Growth has flattened — veterinary

Revenue is up, transactions are down — plateaued growth in a small-animal practice

PRESENTATION — WHAT THE OPERATOR SEES

The practice is collecting more than it did last year and it does not feel like it. ATC keeps climbing, the transaction count keeps slipping, and there is white space on the routine schedule that was not there three years ago. The owner describes it as "we're busier per invoice and emptier per day," and cannot tell whether that is the market or the practice. A multi-hospital veterinary group gets the same presentation one hospital at a time, and reading it group-wide is how it goes unnoticed for another two years.

DIFFERENTIAL — LIKELY CAUSES, MOST LIKELY FIRST

01
Price is doing all of the growth, and volume is eroding underneath it

Revenue rises because ATC rises, while transactions fall. The income statement reads as growth for three or four years while the demand base contracts — until the price lever runs out.

iVET360's 2026 benchmark report on calendar 2025: ATC +7.5%, transaction volume −4.7%, industry revenue +2.6%. IDEXX reported US same-store clinical visits −1.9% for full-year 2025 (−1.7% in Q4). Brakke Consulting put 2025 revenue at +2.5% on visits down roughly 3%. BLS CPI 'Veterinarian services' (CUUR0000SS62054) rose 7.07% in calendar 2025 and 48.8% since December 2019. BEA's real quantity index for pet veterinary services actually fell in 2025 (125.032 → 122.449) while nominal spend rose 3.48%.

iVET360 2026 Veterinary Industry Benchmark Report (N not disclosed — usable only because it corroborates independent datasets); IDEXX Q4 FY2025 Prepared Remarks, explicitly same-store; Brakke Consulting via AVMA/JAVMA News, Feb 13 2026; US Bureau of Labor Statistics CPI series CUUR0000SS62054; BEA NIPA Tables 2.4.3U/2.4.5U, published June 25 2026

NOT THIS IF — Transaction count is flat or growing and ATC growth is running under about 2%. Then the growth is real volume and the plateau is somewhere else — most often capacity or staffing.
02
The existing client base is coming back less often — visit interval is stretching

No client is lost, so the active-client count looks stable, but each client contributes fewer transactions per year. This is veterinary's version of attrition and it shows up as a lengthening visit interval, not as a lapsed-client count.

Vetsource data across roughly 6,000 practices: average days between visits rose from 57.6 (Jul 2020–Jul 2021) to 85.8 (Jul 2023–Jul 2024), a 48% increase. Active clients per practice have fallen about 95 per year since 2019, to 3,351 in 2024; active clients per FTE veterinarian have fallen about 15 per year, to 1,499. IDEXX reported US wellness visits down 3.6% in Q4 2025 — pressured harder than sick visits.

Vetsource, presented by Sheri Gilmartin at the 2024 AVMA Veterinary Business and Economic Forum, via AVMA/JAVMA News Oct 29 2024; 2025 AVMA Veterinary Practice Owners Survey via AVMA/JAVMA News Oct 15 2025; IDEXX Q4 FY2025 Prepared Remarks. Note: VHMA publishes the same 48% increase on completely different absolute values (72.8 → 112.3 days), so the direction is corroborated twice and the absolute figure is not.

NOT THIS IF — Visit interval for a fixed cohort of clients active in both years is unchanged and the entire shortfall sits in first-time clients. That is an acquisition presentation, not a retention one.
03
Throughput is capped by hours and staff leverage, not by rooms or by demand

The practice is open longer than its veterinarians are available, and non-medical work is being done inside veterinarian time. Slots that never get offered cannot be filled.

AVMA reports practices open and accessible an average of 9.5 hours a day, with veterinarians available for scheduled appointments only 7.4 of those hours. A full-time veterinarian in companion or mixed practice had approximately 13 to 14 appointment slots available per weekday and saw 15 patients per day in 2024 (down from 16.6 in 2021). In AVMA's 60-practice data-envelopment study, high-efficiency practices reached 75% more patients per FTE veterinarian per day than low-efficiency practices, and reported up to 45% more daily appointment slots per FTE veterinarian than moderate-efficiency practices — through nine-hour weekdays, a Saturday block, veterinarians consistently available seven hours for scheduled appointments, and non-veterinarian staff consistently using two hours to set up before the veterinarians arrived.

2024 and 2025 AVMA Veterinary Practice Owners Surveys via AVMA/JAVMA News Nov 18 2024 and Oct 15 2025; AVMA 2025 Report on the Economic State of the Veterinary Profession, 'Production and productivity'; Ouedraogo, AVMA Veterinary Economics Division, 60 independently owned companion-animal practices, AVMA Forum Oct 2022 (corrected version)

NOT THIS IF — Slots offered per FTE DVM per weekday already sit at the top of the 13–14 band, fill rate is high, and time-to-third-available for a routine wellness visit is inside a week. Then the constraint is demand, and adding capacity makes the white space worse.
04
Preventive-care compliance is leaking, so recurring revenue does not recur

Compliance is the practice's conversion metric. Every uncompleted protection year is a transaction that was recommended, charted, and never invoiced — and it also removes the reason for the next visit.

