Illustration by Jon Williams
When Dr. Ivan Zakharenkov publicly questioned whether the practice of veterinary medicine benefits from a production-based approach to paying doctors — basically a form of sales commission — he hoped to get his colleagues thinking and talking.
His commentary, Does production pay undermine veterinary team well-being? published in June by the VIN News Service, did just that. Over the following two months, a message board discussion on the Veterinary Information Network, an online community for the profession, drew more than 200 posts by more than 70 individuals.
Some participants expressed strong support for the method, some passionate opposition and some straddled the line. A few described methods that reward employees for contributions that include but aren't limited to production.
In the context of practitioner pay, production is "the revenue an associate veterinarian generates through their delivery of services and sale of products," according to an American Veterinary Medical Association description of compensation methods. Production-based pay may take a variety of forms, according to the rundown:
- Straight production. Compensation is based solely on commission, typically 18% to 21% and not exceeding 25%, plus benefits, with no guarantee of a minimum paycheck.
- Production/salary ("pro-sal" or "ProSal"). Compensation is a combination of a guaranteed base salary plus commission, flat-rate bonuses if certain targets are met, or a percentage of production above a specified baseline.
- Production/salary with negative accrual. Any production amount below a baseline is tracked monthly or quarterly, and future paychecks are docked or shortfalls must be repaid.
Mark Opperman, a certified veterinary practice manager, is credited with introducing pro-sal to veterinary practice around 1990. According to the AVMA, it has become the second most-common approach for paying veterinarian employees, after straight salary. Other sources suggest it's the most common approach. Either way, it's widely used.
Here is a sampling of responses by veterinarians to Zakharenkov's commentary, which argues that other modes of compensation are better at supporting overall veterinary team well-being. Some comments have been edited for length, clarity and style.
I have paid associates using both straight salary and pro-sal model. At one point, our eight-DVM hospital allowed associates to choose which method they preferred. Seeing some of the associates who chose straight salary consistently out-produce the ones who opted for pro-sal convinced me that production-based pay doesn't motivate everyone to produce. I don't think there is one perfect compensation model that works for everyone, since different people have different motivators and needs.
I prefer paying salary. I think most veterinarians are honest and try to only recommend what they feel is best for the pet. But that won't stop a lot of clients from feeling that the DVM is just recommending expensive tests or treatment for the money if they know that a large part of the doctor's compensation comes from production pay.
One of the things that I never liked about production-based pay is that it does not take into account other factors, such as how well the doctor works with the team, whether or not they contribute to a positive practice culture, etc.
The past few years, we have switched to paying our associates salary plus quarterly merit bonuses. The salaries are reviewed each year, and their previous year's production is one consideration but not the only one. We meet once a quarter with each doctor to discuss their goals and, together, decide what they want to achieve for the coming quarter. Part of the quarterly bonus is production-based if the doctor exceeds their goal for the quarter, but it is not a straight percentage of their production and is mostly intended to reward doctors when we are really busy.
In addition, doctors can earn bonuses for mentoring a new staff member, helping out with practice marketing at hospital events, developing new medical or surgical skills, writing client education blogs for our website, helping develop new hospital services, etc. No one is penalized if they don't want to do anything "extra" to earn a merit bonus that quarter, but most choose several things to work toward and receive between $2,500 and $10,000 in additional compensation each quarter.
Dr. Beth Fritzler
To me, ProSal is the only fair method.
I have a base salary that is enough for my budget and then get quarterly bonuses based on my gross. I am never penalized on my base salary, and I always make a bonus check.
I am fast, able to perform big surgeries, have loyal customers, etc. I like that I am in control of my income.
Dr. Elizabeth Anne Tonsich
St. Johns, Florida
I personally loathed being paid production. I simply don't like having my medical recommendations tied directly to my income. It made me feel "icky," and I think I end up not charging for things or discounting more because I feel bad for the charges.
I switched from a production-based pay to salary with my next job, and I loved it. Strangely, I actually make more "production" when my pay is not tied to it. The boss kept telling me I'd make more money if I switched to production-based pay. Thanks, but I am happier this way.
Now I've switched from salary pay to hourly pay and find that this is perfect for me!!! I actually get compensated when I stay late (versus when I was salary and would have some nights where I stayed until 9 p.m. doing records without being compensated for that time). I can leave early/take a long lunch if there are no appointments for me. I still earn more (both for myself and the clinic) than when I was production-based, feel better-valued as a professional and have markedly better job satisfaction.
Dr. Chris Benton
New Berlin, Wisconsin
One argument against production pay is that it incentivizes veterinarians to do more procedures, and that is detrimental to the patient and/or client. But what about the other side of that logic?
You could make an argument that straight salary incentivizes veterinarians to do fewer procedures, and that can also be detrimental to the patient/client.
For example, I'm paid on salary. It's 5 p.m. and a paraplegic dachshund shows up. Do I stay several hours late to do back surgery for no additional pay? Or do I put it off to the next morning when I'm scheduled to be working anyway (and risk the patient becoming permanently paralyzed)?
In either case, we ultimately depend on the veterinarian's ethics and professionalism to base medical decisions on what's right for the patient and client, not necessarily what's best for the veterinarian.
And if a veterinarian lacks the ethics and professionalism and is only concerned about their self-interest? I don't think it matters how they are paid.
