Provincial fees

As the economy continues to limp along, many veterinarians are finding it harder to get clients to come in for their regular appointments. Preliminary information from the 2013 CVMA Practice Owners Economic Survey (1) shows that the number of clients per veterinarian is declining in many provinces. There are many possible explanations for the downturn, but the first and easiest factor to target is fees. After a slow week, many veterinarians ask themselves, “are my fees too high?”

The 2013 CVMA Practice Owners Economic Survey provides information on client production, staffing, expenses, revenues, and fees. Comparing fees in different provinces reveals some trends and relationships that suggest fees are not the problem. In fact, there is some evidence to suggest there are opportunities to increase fees even higher in some provinces.

Each year, a sample of fees from 20 procedures and 3 different markups is collected in each of the provinces. This cluster represents the most popular procedures and is responsible for roughly 65% of total professional revenue in the average companion animal veterinary hospital. Watching the ebb and flow from this group gives us a pretty good idea what is going on in the veterinary profession. Using information on the frequency of each procedure a weighted average is created and then indexed to the national average. This helps compare, at a glance, how the average fees in one province compare to another (Table 1). For example, if you wanted to compare the fees in British Columbia with the fees in Prince Edward Island you could scan down through the list and compare each fee. You would find that some fees are quite different and some less so. Canine vaccine fees in British Columbia are 23% higher than in Prince Edward Island while urinalysis fees are only 13% higher. But then X-ray fees in British Columbia are almost double the fee for the same procedure in Prince Edward Island. Using the fee index we can get a clearer picture of the difference. The average fee index for British Columbia is 95 compared with 72 for Prince Edward Island. The difference between the two indices gives us the overall difference in fees (32%).

Table 1.

Average companion animal fees 2013

	Canada	BC	AB	SK	MB	ON	QC	NS	NB	NF	PEI
Complete physical examination	68.56	70.49	76.66	67.09	64.84	73.37	54.68	68.48	67.77	64.00	49.68
Canine vaccine	101.88	104.47	115.09	98.08	98.01	107.19	85.93	90.65	96.47	100.33	85.20
Feline vaccine	103.81	107.77	110.49	98.39	99.71	113.73	83.07	92.59	95.09	85.33	84.86
Canine spay (all-inclusive fee)	329.69	283.11	366.24	270.17	275.95	390.95	235.03	295.02	291.65	300.00	205.11
Canine neuter (all-inclusive fee)	281.83	245.77	310.52	236.21	224.31	337.13	196.87	250.71	234.20	278.00	185.31
Feline spay (all-inclusive fee)	258.95	220.74	279.34	214.33	212.54	319.73	166.15	223.71	219.47	245.83	169.52
Feline neuter (all-inclusive fee)	165.30	140.61	174.63	115.06	112.61	201.79	120.37	139.88	137.77	164.17	116.27
X-ray fee for set-up/2 plates	170.38	166.40	179.45	139.33	162.44	194.85	123.48	194.93	160.90	161.33	82.25
CBC (differential)	62.90	58.93	62.95	51.46	59.21	61.69	69.06	73.15	65.92	48.17	40.43
Heartworm test	53.19	59.10	58.26	60.65	57.15	53.05	45.19	59.92	52.66	46.40	59.06
Blood collection	24.84	26.00	29.17	23.35	18.25	26.83	21.94	15.75	15.58	18.67	16.40
Complete urinalysis	55.12	50.00	55.25	49.61	51.92	61.76	44.65	62.29	53.50	53.00	44.08
Anesthetic induction + 30 min	202.62	230.46	234.79	130.99	161.79	234.30	140.92	182.99	121.80	120.00	160.97
General nerve block	41.04	34.86	45.49	31.16	35.28	46.14	35.27	37.64	36.35	20.00	30.81
Surgery rate (per 10 min)	85.71	82.91	87.48	73.93	78.31	101.29	58.43	87.38	74.36	103.33	53.83
Dentistry (complete procedure)	383.28	388.70	509.64	381.82	316.75	431.93	234.54	362.99	307.94	254.00	345.56
Cystocentesis	32.92	33.77	38.05	27.04	27.77	32.42	31.25	42.44	31.53	36.00	26.11
IV catheterization (24 h)	129.99	125.44	135.72	126.07	110.66	145.08	105.53	131.82	109.31	117.33	91.50
Euthanasia (catheter, medication)	125.05	116.97	135.87	108.14	82.55	147.18	97.48	101.95	89.70	89.33	60.89
Hospitalization (over night 13.6 kg dog)	75.69	62.60	83.87	51.51	50.62	92.54	57.36	64.89	39.03	80.00	33.40
Dispensing fee	13.48	13.21	12.03	10.43	10.57	16.42	9.45	13.30	14.25	9.51	11.75
Pet food markup (cost ×)	1.43	1.44	1.44	1.49	1.47	1.43	1.41	1.43	1.45	1.48	1.48
Pharmacy markup (cost ×)	2.00	2.0	2.0	1.9	1.8	1.9	2.0	2.0	2.0	1.7	1.9
Lab markup	2.0	2.0	2.0	1.6	1.8	2.0	2.0	1.9	2.0	2.0	2.0
Average fee index (Canada =100)	100	95	112	87	85	115	73	93	85	88	72

