Comparing fee guides

The ultimate objective of the provincial fee guides is to help veterinarians in covering the cost of running their veterinary hospital. In the days before fee guides many veterinarians did not raise their fees for several years. The result was that they worked too many hours, earned less than teachers, and could not afford to take any time off from their practice. Fee guides showed veterinarians what reasonable fees could be charged, and with the help of the fee guide, hours worked became more reasonable, veterinarians started taking vacations, and lifestyles improved.

Each provincial fee guide is based on decades of research into fees, pet owners’ attitudes, and the economics of veterinary medicine. The CVMA sponsors the economic research and works with committees in each province which oversee all research associated with the fee guide (Table 1).

Table 1.

Provincial fee guide for veterinary services

	NL	PEI	NB	NS	QC	ON	MB	SK	AB	BC
Consultation fee	$72.37	$74.62	$89.31	$87.75	$73.67	$79.47	$82.37	$82.24	$68.77	$81.80
X-ray fee for set-up/2 plates	$177.91	$168.60	$194.22	$226.51	$179.34	$205.63	$186.63	$164.89	$162.21	$184.12
CBC fee	$54.67	$72.66	$104.33	$97.82	$74.80	$77.38	$68.84	$60.53	$79.12	$68.38
Heartworm test fee	$55.01	$50.36	$63.96	$72.04	$60.73	$56.36	$61.70	$66.27	$51.35	$47.66
Blood collection fee	$22.52	$29.41	$21.94	$18.37	$32.24	$30.21	$23.64	$22.65	$28.45	$27.53
Complete urinalysis fee	$49.52	$60.65	$67.01	$77.79	$65.04	$67.91	$57.41	$60.53	$65.91	$56.93
Annual canine vaccine fee	$117.86	$108.80	$136.25	$106.56	$96.37	$130.24	$128.12	$114.59	$108.50	$118.30
Annual feline vaccine fee	$117.86	$108.80	$136.25	$106.56	$96.37	$130.24	$128.12	$114.59	$108.50	$118.30
Anesthetic induction/30 minutes gas	$155.39	$219.44	$188.94	$259.71	$339.16	$271.74	$174.97	$160.72	$249.83	$242.23
Surgery fee per 10 minutes	$77.97	$66.78	$89.66	$93.10	$85.13	$105.89	$88.75	$82.86	$84.34	$91.37
Canine spay fee	$290.83	$298.60	$318.14	$352.11	$355.62	$428.31	$291.21	$348.99	$318.77	$296.99
Canine neuter fee	$259.91	$254.24	$262.17	$296.89	$314.19	$376.12	$247.99	$296.70	$274.92	$253.09
Feline spay fee	$225.52	$234.88	$252.43	$279.74	$263.45	$353.39	$241.39	$274.58	$239.39	$230.10
Feline neuter fee	$144.86	$154.26	$161.83	$183.47	$198.75	$258.77	$158.36	$154.25	$156.14	$151.06
Feline dentistry fee	$318.17	$270.42	$393.72	$455.90	$542.45	$393.27	$320.90	$452.51	$472.56	$389.25
Cystocentesis fee	$38.20	$47.30	$45.88	$44.82	$49.49	$30.21	$33.32	$39.55	$43.86	$39.86
Intravenous fluids for 24 hours	$118.98	$170.80	$144.93	$153.04	$149.03	$131.56	$140.22	$141.93	$119.70	$147.41
Euthanasia fee	$81.56	$94.59	$86.72	$113.75	$106.81	$161.87	$105.02	$154.56	$94.36	$91.66
Overnight hospitalization fee	$100.60	$51.46	$59.26	$112.54	$115.32	$119.53	$76.76	$71.49	$94.28	$68.08
Dispensing fee	$12.55	$19.36	$18.31	$18.04	$13.96	$19.99	$12.43	$14.71	$12.21	$16.68

AB — Alberta, BC — British Columbia, MB — Manitoba, NB — New Brunswick, NL — Newfoundland, NS — Nova Scotia, ON — Ontario, PEI — Prince Edward Island, QC — Quebec.

Unlike a fee survey, which merely reports the average fees for a group or a given area, the provincial fee guide contains fees that are designed to cover the costs of running a veterinary hospital, provide a professional level income, and stimulate the demand for veterinary medicine. The fee guide is produced from a fee guide model which mathematically replicates the average frequency of procedures for veterinarians across the country. This fee guide model is built with information from each provincial economic survey and ongoing procedure, time, and frequency studies.

