It all started with the consultants nagging us to raise our prices,” the kindly veterinarian lamented. He and his friends shook their heads mournfully and looked at the floor. There was a sense among everyone that they had done something wrong. We had just finished watching a lecture on declining pet visit numbers, the rising cost of medical treatment, and how using artificial intelligence is essential to making veterinary medicine both sustainable and moral in the near future. Later, on my phone, I read social media posts telling pet owners that upselling is a common problem in veterinary medicine and that they need to push back on “all the tests” veterinarians want to do.
The guilty feelings I sensed about the cost of care reminded me of an interview I recently did. One of the hosts asked me, “If we have all these opportunities to use AI to cut costs and give clients what they want, why aren’t we just doing it?” His implication seemed to be that we willfully hold out on helping clients by not embracing new technology and that we discarded our traditional standards of medical care. My strong feelings didn’t align with the interviewer’s, but I struggled to articulate my concerns.
For years, I have advocated meeting clients where they are and taking a contextualized approach to veterinary care. I never want an adversarial relationship with pet owners, I don’t want pets to become a luxury item, I am troubled by the declining number of visits to many clinics, and I’m very open to change and innovation. So, why do I increasingly react negatively when I hear that veterinarians should:
- Reduce our focus on the highest medical standards?
- Stop insisting that we be directly involved in delivering care?
- Make affordability and client convenience our primary objective?
The answer is, while our mission depends on pets having access to veterinary care, affordability and convenience are not our primary objectives. While we should advocate for the highest standard of care possible for each patient, I worry that such a focus is starting to be vilified. Also, there are good reasons we have regulations around who can provide medical care and how they must do it.
Veterinarians are here to do the best we can to advocate for animal welfare, relieve suffering, and promote public health. Affordability and convenience are tools to serve our greater purpose, but they are not the point in private practice.
The Nail Factory
I first heard the story of the Soviet Nail Factory when I was a kid. A patrol leader in the Boy Scouts, I had led the charge to gather firewood. I think the instructions I gave were simply to collect as much wood as possible. Somehow, I led us astray, and what we needed to make an actual campfire got lost. Instead, the exercise devolved into a competition over who could drag the biggest logs into the campsite. If you know much about 12-year-old boys, this is not surprising.
After 20 minutes, we had a collection of rotted, wet, mastiff-sized stumps lying around. We had no tender, kindling, or fuel wood. We only had soggy logs that would never catch fire. After we tired ourselves out, one of the adults told us the story of the Soviet Nail Factory.
It goes like this:
In the 1950s, Soviet factory workers were instructed to make nails. They were told that their success would be measured by how many nails they could produce in a day and that they had better make their quota. In response, the factory workers cranked out piles and piles of cheap nails no bigger than thumb tacks. The numbers were impressive, but the nails were useless.
The Soviet leadership was infuriated and changed the measurement of success. Workers would now be held accountable based on the weight of the nails they created. No more flimsy nails!
In response, the workers created a single daily nail the size of a truck. It was equally useless.
The lesson for the young campers was that we must be careful not to let our measures become our goals. At the campsite, we focused on finding the most wood and lost sight of the goal of building a functional campfire.
I worry that, in veterinary medicine, we risk forgetting that innovation, affordability, and convenience are critical ways to measure our delivery of care. However, they are not our goal.
Affordability and Access Are Problems
The hard truth is that prices for veterinary care are rising rapidly while the average number of visits is declining across the industry. While I think it’s possible the decline in visits disproportionately affects the clinics that led the way in raising fees, the overall trends are undeniable.
During the lecture I watched with the veterinarians, one of the most engaging points occurred when the speaker talked about taking his own blocked cat to an emergency clinic. He was a veterinarian by training and knew exactly what was going on with his cat. He understood what the emergency doctor recommended and, given that he was in an urban area, had braced himself for an expensive visit. He did not, however, prepare himself for a $9,000 estimate. The treatment plan included three days of hospitalization and the best standard of care. In a room full of small-town South Carolina veterinarians, the price was hard to stomach.
The average veterinary bill in the United States was roughly 60% more expensive in 2024 than in 2014, while general inflation rose about 30% over the same period. When our clients say the cost of care is going up faster than their paychecks, they are not wrong. Those of us who want pets to get treated have a problem on our hands.
Putting Costs Into Context
Before we all panic and cut costs by burning to the ground our standards of care and our regulatory structure, I need to point out that a huge part of the access-to-care problem has nothing to do with us. Outside of veterinary medicine, prices for everything are increasing. Things like groceries, hotels, home repairs, electricity, and human health care are all markedly more expensive now than in recent years. I’m currently looking at college tuition costs, which are stratospheric compared to when I went to school.
