This one’s worth understanding regardless of who owns your clinic, because I think the honest answer surprises people. Veterinary care is genuinely expensive to deliver. And almost nobody in the building is getting rich on your invoice. (“In the building” is doing a lot of work in that sentence.)

The hundred-penny tour

There’s an old exercise practice consultants use with new owners: take every dollar the practice collects, break it into a hundred pennies, and start putting them in piles. Here’s roughly where they go at a typical independent practice. That word independent matters, and not as a boast: these benchmarks come from the practices that report their numbers, and the big groups generally don’t report theirs. The honest baseline available to anyone, me included, is a mostly independent one.

About half of those pennies go to the people - the veterinarians, technicians, assistants, kennel staff, and front desk. Add in the costs that ride on every paycheck - payroll taxes, health insurance, retirement contributions - and over half the dollar is already accounted for.

That is high compared to most places you spend money. Your grocery store spends a little over a dime of your dollar on its people. A full-service restaurant, which nobody thinks of as a low-labor business, runs about thirty-six and a half cents - that is the median for wages and benefits, from the National Restaurant Association’s 2025 Restaurant Operations Data Abstract. Veterinary medicine sits above both, and I’d argue the difference is because the “product” you’re buying is mostly the people themselves. You are not buying a thing on a shelf that someone marked up. You are buying trained people, their experience, and their time.

About 22 pennies buy the actual stuff of medicine: drugs, vaccines, lab tests, surgical supplies, special foods and supplements. This is the line inflation has hammered hardest - our suppliers raised prices dramatically over the past few years, and (as we’ve discussed) small practices pay more per vial than the 400-clinic group down the road.

Another eight to ten pennies keep the lights on and the roof over our heads: rent or mortgage, utilities, maintenance. Another eight to ten cover everything else it takes to run the place - the equipment written down a little each year (the X-ray unit, the dental machines, the lab analyzers, each a five- or six-figure purchase), plus software, insurance, licenses, continuing education, and of course the credit-card company’s cut of the very transaction you’re standing at - got to love the irony when part of your bill is a fee for the privilege of paying the bill.

Add those stacks up and you’ve allocated somewhere around 88 to 90 of the original hundred. What’s left - call it 10 to 12 pennies in a good year, fewer in a bad one - is the practice’s profit. At an independent clinic that margin goes towards things like the owner’s retirement, the next equipment fund, and the raise pool, all fighting over the short stack.

I should say where I’m standing while I write this. Our own numbers are not typical. We chose to build a new building to keep up with our growing clientele, so the roof over it costs us considerably more than the short stack of pennies typically set aside for that kind of thing. Add that to the premium we pay on supplies and the employee benefits, and our overhead sits at the unglamorous end of that range. Some of that is the cost of decisions I am glad we made. Some of it is just the price of being independent.

Why it still feels so expensive

Because you’re seeing something almost no American ever sees in human medicine: the actual price of care, all at once, with nothing standing between you and the number.

Your Frenchie goes down in the hind end and you’re given an estimate at the emergency clinic with a $3,000 line item for the MRI alone (surgery could be 3-4x that). The same scan on your own knee, run through a hospital, lands in much the same range - you just never see that bill, because it’s been laundered through premiums, deductibles, and an explanation-of-benefits nobody reads. So your brain compares that single line item not to its equivalent in human healthcare but to everything else you buy out of pocket. By that standard it looks enormous. By the standard of what it actually is - anesthesia, hospital-grade equipment, a trained surgical team, a radiologist’s interpretation - veterinary medicine remains one of the last bargains in American healthcare. We deliver something getting ever closer to human-grade medicine, and for the whole episode - surgery, anesthesia, days of hospitalization - at a small fraction of human prices.

That’s not an argument that every bill is fair. Nor is it a way of patting ourselves on the back for doing “God’s work.” It’s context for the sticker shock - and it’s why the profession has needed to get better at talking about money for a long time - and finally, slowly, seems to be.

Where ownership changes the math

Everything above describes the cost of delivering care - that part is (mostly) universal. What ownership further changes is what gets added on top and what gets squeezed below.

A consolidator’s practice carries costs an independent doesn’t: the debt service on the leveraged purchase, the management fees, the corporate office, and - above all - the return expectations of the fund that owns it. Those pennies have to come from somewhere, and there are only two somewheres: higher prices or lower costs.

We know that isn’t just theory, because one government checked. I went through Britain’s numbers in a previous issue, so I’ll keep it short: their competition regulator found equivalent services running 18.3% higher at the five biggest groups than at independents, and found that being acquired pushed a practice’s own prices up about 9% within four years, over and above where those prices were already heading. Not everywhere, and not every group. But inflation, wages and drug costs don’t explain it. Being bought does.

These rising corporate prices have buoyed independent prices as well though. When the market rate for an x-ray or an ultrasound climbs, everyone’s estimates climb with it. The tide lifted our prices too. But on average we’re forced to put more pennies in the labor and supplies stacks because our costs are generally higher than a consolidator’s. Or in our unique case, towards a higher mortgage.

Nobody’s bill is padded with villainy. The pennies just end up in different places, and it is worth knowing which.

At the end of the day, when that total feels like too much, you’re not looking at a markup on a bottle of pills. You’re looking at what it costs to keep a room full of trained people ready for whatever walks through the door - including, some days, your dog. That doesn’t make it cheaper. It makes it readable. And nobody asks a good question about a number they can’t read.

One more thing falls out of the arithmetic. If half your dollar is people, then people are the only stack big enough to squeeze. You can’t negotiate much off the drugs - the distributor sets that price, and the small practice pays more for them anyway. You can’t cut the building. The equipment is already bought or leased. So when someone needs to pull a return out of a veterinary practice, there is typically only one pile deep enough to be worth pulling from.

If the appointments at a practice near you got shorter, or the faces behind the counter keep changing, or nobody gets back to you the way they used to - it’s very likely that isn’t your imagination, and it isn’t anyone in the building being careless. It was the only place the money could have come from.

- Zach Smith VMD

Pet care, uncorporated.

Sources: UK Competition and Markets Authority (Veterinary services for household pets, final report, March 2026 - large-group price differential and causal acquisition effects) · dvm360 and AAHA/AVMA practice-management benchmarking (companion-animal expense categories and profitability) · AAHA/VMG Chart of Accounts · FVMA / EquiManagement, after Ann Dwyer DVM and Marsha Heinke DVM CPA (the 100-penny exercise, from which this framing is borrowed) · National Restaurant Association (2025 Restaurant Operations Data Abstract - full-service labor costs) · Earlier issues of The Independent Vet (supplier pricing, spectrum of care, and Britain’s numbers in full)

Right now, I am less certain about this entire topic than I was when I first started this endeavor, but I am more convinced these conversations need to be had. Each question I put to myself, to the veterinary industry, and to the public only seems to raise two more. And the simple fact that I started a newsletter about all of this, with no plan to end it after one arc, probably should have clued me in to where this letter was headed.

The shift itself is one of the few things we can be certain of: independent practices are becoming “corporate” at a pace that would have seemed impossible twenty years ago. I laid out the numbers in the first issue and they certainly haven’t gotten smaller since. But even something as simple as lumping all the buyers (“corporate”) as one villain is too simplistic.

A friend in business, nowhere near veterinary medicine, asked me that shockingly simple question I’m now ashamed to admit I hadn’t considered before: are there differences among “corporate” practices? Outside of independent owners, the two prominent ownership forms are corporations and private equity-backed groups. They are fundamentally different business models, and the cleanest way I can show it is a decision we just finished making at my own practice.

Our hospital spent the better part of a year choosing new software. Somewhere in that year I noticed I was spending less time comparing features and more time reading about ownership. It’s never been easier to build software and ship new features, and on pure capability the options have reached rough parity. Searching for distinctions, I kept landing on ownership, because who owns the software tells you what the software is for.

