What if veterinarians were part of the Affordable Care Act?
Much has been said about the Supreme Court's ruling on the Affordable Care Act. Some of my more conservative friends have jokingly asked if this law includes pets as well. Though there would definitely be some aspects that would lead to a gigantic boom for the veterinary industry (suddenly seeing the two thirds of household pets that currently do not seek veterinary care) and other aspects that would be frustrating to deal with (the bureaucratic stipulations for certain diagnostics) the one aspect of the law that I find intriguing is tying doctor compensation to performance.
We share a similar model of production to medical doctors in that we are paid on how many vaccines we give, how many serum chemistries are run and abdominal exploratory surgeries are done. In the Affordable Care Act, there are attempts to link doctor's pay with the outcomes of their medicine. But if I do a splenectomy I get paid a percentage for that surgery no matter the outcome. In fact, if there are complications and further hospilization, the bill is higher and thus my compensation is greater. But what if there was a system in which I would be compensated more if that splenectomy went uneventfully? There are many situations when we do our absolute best, yet it costs less for the client. Should those situations be rewarded with more compensation than the other?
One could easily argue, "No two splenectomies are alike. You probably did your absolute best, but the outcomes were different no matter what you did. There are complications such as metastasis, clotting disorders and gross anatomical changes that affect the surgical time, aftercare and prognosis." It would be difficult for the medical director or hospital manager, let alone someone as far away as Washington D.C., to determine when a doctor should be rewarded for the best possible outcome, compared to an outcome that was not ideal but was a result of the given circumstances and not related to the doctor's care.
A key facet to the Affordable Care Act is compensating doctors with a flat salary. The parallel trend in veterinary medicine is to pay doctors based on production. This model has been more profitable for both associates and owners alike. Does this model produce a better quality of medicine? Does production-based compensation encourage a doctor to perform more diagnostics for the best interest of the pet? Or does this method lead a doctor to make unnecessary recommendations that drive up pet owners' bills? There are many compelling arguments and individual cases. The bottom line is that our niche of medicine is not considered to be a ballooning cost that will one day be insurmountable. There is no immense federal program that will dictate practice of medicine or decide if our compensation should be based on production or a set salary. These are decisions for our industry to make on its own, each practice and each individual doctor. It would be nice at times to have a huge safety net, but usually free will wins the day. Can I get a 9-0 vote on that?
Dr. Andy Rollo is an associate veterinarian at Madison Veterinary Hospital in Michigan.