While the U.S. economy appears strong based on economic metrics and the stock market, real people are feeling financially pinched across almost all aspects of life. Consumer sentiment plummeted in 2024 to near all-time lows. Yes, people’s finances are stretched thin when they come into our clinics, but most of the stretching occurs elsewhere as resources are consumed by the costs of living that don’t involve animals.
I’m not blaming clients for having priorities beyond their pets, or pretending our prices aren’t rising. I’m saying we need to:
- Put any guilt we feel about rising prices into a larger perspective.
- Remember that we must support our employees who live in this economy.
- Emphasize there is no quick fix for pet owners’ economic pain.
We should be intentional about how we address the challenges of access to care and be alert for opportunistic advocates who seek to benefit from a public perception that high prices are a veterinary-specific crisis demanding radical industry reform.
Beware Opportunistic Advocacy
I recently noticed my younger daughter talking a lot about what will happen when her older sister leaves for college in the fall. The gist of her statements seems to come back again and again to how lonely my wife and I will be with just one kid in the house. My wife and I puzzled over why our youngest brought it up until the answer was made apparent. “You know,” she finally said, “I bet you and Mom would feel a lot less lonely if we had another dog.”
It’s true that my wife and I will be lonely. It’s also true that, in the short term, having a puppy would distract us. However, a desire to mend our loneliness is not the primary reason my daughter talks so solemnly about her sister’s departure. While she cares about her parents, she’s primarily advocating for our well-being because she wants a puppy that someone else (me) will take care of. This, my friends, is opportunistic advocacy.
In the veterinary world, opportunistic advocacy might take the form of a boarding facility advertising its new nonanesthetic dentistry as being cheaper than what pet owners get at their clinic. It could also be an online pharmacy “helping pet owners” by lobbying to allow the purchase of pet medications without a physical examination, or a veterinary practice group that wants to amend the state practice act to allow more appointments with fewer veterinarians. Any solution to affordability that doubles as a massively scalable revenue stream is probably opportunistic advocacy and should be considered carefully.
To be clear, I’m not saying great ideas cannot be profitable ones. That is the aspirational goal of capitalism. Advocacy for affordability and access to care is something we should all support. However, we should cautiously weigh advocacy against alterations to state veterinary practice acts, requirements for veterinarian-client-patient relationships, and reductions in veterinary public health imperatives. Those guardrails are vital for patient safety and public health. Once they are bypassed in the name of customer convenience and affordability, there is little chance to reestablish them.
What’s More Important Than Maximum Accessibility?
Three aspects of veterinary medicine are equally important in keeping care affordable. They are providing a living wage to our staff, protecting public health, and advocating for patients.
When the kindly veterinarian said the troubles began with consultants advocating price increases, I told him I didn’t agree. Until fairly recently, veterinarians did a terrible job of paying themselves and their staff. The pay received by support staff 20 to 30 years ago is frankly embarrassing. Even today, we struggle to create salaries that justify the student debt loads carried by new veterinarians and technicians.
I interviewed Beckie Mossor, the 2025 president of the National Association of Veterinary Technicians in America, about the organization’s job-satisfaction survey results. I asked why job satisfaction had fallen so sharply as technicians’ pay increased. She told me that relatively low wages largely drive falling satisfaction levels and that recent increases across the industry were “lipstick on a pig.” According to her, veterinary decision-makers have a long way to go when it comes to caring for the humans they rely on.
Alternative Protocols
As for the humans who rely on us, our public health mandate must be weighed against efforts to disrupt the industry by lowering prices. For example, using antibiotics to empirically treat a pet for a possible urinary tract infection is less expensive than first doing a urinalysis and much cheaper than a urine culture. The problem becomes poor antibiotic stewardship, while celebrating (or even normalizing) that standard of care can have significant consequences for public health.
Relatedly, a veterinary dermatologist I know has advocated culturing for bacteria before using either cefpodoxime or cefovecin, as both are third-generation cephalosporins. I don’t think she expects it to become our standard of care but instead hopes to raise awareness of what veterinarians do when they reach willy-nilly for the most convenient treatment options. That is why calls to perform more cytology and bacterial cultures before prescribing antibiotics are increasing across almost every specialty. While we know not all clients can or will pay for the diagnostics we recommend, we must not abandon our responsibility to advocate for public health.
