Why Your Vet Bill Is So High

by | Apr 26, 2024 | The Atlantic

In the pandemic winter of 2020, Katie, my family’s 14-year-old miniature poodle, began coughing uncontrollably. After multiple vet visits, and more than $1,000 in bills, a veterinary cardiologist diagnosed her with heart failure. Our girl, a dog I loved so much that I wrote an essay about how I called her my “daughter,” would likely die within nine months.

Katie survived for almost two years. My younger son joked that Katie wasn’t going to let advanced heart failure get in the way of her life goal of never leaving my side, but the truth was that I was the one who wouldn’t let her go. Katie’s extended life didn’t come cheap. There were repeated scans, echocardiograms, and blood work, and several trips to veterinary emergency rooms. One drug alone cost $300 a month, and that was after I shopped aggressively for discounts online.

People like me have fueled the growth of what you might call Big Vet. As household pets have risen in status—from mere animals to bona fide family members—so, too, has owners’ willingness to spend money to ensure their well-being. Big-money investors have noticed. According to data provided to me by PitchBook, private equity poured $51.6 billion into the veterinary sector from 2017 to 2023, and another $9.3 billion in the first four months of this year, seemingly convinced that it had discovered a foolproof investment. Industry cheerleaders pointed to surveys showing that people would go into debt to keep their four-legged friends healthy. The field was viewed as “low-risk, high-reward ,” as a 2022 report issued by Capstone Partners put it, singling out the industry for its higher-than-average rate of return on investment.

[From the December 2022 issue: How much would you pay to save your pet’s life? ]

In the United States, corporations and private-equity funds have been rolling up smaller chains and previously independent practices. Mars Inc., of Skittles and Snickers fame, is, oddly, the largest owner of stand-alone veterinary clinics in the United States, operating more than 2,000 practices under the names Banfield, VCA, and BluePearl. JAB Holding Company, the owner of National Veterinary Associates’ 1,000-plus hospitals (not to mention Panera and Espresso House), also holds multiple pet-insurance lines in its portfolio. Shore Capital Partners, which owns several human health-care companies, controls Mission Veterinary Partners and Southern Veterinary Partners.

As a result, your local vet may well be directed by a multinational shop that views caring for your fur baby as a healthy component of a diversified revenue stream. Veterinary-industry insiders now estimate that 25 to 30 percent of practices in the United States are under large corporate umbrellas, up from 8 percent a little more than a decade ago. For specialty clinics, the number is closer to three out of four .  

And as this happened, veterinary prices began to rise—a lot. Americans spent an estimated $38 billion on health care and related services for companion animals in 2023, up from about $29 billion in 2019. Even as overall inflation got back under control last year, the cost of veterinary care did not. In March 2024, the Consumer Price Index for urban consumers was up 3.5 percent year over year. The veterinary-services category was up 9.6 percent. If you have ever wondered why keeping your pet healthy has gotten so out-of-control expensive, Big Vet just might be your answer.

To get a sense of what might happen when the profit-seeking dial gets turned up too high in veterinary medicine, we need look no further than human health care. An extensive body of research shows that when private equity takes over a hospital or physician practice, prices and the number of expensive procedures tend to go up. A study found serious medical errors occur more frequently after private equity buys the hospital. Another study found that costs to patients rise, too, sometimes substantially. And that’s in a tougher regulatory environment. In veterinary medicine, there is no giant entity like Medicare capable of pushing back on prices. There is no requirement, in fact, to provide care at all, no matter how dire the animal’s condition. Payment is due at the time of service or there is no service.  

Whenever I told people I was working on this article, I was inundated with Big Vet complaints. Catherine Liu, a professor at UC Irvine, took her elderly pit-bull mix, Buster, to a local VCA when he became lethargic and began drooling excessively. More than $8,000 in charges later, there was still no diagnosis. “Sonograms, endoscopy—what about just a hypothesis of what the symptoms could be? Nothing like that at all was forthcoming,” Liu told me. Shortly before Buster died, a vet in private practice diagnosed him with cancer. The disease, Liu said, had not once been mentioned by the vets at VCA. (Mars Petcare, VCA’s parent company, declined to comment on the episode.)

I don’t mean to single out VCA here—in fact, I should note that a VCA vet’s medical protocol was almost certainly responsible for my dog’s longer-than-expected life. One reason Mars-owned chains attract outsized attention for their high costs and customer-service failures is that the company actually brands its acquisitions. That’s unusual. A study conducted by the Arizona consumer advocate Todd Nemet found that fewer than 15 percent of corporate-owned practices in the state slap their own brand identity on their vets; most keep the original practice name, leaving customers with the illusion of local ownership. (When I asked Thrive Pet Healthcare, a chain majority-owned by TSG Consumer Partners, about why the company doesn’t brand its clinics, a spokesperson replied, “We realize the value of local hospital brands and are committed to preserving and supporting them.”)  

Indeed, some pet owners told me that they realized that ownership of their vet had changed only after what they thought was a routine visit resulted in recommendations for mounds of tests, which turned out to have shot up in price. Paul Cerro, the CEO of Cedar Grove Capital, which invests in the pet industry, says this issue is frequent in online reviews. “People will say, ‘I’ve been coming here for four years, and all of a sudden I’m getting charged for things I’ve never been charged for,’ and they give it one star.”