Dr. Bill Thomas
I have been paid an hourly rate for almost 10 years and would not want to go back to salary. My time is precious. It is the only thing I spend that I can never get back, and I appreciate being compensated for it. I have been offered ProSal a number of times but have ethical issues with it, personally.
Dr. Angela DeRosa
When I worked at an ER clinic and everyone was paid on pro-sal, there were those who offered everything under the sky directly and those who offered what was needed at that moment. It created friction at the workplace because the vets who offered what's necessary started to question the integrity of the vets who offered everything at once.
I feel that pro-sal is a good way to go as long as the clinic leadership stimulates equal distribution of cases among the vets, the senior vet is compensated for mentoring the young vet, there is no negative accrual, and critical and clinical thinking is stimulated among vets.
Dr. Evy van Nobelen
Chilliwack, British Columbia
Absolutely, salary only. And unlimited paid time off (PTO). Every six months, re-evaluate down or up depending on production plus how well the clinic is doing financially as a whole.
I feel a happier staff will, in the end, result in a happier clinic, higher gross production and more importantly, improved profit.
Dr. Carl Singer
Our profession needs production — because we attract people that are unusually altruistic and want to do good. 0% of us went into this profession for the money. Because of this, we are pathologic discounters, and we will be afraid to offer services for fear of "ripping off the clients" — to the detriment of our patients.
Also, personally, without the pressure of production, I would have a hard time squeezing in extra appointments. It would be much easier for me to say "family first," refer patients and go home. But with production, if I work extra hours, I can justify that I am not only helping my patients but also my family. I am three times more productive on production. Maybe not true for everyone, but certainly true for me.
Dr. Eileen Lau
If nothing else, this thread shows that among vets, there are some very divergent opinions!
My feeling is that until I control the means of production, i.e., I am the clinic owner, I don't want my pay to depend on production. I don't set the prices or train the techs or create a welcoming environment or run a social media campaign that recruits new good clients — that's the owner's bailiwick. So many things influence what "production" can be generated on a given day — way beyond what I as an associate might choose to do.
I was paid ProSal once. I will never ever work for any form of production again. I work relief and am paid by the hour, and I love it. I feel no burnout! I hope my work is good and my work ethic and professionalism exemplary. If it's not, then the clinic owner need not hire me.
If I were not relief, I would prefer to be paid straight salary but with bonuses available when the team/the hospital did well, because I think that there is so much more helping the hospital achieve success than what production numbers might show. There is client goodwill I might generate. There are arguments and problems occurring at the front desk I might help resolve. There are techs I might train or inspire. There are other vets in the practice I might help out in so many ways. How do you put a production price on any of that?
When I was a brand-new vet, I had this discussion with a practice owner. I asked him, "Why can't we just pay a good salary for good work?" He scoffed, "Human nature is not like that." I find that a terribly sad statement. Of course, I want to be paid well, especially if a practice is doing well, but no matter what, I strive to do my best work.
Dr. Pamela Mueller
I am torn by production pay. One thing I hated the most about production pay that I don't see discussed here is the unpleasant competitive behavior it can create between some associates. I have worked at practices where associates stood over receptionists' shoulders and actively swapped appointments between columns if they saw appointments booked that looked more lucrative than another. One vet told reception staff that they were never to book "her" patients with any other doctor (and "her patients" were defined as her having seen the appointment one time in the 10 years she had worked for the practice).
Maybe the amount of business that developed during Covid-19 has "solved" this kind of fighting between associates in multi-doctor practices?
Dr. Jennifer Babineaux
My practice found a solution. Doctors are paid production (no base salary) and have their own devoted nursing team that also receives a percentage of the production their doctor makes. PTO is based on a "contractually agreed to" base salary and earned via hours worked (for the doctors — support staff is all hourly). So, while they are not paid hourly, the doctors still clock in/out and payroll can accurately assess PTO time accrued.
The doctors love having the same staff to count on each day, whether in exam rooms or surgery. Their clients get to know everyone, and interactions are more personal. The nurses learn how their doctor thinks, functions and communicates, allowing them to prepare ahead, follow-up and ultimately make their doctor more efficient.
But to make this work, the nurses and their doctor have to take the same vacations (calling out sick, as well). This was hard for some to swallow at first. But as support staff saw significant increases in their pay, they figured out how to budget accordingly for periods of time off. Doctors also need to consider the risk of "starving their staff" (and potentially losing them) if they take excessive vacation. This has opened communication between doctors and nurses on additional levels so that both sides take the other into account.
Nurses also know they are leaving their doctor and team in a bind if they call out, so we have seen what I would consider "spurious sick days" decline. We all know emergencies, jury duty, the unexpected, can happen, and we fill in, and some temporary staff changes do happen.
The nurses running "tech appointments" also receive a percentage of what they produce, so we have seen proactive, educated communications regarding best medicine with the owners. This leads to problems caught early with annual blood work, heartworm tests, fecals, truly prophylactic dental cleanings, etc.
We have separate percentage bonus systems for office staff and managers.
My doctors average 36- to 38-hour work weeks and make a good living while maintaining their sanity and having plenty of time for life. Their staff do, as well. It was an experiment started as Covid hit that seems to be working well for all sides.
Dr. Polly Martin