Quick shout out to our recent grad readers: if you’re a ’23, ’24 or ’25 grad (or a student) - we’d love for you to join us for our annual Vets On Tour snow conference in Wānaka, New Zealand in August. But we know that you’re probably… how shall I put this politely… let’s say you have’t quite reached your full earning capacity. So we’ve organised half price rates and affordable accommodation for the week for you. That means your conference ticket will be $975, and we can get you a bed for $1500 for the week.
It’s going to be epic - come join us. (And if you’re not a new grad but you employ one - here’s your chance to be the best boss in the world.) Email matt@vetsontour.com to find out how to get your hands on a these tickets.
From Episode 228 Medicine Feed With Dr Bing Zhu, and a recording with Prof Stan Marks
Something that’s been on my mind a lot recently is history taking. Because regardless of how smart you are (or how smart the AI is that you’re using!) - if your patient history is crap your decision making will be equally crap.
And staying on the topic of excrement - this is why the following thoughts on how to get a great history around diarrhoea from these two smart people resonated with me so much:
Never ask ‘has your pet had any diarrhoea?’ Because most people think diarrhoea means ‘hose pipe pooping’ - the kind that ruins the carpet or paints the wall. Also - ‘normal’ is relative. Their pet might have never had a normal stool in its life, so they think that the sloppy mess on their lawn is what dog shit looks like. But what Prof Stan means when he’s asking about stool consistency is anything that’s not a lovely formed stool. (In the talk I attended he literally had a photo of a turd in a field of flowers!) Anything else means something is going on with the gut. (Does that change your own perceptions? It sure did for me.) So when you get your history, you need to be explicitly clear on what the poop looks like.
So how do we do this practically?
Prof Stan likes the faecal scoring charts made by the food companies. Pick one, and then get your clients to point at a picture.
Dr Bing is a bit more poetic. Here’s what she asks: Can you pick up your pet’s poo cleanly without any of it sticking to the lawn / sand in the litter box?
If you think that this is an excessively detailed soliloquy about faeces - have a listen to the conversation with Dr Bing, then tell me if you still think so.
From Episode 222 Surgery Feed With Dr Patrick Kenny
The episode that this one’s from kinda gives away the punchline - if we’re talking about cutting out pituitary glands then the answer is obviously something hormonal, and when we narrow it down to ‘cats’ and ‘diabetes’, then the cat is out of the bag: hypersomatotropism as the driver for insulin resistance making the diabetes almost impossible to stabilise. Here are a few factoids you should know about this growth hormone abnormality:
Did you know that in a UK study they found that 1 in 4 cats with diabetes have hypersomatotropism? (No wonder we find diabetes in cats so hard to treat!)
A recent study in Aus showed that for us it’s 1 in 6. Similar story in Europe.
If you need to check for it - you’re measuring insulin-like growth factor, not growth hormone. Dr Patrick says the only test that’s validated for IGF-a in cats is run at the Royal College in the UK, which is probably why we’re not testing for it more readily.
And if you diagnose your challenging diabetic cat with hypersomatotropism, what do you do about it? Well, there’s the tricky bit. The only thing that will make a real difference is to have its pituitary gland cut out. Not a small thing, but not impossible. Have a listen to this episode with Patrick to get the details.
From Episode 219 Surgery Feed With Dr Fergus Allerton
We were thrilled at the emergency clinic I worked at when we were able to get our hands on an intravenous formulation of amoxycillin-clavulanic acid. Not your first choice of antibiotic for a run-of-the-mill infection, but a fantastic choice for the septic patient or anything else with a bacterial infection of unknown spectrum in a patient that’s rapidly deteriorating. A few of the vets then started making comments about unexpected and slightly scary reactions. At first we thought it was a once-off, but pretty soon there was a clear pattern: IV amoxyclav, sudden weakness, often vomiting, with urticaria not all that uncommon. And all of a sudden we were all a bit nervous of our new tool.
So I loved this little amoxyclav side-bar in our conversation with Dr Fergus on surgical antibiotic prophylaxis. Here’s what you need to know:
Yes - it’s a thing - it’s not just you. There have been several publications showing significantly higher rates of anaphylaxis to IV amoxyclav compared to other commonly used antibiotics - cefuroxime specifically in one UK study.
The most common signs were urticaria and facial oedema, with a significant proportion of patients developing Type 1 hypersensitivity reactions with vomiting, diarrhoea, and cardiovascular signs. In one paper the rate was as high as 32%, but in a more recent meta-analysis the number was much less dramatic with a reassuring 0.81%.
