Why ‘high quality medicine’ is becoming a harder standard to hold: full analysis

CURRENT FULL VERSION: Dr. Andy Roark’s latest Cone of Shame commentary, “We Can’t All Be ‘High Quality Medicine,’” lands on a sensitive fault line in companion animal practice: what happens when the profession’s aspirations for excellent care collide with staffing shortages, burnout, uneven technician support, and the financial limits many pet parents face. While the source material provided is sparse, the framing aligns with a broader theme in Roark’s recent content, which questions whether veterinary teams are being asked to maintain an inflexible version of “quality” that isn’t always realistic in day-to-day practice. (drandyroark.com)

That debate has been building for some time. In a related Cone of Shame episode on spectrum of care, Roark and Dr. Kate Boatright discussed the idea that acceptable medicine exists on a range, from traditional gold standard care to more cost-effective, less invasive, or less intensive options. Boatright argued that many new graduates default to all-or-nothing thinking, even though most pet parents “fall in that middle ground.” That framing is important because it shifts the question from whether a practice is delivering “the best” medicine in absolute terms to whether it is delivering appropriate, ethical, and achievable care for the patient, the pet parent, and the team in front of them. Recent Roark content has widened that lens beyond medicine alone. In one crossover episode from Uncharted, he highlighted a manager’s concern that visits were dropping even while the clinic still felt swamped, underscoring how operational strain can persist even when top-line demand softens. In another Uncharted discussion, he and Stephanie Goss unpacked what it means when a manager is so exhausted they want to step back into a front-desk role, a reminder that leadership fatigue is part of the same sustainability conversation. (drandyroark.com)

The workforce backdrop makes the conversation more urgent. AAHA’s retention research found that about 30% of veterinary practice team members in clinical practice planned to leave their current role within a year, a signal of how fragile staffing remains. In a follow-up white paper announcement, AAHA CEO Garth Jordan warned that when practices get compensation and support wrong, the impact goes beyond payroll and can create “a cycle of burnout and continued turnover.” AVMA’s 2025 Economic State of the Veterinary Profession report adds nuance: average veterinarian burnout in 2024 was essentially unchanged from 2023 at 26.4 out of 50, though lower than in the 2020-2022 period, and 8.6% of veterinarians said they were considering leaving the profession. Roark’s recent management episodes help explain why those numbers can stay stubborn even when some pandemic-era demand pressure has eased: teams may still be overloaded by workflow inefficiencies, unresolved staffing gaps, and the invisible labor of managing people through change. (aaha.org)

There’s also growing evidence that support staff strain is central to the problem. NAVTA survey findings have shown burnout, debt, and low utilization remain major issues for veterinary technicians, even as pay and education levels have risen. AAHA’s technician utilization guidelines, highlighted by AVMA coverage, explicitly connect fuller use of credentialed technicians with better productivity and staff satisfaction, especially when practices are facing operational capacity challenges. In other words, one reason “high quality medicine” can feel unattainable is that many hospitals are still trying to deliver it with the wrong staffing model, or with technicians doing too little of what they’re trained to do and too much of everything else. That same mismatch shows up in leadership roles too: Roark’s recent discussions around overwhelmed managers and underexamined workflow pressure suggest some practices are asking people to carry responsibilities without enough structural support, training, or role clarity. (navta.net)

Industry commentary around burnout reinforces the clinical stakes. Cornell researchers have noted that burnout in veterinary medicine is associated with increased medical errors and major financial costs to the profession. AAHA has likewise tied burnout to lower client satisfaction, lapses in patient care, higher medical error rates, and turnover. Merck Animal Health’s fourth Veterinary Wellbeing Study, released in January 2024 with AVMA, suggested some post-pandemic improvement in how practices address mental health, but it also underscored that wellbeing challenges remain widespread across veterinarians and support teams. Roark and Peter Weinstein have also framed the problem in more structural terms, warning about an “enshittification” dynamic in veterinary medicine—where value is gradually extracted from the experience of clients, patients, and care teams unless practices actively rebuild systems that support them. (vet.cornell.edu)

Why it matters: For veterinarians, technicians, and practice leaders, Roark’s argument is less about lowering standards than about defining quality more honestly. If “high quality medicine” means every patient gets the fullest diagnostic workup, every recommendation is accepted, and every team functions at peak efficiency regardless of staffing or client constraints, then many hospitals are set up to feel perpetually inadequate. A spectrum-of-care lens offers a more operational definition of quality: safe, ethical, evidence-informed care that matches the patient’s needs, the pet parent’s circumstances, and the team’s real capacity. That may also be a retention strategy. AVMA recommends flexible scheduling, protected breaks, and encouraging staff to use leave, while AAHA’s retention work points to compensation and culture as key pressure points. Roark’s recent management conversations add that sustainability also depends on noticing when “busy” is being driven by broken workflows, overloaded leaders, or expectations that no longer match the clinic’s actual resources. (drandyroark.com)

The harder question is whether the profession is culturally ready to say that out loud. For years, accreditation, training, and peer norms have tied “quality medicine” to excellence standards that are valuable, but sometimes interpreted too narrowly in general practice. That doesn’t mean abandoning high standards. It means recognizing that sustainable quality may depend on better delegation, stronger communication with pet parents, and clearer acceptance that not every case can be managed at a referral-hospital ideal. It may also require more honest conversations about management capacity, HR training, and role design, given Roark’s repeated emphasis that leaders are often promoted without enough preparation and then left to absorb the fallout. That’s an inference from the available reporting and workforce data, but it’s consistent with the direction of current industry guidance. (drandyroark.com)

What to watch: Watch for this conversation to keep expanding in three areas: more explicit use of spectrum-of-care frameworks in GP, more pressure on practices to improve technician utilization and retention, and more open debate about whether “quality” should be measured only by medical ambition, or also by access, team wellbeing, and the ability to keep delivering care over time. Roark’s recent episodes also point to a fourth area: closer scrutiny of the management systems underneath the medicine, including how clinics respond to falling visit counts, leadership burnout, and the risk of making practice more extractive for teams and clients if those pressures go unaddressed. (drandyroark.com)