The Crystal Ball: What Will Veterinary Medicine in the US Look Like in 10 Years?
Veterinary medicine is constantly changing and looks a lot different today than it did 10 years ago. It’s impossible to know the future, but based on current trends here are some predictions about what our profession might look like 10 years from now:
1) Better technology integration and flexible care models
Younger pet owners value access, convenience, and transparency more than any previous generation of pet owners. Pet owners want easy access to the “what”, “when”, and “why” of their pet’s care. Leveraging technology well to provide those things to pet owners is a competitive advantage today, but over the next decade will become a competitive necessity.
Telehealth has established itself as an extremely useful supplement to in-person traditional veterinary healthcare delivery. We’ve seen countless startups try and fail to execute direct to consumer (D2C) telehealth platforms that try to bypass the traditional model entirely, failing to understand how the legal and practical hurdles unique to veterinary medicine prevent a simple “copy and paste” of D2C telehealth services in human healthcare. However, companies that have chosen veterinary hospitals as their primary customers and facilitate adding telehealth (and other tech integrations) to the existing services of those hospitals are thriving.
Flexible care models that supplement traditional veterinary healthcare delivery with additional services beyond telehealth like house calls, tech visits (see below re: paraprofessionals as providers), and flexible appointment scheduling like walk-in blocks or drop-off visits also lean into the convenience and accessibility that modern pet owners value so highly.
2) Pet health insurance and concierge models become the norm
We have seen a societal transformation in how people view their relationship with their pets from being “pet owners” to “pet parents”. This new generation of pet parents are eager to do what is best for their pets and seek medical care that resembles their own in quality, and increasingly in delivery. Pet parents want to spend less time thinking and talking about cost and would rather make decisions strictly on medical merits. However, financial resources are never unlimited, and the cost of care remains a central point of conversation in most exam rooms when significant injuries or illnesses occur. Pet health insurance or concierge payment models align well with what pet parents are looking for: Peace of mind that they can stay focused on their pet's health and not finances during a crisis by turning medical care into a more predictable and consistent expense. Pet health insurance market penetration is growing rapidly, but insured pets still only represent a small fraction of overall pet ownership. As veterinary hospitals start to recognize the medical and financial benefits of ensuring their patients get health insurance, I predict that veterinarian advocacy for insurance will drive pet health insurance adoption up dramatically to represent a majority share of pet owners over the next decade.
3) Paraprofessionals as providers
As we’ve seen in recent years, the current size of the veterinary workforce is insufficient to meet even the current needs of the market in a traditional veterinary healthcare delivery model. Increasing veterinary medical school class sizes and newly accredited schools don’t appear to be on track to meet projected ongoing rising demand for veterinary healthcare services, let alone address the preexisting shortfall. The veterinary healthcare industry will be forced to innovate on the core delivery model, if only because continuing the status quo is not a viable option.
While the human healthcare system is rarely an aspirational place to look to when it comes to operational excellence, one thing that human healthcare does quite well is leverage nursing and paraprofessional staff well in order to deliver more care with a finite supply of physicians. Demand for veterinary healthcare services has vastly outstripped the ability for the veterinary profession to produce more graduates to compensate, and that trend does not appear to be slowing down. Until the slow pivot of increasing graduating classes can be completed, the veterinary profession will have to find new ways to maximize the utilization of the veterinarians in the workforce without overburdening them. Improving the size, quality, and utilization of the support staff workforce (and increasing pay accordingly to reflect a larger role in healthcare delivery) is one way that we can deliver more care with the same number of veterinarians while still ensuring that we keep up guardrails to protect veterinary healthcare worker work-life balance.
4) Increased specialization, and possibly a fragmentation of the degree
The bar for standards of care in veterinary medicine is rising, which is generally a good thing for all interested parties including pets and pet owners. Veterinarians have always prided themselves on their breadth of knowledge as medical “jacks of all trades”. However, higher standards of care necessitate more depth of knowledge and providing excellent care across all categories of medicine for a variety of species grows more and more difficult with each passing year as the pool of medical knowledge available grows. The number and type of cases that will end up requiring specialist level care will likely continue to expand as client expectations around quality of care and expectation of outcomes continue to rise.
