians, they confirm that burnout and workplace mental health didn\u2019t become as big an issue until the mid-\u201990s and early 2000s. As we learned from James Harriott, clients unable to pay a pet\u2019s medical bill and veterinarians working long hours are nothing new. While the causes of our profession\u2019s high rates of burnout, anxiety, and suicide are complex, I\u2019d argue as someone who\u2019s been inside the ring that it\u2019s time we take a serious look at ProSal as a contributing factor. We can\u2019t ignore it any longer.<\/p>\n
The pitfalls of ProSal for the veterinarian are fourfold.<\/p>\n
The employer\u2019s 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 \u201cthe best care\u201d 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.<\/p>\n
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.<\/p>\n
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\u2019s work \u2014 and to restore some of my faith in humanity and in myself. It\u2019s 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.<\/p>\n
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\u2019clock news.<\/p>\n
They did.<\/p>\n
The article advised that savvy consumers shouldn\u2019t 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.<\/p>\n
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.<\/p>\n
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, \u201cThis is a $3,000 sunset.\u201d<\/p>\n
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\u2019t care if I was tired from staying up all night with a gastric dilatation-volvulus patient. It didn\u2019t care if I had mentored the new doctor over a beer after work. It didn\u2019t care if I helped the receptionists count the cash drawer when the books wouldn\u2019t balance at the end of the night.<\/p>\n
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.<\/p>\n
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.<\/p>\n
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, \u201cWow, everyone is so nice here!\u201d She responded: \u201cI\u2019m 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.\u201d<\/p>\n
Seriously.<\/p>\n
The dream team at Scheels got me thinking about why veterinarians don\u2019t think and talk like that. Maybe it\u2019s because the ProSal model doesn\u2019t 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.<\/p>\n
You become a gun-for-hire rather than a true stakeholder in the business.<\/p>\n
It\u2019s time to ditch ProSal and move to a compensation model that rewards:<\/p>\n
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\u2019m proposing is that every veterinarian be compensated as a professional, not as a revenue-generating machine.<\/p>\n
I don\u2019t claim to have all the answers, but we could come up with something better than today\u2019s veterinary version of \u201cThe Hunger Games\u201d if we, as a profession, put our heads together and start talking about what is really happening inside our practices.<\/p>\n
If you earn production pay or are considering a job with that compensation model, check out Student Loan Planner\u2019s ProSal Calculator<\/a>.<\/p>\n The veterinary industry firm Mahan Law defines three types of doctor compensation.<\/p>\n
\nHAVE IT YOUR WAY<\/span><\/h3>\n