In the largest disclosed-N compliance dataset in the vertical — 7,926,392 unique dogs across 3,737 companion-animal practices, 2014–2017 — annual heartworm-preventive compliance was 51.7% for injectable moxidectin and 24.4% for monthly heartworm preventives; 55.6% of dogs on monthly product had a single transaction for six doses in a twelve-month period. Vetsource's weekly tracker across 6,184 practices showed heartworm dispensing −10.3% and flea/tick −10.7% year over year in the week of Jul 27–Aug 2 2025 — roughly four times the rate of the overall visit decline.

Pharmacoeconomic Analysis of Heartworm Preventive Compliance and Revenue in Veterinary Practices in the United States, Frontiers in Veterinary Science 2021 (peer-reviewed, open access); Vetsource Veterinary Industry Summary, week of Jul 27–Aug 2 2025. Caveat carried by the source: dispensing figures measure doses moved through the practice only and are confounded by channel shift to online pharmacies.

NOT THIS IF — Compliance measured against eligible patients seen — not against doses dispensed through the practice — is holding, and the parasiticide decline is entirely explained by clients filling elsewhere. That is a channel problem, not a compliance problem, and it is a different fix.
05
Clients are declining recommended services at the estimate

The visit happens, the recommendation is made, and the client says no. Revenue per completed visit stalls or falls even where visit counts hold, and the mix shifts toward the cheapest acceptable path.

Brakke Consulting's November 2025 survey of practicing veterinarians (N ≈ 350) found 81% reporting clients were more sensitive to costs than in 2024, up from 72% the prior year. The services most often declined, in order: diagnostics, then non-essential procedures, then preventive care. In the same survey 22% said revenue declined versus 2024, and profitability improved for only 32% — the lowest level in several years.

Brakke Consulting, Survey of Practicing Veterinarians, fielded November 2025, N ≈ 350, presented at NAVC VMX 2026 and reported by AVMA/JAVMA News Feb 13 2026

NOT THIS IF — The declined-estimate rate by category is flat year over year and case mix is unchanged. Then the client base is accepting what it always accepted and the volume is simply not arriving.

HOW TO TELL THEM APART

How to tell these apart in your own numbers

Each of these is a measurement you can run yourself, without us.

01 · Price is doing all of the growth, and volume is eroding underneath it

Pull 24 months of transaction count and gross revenue from the PIMS and compute revenue ÷ transactions by month. Plot ATC growth and transaction growth on the same axis.

CONFIRMS IF

ATC growth meets or exceeds total revenue growth while transaction count is negative. That arithmetic means volume subtracted from the result and price covered it.

EXCLUDES IF

Transaction count is flat or rising and ATC growth is under about 2%. Growth is coming from volume; look at capacity and staffing instead.

02 · The existing client base is coming back less often — visit interval is stretching

Fix a cohort — every client with a transaction in the prior 12 months — and compute median days between that cohort's consecutive visits this year versus two years ago. Separately compute the share of last year's active clients with any transaction this year. Write down your lookback window before you start; the institutions do not publish theirs.

CONFIRMS IF

Median interval for the fixed cohort has lengthened materially while the client count is roughly stable. The base is intact and under-utilised.

EXCLUDES IF

Interval is flat for the fixed cohort and the shortfall is concentrated in clients with a first transaction in the period. That is thin new-client volume, not retention.

03 · Throughput is capped by hours and staff leverage, not by rooms or by demand

Count slots offered per FTE DVM per weekday and slots filled. Separately log hours the practice is open, hours a DVM is available for scheduled appointments, and what time non-veterinarian staff arrive relative to the veterinarians.

CONFIRMS IF

Slots offered sit below 13 per FTE DVM per weekday, or the gap between hours open and DVM-available hours is wider than the AVMA average of 9.5 versus 7.4, or setup work is happening inside DVM hours.

EXCLUDES IF

Slots offered are at 13–14 per FTE DVM, fill rate is high, and non-medical setup is complete before the first appointment. Capacity is not the constraint.

04 · Preventive-care compliance is leaking, so recurring revenue does not recur

Run all eight compliance categories that Vetsource's Compliance Tracker defines — annual physical exams, wellness bloodwork, heartworm testing, fecal testing, core vaccines, lifestyle vaccines, parasiticide compliance, dental prophylaxis. Set the denominator to eligible patients seen in the period, not to doses dispensed.

CONFIRMS IF

A category's completion rate against eligible patients seen is falling year over year, and the drop is larger than the drop in visits. Recommendation is happening and completion is not.

EXCLUDES IF

Completion against eligible patients seen is stable and only the practice's own dispensing volume has fallen. Clients are complying and buying elsewhere — a pharmacy channel decision, not a medical one.

