Profit incentive schemes are becoming increasingly common in veterinary practice and as the principal of a small animal practice you are considering this approach for your employees. You have had some preliminary discussions with your employees, some of whom are unsure about how such a scheme would affect the way they perform their duties. Can profit-sharing be compatible with the professional and ethical frameworks of veterinary practice?
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Glen Cousquer graduated from Edinburgh in 1997 and worked in mixed practice for two years and as a wildlife veterinary officer for the RSPCA for four years. Since 2003, he has worked in exotic referral practice and gained additional zoo and exotic animal experience in the UK, South Africa and France. He holds the RCVS certificate in zoological medicine and an MSc in education. He is currently pursuing research interests in ethics and education at the University of Edinburgh's Moray House School of Education.
Issues to consider
A profit-incentive scheme or ‘profit-share’ seeks to encourage employees to produce a greater output in return for a share in company profit. Such schemes are often used to reward employees. As such, staff may be paid a basic wage together with a bonus that varies as a percentage of revenue generated. In some cases, the bonus can form the bulk of the salary; in others, it represents a bonus that is only a small percentage of the total salary.
Profit-sharing, either explicitly or implicitly, provides the veterinary professional with an incentive to work for financial gain. For some, this incentive will be their main (and sometimes only) motivation, whereas for others it remains secondary to other values such as public service, an interest in animal welfare or an interest in the science, art and practice of veterinary medicine and surgery. Blatant profiteering by vets, whether at the expense of insurance companies or animal owners, would undermine public trust in the profession and leave society questioning our motivations in recommending a course of action.
Veterinary professionals often maintain that they have a right to make a profit and earn a living. Closer scrutiny of this last sentence is required if we are to understand it more fully. First, the terms ‘professional’ and ‘professionalism’ must be defined and placed into context and, secondly, it should be recognised that we cannot talk about rights without identifying the corresponding and inalienable responsibilities that accompany them.
The monopoly, credentialism and elitism that are intrinsic to professionalism are privileges that society has accorded to members of the professions. These privileges are easily abused when we allow market forces to dominate our thinking. Freidson (2001) identifies a number of variables that are critical contingencies for establishing and supporting professionalism, including ‘an ideology serving some transcendent value and asserting greater devotion to doing good than to economic reward’. We should not forget that we do not operate in a free market, for only fully informed consumers are effectively equipped to choose among available goods and services in their own best interests; as such, our clients are at our mercy and need to trust in our advice and professionalism. As Freidson points out, ‘The special nature of the knowledge and skill imputed to professionals as well as the fact that their practice is protected’ invokes ‘the need to trust their intentions.’ We therefore have a duty not to abuse our positions for personal gain.
Possible way forward
Vets should not forget that they have a duty to the greater good, society, the profession, the client and patient, as well as their employer. As such, their remuneration should be fair, but should not tip the balance in favour of exploitation of vulnerable clients and insurance companies. In view of this, it may be appropriate to consider other reward schemes that uncouple pay from work undertaken, with rewards being recognised through reviews of an individual's CPD budget, holiday entitlement or the staff social fund.
Regarding the public's need to trust our intentions, it is appropriate to turn to virtue ethics for guidance in this matter. We should learn to apply the virtues (courage, honesty and justice) in order to develop our practical wisdom (phronesis) and work towards the greater good. We should question and scrutinise our motives regularly in order to monitor how our intentions translate into action.
In order to promote trust between vets, their clients and society, transparency and scrutiny should be promoted while abuses of privilege should be flagged up. Vets should feel comfortable explaining the reasons why they are recommending a particular investigation or course of treatment, especially where cheaper options are available. Blanket recommendations (eg, that all clients phoning an out-of-hours service be encouraged to attend) are geared to maximising profit rather than serving the interests of individual patients. Scrutiny of such policies should reveal their underlying motivation (eg, maximising out-of-hours revenue).
The pressures of the market are complex and, at times, overwhelming. Professional ethics can counterbalance the influence of the markets but, in order to create and sustain trust, it is essential that codes of ethics specify in detail and condemn all those actions and circumstances in which the privileged position of practitioners is employed to generate profit beyond the value of the work that is performed (Freidson 2001).
Readers with views to contribute on ‘Principled profit-sharing?’ should e-mail them toso that they can be considered for publication in the next issue, or fax comments to 020 7383 6418. The deadline for receipt of comments is Friday, March 18. Please limit contributions to 200 words.
THIS series gives readers the opportunity to consider and contribute to discussion of some of the ethical dilemmas that can arise in veterinary practice. Each month, a case scenario is presented, followed by discussion of some of the issues involved. In addition, a possible way forward is suggested; however, there is rarely a cut-and-dried answer in such cases, and readers may wish to suggest an alternative approach. This month's dilemma, ‘Principled profit-sharing?’, is presented and discussed by Glen Cousquer. Readers with comments to contribute are invited to send them as soon as possible, so that they can be considered for publication in the next issue. Discussion of the dilemma ‘Violent vet’, which was published in the February issue of In Practice, appears on page 143.
The series is being coordinated by Siobhan Mullan, of the University of Bristol. It is hoped it will provide a framework that will help practices find solutions when facing similar dilemmas.
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