Why I Reject KPIs in Veterinary Medicine for Better Care

I need to be honest with you about something that’s been weighing on me throughout my entire veterinary career. It’s uncomfortable, it’s controversial, and it’s one of the main reasons I started Personalised Mobile Vet.

Every single clinic I’ve worked for has based my pay on financial performance.

Not on patient outcomes. Not on client satisfaction. Not on the quality of care I provided or how well I worked with my team. The numbers that mattered were: average consult fee, number of lab tests ordered, number of surgeries performed, total value of those surgeries, and overall revenue generated.

When I asked for a pay rise, those were the figures pulled out to justify why I didn’t deserve one. Year after year, despite inflation, despite growing experience, despite doing what I believed was right for the animals in front of me—I was told my numbers weren’t good enough.

The Profession Admits the Problem

I’m not alone in recognising this issue. Dr. Robert Esplin, owner of a large practice in Ohio, put it bluntly: “I’ve always thought that unless you’re very busy, production compensation pits associates against each other. They worry about who gets what. They come in on their day off to do the gravy surgery. It turns them into accountants. Being human, often with a large student debt load, they may have a tendency to overprescribe and overrecommend.”

Dr. Justine Lee, a board-certified emergency and critical care veterinarian, was even more direct about what she’s witnessed: “The more dangerous con of commission? It may potentially make you sell or push towards more expensive diagnostics or procedures in an unethical manner, or fight with colleagues over ‘who gets the ultrasound.’ Sound trite? It’s real. I’ve seen people admit cases where owners have significant financial constraints when realistically, that patient may have sufficiently responded to ‘street medicine’ in the form of subcutaneous fluid therapy and antibiotics. Likewise, I’ve seen veterinary staff fighting over who gets the ‘tick titer.’”

She also described vets hovering over technicians while they filled out invoices to ensure their provider codes were properly recorded. I’ve seen this too. I’ve lived it.

The Behaviours This System Creates

In multi-associate clinics, there’s definite competition for the potentially high-income cases. The really sick pets, the imaging cases, the surgical cases—these are highly sought after. I’ve witnessed vets swapping appointments between columns in the schedule or influencing admin staff to swap appointments in their favour to boost their KPIs.

As a locum, I’ve had employers literally stand over my shoulder while invoicing, ensuring all possible charges were included—even after an estimate was given to the client, pushing the final bill over what they’d agreed to pay.

Dr. Marsha Heinke, a practice management consultant, warns about this: “Too much emphasis on performance incentives can lead to ‘unattractive behaviour.’ Too much emphasis on the pocketbook can lead to gouging clients for services, ignoring situations that won’t generate fees, and fighting over clients or lucrative cases.”

Another consultant, Owen McCafferty, noted that practices monitor vets for undercharging, “but only the best monitor for overcharging.”

The Research That Doesn’t Exist

Here’s what’s staggering: despite production-based pay being used in approximately 77% of veterinary practices in the United States, there are no peer-reviewed studies examining how this compensation structure influences treatment recommendations or affects patient care.

The profession has widely adopted a system that openly incentivises revenue generation without ever researching its ethical implications or impact on animal welfare.

We’ve just… accepted it.

The Moral Dilemma

This culture left me in an impossible position. I recommend what I was taught and trained at university—evidence-based medicine that prioritises what’s best for the pet. If the client’s budget can’t accommodate that, I work with them to dial it back to an affordable level while maintaining appropriate welfare. But when diagnostics or treatment have to be scaled back too far to fit the budget, and the animal’s welfare is diminished as a result, serious discussions occur.

Those conversations are stressful for everyone. The client seeks financial aid, applies for payment plans, or—heartbreakingly—chooses euthanasia as the “treatment.”

And through all of this, I was being told I wasn’t generating enough revenue. That my numbers weren’t high enough. That I didn’t deserve a pay rise because my KPIs were lacking.

I was being penalised for practicing what I believed was appropriate, welfare-focused medicine.

