Spectrum of Care: A Middle Ground When Pet Care Gets Expensive

When “gold standard” isn’t an option, what comes next?

Every veterinarian knows the feeling. You’ve diagnosed the problem, you know exactly what this patient needs, and then you see the client’s face when you mention the estimate.

According to a 2017 JAVMA survey, 57% of veterinarians face this situation at least once a day: altering a treatment or diagnostic plan because of client financial limitations.¹ It’s not occasional. It’s daily.

And it’s taking a toll. In that same survey, veterinarians frequently cited financial limitations as an important contributing factor to their professional burnout.¹

The $250 Barrier

The data keeps getting more sobering. A Policy Advisor survey of over 20,000 pet owners found that only 19% could afford a $5,000 out-of-pocket expense.² More recent data from the Pet Lifetime of Care study found that an unexpected bill of only $250 could cause financial hardship for a quarter of clients.³

Think about that. A quarter of the people walking through your door might struggle with a $250 bill.

The Access to Veterinary Care Coalition reported that around 25% of families had been unable to receive veterinary care in the previous two years, with financial barriers cited as the number one reason across preventive, non-emergency, and emergency care.⁴

When clients can’t afford care, especially in emergencies, these conversations become life-or-death discussions. And when euthanasia becomes the only option because of economics, it weighs on everyone: the family, the staff, and you.

As Gary Block wrote in a 2018 JAVMA article: "All too often we’re faced with ill or injured pets whose owners essentially dictate what the standard of care is going to be."⁵

Gold Standard vs. Standard of Care

Here’s the distinction that matters: gold standard and standard of care are not the same thing.

Gold standard is the best available. It’s often defined by specialists, current literature, and ideal conditions. It tends to be more extensive, more expensive, and constantly evolving. That’s great for medicine, but not every client can pursue it.

Standard of care is the minimum baseline we’re legally and ethically held to. It’s defined by what an average practitioner would do in similar circumstances.

But instead of thinking about a single baseline, there’s growing support for a different approach: a spectrum of care.

The Spectrum Approach

Spectrum of care means thinking in terms of a continuum rather than all-or-nothing.

On one end: gold standard. Intensive, extensive, often expensive. On the other end: less intensive options, which might include symptomatic treatment, palliative care, or in some cases, euthanasia. But there’s a huge range in between, and that’s where most patients actually land.

The key principles:

• Rely on evidence-based medicine as much as possible
• Prioritize patient comfort and quality of life within the client’s limitations
• Meet your moral, ethical, and legal obligations while helping more pets

A related concept, incremental care, is defined by the Access to Veterinary Care Coalition as "patient-centered, evidence-based medicine in the context of limited resources."⁴ It’s a stepwise approach: treat based on the most likely diagnosis, reassess, then run the next test if needed rather than ordering everything upfront.

What This Looks Like in Practice

Consider a urethral obstruction in a cat. The ideal workup (blood work, radiographs, urinalysis, IV fluids, hospitalization for 24 to 72 hours) might run $1,500 to $2,500.

But if we know 25% of clients can’t handle $250, a lot of owners simply can’t afford the full estimate.

One option: pare down diagnostics to a mini chemistry panel and electrolytes. Focus on the results that will actually change treatment, then put remaining funds toward unblocking the cat and shorter hospitalization. That might cut the estimate in half.

Another option, when even that isn’t feasible: unblock the cat, load up on subcutaneous fluids, provide pain management, and send home as an outpatient with clear instructions. Is it ideal? No. Is it better than euthanizing a stable cat? For the right case, yes.

The point isn’t that one approach fits all. It’s that offering a range of options lets clients make informed decisions based on their reality, and gives more pets a chance.

Protecting Yourself and Your Team

Practicing this way requires clear communication:

• Educate clients on risks and tradeoffs at each level
• Document everything thoroughly
• Get signed estimates and informed consent
• Use “against medical advice” forms when appropriate

And crucially: remain non-judgmental. A client’s choice along that spectrum isn’t necessarily a reflection of their bond with their pet. It’s a reflection of their circumstances.

The Bigger Picture

Spectrum of care doesn’t solve everything. It won’t eliminate economic euthanasia or burnout. But it shifts the conversation from “all or nothing” to “what can we do?”

And that shift, giving more pets a chance, helping more clients, and preserving your own well-being in the process, is worth having.

This post is based on a VetOnIt CE webinar by Dr. Kate Boatwright. For RACE-approved continuing education on topics like this, explore our On-Demand Library.

References

1. Kipperman BS, Kass PH, Rishniw M. Factors that influence small animal veterinarians’ opinions and actions regarding cost of care and effects of economic limitations on patient care and outcome and professional career satisfaction and burnout. J Am Vet Med Assoc. 2017;250(7):785-794. PMID: 28306486.

2. Policy Advisor. Pet Insurance Survey. 2020. Survey of 20,000+ pet owners on financial preparedness for veterinary expenses.

3. CareCredit, Pet’s Best Insurance. Pet Lifetime of Care Study. 2023. Analysis of pet ownership costs and financial preparedness.

4. Access to Veterinary Care Coalition. Access to Veterinary Care: Barriers, Current Practices, and Public Policy. University of Tennessee, 2019.

5. Block G. A new look at standard of care. J Am Vet Med Assoc. 2018;252(11):1343-1344. PMID: 29772971.

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