There's a growing sense across veterinary medicine that the ground has shifted. Visits are trending down, fees have climbed steadily, and what once felt like a short-term post-pandemic adjustment now looks more permanent. Practices are feeling real pressure to balance rising costs with client affordability, all while trying to stay sustainable and staffed. Today I'm joined by Dr. Karen Felstead, a DVM, CPA, CVPM, and Certified Valuation Analyst with decades of experience in veterinary finance and practice valuation. A nationally recognized consultant and longtime collaborator with VHMA, she brings a data-driven but practical perspective shaped by years of benchmarking work and direct conversations with veterinary leaders. We discuss what the Insider Insights reports are revealing, why declining visits are becoming a long-term concern, and how fee increases are starting to test client limits. We also discuss what a more realistic path into 2026 could look like. That includes stabilizing prices, moving away from growth driven mainly by fee increases, improving efficiency and team training, and using tools like wellness plans more intentionally. The conversation touches on staffing challenges and the current practice sale landscape, always returning to the same question many leaders are asking right now: how do we adapt to changing expectations without weakening the profession we've worked so hard to build? Show Notes: [00:52] A look ahead to 2026 and why current data matters more than optimism when planning for the future. [03:12] Economic uncertainty and political instability are already shaping client behavior and putting pressure on veterinary practices. [04:01] An overview of VHMA's Insider Insights Benchmark Reports and why monthly data offers a real-time pulse on the profession. [05:11] The fee survey stands out as one of the most revealing tools for understanding how practices approach pricing and client reaction. [08:16] Pandemic-driven visit spikes created unrealistic baselines that are now masking a more concerning long-term decline. [09:13] Data from 2025 confirms that declining visits are no longer a short-term correction but a sustained trend. [10:28] Rising veterinary fees have exceeded both inflation and cost increases, becoming the primary driver of reduced visits. [11:27] While access and hours play a role for some hospitals, cost remains the dominant issue across the industry. [12:14] Communicating value and offering payment options are no longer enough to offset affordability concerns. [13:08] Profit expectations may need to reset as the profession cycles into a more constrained economic phase. [14:29] Across-the-board fee reductions aren't the answer, but unchecked increases are no longer sustainable. [16:40] Clients may not track individual fees closely, but they absolutely feel the cumulative impact of total bills. [17:04] Fee increases need to slow significantly, shifting focus away from price-driven growth. [18:09] Offering medical alternatives helps clients stay engaged without feeling forced into only gold-standard care. [18:59] True profitability growth will require better marketing, efficiency, and staff training, not just higher prices. [19:24] Wellness plans help stabilize costs for clients and reduce financial surprises when designed thoughtfully. [21:39] Poorly planned subscription-style programs can backfire without proper financial modeling and execution. [22:09] Team training is essential for wellness plans to work and for clients to understand their value. [23:18] Hiring has improved slightly in some areas, but DVMs and licensed technicians remain in short supply. [24:30] Retaining staff is often more difficult than hiring, especially without strong onboarding and training systems. [25:45] Corporate acquisition multiples have declined, but strong hospitals still command premium valuations. [26:41] Practice quality now matters more than ever in determining sale price and buyer interest. [27:33] Profitability, location, facility condition, and scalability heavily influence whether a practice can sell. [28:51] Some practices are effectively unsellable due to structural and market limitations. [31:11] Veterinary medicine remains a respected profession, but consumers are becoming more selective as prices rise. [32:20] The challenge ahead is adapting how care is delivered and priced without losing trust or long-term stability. Links and Resources: Veterinary Hospital Managers Association VHMA VHMA Benchmark Reports Dr. Karen Felstead, a DVM, CPA, CVPM - PantheraT Dr. Karen Felstead - LinkedIn