Procedure, time, and frequency studies help determine exactly how many procedures per year the average veterinarian will conduct. The results of these studies also show how long it takes the average veterinarian to perform each procedure and how much assistant time is needed for each procedure. The fee guide model contains procedure, time, and frequency data for literally hundreds of procedures.

Each year, financial and production information from the Practice Owners Economic Survey from each province is also used to calibrate the fee guide model. After the fee guide model is calibrated to the average fees in the province, it shows the future impact on veterinary net incomes from changes in fees. The fee guide model is so sensitive, it can capture the average change in net income from raising examination fees by 1 cent.

Veterinary medicine is very diverse and the procedures performed in any given hospital in any given day will vary in clinical complexity and in perceived value by the client. For example, a veterinarian may spend 30 minutes with a client who has a new puppy then go and perform 30 minutes of orthopedic surgery for another client’s pet. Both procedures take the same time but they are very different to both the client and the veterinarian. In this example, the veterinarian would expect to get paid more for the orthopedic surgery. Indeed, a client would expect to pay more for 30 minutes of surgery over the 30 minutes spent with a new puppy.

To account for these differences in clinical complexity and client demand, veterinary fees are adjusted by an “E Factor.” E Factors or fee adjustment mechanisms like the E Factor are used in dentistry and human medicine the same way. These adjustment mechanisms ratchet fees up or down to meet clinical and demand considerations. For example, the fee for 30 minutes of orthopedic surgery may be multiplied by an E Factor of 1.36 so the cost to deliver 30 minutes of orthopedic surgery is multiplied by 1.36 or increased 36%. The 36% increase is justified by the clinical complexity of the procedure and the notion that clients are prepared to pay a premium for more complex procedures. At the same time, the fee for the examination may be multiplied by 0.65 or decreased by 35%. The decrease is necessary to meet client demand. Without the adjustment mechanism, without the E Factor, many fees would be considered to be cost-prohibitive by most veterinarians and staff. For example, the fee guide model shows the cost for an examination in Saskatchewan is $120.85 but after the E Factor the fee guide fee comes in at a more palatable $78.80.

Throughout the fee guide, fees are increased and decreased using the E Factor but in the end, the revenue levels out to the same level it would have been without any adjustment mechanisms. At the end of the year, the average client would pay the same with or without the E Factor; however, with the E Factor, the fees take on a more balanced approach. Fees that offer more perceived value are higher and fees with less perceived value are lower. In the end, the Economics Committee hopes they have preserved veterinarians’ incomes and clients’ positive perception of veterinary medicine.

Comparing fees from province to province shows how unique the fee guides are for each province. For example, average companion animal fees in Quebec are lower than many other provinces yet the fee for anesthesia in Quebec is the highest. This is a direct result of the committee tagging intravenous fluid fees with all anesthesia fees. Nova Scotia has one of the highest examination fees in the country and after adjusting for the cost-of-living, the examination fees are the highest. This is a direct result of the committee in Nova Scotia working towards harmonizing a fee for an annual examination and that for an annual examination with vaccines.

After adjusting for the cost-of-living, the province with the highest average fees is Ontario (Figure 1). Each fee is not necessarily higher; in fact, the only fees that are noticeably higher are surgical fees. After accounting for the differences in the cost-of-living, elective and non-elective fees in Ontario are higher than in every other province. But that is where it stops; the cost-of-living adjusted fees for examinations and vaccines are highest in Nova Scotia and New Brunswick.

Figure 1.

2013 companion animal fee guides adjusted for cost-of-living.

Differences in the clinical approach to a procedure are responsible for a lot of the differences between provinces, but economics comes into play as well. In Newfoundland, the cost-of-living has been going up twice as fast as in the rest of the country so more aggressive increases in fees are required to stop them from falling behind. Newfoundland is where Alberta was several years ago. Over the last 10 years, veterinary fees in Alberta struggled to keep up with runaway inflation. Inflation slowed and veterinary fees eventually picked up moving them to 89% of the national average.

There may never be a national fee guide; the desire for provincial autonomy and historic differences within each province may be too large to bridge in one combined fee. However, comparing and contrasting provincial fees reveals some successes and faults that can be addressed to make future fee guides more successful for veterinarians and preserve the demand for veterinary medicine.