DX / Differentials / VETERINARY GROUPS

D-01 — PATIENT ACQUISITION COST · VETERINARY GROUPS

Cost per new patient is climbing — veterinary

Cost per new client is rising — and there is no published benchmark to check it against

DIFFERENTIAL — LIKELY CAUSES, MOST LIKELY FIRST

1. 01

   The denominator moved — new-client volume is down sector-wide, so identical spend buys fewer

   Cost per new client is a ratio. When the number of pet owners entering the market falls, the ratio rises without anything changing in the media, the creative, or the practice.

   Across roughly 6,000 practices, new clients were down 8.6% year over year and new puppy and kitten patients down 9%. Active clients per practice have declined about 95 per year since 2019, to 3,351 in 2024. Canine patients — about 81% of practice revenue — fell 3.3%, while feline patient visits rose 0.8%.

   AVMA/Vetsource Practice Pulse, N = 6,000 practices, Aug 2023 – Aug 2024, presented by Sheri Gilmartin at the AVMA Veterinary Business and Economic Forum Oct 9 2024, via AVMA/JAVMA News Oct 29 2024; 2025 AVMA Veterinary Practice Owners Survey via AVMA/JAVMA News Oct 15 2025

   NOT THIS IF — Your own new-client count per FTE DVM is falling materially faster than the sector's 8.6%. Then the market moved and something specific to the practice moved further, and the sector figure is a floor, not an explanation.

2. 02

   Acquisition is being asked to carry a job it structurally cannot do

   New clients are a small share of a veterinary practice's revenue. Even a strong acquisition program moves a minority of the P&L, so cost per new client can look bad while being economically irrelevant to the actual shortfall.

   8% of total practice revenue comes from new clients. The other 92% is retention and utilisation of the existing client base.

   AVMA/Vetsource Practice Pulse, N = 6,000 practices, via AVMA/JAVMA News Oct 29 2024, quoting Sheri Gilmartin, VP Data Services, Vetsource

   NOT THIS IF — The practice is a de novo, a recent relocation, or has been open under about two years. Then new clients genuinely are the business and this reasoning does not apply.

3. 03

   The demand is arriving and cannot convert without a phone call

   Cost per new client is measured at the end of a chain. If the last link requires a human answering a phone during business hours, spend inflates to compensate for booking friction that costs nothing to fix.

   Only 33.4% of US veterinary practices had online appointment scheduling in 2024. Two-thirds cannot be booked online at all. By comparison, 76.5% had a PIMS and 59.9% had client communications software integrating with it — the infrastructure is largely present and the booking step is not.

   AVMA 2025 Report on the Economic State of the Veterinary Profession, 'Technology adoption and utilization', pp.52–53, from the 2024 Veterinary Practice Owners Survey (N = 524)

   NOT THIS IF — Online booking is live, a meaningful share of first-time client appointments come through it, and missed-call rate is low. Then the conversion step is not where the cost is going.

4. 04

   Acquiring pet owners genuinely did get more expensive across the whole market

   Media costs and competition for the same pet-owning households rose. This is the one cause where the practice did nothing wrong: the price of paid reach moved, and the honest answer is to re-baseline the target rather than to optimise against a number the market has already left behind.

   Trupanion's audited Form 10-K discloses average pet acquisition cost of $288 in 2025, up from $235 in 2024 and $228 in 2023 — a 22.6% year-over-year increase.

   Trupanion, Inc. Form 10-K for FY2025, SEC EDGAR. Critical scope limit: this is an insurer's cost to acquire a policy subscriber. It is not a veterinary practice's cost to acquire a client and must never be presented as one. It is directional evidence about the cost of reaching pet owners, and nothing more.

   NOT THIS IF — Your cost per new client rose while your media mix, geography and competitive set were all unchanged and your impression costs were flat. Then something inside the funnel moved, not the market.

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.

WHAT RESOLVES EACH

What resolves this, and how you will know it resolved

The denominator moved — new-client volume is down sector-wide, so identical spend buys fewer	Rx 01 · patient acquisition →	Demand mapping and channel work are legitimate here — but sized honestly. In a market where new clients are 8% of revenue and sector new-client volume fell 8.6%, acquisition is a share-of-a-shrinking-pool exercise, and we would say so before taking it on.
Acquisition is being asked to carry a job it structurally cannot do	Rx 03 · patient conversion →	This is the ruling that changes the engagement. If 92% of revenue is retention and utilisation, the money belongs in forward booking, recall and compliance before it belongs in media. We do not scale acquisition into a leaking intake, and in veterinary specifically the leak is usually larger than the pipe.
The demand is arriving and cannot convert without a phone call	Rx 03 · patient conversion →	Online booking and call-center instrumentation. When two-thirds of the sector cannot be booked online, this is the cheapest available improvement in cost per new client and it requires no additional spend. Often it is the whole answer, and that is a fine outcome for us to name.
Acquiring pet owners genuinely did get more expensive across the whole market	Rx 04 · marketing attribution →	Because no external benchmark exists, the only trustworthy version of this number is your own, computed the same way every quarter and normalized to the AAHA/VMG Chart of Accounts. What does not work is adopting a vendor's published veterinary cost-per-new-client figure — several software companies publish them with no disclosed denominator, and no institutional source has one to check them against.

HOW THIS DIFFERS BY SCALE

How this differs by scale

Single site	One practice, one market, and small enough numbers that a single month of new clients is noise. Measure quarterly, not monthly. The most common finding at this scale is that the practice has no marketing account in its chart of accounts at all, so the numerator has never been assembled.
Group	Four to twenty sites, and the first real finding is usually that cost per new client varies more between your own sites than it does between years — which makes the internal spread the benchmark veterinary groups and consolidators never had. Normalize the marketing account across sites before comparing, or the spread is an accounting artefact.
Platform	Twenty-plus sites, and a sponsor who is fluent in CAC and will ask for it directly. Give them the internal series and the explicit statement that no industry comparator exists in veterinary — that is a more credible answer than a sourced-looking number, and it is one they can verify. Pair it with new-client revenue share, which is the figure that actually tells them how much of the thesis rests on acquisition.

OTHER PRESENTATIONS — VETERINARY GROUPS

• Revenue is up, transactions are down — plateaued growth in a small-animal practice
• Thin pipeline — the demand exists and does not become a booked, kept, invoiced visit
• Multi-site variance — same brand, same protocols, wildly different transaction counts per hospital
• Preparing for exit — making growth read as a repeatable system rather than as the owner