[Read: The great veterinary shortage ]

Big Vet denies charging excessive prices. VCA Canada, for instance, recently told The Globe and Mail that prices can increase after an acquisition because “the quality of the care, the quality of everything we offer to them, goes up as well.” A spokesperson for Mars told me, “We invest heavily in our associates, hospitals, state-of-the-art equipment, technology, and other resources.” NVA, which is planning an initial public offering in 2025 or 2026, did not directly answer a question about why veterinary prices were rising so rapidly, instead sending me a statement saying, in part, “Our vision is to build a community of hospitals that pet owners trust, are easy to access, and provide the best possible value for care.”  

Do rising prices really just reflect higher-quality care? There may be some truth to this, but there is also evidence to the contrary. A study published last year in the Journal of the American Veterinary Medical Association , for example, found that vets working for large corporations reported more pressure to generate revenue, whereas veterinarians working for independent practices reported higher levels of satisfaction for such things as the “ability to acquire new large equipment” and the “ability to get new/different drugs.” Preliminary research by Emma Harris, the vice president of Vetster, a veterinary telehealth start-up, found significant differences in pricing between corporate and privately owned veterinary clinics in the same geographic region. Usually, she told me, the increases “occurred immediately after the sale to a private-equity-owned group.”

All of this doesn’t sit well with many in the sector. Vets tend to be idealistic, which makes sense given that many of them rack up six figures in student-loan debt to pursue a profession that pays significantly less than human medicine. One vet, who worked for an emergency-services practice that, they said, raised prices by 20 percent in 2022, told me, “I almost got to the point where I was ashamed to tell people what the estimate was for things because it was so insanely high.” (The vet asked for anonymity because they feared legal repercussions.) Others described mounting pressure to upsell customers following acquisition by private equity. “You don’t always need to take X-rays on an animal that’s vomited just one time,” Kathy Lewis, a veterinarian who formerly worked at a Tennessee practice purchased in 2021 by Mission Veterinary Partners, told me. “But there was more of that going on.” Prices increased rapidly as well, she said, leading to customer complaints. (Mission Veterinary Partners did not respond to requests for comment.)

The combination of wheeling-and-dealing and price increases in the veterinary sector is beginning to attract the government’s attention. In the United States, the Federal Trade Commission required, in a 2022 consent decree, that JAB seek prior approval before purchasing any emergency or specialty clinic within 25 miles of one it already owns in California and Texas for the next decade. In her written comments , FTC Chair Lina Khan said she feared these one-by-one purchases could lead to the development of a stealth monopoly. (JAB denied any wrongdoing.) And in the United Kingdom, where corporate ownership is higher than in the United States (even the practice originally owned by the author of the classic veterinary novel All Creatures Great and Small has been rolled up), government authorities are moving forward with an investigation into high prices and market concentration after an initial inquiry drew what regulators called an “unprecedented” response from the public.

Pet owners used to have an easier time accepting the short lives of domestic animals. Few people were taking the barnyard cat or junkyard dog in for chemotherapy or ACL surgery, to say nothing of post-op aquatic physical therapy. “When we started out over 20 years ago, you had to live near a veterinary teaching hospital to have access to something like an MRI,” Karen Leslie, the executive director of the Pet Fund, a charity that aids people with vet bills, told me. “Now it’s the standard of care. It’s available basically everywhere—but that starts at $2,000.”

Big Vet, in Leslie’s view, helped fuel an increase in expensive services. The same medical progress that’s helped humans beat back once-fatal diseases is doing the same for cats and dogs, extending their life spans to record lengths. But only if you have the money to pay for it. Some pets—my late Katie, Liu’s late Buster—receive one expensive test or treatment after another, sometimes helpful, sometimes not. Other equally loved pets may go without basic care altogether, or even fall victim to what the industry calls “economic euthanasia,” where they are put down because their owners can’t afford their medical bills. (Pet insurance, widely promoted by the industry, is unlikely to help much. Uptake rates are in the low single digits, a result of relatively high costs and often-limited benefits.)

[Watch: Volunteer veterinarians in Ukraine ]

The American Veterinary Medical Association’s tracker shows that vet visits and purchases of heartworm and flea-and-tick medications are down compared with this month last year, even as practice revenues are up, suggesting that some owners are having trouble affording routine, preventative care. The market researcher Packaged Facts found that a full third of pet owners say that they would take their animal to the vet more often if it were less expensive. Shelter Animals Count, an animal-advocacy group, reports that the number of pets surrendered to shelters rose in the past two years. Carol Mithers, the author of the upcoming book Rethinking Rescue, told me that some people give up pets because they believe the shelter system will provide them with necessary medical treatment—something that is, heartbreakingly, not true.

The veterinary past is easy to romanticize. The truth is that pets have never received all the needed care, and that wealthy pet owners have always had access to more care. But the emergence of Big Vet and the injection of cutthroat incentives into a traditionally idealistic, local industry threaten to make these problems far worse. It portends a future in which some pet owners get shaken down, their love for their pets exploited financially, while others must forego even basic care for their pets. I don’t think Katie, who loved all animals, would approve. I certainly don’t.

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