Importantly - nobody died from these reactions!
There are some slow IV infusion protocols being tested, which - so far - seem promising. Published results are expected next year, but in the mean time I’ll certainly be diluting my next septic patient’s amoxyclav and giving it nice and slow.
2 Other Things
“Only while sleeping one makes no mistakes. Making mistakes is the privilege of the active - of those who can correct their mistakes and put them right.”
-Source: The Testament of a Furniture Dealer (1976)
“The largest part of what we call ‘personality’ is determined by how we’ve opted to defend ourselves against anxiety and sadness.”
In our previous post I told you about my recent experience of being better paid than I've ever been as a vet to do non-clinical work. Work that relied on, as my friend Chad said, my ' ‘…unique expertise and experience across multiple domains, and it’s expertise that they need and are more than happy to pay for.’ (Read that first post first if you haven’t already - this one will make more sense.)
So why is it that I’m more valuable, in simple dollar terms, outside of the thing I am specifically trained for, and that I love doing. To help us think through this earnings ceiling in the vet profession, it’s worth unpacking Chad’s statement:
Unique skills - Check.
…across multiple domains - You might not always realise this, but you know much more than facts about sick animals. Definite check.
…skills that they need - As long as anyone cares about animal health - check.
…that…they are happy to pay for. Well. This is where things get sticky.
Because first of all - who exactly is the ‘they’ who need your unique expertise and experience? Are we talking about our clients, or our bosses? Both of these need you. Neither of them are particularly happy to pay you.
To our clients we are often a valuable service that they’d rather not use if they can help it - like paying for a flat tyre or some a plumber to unblock your toilet - you’re happy that the house no longer smells like a public toilet, but you’d have preferred to go out for a nice meal, or an overseas holiday. And even if they are happy to pay for your expertise, sometimes they simply can’t. Unlike the large multinational architectural firm who paid me to review the hospital plan, most of the people who need us do not have Swiss bank accounts and long lines of credit.
To the business owners who pay our wages, we are their biggest expense - the thing that stands between them and their yacht, or sometimes just a decent wage. Now, before the practice owners among us get upset with me - let me state that I know many bosses who care deeply about their teams and would love very much to pay everyone more, if the business could carry it. But from a pure business/profit and loss perspective - vets are an expense that needs to be minimised. Or if not minimised, then offset by higher earnings. In other words, if we want to be paid more, we need to generate more.
Which is where it gets icky. For the architecture firm who needed my expertise, it’s fairly simple: there’s a client who wants a top-notch hospital. The firm calculates their costs, including what they need to pay consultants, sends an estimate, and the client can take it or leave it. If it’s more than they can afford, they lower the design specs, or realise that their business idea is not viable and scrap the project. Nobody suffers, nobody dies. Nobody feels guilty.
Contrast that to your world. I don’t need to spell it out.
So we cut costs where we can so we can keep fixing animals. And what did we just say the number 1 cost is? Which is exactly why I earned 3 times as much for looking over some design drawings in an air conditioned office than I can for doing a life saving surgery, or ending a life with dignity.
So what do we do about it?
If I had THE ANSWER I’d be earning much more than just 3 times my vet wage as the world’s best veterinary business consultant. But I do have some things for us to think about:
I don’t know any homeless vets with starving children. We have a cool job. For the most part we are well respected, despite the fact that many people already make snide comments about how much we charge. So maybe the answer is to stop comparing ourselves to higher-margin, low-guilt professions and accept the fact that the beach house isn’t happening on a vet wage.
Here’s something that sucks: the conversation at your performance review that goes - ‘if you want to earn more you need to bill more.’ It sucks because it can interfere with your integrity as a clinician: am I suggesting bloods because I believe it’s best for my patient, or because I need to pay for my kids’ school fees? It sucks because it’s also a bit insulting in that it completely ignores the value you can bring to a business that is not directly measurable by what you invoice. The architecture firm didn’t want to see a dollar value for my insights into the flow of the vet hospital - they see value in how it will affect patient safety and comfort, and the benefits of a nice work environment for the team. Just like the many non-billable things you bring to your work day that make the practice work. But the architects account for this, and they charge for it. So somehow we in vet land need to do the same, and in the current veterinary business model the way to do that is for the vets to bill more. That’s you. Get comfortable with it. (See our last post to help with this.)
