I have been a lawyer and a consultant for small businesses for decades, and at no time during that period could anyone accuse me of being a champion of labor unions. I'm no lover of big government either, but that doesn't mean that I don't see an important role in our society for both government and labor organization—each has positive attributes that the private sector and small business can learn from.
One admirable characteristic of both effective government and honest collective bargaining is that they tend to elicit transparency. If it weren't for the government, employers would not be required to inform their employees of their rights under the workers' compensation and disability laws. And organized labor has helped force large-scale employers to provide critical information about workplace health risks to their workers. The best disinfectant is sunshine, and there are many examples where openness has proved to be beneficial to both public and private employees.
What can we non-union veterinary folks learn from public and union employees and their efforts? We can see that the key to fairness in the workplace is the disclosure of information critical to employees—in other words, transparency. So what sort of information can organized labor count on that may be hidden (or unintentionally withheld) in the veterinary workplace? All sorts. Here are a couple of anecdotes to make the point:
In a recent veterinary associate contract negotiation my office was involved in, the employer offered no details about the health insurance coverage called for by the contract. The agreement merely said that there would be coverage. The associate didn't think much about the fact that the practice owner didn't provide insurance information. I asked, "Is the carrier Blue Cross of Bob's Health Insurance and HMO Company?" The associate didn't know. "Is your domestic partner covered?" Well, he hadn't thought about that. "If you don't pass the physical and can't get coverage—trust me it happens—do you get added compensation to seek your own coverage in lieu of the employer's policy?" The associate didn't know that could be an issue. My position is that because health insurance can value up to 20 percent of an actual salary, the employer should provide coverage details so an associate candidate can make an educated decision about whether to take the job.
Another client came to me not long ago because he was preparing to give notice to his employer and wanted to be sure he had received all the pay and benefits he was entitled to over the last five years under his automatically renewing contract. The agreement called for a base salary and a percentage bonus for individual production in excess of a certain amount. I asked him if he had been receiving production bonuses and he told me that he had every year. "Are you satisfied with the calculation of the bonus amounts as they relate to your personal production?" I asked. The client wasn't sure what I was talking about. He just got a check somewhere between three and six months after New Year's Day each year. His employer never supplied him with any details about his production, so it was impossible to tell whether all of the contractually obligatory bonus money had been paid.
These situations never happen at my house. Every September, my wife comes home from the first day of school with an armload of information from her school district detailing the ins and outs of her (our) health insurance coverage. The union demands it. Also, she recently had a question about pension credit for a few days of substitute teaching she did 20 years ago. The district researched it and provided the information right away. The state government requires that.
So my thought is: what's fair for public employees should be fair for private ones as well. And it's really in the best interests of veterinary hospital owners to be forthcoming with information that associate doctors—and minority partners or shareholders—are entitled to. It demonstrates goodwill when a practice supplies important work-related documentation without being asked, then nagged, and then eventually sued. Associate veterinarian candidates can urge and cajole future employers into being forthcoming about key information before they take the job. They can do this by politely insisting that certain transparency terms be included in the employment contract. Here are some of the important items to request be included in the language of a proposed employment contract:
1 Provide monthly or quarterly personal productivity figures
If an employer bases an associate's compensation partly or solely on individually generated revenue, then an implicit agreement exists between the employed veterinarian and the practice. The employed veterinarian will work hard to generate income for the practice, and the practice will let the veterinarian know how much revenue was used to calculate his pay.
All production-based veterinary employment contracts should mandate that employers supply production numbers to associates. In fact, employers who pay based on production are legally obligated to provide production figures. But many do not. When the contract specifically calls for the information to be provided, it makes it far less uncomfortable for the associate to request the numbers. If the contract does not state such a requirement, the boss still has to come up with the figures at some point: a claim against him under the labor law would be a slam-dunk. Yet what's the point of straining the work relationship with a lawsuit—or the threat of one? Get it in the contract.
2 Offer up case-by-case client transaction information
There's more to using a productivity-based compensation system than simply telling an associate to work harder next quarter and to get a larger bonus. It's difficult or impossible for an employed veterinarian to know why his productivity isn't what he and management would like it to be. If the doctor only knows that his quarterly numbers are low, he doesn't have enough information to determine what he needs to do to improve.
Transparency includes complete revenue production information, including the number of client visits, revenue that's generated through surgical procedures, medication revenue and so on. Absent this information, it's fairly meaningless for a boss to say, "Unless your production rises, we can't afford to keep you on." Does the associate need see more patients? Operate faster? Socialize less in the exam room? Come in earlier? Without detailed transaction data, it's nearly impossible to know.
3 Give access to client lists—but monitor them closely
One reason practice owners give for keeping transaction information close to the vest is that they don't feel comfortable giving an associate a list of clients for any reason. Even when a noncompete agreement is in force, practice owners are notoriously careful about who has access to client lists. This really doesn't need to be a problem. Supply detailed client transaction data to associates for them to review in the hospital under the observation of managerial staff. The doctors can look over the client transaction information and take notes. Smart associates should insist on this quality time with their individual practice transaction data. Why?
When an associate doctor can spend meaningful time with a list of her recent client transactions and information about the fees she's generated, it helps her to see where the practice missed a charge or undercharged for a procedure. She can also make certain she's receiving production credit for all the items her employment contract stipulates. If the associate knows the client's name and can review the charge history closely, it becomes clear as to whether she indeed received appropriate production credit for prescriptions, refills, medicated baths, e-collars, prescription diets and other items that aren't strictly medical services but should inure to her benefit at bonus-calculation time, per the employment contract.
4 Provide some data on other associates
The economy has changed since 2008, and I know this from the types of disputes and issues that come into my office. In 2007, I was hearing from veterinarians who felt they should get higher salaries because their employers were giving them too many cases to handle. Now the situation has switched: Doctors are nervous their employers are not giving them enough cases to allow them to generate a personal bonus. Multi-doctor hospitals are experiencing disputes among associates who claim that one doctor is grabbing appointments from others in order to generate a higher production number.
The solution? Associates who are concerned about their personal revenue generation should be granted access to at least minimal information about the number of clients other associates see in the practice and their average transaction amounts. While names don't need to be attached to these computer-generated transaction figures, this data can help point out where production inequalities lie and how far off out of balance they are.
Dr. Christopher Allen is president of Associates in Veterinary Law P.C., which provides legal and consulting services to veterinarians. Call (607) 754-1510 or e-mail [email protected]