Ultimately the veterinary profession may benefit from an optional fragmentation of general practice credentialing by species category, with tracking making it feasible to maintain the veterinary medical degree as a 4-year program despite continued crowding of the curriculum. A true “all species” degree should remain as an option, but it seems unfeasible to keep it confined to a 4-year program in the future as the body of medical knowledge continues to grow. We are already seeing a decline in clinical competency among new graduates as didactic learning occupies a growing proportion of veterinary education.
5) The student debt crisis reaches a breaking point
The cost of getting a veterinary medical degree has increased over the last two decades at a pace vastly outpacing both inflation and debt-to-income ratio. This is an unsustainable trajectory that negatively impacts every corner of our profession. Excessive debt creates a direct financial burden on young veterinarians, narrowing their pool of available employers since they simply cannot afford to work at practices that can’t pay enough to support their debt-imposed salary needs. This amplifies the rural veterinary healthcare access crisis (see below) and ultimately drives up the cost of veterinary healthcare to clients in order to support rising associate salary demands. To make matters worse, rising debt loads are making young veterinarians less likely to be willing to accumulate additional debt to finance practice purchases, opening the door for the rapid growth of non-veterinarian corporate ownership of the profession.
Veterinary medicine has always benefited from attracting top applicants to veterinary medical schools, but with the profession needing to grow to meet rising demand for veterinary healthcare services and ballooning debt-to-income ratios eventually the quality of talent entering the profession will start to suffer if the leadership of the profession don’t take drastic action to addressing the erosion of financial incentive for becoming a veterinarian. It is this author’s opinion that the AVMA must institute maximum administrative overhead and debt-to-income restrictions as a condition of academic accreditation.
6) Consolidation continues and rural communities face a crisis of access to care
Veterinary medicine is moving from the early innings of consolidation into the mid innings, but there is a long path of consolidation still ahead. It seems likely that a large portion of the industry, perhaps as much as half, will remain fragmented on a long-term basis as the economics of small rural practices make them less likely to consolidate. Urban and suburban markets are likely to continue to rapidly consolidate as the gap between the valuations provided by corporate buyers and individual buyers for veterinary practices in these markets widens in middle and late innings of consolidation. What the endpoint of this consolidation looks like will depend on who the players in the market end up being and how the veterinary profession holds them accountable. Many veterinary corporate groups have already earned very poor reputations for their behavior, but this has led to a rise in new groups (like AVP) who are able to align with practice sellers who are seeking a buyer for their practice who value the future clinical excellence, continuity of culture, and legacy of their practice.
Small rural practices face a growing transition crisis. Many owners of 1-2 DVM rural practices are moving to retirement age and finding few or no buyers. Many of these practices generate little to no EBITDA (profit) after accounting for fair-market clinical salary and rent and are challenging to hire associates in a tight job market, resulting in a lack of interest from most corporate buyers. Individual veterinarian buyers, once the mainstay of rural practice transition, are few and far between now due to a variety of factors (student loan debt, rising associate veterinarian pay, and younger veterinarians putting more value into work/life balance) converging to reduce the number of veterinarians willing and able to buy veterinary practices, especially small and rural ones. Unfortunately, at least a subset of these practices will end up cycling out of the market without finding buyers, reducing access to veterinary care in rural communities. It’s unclear what the solution is to this crisis, although it seems likely that regional care (fewer, larger rural hospitals that draw from wider geographies that used to be served by multiple solo-vet practices) may be the most economically sustainable rural veterinary care solution. Getting ahead of this impending crisis needs to become a significant priority for leadership in the industry in order to prevent rural veterinary healthcare access from crumbling over the next decade.
7) Pet life expectancy and quality of life continue to improve with access to higher quality of care and adoption of predictable healthcare expense models
Pets seem to be the clearest winner in the current upward trend in quality of medical care being provided to animals. Increased client adoption of pet health insurance and/or concierge pricing systems will reduce the incidence of economic euthanasia by reducing or eliminating large unexpected medical bills. As medical knowledge and tools continue to improve so will the options available to veterinarians and pet owners in order to extend quality and duration of life for pets. Cost of care is and will remain a hurdle to providing best possible care but ensuring that cost is consistent and predictable significantly mitigates cost concerns.