There’s no consideration for non-tangible aspects like teamwork, client perception, communication skills, or compassion. It’s all about the numbers. You’re faced with a choice: boost your pay packet by overcharging and over-recommending, or practice morally appropriate medicine and suffer financially.

This culture burned me out. Not once, but multiple times. It’s one of the major reasons I decided to become my own boss, despite the challenges that come with that.

How PMV Is Different

When I’m examining your pet and making clinical decisions at PMV, revenue, profit and loss statements, spreadsheets, and KPIs are not part of the equation. I don’t track my “average consult fee.” I don’t have targets for the number of blood tests I should be ordering. There’s no black cloud of performance metrics hanging over my head while I’m trying to figure out what’s wrong with your pet.

I believe this genuine, transparent care breeds trust.

If you get even an inkling that a vet is recommending something that may not be needed, or over-prescribing, or overusing diagnostics to hit targets, you lose trust. You’re less likely to follow recommendations. And at the end of the day, the pet suffers.

At PMV, I’m not performance-based—I’m welfare-based. When I recommend diagnostics or treatment, it’s because I believe it’s what’s best for your pet, not what’s best for my bottom line. And when your finances can’t provide the level of care I believe is appropriate, I discuss that openly with you. We talk about what we can do, what we can’t do, and what the implications are for your pet’s welfare.

The Uncomfortable Truth

I’ll be the first to admit: mixing money and medicine is my least favourite part of this job. Unfortunately, it’s necessary. Businesses need to maintain profit to stick around to help your pet. Veterinary medicine is expensive—there’s no escaping that. Equipment, medications, insurance, continuing education, staff, facilities—it all costs money.

But I believe if you practice good medicine, profitability should be possible without constantly having KPIs as a black cloud over your head while making clinical decisions. You don’t have to go over the top. You don’t need to do more than what’s actually needed.

Where Patience Meets Care

This is why PMV exists. This is why I reject KPIs as a core value. This is why there are no time limits on appointments, no pressure to see more patients, no targets for revenue per consult.

Because when I walk through your door to see your pet, I want you to trust that every recommendation I make is genuinely in your pet’s best interest—not mine.

That’s the kind of care I wish I’d been able to provide in every clinic I worked in. That’s the kind of care your pet deserves.

And that’s the kind of care that’s only possible when medicine and money are kept as separate as they can be.

Reference list

Moses, L., Malowney, M.J., & Wesley Boyd, J. (2018). ‘Ethical conflict and moral distress in veterinary practice: A survey of North American veterinarians’. Journal of Veterinary Internal Medicine, 32(6), pp.2115–2122. Available at: https://onlinelibrary.wiley.com/doi/10.1111/jvim.15315 (Accessed: 10 December 2025).
Batchelor, C.E.M. & McKeegan, D.E.F. (2012). ‘Survey of the frequency and perceived stressfulness of ethical dilemmas encountered in UK veterinary practice’. Veterinary Record, 170(1), pp.19. Available at: https://veterinaryrecord.bmj.com/content/170/1/19 (Accessed: 10 December 2025).
Lee, J. (2018). ‘The pros and cons of commission-based pay in veterinary medicine’. VETgirl Blog. Available at: https://vetgirlontherun.com/the-pros-and-cons-of-commission-based-pay-in-veterinary-medicine/ (Accessed: 10 December 2025).
Heinke, M.L. (2011). ‘The ugly side of production-based pay’. DVM360. Available at: https://www.dvm360.com/view/ugly-side-production-based-pay (Accessed: 10 December 2025).
American Veterinary Medical Association (AVMA). (2019). ‘Economic Report on Veterinary Compensation’. AVMA. Available at: https://www.avma.org/resources-tools/reports-statistics/market-research-statistics (Accessed: 10 December 2025).
UK Competition & Markets Authority (2024). ‘Veterinary services market investigation: Statement of issues’. Competition & Markets Authority. Available at: https://www.gov.uk/cma-cases/veterinary-services-market-investigation (Accessed: 10 December 2025).