By Veterinary Practice News Editorial Analysis
Based on insights by Patty Khuly, VMD, MBA

Executive Overview

Veterinary medicine is currently experiencing an identity crisis defined by a profound paradox. On one hand, the profession has mastered the vocabulary of modern, progressive healthcare. Practitioners, academics, and industry leaders routinely champion ideals such as evidence-based medicine, One Health frameworks, antimicrobial stewardship, client-centered communication, the spectrum of care, clinical independence, and systemic diversity.

Yet, beneath this polished rhetoric lies an uncomfortable reality: the veterinary profession is often considerably less accomplished at executing these principles than it claims to be.

According to a sweeping critique by Dr. Patty Khuly, VMD, MBA, the hurdles facing modern veterinary practice are not solely external pressures—such as private equity consolidation, crushing student debt, inflation, workforce shortages, or rising operational costs. Instead, a significant portion of the profession’s struggles stem from self-inflicted roadblocks.

Veterinary medicine suffers from entrenched habits, unexamined hierarchies, a hesitancy to step into business ownership, and a systemic willingness to outsource professional governance to corporate and non-clinical interests. This analysis explores the six core areas where veterinary medicine must reclaim its agency, dismantle outdated behaviors, and proactively steer its own future before external forces dictate it entirely.

Detailed Chronology: The Evolution—and Stagnation—of Clinical Culture

To understand how the veterinary profession reached this juncture, one must look at how clinical culture has evolved over the past several decades.

• The Mid-to-Late 20th Century (The Foundation of Autonomy): Traditional veterinary practice was largely built on independent, single-doctor or small-group brick-and-mortar clinics. Decision-making was localized, hierarchical, and deeply personal. Veterinarians served as both clinicians and small business owners by default, learning basic operations through trial and error.
• The Turn of the Millennium (The Rise of Specialization): As veterinary medicine advanced scientifically, the demand for specialized care exploded. Referral centers proliferated, and general practice grew more complex. Simultaneously, veterinary education expanded to emphasize diagnostic rigor, pharmacology, and technological integration. However, this academic expansion inadvertently fostered a rigid institutional hierarchy: general practitioners deferred to specialists, associates deferred to practice owners, and young graduates deferred to veterans.
• The 2010s (The Corporate Wave and Policy Shifts): Private equity and corporate consolidators entered the market en masse, acquiring independent practices at an unprecedented rate. While corporate ownership introduced administrative efficiencies and advanced equipment, it also shifted the locus of control away from the exam room. Standardized, cookie-cutter diagnostic panels and rigid hospital policies began to replace individualized clinical discretion.
• The Present Era (The Rhetoric-Reality Gap): Today, the profession talks extensively about "One Health" and "spectrum of care," yet practitioners remain trapped in automated habits—overprescribing broad-spectrum antibiotics, ordering expensive diagnostic panels out of routine rather than clinical necessity, and handing out Against Medical Advice (AMA) forms rather than practicing flexible, tiered medicine. The historical autonomy of the veterinarian is slowly being eroded, not just by external corporate forces, but by internal resignation.

Supporting Context & Metrics: The Cost of Complacency

The challenges outlined by Dr. Khuly are underscored by underlying structural shifts within the industry. Understanding these metrics helps clarify why reclaiming professional agency is no longer optional.

1. The Antimicrobial Stewardship Gap

Despite decades of warnings regarding antimicrobial resistance and the One Health initiative—which ties human, animal, and environmental health together—reflexive prescribing remains widespread. Studies across small animal practices frequently indicate that broad-spectrum antibiotics like doxycycline and amoxicillin-clavulanate are routinely deployed for self-limiting upper respiratory infections or uncomplicated acute gastroenteritis before diagnostic cultures are even considered.

2. The Corporate Consolidation Trajectory

Over the past decade, corporate-backed practice groups have acquired an estimated 25% to 35% of all general veterinary practices in the United States, with urban and suburban markets seeing much higher concentrations. As institutional and corporate owners increasingly shape practice management protocols, the voice of the independent, boots-on-the-ground clinician is frequently diluted.

