I read with interest the Jan. 15 article Netherlands targets incentive-based pay for veterinarians. As a veterinarian who has practiced for over 25 years in the United States, I can tell you that linking veterinarians' pay directly to the revenue or profit they generate can have an ugly side. But the reality is that the vast majority of practitioners are ethical and do not practice purely for profit.

Recently, I became a solo practitioner, making the move for many reasons, one of which was to get out of the corporate rat race. Having worked for two large corporate chains, one not-for-profit hospital and two small independent practices, I've been paid either a fixed salary or what's commonly known as ProSal, a combination of a salary and production-based pay.

I subscribe to the idea that good medicine is good business. All you need to do is practice good medicine, and the practice will do well. I practice flexible, individualized care the way I was taught in school and during my internship, and that has made me relatively successful while being able to comfortably sleep at night.

In my humble opinion, there are a few big factors that are pushing up the cost of veterinary care that have nothing to do with incentive-based veterinary salaries.

For one, practices historically supplemented their revenue by selling parasite preventives and other medications from their own dispensaries. Veterinarians weren't selling these products just to make money. We believe wholeheartedly in their therapeutic value. Revenue from their sales accounted for 20% to 25% of the bottom line. That income has been eroded by online pharmacies run by large corporations, often owned by venture capital groups.

Veterinarians and practices still need to make money to cover their expenses. So practices raised prices for services to offset the loss of revenue. Consumers' jump at quick savings and convenience ended up costing them more in the long run.

Secondly, all the big corporate chains steadily raise prices, and individual veterinarians have little to no control over that. During my last year in corporate practice, I saw three price increases in one year: two of 3% to 6% each and another of 6% to 7%. Lab prices go up 6% to 8% a year. And already this year, prices have gone up 6% to 9% on many medications and supplies. The major labs and suppliers, like veterinary practice chains, are owned by large corporations. Most of the veterinarians I have spoken to and worked with feel these price hikes are egregious.

In many cases, fixed salaries have pitfalls, in my opinion. First, dedicated practitioners will not be fairly compensated for working hard. There is no real financial incentive to go that extra mile in a veterinary profession burdened with mental health challenges and struggles to achieve work-life balance. Incentive-based salaries make practitioners a "partner" in the practice. This ultimately helps all parties.

As a generalization, veterinarians are not good businesspeople and do not negotiate well. I see this leading to exploitation by the more savvy and strong-handed corporate practices or owners. When my previous practice switched from fixed salaries to ProSal, one practitioner's salary doubled. She felt so exploited because she had trusted that she previously was being compensated fairly.

I also wonder if practitioners on fixed salaries will necessarily recommend the highest-quality care. Better medicine takes more work. For example, trialing one or two medications based on a best guess is easier than working up a case, investigating causes and performing diagnostic procedures. Without production-based compensation, I see many practitioners more often taking the easier path.

Of course, there are advantages to fixed salaries. Veterinarians tend to get a true paid vacation, as opposed to the draw-based systems, which base vacation pay on how much revenue they generate. Additionally, fixed salaries do discourage greedy behavior or territoriality over lucrative cases, though, as I mentioned before, I feel this is rare in our profession.

Overall, I wonder: Why are we constantly attacking the little guy? Instead of banning certain forms of compensation, why not look at inroads of corporate influence and control? Why not address anticompetitive market shares, the prioritization of profit over all other goals and the constant increases in fees?

One of the appeals of being a veterinarian was the respect we used to get. We are not the enemy. We dedicate our lives to our patients and their people. Often, this is to the detriment of our own mental health. We aren't millionaires. After eight years of higher education, we often carry heavy student debt. I personally feel squeezed from all sides: Make care more affordable for the consumer. Pay higher staff salaries (well-deserved, by the way). Pay higher lab costs. Pay more for supplies.

Instead of legislating against the practitioner, identify the true sources of rising veterinary costs, and tackle the problem at its roots. Only then will the solution be effective.