Here’s how I thought about this when I owned my emergency clinic. I set out with two core principles around staff remuneration:
In our business structure I was paid an hourly rate for any of my clinical work. It was hard work, including overnight shifts with high levels of responsibility. I asked myself how much I needed to be paid to not feel resentful. What’s the number that will make me clean up haemorrhagic diarrhoea at 3 in the morning with a smile? The number I came up with was substantially higher than your average vet wage at the time, and set that as a benchmark for the whole team.
I decided that I wanted to have the best-paid team in the state. I never wanted anyone to leave because of money. (Pro tip: it turns out to be a great recruitment tool too!)
So we set our prices with these 2 things in mind and opened the doors. For the next 7 years, whenever the gap between the wage bill and our revenue in the quarterly financials made me sweat, I’d adjust pricing. It’s a simple formula, but it worked: start with the end in mind.
But again, this only works up to a point, until the people who want our help can no longer afford our expertise. Which, to many, is what it feels like in 2026.
So what are our options?
Vets can be a bit allergic to the term ‘productivity’ - it can feel like ‘flog you harder so we make more money.’ But the simple fact is that if we can’t / don’t want to charge more, then we need to DO more. And I don’t mean ‘do more per client’ - that’s a slippery slope towards do you want fries with that? I mean fix more animals. Without burning out the teams.
This requires systems. Google Aravind Eye Hospital, or read this book. It’s the story of an eye hospital in India that found a way to deliver world-class cataract surgery at massive scale, including free or heavily subsidised care for patients who couldn’t afford to pay, without making the clinical care second-rate. They did it by treating affordability as a systems problem. This meant standardising the repeatable parts, obsessively measuring outcomes and making adjustments based on what they found, leveraging support staff properly, designing workflows so surgeons spend most of their time doing the thing only surgeons can do, and letting paying patients cross-subsidise those who couldn’t pay. (I’d love to ask them how they are bringing AI into their systems!)
The lesson isn’t that vet clinics should copy a cataract hospital. It’s that the solution to affordable vet care doesn’t have to come from asking skilled people to work for less. Sometimes it comes from redesigning the work so the same team can safely help more patients, with less waste, less friction, and fewer humans being slowly minced by the machine.
If some of the people who need our help can’t pay, is there somebody else who might want to foot the bill? To some extent this is already happening. It’s kinda what pet insurance does. And in many countries this is how charity low-cost hospitals operate: through fundraising and donors. Think RSPCA, PDSA, Blue Cross, or the shelter care models in the US. And we’ve all heard grumblings of publicly-funded animal care - a Medicare or NHS-type model.
Until that happens, where we don’t have access to low-cost subsidised care, we’ll need to get creative.
I like that last line of the Aravind approach: letting paying patients cross-subsidise those who couldn’t pay. Could we stratify our clients in a way that helps us even things out? Does the Northern Beaches family want a properly-priced 100% markup endoscopic dog spay, where precious (pick your flavour of -oodle) gets an anaesthetist, wakes up in climate-controlled cage with owner-assisted recovery - with some of that profit helping to pay for the GDV later that night? With their consent of course - they might embrace this. Maybe you start charging a ‘Frenchie tax’ - similar to the luxury tax imposed on cigarettes and alcohol that helps to fund public health care? (You can call it a stupidity tax behind closed doors if you want.)
Are there high-value, high-margin services that we can provide that do not involve using animal suffering as a bargaining chip? I know that’s not actually what we do, bit that’s what it can feel like, right?
Could the general practice of the future lean more on profitable services that are desirable, useful, and not built around crisis? Maybe it means rethinking wellness plans - from a lazy ‘bundle of discounted stuff’ to properly designed prevention programmes, longevity clinics, mobility programmes. I’ve often thought that a well-run, effective weight-loss clinic or a high-touch skin plan would be a great business. (Still involves Frenchies though…)
And outside the clinic walls? Could practices sell their expertise to companies or individuals with deep pockets? Could we charge properly for the invisible stuff we give away for free every day: advice, systems, education, risk assessment, animal welfare judgement, and the ability to spot bullshit at 20 paces?
These are just ideas to get us thinking. Some are probably terrible. Some are already being done, but could be done better, or marketed better. Some would create new problems. But it’s worth asking the question: not just ‘how do we charge more for vet care?’ Maybe the better question is: what else do veterinary skills create value for, and how do we use that value to keep essential care within reach?
Which of these would you actually try? Hit me with your best ideas.
Much love,
Hugh
How to connect with us:
Comments
Nothing yet. Say the first thing.
Sign in to join the conversation.