A system owned by a diagnostics laboratory exists, at least in part, to feed the laboratory. A system backed by a private equity firm exists to be sold. Usually within the better part of a decade, usually to a bigger firm or a bigger company, and the decisions made between now and then are shaped by what the eventual buyer will pay more for. And a system still owned by the people who built it, sometimes veterinarians themselves, exists to keep its customers, because customers are the only business it has. Independence isn’t a guarantee of anything either - small companies get bought, and ownership is a snapshot, not a promise - but the incentives at least point at the clinic, and through the clinic, at you. These aren’t secrets or scandals. They’re business models, and if you can see them clearly, you can plan around them. (As I write this, federal regulators are asking a version of the same question about a proposed merger of two of the biggest suppliers in the veterinary industry, partly over who would own a specific practice software that a significant share of American clinics run on - our practice has a horse in this race too, and I’ll come back to it in a future letter.)

None of this necessarily makes the software bad either. Some of it is excellent. But different owners want different things from the same product, and if you never ask the question, you never see the difference. Clinics work the same way. A corporation buying practices to operate them typically has a goal of running them for a long time and feeding other parts of their business. A fund buying practices to sell them wants them looking their best at exit. And in both scenarios, the important decisions happen away from the exam room, at a scale where the math is just different.

Does any of it change what happens to the animal on the table? Here the software parallel holds one more time: on what’s possible, I think there’s rough parity across the industry, regardless of who owns the building. But possible is not guaranteed, and nobody can prove the difference either way, because nobody is measuring.

Looking into this - looking for someone measuring, or even just a way to measure - it feels pretty hopeless at times. Those studies from human medicine that opened my last letter, the ones that could measure what happened to patients after private equity bought hospitals, didn’t exist because someone decided measurement was important. They exist because Medicare had to pay the bills. When a payer has to pay, somebody writes down things like what was wrong with the patient, what was done about it, who did it, and who owned the building. The ability to ask hard questions and find real answers falls out of it as a byproduct.

In our industry, nobody but you, the pet owner, has to pay for your dog. More than 95% of American pets are uninsured, and even for the ones that are, the model looks nothing like human health insurance. There’s no grand conspiracy here. There’s no payer, so no impetus to write it down, and no way to even ask the questions.

Which brings me to a conversation I keep having with anyone who’ll entertain me (which now includes you, dear reader), and the reason I feel this finale has turned into more of a beginning.

When I raise all of this inside the profession, the same question keeps coming back. It comes from people I respect, plenty of them doing excellent medicine in “corporate” practices: why does it matter so much that the public knows who owns the business I work for?

I’ve turned that over for months (years? it’s getting awful fuzzy…), because it deserves more than a comeback. The best answer I have is this: everywhere else you spend money, knowing who you’re buying from is the default. It’s on the sign, it’s on the label, it’s in the fine print somewhere. In the UK it is about to be the law for vet clinics too: regulators finished a two-year investigation of the veterinary market this spring, and among the required fixes, the big chains will have to make their ownership plain in the practice’s own branding.

Veterinary medicine here, meanwhile, has drifted into a strange place where the question itself gets heard as an accusation. It shouldn’t be one. A pet owner asking who owns the practice shouldn’t be alleging bad medicine. They’re asking the most ordinary question in commerce about one of the least ordinary things they’ll ever pay for.

Transparency shouldn’t be just a courtesy. It’s the first measurement. You can’t compare what you can’t sort, and I could not find a single clinical dataset, anywhere, that records who owns the practice alongside what happened to the patient. Which means every strong opinion about corporate veterinary medicine (and the public has plenty, and obviously I do too) is running on anecdote. Disclosure isn’t what we settle for while waiting for evidence. It’s where evidence starts.

So. Where do we go from here?

I can tell you where I go. My practice’s core prices are public. Its ownership is on the website: me and my family. I’ll also keep asking the measurement question of anyone who’ll take the call, software vendors included, because the recording has to start somewhere and the tools are closer to existing than most of us think. And I’ll keep having the uncomfortable version of this conversation inside the profession, because inside the profession is where it has to happen first.

For you: you can find out who owns your clinic. This can be as simple as one plain question at the front desk. What I can’t tell you yet is how much the answer should change your decisions. The evidence isn’t there. What I can tell you is that everything from the industries that do keep score says the question is worth asking. And the asking itself, multiplied across enough exam rooms, is how a default begins to move.

I called this arc Who Owns Your Vet Clinic. Five issues later, the honest summary is that finding out is possible, proving whether it matters isn’t yet, and the distance between those two facts is the work. Not just mine. The profession’s.

This isn’t the conclusion I planned. I think it might be better. Conclusions end things.

- Zach Smith VMD

Pet care, uncorporated.

Sources: Kannan S, Bruch JD, Song Z. Changes in Hospital Adverse Events and Patient Outcomes Associated With Private Equity Acquisition. JAMA. 2023;330(24):2365-2375 (analysis of 100% Medicare Part A claims) · Competition and Markets Authority, Veterinary services for household pets, final decision report, 24 March 2026 · NAPHIA State of the Industry Report 2026 (4.27% of US pets insured) · Ownership review of veterinary data resources including VetCompass (Royal Veterinary College), SAVSNET (University of Liverpool), CAVSNET (University of Minnesota), the VetCOT trauma registry (ACVECC), and insurance datasets in the US, Sweden and Japan: none records practice ownership as an analyzable variable · Bloomberg, FTC Reviews Covetrus, MWI Animal Health Merger for Antitrust Concerns, August 4, 2026

Falls rose 27%. Central line infections rose 38%. Hospital-acquired conditions overall went up about 25%. In-hospital mortality actually fell slightly, which sounds like good news until you read the authors’ explanation: those hospitals were admitting lower-risk patients and moving them out sooner.

These numbers describe human hospitals, not veterinary practices, but what matters is the shape of the thing. Somebody asked a hard question about ownership and got a real answer.

I can’t do that for the practice down the road. Neither can anyone else for any veterinary hospital in the country.

So this issue isn’t about what corporate ownership and private-equity backing has done to your pet’s care. It’s about how much anyone actually knows.

Usual disclosure: I own an independent practice, so I have an interest in one answer here. Weigh what follows accordingly. I’ve tried to write the version I’d still stand behind if the evidence went the other way.

What we can see without a study

More than I expected when I started looking.

The private equity-backed model has a recognizable shape, saying what it wants out loud in trade press and in materials written for investors. Formulaic investments. Rapid consolidation. Specific timelines. A singular goal: returns.

And some of what follows from that is documented, not alleged. Britain’s competition regulator spent two and a half years on the veterinary market and published the ownership map by name. Five of the six large groups own referral centers. Three own diagnostic labs. Three own online pharmacies. Two own crematoria. Two own the out-of-hours service. Those are the places their own practices send you.

In the same investigation, only 30% of pet owners said they were offered a choice of where to go when their pet was referred. The other 70% were simply sent somewhere.

None of that is about the person examining your dog. Those decisions get made a long way above the exam room.

What has been measured

We have to keep looking internationally to find anything that is measured, and even there, there’s really only one set of data that’s been looked at - price.

Between January 2023 and July 2024, average prices at five of Britain’s six large veterinary groups ran 18.3% higher than at independents, for consultations, treatments and medicines. This isn’t a survey of impressions - in the UK, the regulator had the authority to compel the actual numbers.

It went further. For at least three of the five groups that had been buying practices, acquisition raised prices about 9% within four years, measured against where that practice’s pricing was already heading.

Two of the six don’t fit that pattern. The same analysis found no significant price difference between Pets at Home and independents, and no acquisition effect from Linnaeus at all. So, corporate isn’t one thing, and the regulator’s own report says so.

A separate peer-reviewed study in 2025 compared prices at 771 clinics in Sweden and Norway, across corporate chains, independents, and Sweden’s government-run district veterinary service. The chains charged more. The Nordic researchers listed equipment investment, staffing levels, continuing education spend and plain profit expectation as possible explanations, and declined to say which one was doing the work.

So, being precise about my own headline - somebody did keep score, on price, in a couple of countries across the pond, and only because a competition regulator had the power to make it happen. On whether the animals did better or worse, nobody has kept score anywhere, and nothing exists that could.

Why that study can’t be run

Four things are missing.

There’s no claims database. More than 95% of American dogs and cats are uninsured, so there’s no equivalent of Medicare Part A. No central record of what was done, to whom, or what it cost. (This isn’t an argument for pet insurance. That’s its own complicated conversation I plan on wading into, buckle up.)