CBC — complete blood (cell) count; BC — British Columbia; AB — Alberta; SK — Saskatchewan; MB — Manitoba; ON — Ontario; QC — Quebec; NS — Nova Scotia; NB — New Brunswick; NF — Newfoundland & Labrador; PEI — Prince Edward Island.

Looking at these two provinces with vastly different fees it begs the question, “Who has the right fees?” Are the fees in British Columbia too high or are the fees in Prince Edward Island too low? Before that question can be answered there is an important difference that has to be accounted for; the cost-of-living is a lot higher in British Columbia than it is in Prince Edward Island. According to Statistics Canada, the average family in British Columbia spends 27% more than the average family in Prince Edward Island (2). This suggests veterinary fees (and every other fee) could be 27% higher in British Columbia and the family spending the money would feel the same as the same family in Prince Edward Island. Using this information from Statistics Canada, we can adjust all the fees for the different cost-of-living in all the provinces (Table 2). After the adjustment we find that neither British Columbia nor Prince Edward Island has the right fees. Compared to the rest of the country veterinary fees in both provinces are too low.

Table 2.

Fees adjusted for cost-of-living, with the Canadian average as 100

CND	100
ON	110
NS	102
NB	98
NF	97
AB	96
MB	94
BC	92
SK	91
PEI	87
QC	82

With the costs-of-living adjustment on fees, Ontario has the highest fees in the country followed by Nova Scotia. Not too far behind Nova Scotia are New Brunswick, Newfoundland, and Alberta; three very distinctive provinces all with very similar fees. British Columbia and Prince Edward Island can both be found near the bottom of the list with 5% separating them after making the cost-of-living adjustment.

Interestingly, the average fee index portrays a clear ranking but within those ranks there are enough outliers to suggest the ranking or the fate of a province and their fees is subject to change. If you look at the average provincial fees for each procedure in the survey, you will find that even after the adjustment is made for the cost-of-living, Ontario and Nova Scotia do not dominate the list. In fact 9 of 10 provinces are listed as having the highest average fees for 1 or more specific procedures (Table 3). The cost-of-living adjusted examination fee is highest in New Brunswick. New Brunswick also holds top spot for canine vaccine fee but the highest feline vaccine fee is found half way across the country in Manitoba. Ontario only holds top spot for 5 procedures and Nova Scotia holds the top spot in 4. This variation in specific fees suggests that the difference has less to do with regional economics than many suspect. In fact, an even stronger argument for harmonized fees can be found comparing markups.

Table 3.

Province having the maximum fee per procedure

Complete physical examination	NB
Canine vaccine	NB
Feline vaccine	MB
Elective surgery	ON
X-ray fee for set-up/2 plates	NS
CBC (differential)	NS
Blood collection	ON
Complete urinalysis	NS
Anesthetic induction + 30 min	BC/ON
Surgery rate (per 10 min)	NF
Dentistry (complete procedure)	AB
Cystocentesis	NS
IV catheterization (24 h)	NS
Euthanasia (catheter, medication)	ON
Hospitalization (over night 30 lb dog)	ON
Dispensing fee	NB
Pet food markup (cost ×)	PEI
Pharmacy markup (cost ×)	NB
Lab markup	NF

CBC — complete blood (cell) count; BC — British Columbia; AB — Alberta; MB — Manitoba; ON — Ontario; NS — Nova Scotia; NB — New Brunswick; NF — Newfoundland & Labrador; PEI — Prince Edward Island.

If regional economic variations really drove veterinary fees then we should see the same difference in markups that we see with professional services. If the cost-of-living is 27% higher in British Columbia then shouldn’t veterinarians in Prince Edward Island have lower markups on drugs and medications, food, and referral lab fees? They don’t. The average pet food markup is higher in Prince Edward Island than British Columbia, the pharmacy markup lower by a factor of 0.1, and the referral lab markup is identical. After accounting for differences in the cost-of-living, pet owners in Prince Edward Island are paying a lot more.

One of the biggest advantages of a national study is the ability to compare and contrast metrics in each of the provinces. Both inconsistent regional differences in fees and similarities in markups across the country give strong evidence that even in the face of trying economic times, there is still an opportunity to raise fees.