Why more veterinarians are referring out, even when cost is a barrier

Version 2

Veterinarians are increasingly sending patients to specialists even when they know the bill may be hard for some pet parents to manage, a tension highlighted in Patty Khuly’s March 10, 2026 Veterinary Practice News commentary. Her central point is striking because it cuts against the economics many practices live with: production-based compensation and bonus structures can reward more diagnostics and treatment done in-house, yet many clinicians still decide referral is the better course. (veterinarypracticenews.com)

Part of what’s changed is the broader structure of care. Veterinary medicine has become more specialized, and professional guidance is evolving with it. AAHA’s 2025 Referral Guidelines frame referral less as a one-time transfer and more as a spectrum that includes general collaborative conversations, case-specific professional consultations, and formal hands-on referrals. The guidelines also put unusual emphasis on referral coordinators, web-based information sharing, post-referral communication, and upfront conversations about likely costs. (aaha.org)

That framework matters because the pressure behind referrals is not only clinical. A 2024 AAVMC workforce statement said demand for U.S. pet healthcare services has been rising at an inflation-adjusted rate of more than 6% per year, and described the shortage of specialty-trained veterinarians as especially pronounced. The same statement said insufficient primary care capacity is contributing to longer waits, sicker patients at presentation, and more cases being referred because teams are too overworked to complete thorough workups and management in general practice. An ACVIM letter published in 2025 also pointed to a national shortage of veterinary specialists and a mismatch between internship graduates and residency training programs. (aavmc.org)

Research on client experience helps explain why some veterinarians may still choose referral despite the financial discomfort. In a 2024 Veterinary Practice News article discussing a 2023 JAVMA study, oncologist Kai-Biu Shiu wrote that referral pathways in veterinary medicine remain inconsistent, but that clients respond strongly to visible collaboration between their primary veterinarian and specialist. AAHA’s 2025 guidelines similarly say timely referral can extend survival, improve quality of life, and increase positive client perceptions, citing Collaborative Care Coalition findings that clients were six times more likely to report improved perceptions after referral. (veterinarypracticenews.com)

Industry commentary is also shifting from a simple “refer or don’t refer” mindset to a more flexible model. AAHA’s guidance and related coverage highlight teleconsultation as a practical option when specialists are far away, fully booked, or financially out of reach. In those cases, a general practitioner may keep hands-on care in the clinic while getting specialist input for a reasonable fee, potentially reducing travel, repeat visits, and unnecessary escalation. That idea echoes a broader message from Vet Life Reimagined: veterinary practices can get stuck in inherited workflows, even when an outside perspective can see a simpler path. In that discussion, practice co-owner Christopher Martin argued that the real goal is not to capture the most referrals, but to get the most referrals “done correctly,” and suggested that veterinary teams often leave efficiency gains on the table by accepting long-standing processes instead of redesigning them. (aaha.org)

That outside-business perspective is part of why the point lands. Martin came into veterinary practice ownership after a career in other service and healthcare settings, including hospice and nursing homes, where relationship building and creative problem solving were central. The takeaway for veterinary teams is not that non-veterinarians have the answer, but that referral friction may be operational as much as medical: who makes the call, how records move, how options are explained, and whether anyone has stepped back to ask why the process works that way in the first place.

Why it matters: For veterinary professionals, the referral trend raises a practical question about what good medicine looks like in a constrained system. If general practice teams are overloaded, specialist access is uneven, and pet parents are price-sensitive, then the old assumption that keeping a case in-house is better for continuity or revenue becomes less reliable. In many settings, the better approach may be earlier referral discussions, standardized referral criteria, and shared-care models that preserve the primary veterinarian’s relationship with the client while drawing on specialty expertise only where it adds the most value. That can protect patient outcomes, reduce overreach, and improve trust, especially when teams avoid prejudging what a pet parent can or can’t afford and instead present options clearly. (veterinarypracticenews.com)

There’s also a business implication. Referral no longer has to mean surrendering the case or the client relationship. AAHA explicitly positions a well-run referral process as a trust-building tool that can keep clients connected to the primary practice, and its guidelines warn against duplicated testing and poor communication. For clinics under production pressure, that reframes referral from “lost revenue” to “better workflow, lower risk, and stronger retention.” And if Martin’s critique is right, some of the biggest gains may come from reworking the mechanics of referral itself rather than debating referral in principle. (aaha.org)

What to watch: The next phase will likely center on execution: whether practices build formal referral workflows, use teleconsulting more routinely, and train teams to discuss referral costs earlier and more transparently. If specialist shortages persist, hybrid models that blend primary care management with specialist input may become less of a workaround and more of a standard operating model. Watch, too, for more clinics to borrow ideas from outside veterinary medicine to simplify referral logistics and challenge “we’ve always done it this way” processes that slow care. (aaha.org)