We have met the enemy—and he is us. We are destroying our profession by continuing to pile up a monumental deficit in self-esteem. Published studies have documented that from the time of admission to veterinary college, student self-esteem falls further with each year of training. Then graduation tosses the new graduate into the clutches of experienced practice owners who may denigrate his or her state-of-the-art skills.

In many parts of the country, veterinarians and their teams are underpaid and struggling to meet expenses. However, my consulting experience shows that practice owners often have to be dragged into greater profitability. So many want to play zebra, mixing in with the rest of the anonymous herd—trying to charge just enough to get by—not only avoiding the attention of the prowling competitors but failing to provide for their family and themselves the financial comforts so easily in their grasp.

Veterinarians, by and large, adjust their fees only under duress and seldom ask accountants for advice. Veterinary management consultants are also seldom consulted, even when the bottom line starts playing Titanic.

Fear is the destroyer

Is there a reader out there who hasn't experienced fear at raising office visit fees a few dollars? Did you not expect an avalanche of disgruntled clients storming in to get their pet's records and transfer to the competing hospital down the street? Did it happen? No! In fact, I can assure you that a 15 percent increase in non-shopped fees across the board would elicit complaints only from clients who would complain even if you lowered your fees. Yet, you and your staff remain like 80 percent of practices, dwelling in the deadly middle—underpaid and struggling.

To most Americans, the middle is the place for not the cheapest and not the best. Do you want that reputation? High prices mean high quality with great service. That's what clients want when their beloved finned, furred or feathered family member gets sick. Low prices mean low profit, no loyalty.

You need to be slightly above the rest with the perception of being the best in service and quality. The smartest and wealthiest practitioners today give their e-mail addresses to clients with hospitalized pets. They charge fees that are demographically correct without regard to competition, and they correct for inflation quarterly. Rarely is that e-mail abused, but loyalty zooms through the roof along with average hospital transaction.

Is there a glass ceiling for fees? Yes—and you set it! I have clients charging $450 for two radiographic views. I have clients charging $60 for any pharmaceutical injection. I have two clients in the same block where one insists on an IV line for any surgery but can't seem to get clients to agree to a pre-op EKG. Her neighbor insists on a pre-op EKG but can't get his clients to agree to an IV line. You set your own ceiling.

I know of a relatively small town with three veterinarians with exam fees of $38, $49.70 and $58.40. The higher-fee practice sees 24 percent more transactions per veterinarian than the second-highest. The lowest-fee practice just laid off her associate.