There’s no mandatory adverse-event reporting. Nothing collects complications, infections or errors across practices.

There’s no outcome registry. Nobody is tracking whether patients did better or worse, at any scale, anywhere.

And there’s no ownership disclosure requirement. You couldn’t sort practices into groups to compare them even if you had the rest, because nothing obliges a practice to tell you who owns it.

None of this is a cover-up. It’s what happens when a profession grows up as thousands of small independent businesses without mandatory reporting. Human medicine built its records largely because centralized payers demanded them, and oversight followed the money. Veterinary medicine never had that pressure. So nobody built the thing that would notice, likely because for most of its history there wasn’t much to notice.

It isn’t specific to ownership either. Veterinary medicine publishes very little about itself in general. A 2026 study of 177 American small animal clinics, sampled across eight states including Maine, found that of the 157 with websites, only three posted any prices at all. Prices aren’t medical complications, and we can’t draw a direct comparison there. But a price list is probably one of the lowest bars of transparency a practice could publish, and almost nobody does. We have to assume the harder measurements will never appear on their own.

Where I have to be careful

Absence of evidence cuts both ways, and this is the part I can’t skip.

Nobody can demonstrate that corporate ownership has degraded clinical care in veterinary medicine. Anyone who tells you they know what it’s done to quality of care is claiming more than the evidence supports. That includes people who agree with me. And it especially includes me, on a day when I’m not being careful and feeling petty.

Here’s an example of what I mean. Vets told that same regulator that internal targets, protocols and IT systems influence which tests and treatments get recommended. Vets saying that about their own workplaces carries some weight. But other vets in the same report said they always offer the most comprehensive option available, and the regulator filed all of it as anecdotal. So, grain of salt, but I do like salty things…

Additionally, nothing about independent ownership prevents over-testing, overcharging, long waits, or a bad exam room. A lot of the same incentives are available to me and to every other owner. The difference, as far as I’ve been able to work it out, is who the pressure answers to and how far away they are from the exam room.

This is the whole project

I named this newsletter The Independent Vet, so you could be forgiven for assuming I can prove independent practices are better. I certainly have my own opinions, and suspicions. But objectively I can’t prove it, and neither can anyone partaking in this discussion.

That isn’t the same as knowing nothing though, and it isn’t a reason to stop thinking. In fact, it’s a reason to be honest about what kind of thinking it is. A business model that states its aims openly. Pricing data pointing the same direction in three countries. And a long track record in industries that do keep score.

None of that adds up to proof. It does add up to a reason to start doing something. A practice publishing its prices is a good idea, and a first step toward transparency, regardless of whether or not ownership turns out to matter. So is saying plainly who owns it. So is sharing records with somebody who’s counting. None of it requires anyone to win this argument first, which is exactly why it’s where I think we need to start, and is needed before we continue the conversation.

In the meantime, nothing is being recorded. Which means some of the only observations being made anywhere are the ones you make in the exam room. Whether the appointment got shorter. Whether you were offered options or handed a single plan. Whether the price moved, and whether anyone explained why. Whether anyone told you that waiting and watching was allowed. When the British regulator asked that kind of question, only 30% of pet owners had been given a choice.

This is what I’m thinking and worrying about at 3AM when I’m lying in bed, awake. Every year the ownership mix shifts further, and the group we can compare against gets smaller. We get one veterinary profession, it is changing quickly, and change on this scale rarely reverses. My instinct is to claim they’re uncharted waters, and to an extent they aren’t, but really they are.

Next, and the last part of this arc: what it would take to start keeping score. There are people already trying. There are models from other industries that worked.

- Zach Smith VMD

Pet care, uncorporated.

Sources: Kannan S, Bruch JD, Song Z. Changes in Hospital Adverse Events and Patient Outcomes Associated With Private Equity Acquisition. JAMA. 2023;330(24):2365-2375 · Competition and Markets Authority, Veterinary services for household pets: final decision report and summary of final report, 24 March 2026 (ownership of referral centres, laboratories, crematoria, out-of-hours providers and online pharmacies among the six large groups; choice of referral centre; the 18.3% price differential; and the measured effect of acquisitions on price) · Egenvall A, et al. Prices for veterinary care of dogs, cats, and horses in Sweden and Norway: comparisons between corporate chain, government-run, and independent clinics. Front Vet Sci. 2025;12:1544996. doi:10.3389/fvets.2025.1544996 · Adams A, Gilley A, Morris V, Wisnieski L. Lack of online price transparency of small animal veterinary clinics in the United States. Front Vet Sci. 2026;13:1788878. doi:10.3389/fvets.2026.1788878 · North American Pet Health Insurance Association, State of the Industry Report 2026

If you are reading this in a hurry, skip to the first list.

For scale: nationally an emergency visit tends to start somewhere around $300, and can reach $4,000 or more once diagnostics and a night in the hospital are added. Emergency surgery for a blockage, a bloat, or a car accident (just for the procedure itself) runs anywhere from $1,500 to $5,000. So an $800 guess is not the worst case.

This is my personal field guide - the same rough triage I’d walk a friend through on the phone. For context, I’ve been practicing for about a decade. I spent my first year out of school as an intern at one of the busiest emergency and referral hospitals on the east coast. Since then I’ve been back in Maine primarily working in general practice with a component of urgent care, simply by the way we have structured our practice. I’ve tried to be as general as possible and pull both from my own experience as well as sources reporting the most common emergencies, and referenced verifiable data when possible.

Two additional notes. This is education, not a diagnosis; nobody can triage your pet from a newsletter. And the golden rule that overrides everything below: when in doubt, call. Every ER has someone who answers the phone, and describing what you’re seeing costs nothing.

Go now - tonight, not tomorrow

Trouble breathing. Open-mouth breathing in a cat, blue or gray gums, labored or noisy effort in any pet. Nothing on this list outranks it.

A male cat straining in the litter box producing nothing. This is a urinary blockage until proven otherwise, and it can kill within hours. It looks like constipation. It is not constipation.

Unproductive retching, especially in a large or deep-chested dog - trying to vomit with nothing coming up, often with a swollen or tight belly, pacing, and distress. That’s bloat (GDV) until proven otherwise, and the clock is measured in hours.

A rabbit that has stopped eating entirely. They’ve got funky gastrointestinal anatomy that utilizes fermentation - if things stop moving, their condition snowballs and can become fatal within hours.

Collapse, extreme weakness, or pale/white gums. Internal bleeding, heart trouble, and shock all look like this.

Seizures - a first-ever seizure, any seizure lasting more than a minute, or more than one seizure in a 24 hour period.

Known or suspected toxins: antifreeze, rodenticide, xylitol gum or candy, grapes and raisins, human medications, chocolate, marijuana edibles. Don’t wait for symptoms - with the worst toxins, symptoms mean it’s too late.

Trauma that involved real force - hit by car, a fall, a dog fight with puncture wounds. Pets hide internal injuries astonishingly well for hours to days.

Eyes: sudden squinting, bulging, or an eye that’s changed shape or color. Eyes have almost no tolerance for waiting.

Again, this is not exhaustive. It never hurts to call.

Call first - same-day matters, but start with the phone

Repeated vomiting or diarrhea - more than two or three rounds, or any amount in a very small, very young, or very old pet. They dehydrate fast.

A cat who hasn’t eaten in more than a day. Cats punish fasting in a way dogs don’t. Feline anorexia is its own emergency track.

Sudden non-weight-bearing lameness - holding a leg fully up is different from a limp.

Wounds that are more than superficial, anything that might need stitches, or any bite wound (they’re always deeper than they look).

Straining to urinate but still producing some (any pet), or visible blood in urine.

A dog who ate something dumb but non-toxic - the sock, the corn cob, the toy. Sometimes it’s a wait-and-watch, sometimes it’s not; let the professional make that call.

Can usually wait for your regular vet

A single vomit from an otherwise bright, normal pet who wants dinner afterward. A mild limp where they’re still using the leg. Itchy skin and ear-scratching that’s clearly uncomfortable but days old. A broken toenail that’s stopped bleeding. Coughing or sneezing in a pet who’s otherwise eating and playful.

Watch, note what you see, and call in the morning.

