Revisions clarify unethical practice of fee-splitting

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The Executive Board approved revisions to the Principles of Veterinary Medical Ethics of the AVMA, more clearly defining the unethical practice of fee-splitting.

The most notable change to the principles is in section IX, which now includes the following statement: "It is unethical for veterinarians to engage in fee-splitting. Fee-splitting is defined as payment by a referral veterinarian of part of their fee to the attending veterinarian who has not rendered professional services. Under this definition, the use of consultants, laboratory services, and online pharmacies does not constitute fee-splitting."

Fee-splitting is considered unethical because it involves a veterinarian receiving financial compensation for services or products that he or she did not render or dispense, explained Dr. David Beauchamp, Judicial Council chair.

While it is not known how common fee-splitting is, several AVMA members have asked the Judicial Council for an opinion in this matter, Dr. Beauchamp added. After careful review of members' questions, the council decided the best course of action was to modify the PVME to better clarify differences in fee collection when an attending veterinarian asks for assistance from a consulting veterinarian versus when the attending veterinarian refers a patient to a referral veterinarian for treatment.

Specifically, a modification was made in section IV, part B (1), to indicate that because the use of a consulting veterinarian does not create a new veterinarian-client-patient relationship, collection of a fee by the attending veterinarian from the client for the consultation would not be considered fee-splitting. In contrast, PVME section IV, part C, states that a new veterinarian-client-patient relationship is established when a patient is sent to a referral veterinarian. As a result, the referral veterinarian should collect his or her own fees from the client, independent of the attending veterinarian.

The second revision was made in section IX, part B, of the principles to make a clearer distinction between attending and referral veterinarians versus consultants, laboratory services, and online pharmacies on the matter of fee collection.

During discussion the council noted that as originally worded, the section may not have been in keeping with contemporary veterinary practice. In light of this, the Judicial Council sought additional input from the Council on Veterinary Service on the adequacy of direction provided regarding fee-splitting in the PVME.

After review of COVS input and subsequent deliberation on the distinction between markup and fee-splitting, the Judicial Council recommended revising the PVME.

With scientific advances in veterinary medicine comes the opportunity for commercial and financial advancement, Dr. Beauchamp said. "The AVMA Judicial Council recognizes this development within our profession and has made proactive modifications in the PVME to guide our AVMA members to maintain the highest caliber of conduct in their professional lives," he said.