One playbook, different results by location — veterinary

Multi-site variance — same brand, same protocols, wildly different transaction counts per hospital

PRESENTATION — WHAT THE OPERATOR SEES

The group runs one set of protocols, one fee schedule and one marketing program, and the hospitals still land in a spread the leadership cannot explain. One site's DVM production is nearly double another's. The instinct is to conclude that one medical director is better than another — and before that conclusion is available, two cheaper explanations have to be ruled out.

DIFFERENTIAL — LIKELY CAUSES, MOST LIKELY FIRST

01
The sites are not measuring the same thing — definition drift

Active clients, bonding, revenue per practice and even 'transaction' are defined differently by different systems and different managers. Comparing them produces a spread that is arithmetic, not performance.

The lookback window for 'active client' is not merely inconsistent across the industry, it is unstated: AVMA publishes 1,499 active clients per FTE veterinarian with no stated window; VHMA publishes a client bonding rate of 62.5% with no window; AAHA's Pulsepoints figure of 1,837 active clients per year per FTE DVM implies twelve months; Vetsource's RETRIEVER treats 14, 16 and 18 months as inactivity thresholds. On revenue per practice, four defensible figures exist for overlapping periods — approximately $1.5M (AVMA, 524 practices, 93.9% independently owned), $1.841M (US Census 2022 Economic Census, derived from $62.819B across 34,126 establishments), $2.2M (Vetsource, 6,184 connected practices) and approximately $2.7M (Vetsource via Brakke, which Volk himself flags as skewed toward larger practices).

2025 AVMA Veterinary Practice Owners Survey; VHMA Insiders' Insight; AAHA Financial and Productivity Pulsepoints via Today's Veterinary Business Oct 2018; Vetsource RETRIEVER product documentation; US Census Bureau 2022 Economic Census EC2254BASIC, NAICS 541940; Vetsource weekly Industry Summary; John Volk, Brakke Consulting, via AVMA/JAVMA News Feb 13 2026

NOT THIS IF — All sites run one PIMS, one chart of accounts and one written lookback window, and the spread survives re-cutting to those definitions. Then the variance is real and worth investigating.
02
The spread is normal — productivity dispersion in veterinary is genuinely enormous

Leadership benchmarks its sites against each other and reads any gap as a failure. The sector's own distribution says a two-fold spread inside one practice type is ordinary.

Gross revenue per FTE veterinarian, companion animal exclusive practices: lower quartile $411,111, median $616,667, upper quartile $867,901. Q3 is 2.1× Q1 — within the same practice type, the same year and the same instrument. Companion animal predominant runs $351,500 / $608,553 / $760,887.

AVMA 2025 Report on the Economic State of the Veterinary Profession, p.47, from the 2024 Veterinary Practice Owners Survey. This is the only published quartile distribution in the vertical.

NOT THIS IF — Your worst site sits below the sector's lower quartile for its practice type. A site under $411,111 per FTE veterinarian in companion-exclusive practice is not exhibiting normal dispersion; it is underperforming the bottom 25% of the market.
03
Operating hours, setup discipline and staff leverage differ by site

The highest-leverage differences between hospitals are structural and unglamorous: how many hours the doors are open, how many of those hours a DVM is actually available for scheduled appointments, and whether non-medical setup happens before or during DVM time.

Sector average: practices open 9.5 hours a day with veterinarians available for scheduled appointments 7.4 of those hours. In AVMA's 60-practice efficiency study, high-efficiency practices operated nine hours a day Monday to Friday plus roughly three hours Saturday, with veterinarians consistently available seven hours a day for scheduled appointments and non-veterinarian staff consistently using two hours to set up before the veterinarians arrived — and reached 75% more patients per FTE veterinarian per day than low-efficiency practices, with up to 45% more daily appointment slots per FTE veterinarian than moderate-efficiency ones.

2024 AVMA Veterinary Practice Owner Survey via AVMA/JAVMA News Nov 18 2024; Ouedraogo, AVMA Veterinary Economics Division, data-envelopment analysis of 60 independently owned companion-animal practices, AVMA Forum Oct 2022 (corrected version)

NOT THIS IF — Hours open, DVM-available hours, Saturday coverage and setup timing are documented and identical across sites. Then the difference is not in the operating envelope.
04
Physical provisioning differs — rooms, square footage, vets per room

A hospital acquired rather than built carries whatever room count its previous owner chose. Two DVMs sharing three rooms and two DVMs sharing five rooms are not running the same business, and no protocol closes that gap.