The overarching theme: energy, breathing, gums, and appetite are the four dials that matter most. A pet who is bright, breathing comfortably, pink-gummed, and interested in food has bought you until morning far more often than not.

The 2 a.m. resources

Save these in your phone tonight - not the night you need them:

Your nearest emergency hospital’s number and address. Look it up now; know your backup, too, because ERs sometimes close or hit capacity (a subject I will come back to).

ASPCA Animal Poison Control: (888) 426-4435. There is a consult fee, but they are staffed by veterinary toxicologists and it is worth every penny at 2 a.m. If they send you to the ER, the ER will want that case number. And if you have not called already, the ER will likely call them itself and may pass the fee back to you at a markup.

Your regular vet’s after-hours message. Ours gives you the option to forward straight through to the right ER. Most modern phone systems make that easy, so a lot of practices already have it set up.

One honest note about the ER - specifically the bill

Emergency medicine is the most expensive room in veterinary care, and the sticker shock is real: you’re paying for a facility that’s staffed, lit, and stocked at 3 a.m. whether anyone walks in or not. It is also, increasingly, a corporate-owned room - which is a story I will come back to. But none of that changes the triage above. If your pet is on the go-now list, go now.

The numbers underneath that sticker shock are worth knowing before you need them. In Rover’s 2026 report, 38% of pet owners said they could not cover an emergency visit without taking on debt. In the same survey, nearly nine in ten said they had felt financially prepared when they brought the animal home. Only about one in ten has money set aside for a pet emergency specifically.

Pet insurance is a lever more people reach for, and it is worth being precise about what it actually does. Enrollment rose 9% last year, but more than 95% of American dogs and cats are still uninsured, and cats are barely covered at all, at roughly 2%. More to the point for tonight: most policies reimburse rather than pay. You settle the bill at the counter and the money comes back weeks later, which is no help at all at 2 a.m. A few insurers will pay a hospital directly, and if you carry a policy it is worth finding out tonight whether yours is one of them. Pre-existing conditions are also excluded more aggressively than in human health insurance, and premiums generally climb as an animal ages into the years it is most likely to need care. None of that makes it a bad product. It makes it a different product than a lot of people think they are buying, and it is not the answer to the problem in this issue.

On an ordinary evening, when nothing is wrong, it is worth deciding roughly what you could put your hands on if you had to. A number picked in advance is worth more at 2 a.m. than any amount of resolve. It also makes the veterinarian in front of you far more effective than one guessing at what you can spend, which is what the last issue was about. What the financing options actually cost, including the ones advertised in the lobby, is a whole issue of its own and it is coming.

Next up: when private equity bought American hospitals, researchers could measure exactly what happened next. In veterinary medicine, nobody built anything that would notice.

- Zach Smith VMD

Pet care, uncorporated.

Sources: ASPCA Animal Poison Control Center · AAHA/AVMA emergency care client resources · Rover Cost of Dog Parenthood Report 2026 · NAPHIA 2026 State of the Industry Report · emergency cost ranges via dvm360, July 2026 · Clinical content reviewed and edited by Zach Smith VMD - this article is educational and is not a substitute for examination by a veterinarian.

I hear some version of that most weeks. Sometimes it is exactly the right plan. Sometimes it means a family just did math in their head that they were never going to say out loud, and I missed my chance to be a part of the conversation, or never gave them the space to have it in the first place.

In a 2025 national Gallup survey commissioned by PetSmart Charities, 52% of dog and cat owners said they had skipped or declined needed veterinary care in the past year. Of those, 71% pointed to cost. And 73% of the owners who declined care over cost reported they were never offered a lower-cost alternative.

Sometimes there genuinely isn’t a cheaper option worth offering. But 73% is far too high for that to be the whole story. What that number mostly describes is care that never became a conversation.

When Gallup asked veterinarians a version of the same question, 81% said that when a client declines care over cost, they always or often recommend an alternative plan. Vets believe they’re offering the range. Owners aren’t hearing it. Something is getting lost between the two sides of the exam table, and it is costing pets real care.

There are a lot of reasons for a gap like that. The one I want to talk about today is a phrase. Veterinarians and human doctors alike call the most advanced version of a plan the gold standard, but once you have named one option the gold standard, you imply to the room exactly what you think of the rest. Thankfully, that is starting to change.

Where “gold standard” came from

Somewhere along the way, veterinary medicine picked up a habit from human academic medicine: presenting the most advanced, most thorough, most technology-intensive plan as “the gold standard” - with everything else framed, implicitly or explicitly, as a compromise. The full bloodwork panel, the imaging, the referral, the specialist. Anything less and you could hear it in the voice: we can do that, I suppose.

The instinct behind it is genuine - vets want the best for their patients, and teaching hospitals train doctors on the full workup because that’s their job. But the effect in exam rooms has been corrosive in two directions at once. Owners who can’t reach the gold standard feel like failures and, per the data above, often walk away with nothing. And veterinarians - trained to equate the maximal plan with good medicine - feel like failures offering anything else. Nobody in the room is happy.

To be clear, this isn’t me psychoanalyzing my colleagues - it’s what we report about ourselves. In the veterinarian half of that same Gallup series, published this January, 94% said clients’ financial considerations often or sometimes stop them from providing the treatment they would recommend. In a separate survey of more than a thousand veterinarians, 88% agreed with the statement that they are uncomfortable offering anything other than what they think is best for the animal.

That pressure is baked into how we were trained. Veterinary curricula were built around the full workup for decades, and the clearest sign that the profession is changing course is that the schools are now formally rewriting them around spectrum of care. The AAVMC published a national education model for it in 2024.

This is expanding further as well. The profession is finally saying it out loud. A 2025 review in Advances in Small Animal Care, from a Guelph research group whose chair is funded by VCA Canada, describes veterinary medicine as undergoing a paradigm shift away from “the once-idealized notion of a gold standard of care.” The AVMA and a growing academic literature have converged on the replacement idea.

What spectrum of care actually means

Spectrum of care (you’ll also hear “contextualized care” elsewhere) is the recognition that for most conditions there isn’t one right treatment plan. There’s a range of legitimate, evidence-based options, from lower-cost and lower-intensity to advanced and intensive, and the right one depends on the pet, the disease, the family, and yes, the budget.

The key word is legitimate. Spectrum of care is not good medicine for the rich and discount medicine for everyone else. Treating a straightforward case empirically instead of testing first, monitoring a stable finding instead of imaging it immediately, managing a condition medically before escalating to a $10,000 surgery - for many everyday cases these carry evidence as good as the maximal workup and reach the same outcome. And it cuts both ways. Pushing the maximal plan on everyone is one failure. Quietly deciding a client can’t afford the full workup, and never offering it, is the other.

The other half of the idea is shared decision-making: your vet’s job isn’t to hand down a verdict - it’s to lay out the real options, with honest tradeoffs including cost and what happens if you wait, and then build the plan with you rather than for you. Clients consistently tell researchers this is exactly what they want: a range of options, the pros and cons of each, and the price. It sounds almost embarrassingly obvious. Per that 73% statistic, it is still not the norm.

And what your vet knows about your situation changes what you get offered. In a 2024 survey of 1,160 veterinarians published in the journal Animals, 91% said they always or often offer a range of options to clients with known financial limitations. For clients with no known limitations, it dropped to 61%. Only about half said they generally start with the simpler option and escalate if needed. Your vet cannot weigh a constraint they do not know about, which makes saying something out loud more powerful than it should have to be.

What it looks like in a real exam room

Let’s look at one of the most ordinary presentations in small animal practice: a three-year-old dog who’s been vomiting for a day but is bright, hydrated, and happily wagging his tail as the vet enters the room.

The maximal plan is real, defensible medicine: bloodwork, radiographs, ultrasound, fluids, hospitalization for observation. This quickly becomes a significant investment in time, money, and effort on everyone’s part - and in the right case (a deteriorating dog, a suspicious abdomen, an owner who wants every base covered) it’s exactly the right call.

At the same time, it can be just as reasonable to do a thorough physical exam, have a frank conversation about warning signs, give an anti-nausea injection and some fluids, send home a bland diet, and plan a check-in call for tomorrow - with a clear agreement about exactly which symptoms mean we escalate. A fraction of the cost, and for a good portion of these dogs, the same outcome.

