Why more veterinarians are referring cases they know clients may decline

A new Veterinary Practice News opinion piece published March 10, 2026, argues that veterinarians are increasingly referring cases to specialists even when they suspect a pet parent may not be able to move forward financially. Patty Khuly, VMD, MBA, frames that shift against a familiar business backdrop: production-based compensation and bonus structures are supposed to reward more complete in-house workups and bigger invoices, yet many clinicians still feel it’s preferable to refer than retain certain cases. (veterinarypracticenews.com)

That tension lands at a moment when referral medicine is being reshaped by workforce shortages, evolving expectations around standard of care, and a broader push toward collaboration. In March 2024, the Association of American Veterinary Medical Colleges said shortages exist across veterinary sectors, and that the shortage of specialty-trained veterinarians is “especially pronounced.” The group also said overwhelmed primary care teams are increasingly referring cases or routing them through emergency services because they lack the capacity for thorough workup, diagnosis, and management in general practice. (aavmc.org)

Recent guidance from AAHA suggests the profession is trying to make that shift more structured, not less. The 2025 AAHA Referral Guidelines position teleconsulting as a practical bridge between general practice and specialty care, saying it can reduce client costs and frustration over long referral wait times while improving access to timely intervention. In related AAHA commentary, task force member Bret Moore, DVM, PhD, DACVO, said that at the University of Florida’s ophthalmology service, roughly 65% of after-hours referrals sent without a phone call were cases that could have been handled at the level of a fourth-year graduating veterinarian. That points to a nuanced reality: some cases are being referred because they truly need advanced care, while others may reflect uncertainty, workflow pressure, or underused specialist-to-GP collaboration. (aaha.org)

The affordability problem sits underneath all of it. In January 2026, Gallup and PetSmart Charities reported that 94% of veterinarians said clients’ financial considerations sometimes or often limit their ability to provide recommended care. The same release said prior research found 73% of pet parents who declined care due to affordability were not offered a more financially accessible option, and only 23% reported ever being offered a payment plan. That helps explain why a referral can feel ethically correct but practically impossible: the clinician may believe specialist care is the best next step, while also knowing the pet parent may decline, delay, or opt for euthanasia because of cost. (petsmartcharities.org)

The second source, a Vet Life Reimagined podcast episode highlighted by Megan Sprinkle, DVM, adds a management lens to the story. Its core argument is that “this is how we’ve always done it” can quietly damage a practice, and that outside perspective can expose outdated assumptions. Applied here, that idea cuts both ways. Some hospitals may be referring too quickly because confidence, mentorship, or systems have eroded. Others may still be holding cases too long out of habit, production pressure, or a desire to avoid difficult cost conversations. Either way, the takeaway is that referral behavior is increasingly a systems issue, not just an individual doctor preference. (veterinarypracticenews.com)

Why it matters: For veterinary teams, the real question isn’t whether referrals are increasing, but what those referrals now signal. In many hospitals, they signal a profession under strain: thinner staffing, more complex medicine in general practice, rising client expectations, and less tolerance for clinical uncertainty. They also signal a need for better triage between full referral, informal specialist input, and spectrum-of-care management in-house. When referral becomes the default answer to overload rather than only to complexity, practices risk frustrating pet parents, overburdening specialty centers, and missing chances to build team capability. But when practices avoid referral because they assume a client can’t pay, they may also close off valid options too early. (aavmc.org)

That puts more weight on communication and process. AAHA’s guidance suggests teleconsulting, proactive specialist relationships, and explicit role-setting between primary and referral teams can preserve continuity while limiting unnecessary transfers. Industry commentary has also emphasized discussing costs early, presenting payment options, and giving pet parents realistic pathways instead of a simple yes-or-no referral choice. For practices, that may mean building referral protocols, identifying specialists willing to consult, training associates on spectrum-of-care conversations, and periodically inviting an outside review of why cases are kept, shipped, or escalated. (aaha.org)

What to watch: The next phase will likely center on whether practices adopt teleconsulting and structured referral workflows widely enough to reduce unnecessary handoffs while still protecting case quality, especially as affordability pressures and specialty workforce constraints continue. (aaha.org)