The average US practice runs 3,845 square feet, 3.5 exam rooms and 2.76 FTE veterinarians — 0.92 FTE veterinarians per exam room, against AVMA economist Frederic Ouedraogo's stated target of 'about 0.5.' Gross revenue per exam room, companion animal exclusive: lower quartile $260,000, median $371,500, upper quartile $500,000. Gross revenue per square foot, companion animal exclusive: $257 / $400 / $636.

2025 AVMA Veterinary Practice Owners Survey via AVMA/JAVMA News Oct 15 2025; AVMA 2025 SotP Report, p.47

NOT THIS IF — Vets per exam room and revenue per exam room are close across sites. Then provisioning is not the constraint and the difference is behavioural.
05
The technology stack and the staffing base are not uniform across sites

A group assembled by acquisition inherits a different PIMS, a different reminder system and a different turnover history at every hospital. The playbook is uniform; the substrate it runs on is not.

Technology adoption across US practices in 2024: PIMS 76.5%, electronic medical records 66.8%, PIMS-integrated client communications 59.9%, digital inventory 43.5%, online appointment scheduling 33.4%, telehealth 29.2%. On staffing, VMG's 2025 Economic Survey of independent owners reported annual turnover above 31% for veterinary assistants, about 25% for receptionists and about 17% for CVTs. BLS reports veterinary technologist and technician employment fell from 131,320 (May 2024) to 129,140 (May 2025) while mean annual wage rose from $46,280 to $49,120.

AVMA 2025 SotP Report, pp.52–53 (N = 524); VMG 2025 Economic Survey (member report; VMG members are self-selected independent owners and staff larger than the AVMA average); BLS Occupational Employment and Wage Statistics, May 2024 and May 2025 national estimates

NOT THIS IF — Every site runs the same PIMS with the same modules live and turnover by role is comparable. Then the stack is not the differentiator — which makes the operating-envelope test the next one to run.

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 · The sites are not measuring the same thing — definition drift

Re-pull every site to one set of definitions before comparing anything: one written active-client lookback window, one chart of accounts, one same-store rule, one definition of a transaction. Normalize to the AAHA/VMG Chart of Accounts — it is free to all veterinary practices and AVMA recommends it as the standard.

CONFIRMS IF

The site ranking changes materially after re-cutting. The variance you were managing was partly an accounting artefact.

EXCLUDES IF

The ranking is stable through re-cutting. The spread is real and the remaining tests apply.

02 · The spread is normal — productivity dispersion in veterinary is genuinely enormous

Compute gross revenue per FTE veterinarian for each site and place each one against AVMA's published quartiles for its practice type — $411,111 / $616,667 / $867,901 for companion animal exclusive.

CONFIRMS IF

Your sites are spread across the sector's own interquartile range and none falls below Q1. That is a normal-sized spread and chasing it site-by-site is lower-yield than lifting the group's median.

EXCLUDES IF

A site sits below the sector's lower quartile. Below Q1 is not dispersion — it is a specific, addressable problem at that hospital.

03 · Operating hours, setup discipline and staff leverage differ by site

For each site, log for two weeks: hours open, hours a DVM is available for scheduled appointments, Saturday coverage, slots offered per FTE DVM per weekday, and what time non-veterinarian staff arrive relative to the veterinarians.

CONFIRMS IF

The high and low sites differ on DVM-available hours, slots offered, or setup timing. These are the exact levers the AVMA efficiency study isolated, and they are directly changeable.

EXCLUDES IF

The operating envelope is identical across sites and the spread persists.

04 · Physical provisioning differs — rooms, square footage, vets per room

FTE veterinarians per exam room, revenue per exam room and revenue per square foot for each site, placed against the AVMA quartiles for its practice type.

CONFIRMS IF

The low site is above 0.92 FTE veterinarians per exam room — more doctors than rooms can serve — or its revenue per exam room sits near the lower quartile while its revenue per FTE DVM does not. That is a room constraint, not a doctor constraint.