Traditionally the first plan is “the gold standard.” But they’re both good medicine for different dogs, different days, and different families. A vet practicing spectrum of care offers both options (and sometimes even more), explains the tradeoffs honestly, and doesn’t let you feel like a lesser owner for choosing the second one - or a sucker for choosing the first.

For me, personally, the days that I feel confident I’ve done my job well are not the days when everyone says yes to the gold standard plan that I offer. They are the days when I feel I was able to do a good job explaining to clients my findings, what I feel our options (plural) are going forward, and what my recommendation would be. There are scenarios where there is only one reasonable option, and there are days when I don’t explain and present things as well as I should. But I suspect most of us feel the most useful when we work together with the client to find the right solution for them and their pet at that specific time.

How to ask for the spectrum

If your vet already practices this way, you’ll know - you leave feeling like a partner. If you’re not sure, a few phrases that reliably open the conversation, at any practice:

“What are all of our options here, including the wait-and-see one?” You’re signaling you want the range, not the flagship. Like I said before, this is not only what will help get you to the right plan - it also gives your vet an opening I am always glad to take, and I suspect I am not alone.

“What are we looking for with this test - and how would the results change what we do next?” Understanding why a test is being offered, and how the results would shape the plan, is a fair check for you and the care team both: it makes sure everything being done has a purpose.

“What am I watching for that would change the plan?” Just like the test question, this gets everyone thinking a step ahead - and it makes you an active participant in your pet’s care. Watching and waiting with a clear plan isn’t declining care, it is just another form of it.

“Do you offer payment plans, or work with any payment providers?” Two thirds of pet owners say they could pay $1,000 or less for lifesaving treatment, and 64% say an interest-free plan spread over a year would let them at least double that. Fewer than a quarter have ever been offered the option. It costs nothing to ask. Plenty of practices can’t carry in-house plans, but a growing number work with outside providers like CareCredit or Cherry. Those two are far more different from each other than they look, and that is its own issue. It is coming.

And a request from the other side of the exam table: when your vet does offer you a range, take it in the spirit it’s meant. It isn’t indifference, and it isn’t a softer kind of sales pitch. It’s respect.

The thread we’ll pull later

This issue wasn’t about who owns your vet. The next two pick that thread back up. But file one question away in the meantime: offering a true spectrum of care takes time, flexibility, and a doctor who’s free to recommend the $100 plan when it’s the right one. Some practice models make that easy. Others make it quietly, structurally hard. Which is which - and why - is a story for another day. And fair warning: the answer cuts across the ownership line in ways you might not expect.

- Zach Smith VMD

Pet care, uncorporated.

Sources: PetSmart Charities / Gallup, State of Pet Care survey 2025 (52% declined care; 71% cited cost; 73% offered no alternative; payment and affordability figures) · PetSmart Charities / Gallup, State of Pet Care: Veterinarians’ Perspectives on American Veterinary Care, January 2026 (94% limited by client finances; 81% recommend an alternative) · Dolan & Slater, “Veterinarians’ Self-Reported Behaviors and Attitudes toward Spectrum of Care Practices,” Animals 2024;14(10):1416 (n=1,160; 91% vs 61%; 88% discomfort figure) · Coe, Janke, Gray & Serlin, “Clinical Communication Tools for Contextualizing Spectrum of Care,” Advances in Small Animal Care 6:191-208 (2025) · AVMA (spectrum of care initiative and resources) · Fingland et al., JAVMA 2021 (spectrum of care in veterinary education) · AAVMC Spectrum of Care Education Model (2024) · AAHA (access to care guidelines)

First thing before we start: independent doesn’t automatically mean better, and corporate doesn’t automatically mean worse. I own an independent practice, so discount me accordingly. The point of this isn’t to sort practices into heroes and villains - it’s to help you choose with your eyes open.

And a second thing before we start: I’ve renamed this series, from “Who Owns Your Vet” to “Who Owns Your Vet Clinic.” It’s a small change and an important one, and I appreciate the colleagues who pointed it out. Nobody owns a vet. Not our medicine, not our judgment. The system a veterinarian works inside can shape how much room that judgment gets - but the judgment itself, and the responsibility for it, belongs to each of us alone. It was never my intention to imply otherwise - a small oversight on my part, but one worth correcting.

Reading the room

Start with the homework, condensed: issue #1 walked through how to check who owns any practice - privateequityvet.org, your state’s business registry (in Maine, the Secretary of State’s corporate name search), the fine print on the practice’s own website, or simply asking.

No database can tell you whether a practice is any good. AVMA research on how people pick a vet found that owners choosing a new practice mostly decide on location and price - the two things that say the least about the medicine. The things that make people stay - knowledge, quality of care, compassion - usually take a few visits to reveal themselves. But you can spot most of them on the very first one, if you know what to look for. That skill is reading the room, and here’s what I’d pay attention to, walking into a practice I’d never seen.

How you and your pet are greeted - and interacted with throughout the visit - is probably the most telling. Is the staff engaged when they greet you? Does there seem to be good communication throughout the hospital (do they interact like colleagues or strangers sharing a shift)? Do the vets seem rushed or able and willing to give you the space to ask all the questions you want? And if a follow-up is needed, do they start coordinating it before you leave - or is the next visit left entirely to you to figure out?

Treat estimates as an x-ray of the practice. When one shows up, notice whether it arrives with a conversation or as a printout that’s left in front of you. A practice that talks in ranges and choices - including the honest “here’s what happens if we wait” - is showing you how it thinks. A single take-it-or-leave-it number is telling in a different way.

Ask “Can I book the same doctor next time?” This isn’t sentimental - in human medicine, continuity with the same doctor is associated with measurably better outcomes (mortality included), and there’s no reason to think our patients are different. The answer matters, but how it’s answered matters more - no practice can promise it every time, but a good one will make a real effort to make it happen.

None of this is earth shattering. But paying attention to a few key details - with some understanding of what might be going on behind the scenes - builds a much better picture of who you’re entrusting with your pet’s care. If you read issue #2, you’ll recognize the funnel when you’re standing in one - and you’ll recognize the opposite, the visit with room left for the “oh, one more thing.” Trust that read. It’s usually right.

These are all things I try to practice myself, and try to give my staff the atmosphere and operational space to practice too. We’re all human though and there are plenty of days I fall short of this. With this in mind, I believe a poor interaction shouldn’t necessarily be a dealbreaker - look for trends, and as crazy as it sounds, pay attention to “vibes.” At the end of the day I also know that we (and any clinic) will not be the clinic for everyone - whether it’s because we interacted on a bad day or simply because our operational style isn’t the right fit for you - the priority is always for you and your pet to find somewhere you are comfortable, because you’ll maximize the chance of your pet getting the best possible care.

What independent actually buys you - and what it doesn’t

Ownership is not the be-all, end-all, but I wouldn’t be writing these pieces and exploring it in such depth if I didn’t think it was an important piece of the puzzle.

What independence reliably means: the person setting prices, appointment lengths, and staffing levels works in the building and answers to patients and staff. In my experience this results in scenarios where decisions can bend around a hard case, a long-time client, a gut feeling much more readily. That can happen in a corporate practice too - plenty of local leaders bend the rules for a hard case. The difference is the default. At an independent practice, prioritizing finances over a patient is a choice someone in the building makes and owns. Under outside ownership, the return layer is built into the structure - local leadership can push against it, and the good ones do, but the layer is always there, and every resale re-decides how heavy it sits.

What independence does not guarantee: better medicine. An independent practice can be under-equipped or simply badly run. A corporate practice can be superbly equipped and staffed with excellent doctors. Ownership shapes incentives; it doesn’t replace judgment. You still have to evaluate the practice in front of you - that’s what reading the room is for.

Your half of the partnership

This part gets written about far too little: great veterinary care is a partnership, and you hold half of it. To an extent, this is a legal requirement - a veterinarian-client-patient relationship (VCPR) is legally required before a veterinarian can diagnose, treat, or prescribe for your pet. And this is a true relationship where all parties must be willing and active members. Just as you have the right to switch clinics, a veterinarian has the right to discharge clients (except for those with pets in emergent need of medical care, or with an active condition they are responsible for treating) if the mutual trust has eroded from the relationship, or for a number of other legitimate reasons.