3. Professional Association Disengagement

A vast majority of practicing veterinarians do not maintain active memberships in their local, state, or national veterinary medical associations (VMAs). Consequently, policymaking bodies responsible for defining the Veterinary-Client-Patient Relationship (VCPR), telemedicine regulations, controlled substance oversight, and technician scope of practice are often populated by individuals who may represent corporate interests rather than frontline clinicians.

Official Statements & Professional Insights

The disconnect between high-level professional ideals and everyday clinical reality has sparked urgent dialogue among veterinary leaders.

"We’ve got enough people telling us what’s wrong with our profession… Instead, consider this a list of things we already know how to do—and could probably start doing tomorrow if we could get out of our own way long enough to think things through a little better."
— Dr. Patty Khuly, VMD, MBA, Small Animal Practitioner and Columnist

Dr. Khuly’s critique touches upon several critical operational shifts that must occur within clinics, academic institutions, and professional organizations:

• Ending Reflexive Habits: Veterinary education heavily emphasizes the acquisition of baseline knowledge, but true clinical mastery requires the harder, ongoing work of unlearning outdated practices. Whether it is reflexively reaching for metronidazole for acute diarrhea or ordering expensive, standardized blood panels that do not alter the medical plan, clinicians must routinely audit their own habits against modern evidence.
• Redefining the Spectrum of Care: The term "spectrum of care" is frequently uttered at conferences, yet hospital workflows often fail to support it. When a client faces financial constraints, the traditional veterinary model too often involves a technician delivering an overwhelming cost estimate, followed by the client signing an Against Medical Advice (AMA) form. Dr. Khuly argues that guiding a client from "Plan A" to a medically defensible "Plan B or C" is the core duty of the veterinarian—not the administrative staff.
• Challenging the Clinical Hierarchy: Junior veterinarians, interns, and associates frequently suffer from institutional intimidation, deferring blindly to older colleagues, practice owners, or corporate guidelines even when clinical intuition suggests otherwise. Mentorship must evolve to include teaching young professionals how to respectfully and professionally disagree within a medical team.
• Demystifying Business Ownership: The pervasive myth that veterinarians are "too scientific for business" has driven many clinicians away from practice ownership. Viewing business acumen as an inherited trait rather than a learnable skill has left the door wide open for non-clinical entities to dictate the financial and structural future of veterinary medicine.

Future Outlook: Reclaiming Agency in Veterinary Medicine

If veterinary medicine is to navigate the complex economic and cultural pressures of the 21st century, the profession must pivot from passive observation to active participation. Waiting for external entities—whether corporate boards, insurance providers, or regulatory bodies—to solve internal professional challenges is a recipe for continued burnout and loss of autonomy.

1. Grassroots Leadership and Policy Engagement

Veterinarians must re-engage with local, state, and national VMAs. Sitting on committees, attending regulatory hearings, and running for leadership positions ensures that policies governing telemedicine, prescription protocols, and practice ownership reflect the realities of everyday clinical work rather than corporate bottom lines.

2. Democratizing Practice Ownership

The future health of the profession depends on diversified ownership models. Beyond building large, traditional multi-doctor hospitals, modern veterinarians can explore cooperative ownership, micro-practices, mobile clinics, targeted niche practices (such as feline-exclusive or species-specific care), and buy-ins at existing hospitals. True professional power resides with those who own and operate the businesses.

3. A Cultural Shift Toward Courage

Ultimately, reclaiming agency requires individual courage. It requires the courage to question habitual protocols, the courage to explain financial estimates and adapt care plans personally, the courage for junior staff to voice clinical insights, and the courage to step outside the exam room and into the boardroom.

Veterinary medicine has never lacked scientific brilliance or compassion. By shedding unnecessary administrative hurdles, dismantling toxic hierarchies, and actively participating in professional governance, the profession can ensure that the future of veterinary practice remains firmly in the hands of those who care for animals every single day.