You don't have to be everything to everyone
As a business owner the hardest word to learn is often "no", especially when it is directed to a client. The instinct of every business owner is to try to capture every possible revenue opportunity, but trying to be everything to everyone at all times is unrealistic and a one-way ticket to burnout for you and your staff.
It is important to have a realistic vision of your practice's minimum and ideal standards of care...and what they should cost.
"Gold standard" medicine looks beautiful in textbooks, but in practice it can quickly become prohibitively expensive in many cases. Our ethical duty as veterinarians dictates that we should default to recommending gold standard care. However, the reality of clinical practice means that we often have to fall back to less expensive, less ideal plans when gold standard recommendations are declined. However, there are only so many compromises that can be made before the quality of the care being provided falls below the minimum standard of care, both legally (as determined by your state practice act and in the judgment of its board) and ethically (as determined by a practitioner's personal belief on what qualifies as "not doing enough"). For nearly all veterinarians their personal ethical line of what they feel is the minimum standard of care falls somewhere closer to ideal than the legal minimum, and having a clear idea of where your line sits as a doctor and as the leader of a medical team is important.
Setting a high bar for the quality of medicine at your clinic is all well and good, but good medicine is inherently more expensive to provide. It is critical to realize that clinician time is one of your biggest expenses as a hospital and that gold standard medicine is extremely time-intensive because great medicine requires great client education. If practicing great medicine means bumping the length of your sick visits from 20 minutes up to 30-40 that's a totally valid stance to take, but if you're not scaling your exam fee and other service fees up accordingly then that means that you're subsidizing the decision to provide more value to your clients at the same price point out of your own pocket. Doctor and technician time isn't free to you, so providing more of it to your clients shouldn't be free to them. Extra time spent that isn't charged for is an opportunity cost since you otherwise would've spent it on other billable activities. Understanding that your clinical time provides billable value to your clients and cost to your business is important in understanding why providing higher quality care inherently means that it is going to be more expensive. 10 extra minutes on an appointment is an expense for your clinic just the same as a pack of suture or a tray of vaccines.
Don't turn client misperception of value into an excuse to charge less than the real value of your services
Most clients come in with unrealistically low expectations about the cost of care. Often it is shaped by outdated expectations (like most things, medicine costs more than it did 20 years ago), apples-to-oranges comparisons to low-cost or subsidized options, or comparisons to the cost of care in lower cost-of-living areas. The path of least resistance is to shift your pricing down to meet their expectations in an effort to retain their business, but doing so does not change the value of the services that you have provided to them and their pets and only serves to reinforce their incorrect assessment of the value that they've received. Instead, your focus should be on educating clients on the value of the care their pet is receiving and therefore why your fees reflect the value that has been delivered. Their pet didn't just "get his shots", the client and the vet came together to make sure that particular patient was protected against several deadly diseases. Their pet didn't just "get fixed", she was saved from the potential to develop life-threatening pyometra at some point in her lifetime and her risk of developing mammary tumors later on in life was dramatically reduced by getting spayed.
Subsidized care is a great option for budget-conscious clients, but don't get stuck competing with low cost care options on price
This is particularly relevant when it comes to spay and neuter surgery pricing. Client expectations about the price and value of spay/neuter are largely informed by HQHVSN programs which rely on subsidized funding (whether public funding, private donation, or both), volume, and specialized focus in order to keep costs down. It may also be informed by local competitors who may treat spay/neuter as a “loss leader” because they're not willing to risk losing a chance to generate a long-lasting client relationship early in a pet's life. Trying to compete on price with subsidized, high-volume spay/neuter is a case where general practices are best off not trying to compete at all. Low cost and subsidized care options are playing by an entirely different financial calculus than you are and if you try to treat them as competition you will lose. If you're providing dedicated anesthetic monitoring, post-op monitoring, and individualized care then THAT is where you should be emphasizing the value of why your services cost what they do. Treating any service as a "loss leader" only serves to reinforce the misconception in your clients' minds that the care you're providing is worth less than it actually is.
Don’t let your feeling of obligation to your clients override your very real responsibility to your employees
Veterinary healthcare workers deserve to get paid a robust living wage and benefits consistent with the high quality of skilled work that they perform. You can’t pay your people what they deserve unless you’re charging appropriately for the value of the work that they perform. Undercharging your clients means you’re putting less food on the shared table that you and your staff eat at. They’re responsible for doing good work, and you’re responsible for making sure they get paid well for doing it. Improving margins at your practice by revisiting out-of-date or under-priced items in your fee schedule leads to more resources at your fingertips with which to reward and retain your team, as well as improving your ability to hire talented new employees by being able to offer competitive salary and benefits.
In summary, when it comes to standards of care and the associated inherent expense it is impossible to be everything to everyone. Having an honest assessment of what your goals are as a clinician, as a practice, and how those goals intersect with the financial capacity of your core clients is critical to avoiding constant internal and external conflict. Being able to serve the needs of your core clients is important, as is being willing and prepared to refer away clients whose desired intersection of cost and quality of care exceeds (can be referred to a specialist or higher-end GP) or falls below (can be referred to a low-cost and/or subsidized care option) your clinic's standards. Many clients will come in with a fundamentally unrealistic desired intersection of cost and quality of care. Your job is to help them understand the value of the services that you provide, not to indulge their disconnect with the true cost and value of high quality medical care.