Quebec veterinarians receive, in addition to their base salary, a percentage of the services and products billed to clients. This practice from the United States is mainly present among specialists who work in veterinary emergencies belonging to large brands, but it extends to certain neighborhood clinics. A trend that is still marginal, but which is growing and which worries some veterinarians.
An independent veterinarian who requested anonymity for fear of reprisals believes that the big brands, which occupy an increasingly important place in the sector in Quebec, “are changing the face of the veterinary market”. Paying a percentage of the bill to veterinarians rather than paying them only by the hour can lead to ethical abuses and affect the quality of their work, he believes.
Among the fears expressed by this veterinarian — and others — is the danger of overcharging and working too quickly. “The faster you go, the more you [factures au client], the more money you will make in your day. It’s so direct [comme lien] that it sure puts pressure. »
If this method of remuneration continues to spread, this veterinary owner fears that he too will have to resolve to pay his veterinarians in this way. “I will have no choice but to follow” the market trend, he also mentions.
Paying veterinarians a percentage of the bill does not contravene their code of ethics, mentions the Dr Gaston Rioux, president of the Order of Veterinary Physicians of Quebec (OMVQ). He notes that other health professionals — doctors and dentists, in particular — are paid on a fee-for-service or percentage basis. “But this type of remuneration must not influence the choices of veterinary doctors [pour traiter un animal] “, he specifies.
Article 19.2 of the Code of Ethics for Veterinarians stipulates that “the veterinarian is in particular in a situation of conflict of interest if he receives, in addition to the remuneration to which he is entitled, a commission, a rebate, a advantage “. A distinction must, however, be made between a percentage and a commission, mentions the Dr Rioux. “A commission, we see it more as [quand on dit à un vétérinaire] : “You are going to sell so many bags of dog food, you are going to sell this type of vaccine and, if you do not make your quota, you are going to have penalties.” This is really what is not acceptable. »
Reward good work?
The Vet et Nous brand, which has 34 establishments, is one of the clinics that offer this type of remuneration to several of its veterinarians. A percentage of the money billed to customers for a range of medical care and products (such as food) is paid to them. “The “commission” part represents a very small percentage above the salary,” explains Sébastien Kfoury, president and director of medical services at Vet et Nous.
This practice is “especially [présente] among our specialists in reference centers and emergencies,” he says, adding that he is not opposed to this method of remuneration being extended to more of the brand’s veterinarians. “I think it’s a great way to encourage them to work well, to work harder and to give more to customers. » Offering a percentage allows you to reward, for example, a surgeon who will get up at night to operate on a dog or who will stay later at work to treat a complex case, he mentions.
The Dr Kfoury recognizes that this type of remuneration is not unanimous among veterinary doctors, in particular because of the perception that clients may have of it. But, according to him, there is no link to be established between the method of remuneration and the work ethic of the veterinarian, which is governed by his code of ethics. “We are not salespeople, we are doctors. OUR jobis to care for the animal. […] This is when there is a quota [à atteindre] that it becomes a little more at risk of drift. »
Daubigny, the largest veterinary conglomerate in Quebec with its 105 establishments, did not want to grant an interview to Duty on this subject or provide us with a written statement.
Caroline de Jaham, CEO of the DMV group, which includes 30 Passionimo clinics in addition to reference centers, indicates that her group refuses “to go down this avenue”. “Our philosophy is not to put financial pressure on veterinary doctors,” she says. They are already under pressure — and often caught in difficult discussions — navigating between the financial capabilities of pet owners and the quality of care they want to provide, she says. “We say to ourselves that adding an element of complexity which is “my pay depends on it” would be counterproductive. »
Ethical pressure
Former president of the OMVQ Caroline Kilsdonk, who offers ethics workshops at the Faculty of Veterinary Medicine at the University of Montreal, argues that there is no perfect method of remuneration and that it is “understandable that the remuneration of veterinary doctors can vary with a certain productivity”.
According to the analysis of this veterinarian and bioethicist, “the more the commission represents a significant part of the income, the greater the ethical “violation””. She adds that with advances in veterinary medicine, “there is already a medical, technical, scientific context which leads to doing as many tests as possible to seek diagnostic certainty and a truly effective treatment”.
This pressure “exists anyway”, but percentage remuneration “can amplify” this phenomenon, she continues, without it being done consciously by the veterinarian. “Ethics is not just about people saying [ou non] : “Ah, I’m going to take advantage of the others.” It’s a whole organizational context. »
What case law?
According to the DD Sonia Voyer, the trustee of the OMVQ who is responsible for enforcing the regulations, this method of remuneration would be derogatory only if it was demonstrated that the veterinarian’s judgment was biased and that he wanted to “promote his personal interests instead of the interests of its client. Setting a minimum sales amount to be entitled to a percentage would also contravene the Code of Ethics, she specifies.
Lawyer Véronique Brouillette, partner at Cain Lamarre and lecturer in professional law at UQAM, indicates that she has not found any decision “in which one would have concluded that remuneration by percentage, in itself, would represent a commission, a discount or an advantage and would therefore place the professional [vétérinaire ou autre] in a situation of conflict of interest.
She adds, however, that, according to her reading, “a percentage agreement which would provide, beyond professional fees [pour les services rendus]an amount for the sale of products could place the professional in a situation of conflict of interest.”