To be clear, none of this is about being a “good customer.” It’s about being an effective advocate for your pet - and helping the people caring for your animal do their best work.

Show up. No-shows are one of the quiet killers of small practices; a missed appointment at a three-doctor clinic can’t be absorbed the way it can across a forty-clinic group. This is not to say that life doesn’t happen and you may have to cancel last minute every once in a while, but let the clinic know and try to minimize how often it occurs.

Bring your records - or better, have them sent ahead. Appointment times go a lot further when the vet has the full picture, and first quarter isn’t archaeology. (Something many owners don’t know: the practice owns the record, but you’re entitled to copies - virtually every state requires practices to provide them on request. Switching practices or getting a second opinion doesn’t require anyone’s permission - though plenty of clinics still treat it like it does.)

Be an advocate for your pet and yourself - be sure that you understand what is being recommended and offered. Ask questions. Questions build trust - and trust is what you’ll lean on when the hard decisions come. Which questions you ask matters, too. Asking about your pet’s condition, the options on the table, the costs, and what to watch for at home - those mark an engaged client, and good clinics lean in for engaged clients. Challenging a doctor’s competence, arguing hospital policy at the front desk, or arriving with a diagnosis already made and a demand for the prescription ChatGPT told you to request - those erode the clinic’s trust in you, one visit at a time.

Pay your bill, and if money is tight, say so up front. A good vet can do a lot with an honest budget - and a surprise at checkout harms everyone, the relationship included.

Leave the review. Corporate groups have marketing departments and ad budgets working for them; an independent practice’s reputation lives almost entirely in word of mouth and its Google page. A few minutes of typing is genuinely one of the most valuable gifts you can give a small practice - and odds are, the owner reads every single one.

And be nice. The team that remembers your dog’s name is what you’re actually paying for. Treat them like it.

If there’s no independent option near you

For plenty of people - especially in specialty and emergency care, where corporate ownership tops 75% nationally - there simply isn’t an independent choice. If that’s you, don’t carry guilt into the exam room. The veterinarians and technicians inside corporate practices are genuinely good people doing real medicine, and every question in this guide works just as well in a corporate building. Ask about options. Ask about continuity. Reward the doctor who talks to you straight.

Ownership is one input. A vet who’s honest with you is the actual goal - wherever you find one.

Next up: something that has nothing directly to do with ownership - what “the gold standard” actually means in veterinary medicine, and why the most expensive option isn’t automatically the right one.

- Zach Smith VMD

Pet care, uncorporated.

Sources: AVMA (pet owner research - how owners choose a veterinarian) · Pereira Gray et al., BMJ Open 2018 (continuity of care and mortality, systematic review) · AVMA Principles of Veterinary Medical Ethics and state statutes (the VCPR, client right to record copies, and client discharge) · Brakke Consulting via AVMA News (national ownership estimates) · privateequityvet.org (corporate ownership database) · Maine Secretary of State (corporate name search) · Issue #1 of The Independent Vet (the ownership landscape and how to check it)

It’s the right question to ask, and my honest answer after spending a lot of time sitting with and looking into this exact thing is that often it can barely matter at all. But it can also make all the difference, because everything about a visit may have been quietly redesigned around numbers you’ll never see. This article is meant to start the process of unraveling what that redesign looks like from inside the exam room - not as a scare tactic, but to reveal the machinery behind it all, so you can make informed decisions for your pet and their care.

One note before we start: corporate practices employ some of the best clinicians I know, and I intend to point out where the corporate model genuinely helps. But a veterinary hospital is a business, and the fundamentals of that business - the primary incentives and obligations - change once a practice is no longer locally owned. Excellent care, and sometimes the only option for certain types of care, still happens inside these systems every day.

The appointment gets shorter - or denser

Every practice, regardless of ownership, lives and dies by the schedule - a full book is the first sign of a healthy one. And buried inside that schedule is the single most powerful lever a clinic has: the length of an appointment. I stare at it constantly. Assuming the demand is there, shaving five, ten, or twenty minutes off appointments at a single practice can generate hundreds of extra visits a year without hiring anyone. Multiply that across tens or hundreds of practices, and the math becomes impossible to ignore.

So what keeps the lever from getting pulled? Mostly, proximity. When I weigh shaving minutes, I’m picturing the specific clients and cases who need the slack - because I’ll be standing in those rooms, or asking my associates to be. A scheduling decision made across 400 practices is made without those faces in view. Distance makes the lever easier to pull, and that’s the part that seems to track with ownership.

Is there concrete proof this actually happens more in corporate than independent practices? In veterinary medicine, honestly, not really - nobody has published a head-to-head comparison of appointment lengths by ownership type. (Add it to the list of studies our profession needs.) The closest hard data comes from human medicine: a 2022 JAMA Health Forum study tracked physician practices after private equity acquisition and found they saw roughly 26% more patients and 16% more visits than comparable practices that weren’t acquired. Same buildings, more throughput. (And to be clear, what’s being borrowed here isn’t the market, it’s the buyer. Same funds, same playbook. If anything, our market is more exposed: human medicine has insurers pushing back on every price, and we have only the client’s wallet.) This parallels what clients who switch to us describe, and what colleagues tell me. At the end of the day this is anecdotal - but every signal I can find points in the same direction.

Why this matters - the biggest consequence to a shortened visit is that vets are pushed to get to what they think is the point before they’ve even walked into the room. Tight appointments strip out the time for the “oh, one more thing” questions - which far too often can mean the difference between getting to the root of your pet’s illness or not. The limping you almost forgot to mention. The change in energy you noticed but figured was nothing. Compressed appointments don’t make the medicine worse, but they make the visit a funnel, and anything that doesn’t fit the funnel gets pushed to another visit, or missed entirely.

At my clinic, we’ve deliberately set appointment lengths past the industry standard. Most visits don’t need all of it, and the slack never goes to waste; drop-off patients and catch-up work absorb whatever’s left. But when the “one more thing” turns out to be the whole visit, the time is already there. By spreadsheet standards, we’re inefficient. By medicine’s standards, that’s the point.

How your vet gets paid probably changed

This is the piece most pet owners have never heard of, and it probably illuminates more about the industry than anything else in this article.

More than half of associate veterinarians - 56% as of 2024 - are now paid on a model called production-based pay, or “ProSal.” This system is comprised of a base salary plus a percentage of the revenue they personally generate for the hospital. Among new graduates entering practice, the number of associates working under this model balloons to 70%.

The model exists everywhere, including plenty of independent practices. (Nobody publishes the breakdown by ownership type - I’d genuinely like to see it - but it’s standard fare in the large groups’ contracts, and the new-graduate number tells you where the industry is headed.) And there’s nothing inherently wrong with the model - at its best, it means a doctor’s paycheck reflects the medicine they actually practice. The associate who builds a loyal following and a full book gets paid like it, without waiting on anyone’s permission for a raise. But inside larger systems that tend to rely much more heavily on revenue targets, dashboards, and monthly production reports, it stops being a payment method and becomes a nudge - on every estimate, every bloodwork recommendation, every “we could also run…”

I want to be crystal clear: the overwhelming majority of vets do not practice with their paycheck in mind. But “the nudge” is real, and relied upon by corporations, and if you also layer in the debt… The average veterinary graduate in the class of 2025 who had to take loans left school owing $212,499 - a debt-to-income ratio of 1.4 to 1. When a young doctor is carrying a mortgage worth of student loans without the house, production pay isn’t a bonus system. It’s a lifeline.

Step back and look at what that adds up to: nobody has to pressure anyone for this to work. An employer whose obligation is revenue offers pay tied to revenue, to doctors who can’t afford to decline it - and the incentives align all by themselves. No villains required. The system does the pushing so no person has to.

The upsell isn’t a scam - it’s a system

When people describe feeling “sold to” at the vet, it’s natural to blame the doctor, but I’m here to argue that they’re blaming the wrong person.