EXCLUDES IF

Vets per room and revenue per room track together across sites.

05 · The technology stack and the staffing base are not uniform across sites

Per site: which PIMS, which modules actually live, whether online booking is enabled and what share of visits it carries, and twelve-month turnover by role (DVM, CVT, assistant, receptionist).

CONFIRMS IF

The low-performing sites are the ones without online booking on their own site, or without PIMS-integrated reminders, or carrying turnover well above the group. Both are fixable and neither is a medical-director problem.

EXCLUDES IF

Stack and turnover are comparable across sites.

WHAT RESOLVES EACH

What resolves this, and how you will know it resolved

The sites are not measuring the same thing — definition drift	Rx 04 · marketing attribution →	One readout, one set of definitions, normalized to the AAHA/VMG Chart of Accounts, with the active-client lookback written down. This is the cheapest fix on the list and it has to happen first — every other test is unreliable until it does.
The spread is normal — productivity dispersion in veterinary is genuinely enormous	Rx 04 · marketing attribution →	Sometimes the correct output is a decision not to act. If the sites sit inside the sector's own interquartile range, the group's leverage is in raising the median, not in chasing the tail — and we would rather say that than sell a five-site remediation program.
Operating hours, setup discipline and staff leverage differ by site	Rx 03 · patient conversion →	Slot design, DVM-available hours, and moving setup and non-medical work out of veterinarian time. The AVMA efficiency study's entire mechanism was operational — hours, setup discipline, staff leverage, slot count. No part of it was marketing.
Physical provisioning differs — rooms, square footage, vets per room	Rx 04 · marketing attribution →	This one is frequently a capital decision rather than an operating one, and it belongs in the readout so it can be argued on numbers. We would not take on a growth engagement premised on fixing a room shortage with media.
The technology stack and the staffing base are not uniform across sites	Rx 03 · patient conversion →	Bring online booking and PIMS-integrated reminders to parity across sites first, then re-measure. One caution on the labour side: the veterinary consulting community's labour-cost ratios trace largely to AAHA's Financial and Productivity Pulsepoints 10th edition (2019) and the 2019 Well-Managed Practice benchmarks. Those predate two rounds of double-digit wage inflation. Do not manage a site against them as if they were current.

WHAT "RESOLVED" LOOKS LIKE — Gross revenue per FTE veterinarian by site, reported to one definition, with the intra-group spread tracked as its own number

MEDIAN

$616,667 (companion animal exclusive); $608,553 (companion animal predominant)

TOP DECILE

No decile is published in veterinary. The upper quartile is $867,901 for companion animal exclusive and $760,887 for companion animal predominant. The lower quartile is $411,111 and $351,500 respectively — the sector's own Q3-to-Q1 ratio is 2.1×.

TARGET

Bringing the lowest site above the sector's lower quartile, and narrowing the group's own Q3-to-Q1 spread to less than the sector's 2.1×. Lifting the floor, not the ceiling. This is a distribution position, not a promise, and a group whose worst site already clears the sector median has a different and much harder problem.

AVMA 2025 Report on the Economic State of the Veterinary Profession, p.47, from the 2024 Veterinary Practice Owners Survey

HOW THIS DIFFERS BY SCALE

How this differs by scale

Single site	A single hospital has no cross-site comparison, so the substitute is DVM-level variance inside the practice — DVM production, forward booking rate and compliance by doctor. The same definition discipline applies: one lookback, one denominator, before anyone is ranked.
Group	Four to twenty sites is where this presentation actually lives, and where definition drift does the most damage because the group is large enough to have inherited multiple systems and small enough not to have a data function. Never rank sites on a single month: VHMA's own panel of 5,000-plus practices swung from visits −4.2% in August to +3.5% in September 2025.
Platform	Twenty-plus sites, where same-store discipline becomes the whole game. Note the structural context a sponsor will already know: US Census 2022 shows the 50 largest veterinary firms holding 37.3% of sector revenue across 18.9% of establishments, and the four largest holding 22.4% of revenue across 12.7% of establishments — consolidated practices run roughly twice the size of the average one. A platform benchmarking its sites against all-practice averages is benchmarking against a smaller business than it operates, which is why the comparison set for a multi-hospital practice group is its own site distribution.

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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