The shrinking middle

Every partner hospital is different, and so are we!
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“Business is all about solving people’s problems — at a profit.”  — Paul Marsden

I’ve been a general practitioner all my life. There’s no shame in that – I’m proud to have been able to provide value to a variety of clients with a wide range of needs. However, these day, the profession is changing and it’s becoming ever more challenging to find success in general practice.


General practice is under pressure from two directions: “above” and “below”. On one end, many more of the pets Americans own are rescues – dogs and cats that came from adoption agencies of one sort or another, not purchased from a kennel or breeder. Nearly all have received the immediate veterinary care that they required; they have been examined, tested, wormed, vaccinated and spayed or neutered. These services were formerly the foundation of veterinary care, especially in that important period when clients were bonding with their new pet.

What’s more, there are a number of value-priced options for consumers seeking ongoing care. Many shelters offer wellness services themselves, pet stores sponsor veterinary care on weekends (sometimes in their parking lot) and, of course, Dr. Google is always on call. In this end of the market, veterinary care becomes a commodity.


Once upon a time, if you weren’t located in or near a big city, a referral to a specialist required traveling to a university hospital. No longer – it seems as though there’s now a specialty hospital on every corner. Even the formerly rare specialties (cardiology, ophthalmology, oncology) aren’t so rare anymore. This can result in better care for sicker patients, although it doesn’t always work that way. Complex surgeries, interventional radiology and radiation therapy have raised the standards of care – if you can afford it.

There is no question that this trend has resulted in rapid escalation in the cost of veterinary care; what once seemed to be unimaginable fees have become routine in many areas of the country. In an economy that has seen middle class wages stagnate, many owners have been priced out of this end of the market.

The Squeeze

So, where does that leave the general practitioner? Doing less puppy and kitten care. Performing fewer surgeries. Sending more of the complex cases out to referral practices. There’s not much profit in doing that – so being in general practice isn’t the easiest way to retire your educational debt or buy a home or send your kids to college. Moreover, for the practice, it makes it more difficult to attract and retain good employees, buy modern equipment or fund continuing education. The squeeze is part of what’s making it harder to manage educational debt and driving more new graduates to internships in the hope that specialty practice will save them.

This hollowing out of the middle feels inevitable. Are the days of general practice drawing to a close?

Finding and giving value

Of course, there are, and will continue to be, very successful general practices. Strong earnings allow these practices to retain high quality staff, update their equipment and still reward the owners. What’s their secret?

  • Develop relationships – the old maxim that people “don’t care how much you know until they know how much you care” is true. Humans are social creatures, wired for relationships that help them make decisions and keep them safe. Learn about them and share of yourself to develop trust. Clients appreciate high-touch businesses, and are willing to pay for the value they receive – and become loyal customers for the long term.
  • Demonstrate value – communicate, communicate, communicate! Explain what you’re doing during a physical examination. Teach your clients about how you control pain in their pet. Use names that mean something to your clients on your invoice, instead of leaving them to wonder what a Chem12 is and why it costs so much money.
  • Price fairly – especially on easily compared products like flea, tick and heartworm medications. Remember the first bullet; you’re working to develop trust and a long-term relationship. Be ready to explain your prices – not defend them.
  • Focus on your customer – you need to be more nimble, more flexible and more committed to solving their problems than other providers. Your clients live in a retail environment that constantly works to reduce the friction on every transaction. Do you? Ask your clients what they want – Sunday hours? Weekday evenings? Convenient drop-offs? No waiting? The days of expecting clients to mold themselves to the way want to provide services are gone.
  • Pay attention to costs – in a very competitive environment you need to be efficient to find success. Don’t skimp on things that provide value to your clients, but keep your eye on the business behind the medicine.

What do clients want these days? Other than “everything”, they want a veterinarian who is truly “their other family doctor” – a trusted generalist who they know is committed to enhancing and extending the precious relationship they have with their pet.

And there’s profit in that.

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