Understanding that large-group medicine runs on protocols and metrics - average transaction value, diagnostic capture rate, dental compliance, wellness-plan enrollment - the picture becomes clear. (None of this is an explosive exposé, by the way. These are the industry’s own management terms - you’ll hear them at any practice-management seminar.) Individually, each metric can be defended - dental disease genuinely is under-diagnosed (most dogs and cats show periodontal disease by age three), adult and senior pets genuinely do benefit from bloodwork, etc, etc. And that’s exactly what makes this hard to see - the recommendations are usually defensible medicine. What’s changed is that somewhere above your exam room, someone is tracking how often your doctor makes them, and that number follows your doctor around.

The tell isn’t any single recommendation - most often it’s the absence of a conversation. For example, if every visit produces the same tiered estimate and nobody asks what you’re able to do, what matters to you, or what happens if you watch and wait, you and your pet aren’t being treated. You’re being processed.

Often the opposite failure can occur at independent practices - doctors who never offer the full workup because they’ve already decided you can’t afford it. That’s not kindness, that’s making assumptions and deciding for you. In my opinion, the right version, anywhere, is options plus honesty. There’s a whole issue coming on that, because it deserves one.

The faces keep changing

Veterinary medicine has a turnover problem. Average practice staff turnover is running near 30% a year - roughly double the all-industry national average. For technicians it’s 32%; for the front desk, 33%. And the churn doesn’t stop at support staff: it runs up through associate veterinarians and even medical directors, with the most heavily documented examples coming from large corporate groups, though plenty of independent practices lose people just as fast.

Most of that turnover is a burnout story. Veterinary medicine is hard everywhere - emotionally, physically, financially - and our profession carries some of the highest burnout rates in healthcare, along with a suicide rate well above the general population. Nobody disputes the crisis, and the whole industry says it’s fighting it. The difference is the angle of attack - and that’s where ownership starts to show.

Colleagues who’ve come to us from other (mostly corporate) practices describe working hours counted as appointment hours only - the records, the lab callbacks, the emails, all pushed to evenings and days off. Nobody publishes data on this; I can only tell you how consistently I hear it. That math breaks people.

This matters because continuity is a clinical tool. The technician who has drawn blood from your cranky old terrier eleven times knows things about him that no record captures. The vet who felt the lump six months ago carries a mental baseline no new hire inherits. When a practice churns a third of its people every year, your pet’s story gets retold from scratch, over and over - and details drop every single time.

As a practice owner, one of the greatest compliments I’ve ever received was a technician calling us a “unicorn practice” - the kind of place you want to spend your whole career. No practice is that for everyone, and there are unicorns on both sides of the ownership line. But here’s what’s worth sitting with: the big groups are demonstrably better at retention perks than any independent can be - signing bonuses, benefits packages, CE stipends, all bought at scale. That’s an angle of attack, and it isn’t nothing. But if perks were what kept people, the largest groups would have the longest tenures in the profession, and the industry’s turnover crisis would be over. It isn’t.

Based on my experience, what actually keeps people is harder to purchase: sane schedules, a voice in how the place runs, and medicine they’re proud of. Those don’t come with a volume discount.

What corporate ownership can genuinely do better

The corporate advantage is real, as I started to get into in the previous section, but it’s structural, not clinical. It’s not that corporate doctors practice better medicine, or that independents practice worse. Mostly, it’s that the model can write bigger checks and absorb bigger risks.

Capital is obvious. A corporate group can drop six figures on a CT scanner or a full dental suite the year it decides to, where an independent owner might plan and save toward it across several. (The flip side of that coin is that just because they have the money doesn’t mean they will spend it - since the bottom line is so important, they can be incredibly stingy.)

Coverage is probably the most powerful one. A forty-hospital group can keep an overnight ER staffed in a town that would otherwise have none. And they can more easily absorb a doctor’s parental leave without canceling a month of appointments.

Scale itself can also serve the profession in real ways: formal mentorship programs for new graduates, career ladders that keep good technicians from leaving the field, employee benefits a three-doctor practice has to stretch to match, and records that follow your pet seamlessly when the network’s GP transfers them to the network’s ER at 2 a.m.

I want to call your attention to what’s on that list - money, logistics, and infrastructure. What’s not on it: the doctor’s judgment, the time you get in the room, or the honesty of the conversation. Those don’t improve with the size of headquarters - they come from the doctors themselves. The structural advantages are real, they matter, and pretending otherwise would make everything else I write here easier to dismiss.

What this all means - and what you can do in the room

The honest frame isn’t good versus evil. It’s that corporate medicine is optimized, and you deserve to know what it’s optimized for. Money is always the biggest part of the answer. Sometimes it’s excellent care that also makes money; sometimes the care is just along for the ride. From your side of the exam room, those two can look identical - right up until they don’t. And this is not to say that money isn’t a significant factor in an independent practice as well - it is. But there it’s counterbalanced by something personal: the owner’s name is attached to every decision, and the person setting the prices has to stand across from you in the exam room. A corporation, whatever its virtues, never has to do that.

With that in mind, a few habits that work at any practice, corporate or independent:

Book the visit you actually need. Say everything you want covered when you schedule - the ear thing, the lump, the list. Do this when you book the appointment, do it again at check-in, and repeat it again to the doctor.

Ask to book with the same doctor next time. Most practices will honor the request if you make it - and if they can’t every time, they should at least make an honest effort.

Notice the vet who lays out the full range before you have to ask - including the honest “here’s what happens if we wait” - and who asks what matters to you instead of assuming what you can afford. (And if the range doesn’t come unprompted, a simple “what are my options?” usually shakes it loose.) Assumptions cut both ways: pushing the maximal plan on everyone is no better than quietly deciding someone can’t pay for it. The range, the discussion, and the space to make a decision is the respect. When you find a vet who offers it unprompted, this can be incredibly telling - and I’d argue that deserves your loyalty far more than any ownership structure or sign on the building.

- Zach Smith VMD

Pet care, uncorporated.

Sources: AVMA (Chart of the Month: compensation trends, 2024 - ProSal adoption; Senior Survey, class of 2025 debt figures) · AAHA/iVET360 (practice turnover benchmarks vs. 12-15% all-industry average, 2025) · CDC/JAVMA (Tomasi et al., 2019 - veterinarian suicide rates vs. general population) · AVMA/AAHA (periodontal disease prevalence by age three) · AAHA Trends (Corporate consolidation and the rise of private equity) · PBS NewsHour (As veterinary costs climb, private equity ownership draws scrutiny) · warren.senate.gov (Warren & Blumenthal letter on PE consolidation of veterinary care) · JAMA Health Forum (Singh et al., 2022 - spending, utilization, and practice patterns after private equity acquisition of physician practices)

Not who works there — who owns it. The name on the building, the doctors, even the scrubs may be exactly the same as five years ago. But there’s a decent chance the practice itself now belongs to a private equity fund or a corporate chain, and you were never told.

In 2011, corporate and private equity groups owned <10% of U.S. veterinary practices. Today the best estimates put it at just over 50% of general practices — and more than 75% of specialty and emergency hospitals. If your pet has ever needed an overnight ER, an oncologist, or a cardiologist, you were almost certainly inside a corporate-owned hospital, whatever the sign said.

I’m a veterinarian in Maine, in the greater Portland area. Where I practice, 100% of specialty and emergency care and roughly 75% of general practices are now corporate- or PE-owned. And nearly all of that happened in the last 5-10 years. I’m writing this because I think you deserve to know how the industry that cares for your animals actually operates, how it is changing, and if and how it could impact that care.

Why the sign never changes

These foundational changes fly under the radar, by design. When a corporate group buys a beloved local practice, the last thing they want to do is tell your clients. The practice’s name, its Google page, its decades of community trust — that goodwill is a major part of what they’re buying. “Riverside Animal Hospital” stays “Riverside Animal Hospital.” The ownership disclosure, if it exists at all, lives in fine print and state filing databases.

This is a deliberate strategy, and corporate and PE-ownership is succeeding on this front. Surveys and reporting consistently find most pet owners have no idea their vet is corporate-owned.

We see this all the time with clients switching to our clinic. They’ll mention that something changed at their old clinic over the course of a few months or years, but initially they couldn’t quite put their finger on it. Then one day it clicked — they figured out where to look, or asked the right question, and things fell into place.

Who the players are

A few names own a staggering share of American vet care.

Mars — yes, the candy company — is the largest owner of veterinary practices in the world. Through VCA, Banfield, and BluePearl, Mars owns roughly 2,000 U.S. practices, plus one of the two major diagnostic lab networks in the country (Antech).

Private-equity-backed platforms — companies like Ethos Veterinary Health, PetVet Care Centers, Thrive, VetCor, and Heartland — buy dozens to hundreds of practices each. From there the focus turns to streamlining and maximizing profits — and often to bundling the practices and reselling the whole platform to another fund within 3-7 years. Your vet clinic can change hands twice without anyone telling you once.

Closer to home, Rarebreed Veterinary Partners — headquartered right here in Portland — burst onto the scene in 2018, and over the past 8 years has consolidated more than 110 hospitals across 11 states, from Maine to Florida. Within 20 miles of Portland they own seven practices, including one of the region’s two specialty referral hospitals. This isn’t overtly a negative thing, we have an excellent working relationship with the staff at their referral hospital, and preferentially refer to them. But, unfortunately, Rarebreed doesn’t just “roll up,” they also close up. In 2024 they shut the only animal hospital in Whiting, New Jersey, so abruptly that the staff found out at an emergency meeting, and in just the past few weeks they’ve quietly closed PetMedic urgent care clinics (a brand they built themselves) across New Hampshire and Massachusetts.

There’s an amazing database, privateequityvet.org, that tracks over 14,000 corporate-owned practices and is the fastest way to look up your own clinic — if it’s listed, then it’s not locally owned. (I have no affiliation — it’s simply the best public resource I’ve found.)

Why private equity really wants your vet

Veterinary medicine is close to a perfect private equity target: spending is relatively recession-resistant, demand rises almost every year, clients pay out of pocket at the time of service (this is the big one), and the industry was (until recently) fragmented into thousands of small businesses that could be bought cheap, bundled, and resold. The recent pandemic also lead to boom in the veterinary industry — clinics were so busy many stopped taking new clients, and existing clients had to wait months to be seen — giving a false impression that the industry was some golden egg that had just been missed. To compound the situation, there’s a whole generation of aging practice owners looking to exit and cash in on their sweat equity, and a generation of new grads carrying too much debt to buy them out. At the end of the day it’s the perfect storm — a steady supply of sellers of an apparent bottomless industry, and almost no competition to buy.

Their playbook is called a “roll-up”: buy many small practices, centralize purchasing and pricing, raise revenue per patient, and sell the bundle at a higher multiple. And most importantly to you, none of that math has anything to do with your dog.

What changes after the sale

This is the part I care about most, and it deserves its own full piece (coming soon). The short version of what the reporting and research show — and what those of us in the profession see:

Prices rise. U.S. veterinary prices have climbed dramatically (faster than overall inflation). Consolidated practices keep drawing scrutiny over exactly this, from journalists, economists, and even Congress.

Vets get production targets. Many corporate compensation structures tie pay directly to revenue generated. Most vets truly resist letting that shape their medicine, but incentives are incentives, and as the cost of vet school continues to rise and more and more vets are graduating with staggering amounts of debt, those targets can make the difference between being able to pay your monthly student loan bill or not.

Staff churn. Veterinary medicine overall has a well-documented burn-out and turnover problem. This is amplified in corporate clinics, and not just at the front desk or at the technician level, all the way through associate vets and even medical directors. Industry-wide, practices now lose nearly a third of their staff every year, and corporate clinics consistently post some of the worst of it. So there is a decent chance that the doctor who knows your dog’s whole history will be gone by your next annual exam.

To be fair (which truly is my goal here), some corporate practices deliver excellent medicine, some indie practices are badly run, and the individual veterinarians inside corporate systems are overwhelmingly good people practicing under constraints they didn’t choose or cannot avoid. But none of that changes the math underneath. A private equity fund exists to return money to its investors — that’s not an accusation, it’s the job description. These groups bought thousands of practices with borrowed money, and they have a set number of years to pay it back, with profit. And corporations, just as consequentially, are answering to their own investors and board members. Advancing medicine, delivering great care, filling gaps nobody else will — all of that can happen inside the model, and sometimes does, but it will always take a back seat to profit.

There’s another side of this clients never see. As an independent practice owner, I spend a lot of time dodging the landmines consolidation leaves behind. For example, we can’t promise a supply distributor the millions in purchasing volume a corporate group can, so they get discounts we can’t touch and our costs go up. We certainly can’t match the signing bonuses a PE-backed group can dangle in front of associates, and many chose to offer set salaries versus production-based pay, capping an associate’s potential income, which narrows our potential candidate field. And at least once every month, the letter or phone call arrives offering to make all of it go away — just sell and cash in all that sweat equity. Every independent practice you still have is one that keeps saying no. (What those offers actually look like is its own story, coming later.)

Even the regulators have noticed

The FTC has intervened repeatedly in veterinary consolidation. For example, requiring divestitures from JAB (the Ethos and SAGE deals) in 2022, and requiring Mars to divest 12 clinics as a condition of acquiring VCA. Advocacy groups have drafted model state legislation (the “Save Our Pets Act”) to limit corporate roll-ups, and several states are examining their corporate-practice-of-veterinary-medicine laws.

To its credit, Maine used to make roll-ups hard. Under our Veterinary Practice Act, a veterinarian could practice only under their own name or alongside other licensed veterinarians, and putting a corporation between the doctor and the patient was an “unauthorized association,” essentially locking them out of the industry in the state. That changed in 2012. The pitch wasn’t an outright giveaway to consolidators — it was an emergency bill whose stated purpose was letting veterinarians work for Maine’s emerging aquaculture and bioscience industries — fish health, diagnostic labs, research, export certification. But the amendment quietly weakened the wall, and a broader update in 2015 broke down the wall entirely. In the intervening years, it has become very clear who the primary beneficiaries of these bills are.

At the end of the day, when the FTC starts writing consent orders about your dog’s vet, something structural is happening, and we should be worried.

What you can actually do

Look up your clinic at privateequityvet.org, search your state’s business registry for the practice’s legal entity name (it’s often “XYZ Holdco LLC” behind the familiar name), or check the practice’s own website — the fine print on the privacy policy and accessibility pages often links straight back to the corporate or PE parent company.

Just ask. “Is this practice independently owned?” is a fair question, and the front desk’s answer — or hesitation — tells you a lot.

If you’re looking for a new vet, ask about ownership before your first visit. Independent doesn’t automatically mean better — but it does mean the person setting prices and appointment lengths works in the building.

Don’t punish your corporate-employed vet. They didn’t buy anything. Be kind to them; the system is harder on them than it is on you. And there are many vets working within the system with good hearts, great intentions, and putting your pet’s care first.

Subscribe and stay tuned.

What this newsletter is

My goal is to regularly publish about what consolidation means for your pet, plainly and with numbers — plus resources for independent practices trying to stay that way. I also plan to dive deeper into the industry overall and how it is changing and evolving before our eyes. None of this is meant as virtue-signaling, or moral-grandstanding, and when I gravitationally drift in that direction, I expect to be held accountable. I will always strive to provide an objective, fact-based presentation of what I know to be true based on my experiences and the information available.

Next up: what actually changes in the exam room after a practice sells — appointment math, production pay, and the upsell patterns to watch for.

If this was useful, share it with one person who has no idea who owns their vet. That’s most people.

— Zach Smith VMD

Pet care, uncorporated.

Sources: AAHA (Corporate consolidation and the rise of private equity) · PBS NewsHour (As veterinary costs climb, private equity ownership draws scrutiny) · privateequityvet.org · dvm360 (FTC requires Mars to divest 12 veterinary clinics) · FTC.gov (JAB Consumer Partners actions, 2022) · warren.senate.gov (Warren & Blumenthal letter) · economicliberties.us (Save Our Pets Act) · Frontiers in Veterinary Science (SWOT analysis of the independent practice segment, 2025) · Maine Legislature (32 MRSA §4864, amended by PL 2011 c. 594 and PL 2015 c. 209) · pets.care/CARE for Pets (Rarebreed Veterinary Partners profile; Whiting Veterinary Clinic closure, Nov. 2024) · Jersey Shore Online (Whiting Veterinary Hospital abruptly closes, Nov. 2024) · petmedicurgentcare.com (current locations and closure notices, July 2026)