05 · Clients are declining recommended services at the estimate

Track declined-estimate rate by category and by DVM for one quarter — diagnostics, dentistry, surgery, preventive — as a share of estimates presented.

CONFIRMS IF

Decline rate is rising, and it is rising fastest in diagnostics, matching the sector's reported order of refusal.

EXCLUDES IF

Decline rate is flat and consistent across DVMs. The recommendation-to-acceptance step is working; the problem is upstream of the exam room.

WHAT RESOLVES EACH

What resolves this, and how you will know it resolved

Price is doing all of the growth, and volume is eroding underneath it	Rx 04 · marketing attribution →	The first fix is measurement: a monthly readout that separates transactions from ATC so the practice stops reading price as growth. What does not work is another price increase. Vetsource's own quartile analysis of roughly 8,000 practices found the top 25% by visit maintenance grew visits 10% year over year while raising average client transaction 0.14% — the bottom 75% raised ACT 3.5% instead. And VetSuccess's revenue model, built on about 2,000 practices, holds that visits account for roughly two-thirds of revenue per patient and ACT for about the remaining third. The lever with twice the weight is the one the sector is not pulling.
The existing client base is coming back less often — visit interval is stretching	Rx 03 · patient conversion →	Forward booking at the point of discharge, reminder sequencing against a stated active-client window, and a recall list worked as a queue rather than a mailing. This is a base-utilisation problem and acquisition spend does not touch it.
Throughput is capped by hours and staff leverage, not by rooms or by demand	Rx 03 · patient conversion →	Slot design, same-day capacity matching, and moving setup and non-medical work out of DVM hours. The AVMA efficiency study's mechanism was entirely operational — hours, setup discipline, staff leverage, slot count. None of it was marketing, and we would not sell marketing against it.
Preventive-care compliance is leaking, so recurring revenue does not recur	Rx 03 · patient conversion →	Compliance is a clinical outcome before it is a revenue one, and it should be reported that way — by category, against eligible patients seen, with the pharmacy channel split out so a Chewy migration is not misread as a medical failure. Pair with Rx 04 so the categories appear in the monthly readout.
Clients are declining recommended services at the estimate	Rx 02 · medical practice websites →	Where cost sensitivity is real, the honest answer is presentation and spectrum-of-care options communicated before the exam room, not a discount and not more media. If 81% of veterinarians are seeing more price resistance, buying more traffic into the same conversation is the most expensive available mistake.

WHAT "RESOLVED" LOOKS LIKE — Gross revenue per FTE veterinarian, companion animal exclusive practices, with transaction count flat or positive

MEDIAN

$616,667

TOP DECILE

Veterinary publishes no decile. The highest sourced position available is the upper quartile: $867,901. Lower quartile is $411,111 — Q3 is 2.1× Q1 within the same practice type, same year, same instrument.

TARGET

Movement from wherever the practice sits toward the upper quartile, with transaction count holding flat or rising while it happens. Revenue per FTE veterinarian that rises on ATC alone is not the outcome. This is a distribution position, not a promise, and the practice's own starting quartile determines how far the distance is.

AVMA 2025 Report on the Economic State of the Veterinary Profession, p.47, from the 2024 Veterinary Practice Owners Survey reporting on 2023. Context: all-practice gross revenue per FTE veterinarian was $554,982 in 2024, down in inflation-adjusted terms from nearly $600,000 in 2019 (2025 AVMA Practice Owners Survey).

HOW THIS DIFFERS BY SCALE

How this differs by scale

Single site	One site, one PIMS, one owner who is also the highest producer. The decomposition takes an afternoon and the interval test is trivial because the client base is small enough to see. The trap is that the owner's own production masks the trend — practice owners spend 74% of their time seeing clients and patients and 22% managing the practice (2024 AVMA Owner Survey), so the person who would notice is the person filling the schedule.
Group	Four to twenty sites, usually assembled rather than built, and often on more than one PIMS. Before any of these tests mean anything, the sites have to be reporting to one definition — one active-client lookback, one chart of accounts. The AAHA/VMG Chart of Accounts is free, AVMA recommends it as the standard, and any cross-site comparison not normalized to it is arithmetic over inconsistent categories.
Platform	Twenty-plus sites and a lender or sponsor reading the numbers. Here the distinction that matters is same-store versus panel: IDEXX's −1.9% is explicitly same-store, while the Vetsource tracker's −2.9% runs on a panel that grew about 10% across the published series with no same-store disclosure. A platform reporting blended growth that includes acquisitions is reporting something a buyer will re-cut, and it will be re-cut downward.

OTHER PRESENTATIONS — VETERINARY GROUPS

A differential narrows the field. It does not replace the examination — that is what the six weeks are for. Every figure above is an industry reference range, not a client's numbers; those stay sealed. Sources are set out at /sources.

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