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The escalating discrepancy between emotionally invested owners and the higher cost of advanced veterinary medicine has been widely characterized by industry analysts as an affordability crisis. The primary concern is that as the gap between veterinary cost and ability to pay widens, a lower percentage of pets will receive the treatments the industry has prepared for them.

Despite a rise in pet ownership, the overall number of veterinary visits has dropped, driving speculation that veterinary care may be increasingly unattainable for pet owners at the lower end of the economic spectrum [1].

At risk is not just the veterinarian–client–patient relationship the profession has meticulously nurtured over the past several decades, but the wider industry itself. Should mounting affordability concerns lead future generations of pet owners to adopt a more adversarial attitude toward veterinary medicine – or, worse, a dismissive one – the industry stands to lose more than just the reputation of its veterinarians. Nothing less than the profession's future economic viability is at stake.

Further, it is clear that affordability represents an existential threat to the veterinary profession's moral fabric. When the veterinarian's oath pledges to “promote animal health and welfare, relieve animal suffering, [and] protect the health of the public,” it cannot equitably and ethically do so if it incommensurately serves the needs of the most affluent, educated or dedicated pet owners.

To examine the issues involved in more detail, it serves to categorize the relevant concerns as flowing from the demand side versus the supply side. Primary affordability factors affecting the demand for veterinary services include the following.

 Pet keeping is expensive and overall pet costs are on the rise, which can make healthcare (especially of “healthy” animals) a lower priority. Indeed, the average pet owner spends more than ever before on their pets' nutrition, effectively lowering the percentage of income available for veterinary expenses.

 Higher income pet owners expect higher quality healthcare. For this segment of the population, the notion of pets as family means they are willing to dedicate extraordinary sums to their pets' healthcare. This fuels much of the progress in veterinary medicine.

 Income inequality: as the gap between rich and poor widens, more and more veterinary patients are priced out of veterinary services altogether. This despite the fact that pet keeping appears to have increased roughly proportionately across all income levels.

 Pet owners enjoy a greater emotional attachment to their pets than in previous generations, effectively increasing a pet's overall value to the household. Given that pet care costs are similar for all pets, lower income owners spend a disproportionately larger percentage of their earnings on them.

 Wellness aversion: for a variety of reasons, lower income pet owners tend to eschew wellness services preferentially. This only exacerbates affordability concerns given that emergent services are innately more expensive, typically unplanned, often delivered by secondary care centers, and more likely to be required when routine care is forgone.

Supply‐side considerations factoring into the affordability of veterinary care include the following.

 Higher standards of care: the veterinary profession has responded preferentially to the higher expectations of more affluent pet owners by raising the standard of care (see 9.4 Standards of Care).

 Uniformity of service offerings: higher standards of care have been adopted with impressive uniformity across the profession. As a profession, veterinarians have traditionally prioritized patient needs over client needs. Veterinarians who do not keep pace risk discipline.

 Professional liability issues: public attitudes toward pets and concerns over legal decisions awarding damages for emotional loss have spooked the profession. This has led to more expensive defensive medicine, justification of pricing decisions, and/or refusal to treat patients at a lower standard of care.

 Practice management philosophy: veterinarians receive business counsel from a relatively small group of industry advisors. Their traditional emphasis on profitability has steered veterinarians toward a more affluent client base, often by recommending financial policies which may unintentionally discourage lower income clients.

 Language and cultural barriers: the veterinary profession suffers from a lack of ethnic diversity. Fewer cross‐culturally attuned veterinarians often means fewer financial solutions for lower income pet owners.

 Workplace stress and burnout: financial discussions with pet owners have been cited as one of the principal drivers of veterinary stress, leading veterinarians to avoid interactions that could potentially help pet owners overcome affordability concerns (see 8.16 Dealing with Compassion Fatigue and Burnout, and 8.17 Dealing with Compromise Fatigue).

 Secondary‐ and tertiary‐level care: veterinary schools and specialty centers target the most affluent of all, offering few clinical or financial options for those without the means to pay for the best services available.

 Specialization: the trend toward specialization in veterinary medicine continues unabated.

 Corporatization: the aggressive rate of corporatization and consolidation of veterinary practices has led to a decrease in diversity among practices in most major metropolitan areas. Standardization of clinical options and financial policies typically serves to discourage lower income clientele.

 Veterinary income loss due to online pharmacy competition: the widespread adoption of online outlets for veterinary drugs and products has helped save pet owners money on these items. Unfortunately, it has also raised the price of veterinary services (see 9.10 Dispensing and Prescribing).

 Consolidated supplier pricing: the muscular market power of an increasingly consolidated veterinary supply industry means higher prices on veterinary drugs and supplies for pet owners, too.

 The cost of veterinary higher education: higher student debt loads have translated into higher starting salaries, which are increasingly reflected in higher prices for veterinary services.