Finally, we must do everything in our power to avoid putting financial concerns above what is best for patients. As I graduated from veterinary school almost 20 years ago, one of my best friends went to work for a doctor who insisted that postsurgical pain medication should be an optional add-on for clients. When my friend pressed him on changing the policy, he said, “No, the clients will believe we are ripping them off.” Ultimately, my friend got the policy changed.
We need to remember that medicine was in a different place 20 years ago. However, I haven’t forgotten how I felt hearing about the well-meaning veterinarian’s patients who didn’t get pain control after surgery because he wanted to keep prices down.
Over the course of my career, I have seen countless examples of veterinarians who assumed clients might be experiencing financial hardships and thus downplayed or didn’t recommend the optimal treatment plan. I know I was probably one of those doctors. While there might be veterinarians who knowingly encourage clients to do more than is needed to achieve optimal patient outcomes, they are aberrations. Our professionis a kind and generous one that cares deeply about our patients and their families. We don’t need to be made to feel guilty about what things cost as we try to act ethically.
In the lecture where the speaker discussed his $9,000 estimate, he noted that research shows that cats treated as outpatients (at a significantly lower cost) have a 31% reblock rate. Blocked cats hospitalized and treated as inpatients had an 11% reblock rate. The speaker said the outpatient approach costs about one-third the price and that a 31% recurrence rate is quite low. He advocated using artificial intelligence to identify opportunities to save pet owners money by presenting them with options like outpatient care.
That is valuable knowledge for us, and we should clearly communicate options like this to pet owners. At the same time, as the patient’s advocate, I need to point out that deciding not to hospitalize means the pet owner is three times more likely to end up in another emergency when his cat reblocks. I don’t want the client to feel guilty if hospitalization isn’t possible financially, but I think we owe it to cats to make the point.
Finally, imagine for a moment that one of your family members had to choose the medical care you urgently needed. Would you want your doctor to focus on and emphasize low prices? Or would you want your doctor to gently push for what she thought was most likely to result in the best outcome for you, and then work down from there?
Finding the Balance
Think of all the infected, neon-red, pus-filled ears that would get eardrops but no pain medication if veterinary professionals didn’t advocate for the extra expense. Consider the pet owners who, unaware of all the implications, would happily sign up for nonanesthetic dentistry or opt out of vital dental radiographs if the option were presented flippantly. How many pet owners would be happy never to test their dog for heartworms again if it weren’t required to stay on a preventive?
A customer’s desire for lower prices is understandable. Still, we must remember that clients do not have the medical training to fully assess the short- and long-term ramifications of every medical decision we might ask them to make. We also must remember that our patients cannot speak for themselves and that their owners do not and will not ever know what their furry family members would say. That’s why our advocacy role is so important. We understand better than anyone else the condition of, and the consequences for, our patients.
I am excited about the potential for innovation and evolution in veterinary medicine. I believe new technologies, services, and business models will emerge to help us match quality care with the diverse needs and resources of modern pet owners. I also think we can do these things without making anyone feel ashamed or taking an adversarial stance in the exam room. We must not be resistant to change, nor can we dismiss concerns about the increasing barriers to care.
At the same time, we must remember that affordability and convenience also measure how we achieve our goals as healers and advocates. If we want to make meaningful progress in the fight to keep medicine accessible to the general public, we must first define what we are not willing to give up. We must remember we are advocates for those who cannot speak for themselves. We are also the line that separates society from endemic and zoonotic diseases.
We are not here to maximize profits or get drugs into the hands of pet owners as cheaply as possible. Our purpose is greater than one-click shopping and quarterly earnings.
FASTENER FACTS
According to The Craftsman Blog, “Until the 18th century, nails were individually hand-forged by blacksmiths. Skilled blacksmiths would heat iron or steel rods and hammer them into shape, creating nails with heads and points. It was slow and expensive and resulted in a huge disparity in the quality of each nail.”
BE A BETTER LEADER
Dr. Andy Roark has partnered with VetFolio to release the Uncharted Leadership Essentials Certificate. The program provides training appropriate for anyone who leads or manages others. The topics covered include setting a team’s vision and values, building trust, achieving team buy-in, delivering feedback, understanding communication styles, setting priorities, delegating effectively, and managing time. Learn more at bit.ly/Uncharted-VetFolio.
PRACTICAL TECHNIQUES
Today’s Veterinary Practice published a peer-reviewed, step-by-step guide to the surgical intervention of the blocked male cat. Learn more at go.navc.com/4j75g1Y.
STORY ARCHIVE
Veterinarian and award-winning columnist Dr. Andy Roark has contributed to Today’s Veterinary Business since 2017. Among his articles are these: