Why talking about money when your horse is unwell is one of the hardest conversations we have as vets
A friend asked me a question the other day that really made me think.
We’d been chatting about AI, technology and how much the world is changing when, completely out of the blue, they asked:
“Why did you become a vet?”
My answer came straight out, without really thinking about it:
“Because I like fixing problems.”
And actually, the more I thought about it, the more I realised that probably is the simplest and most honest answer I can give.
I like making things better. I love being presented with a horse that has a problem and trying to work out what’s wrong. I love that moment when the pieces start to fit together and, hopefully, we have the knowledge, equipment and experience to do something about it.
It’s one of the best parts of my job. But being a vet isn’t always about fixing things. Sometimes we can’t make things better. Sometimes the kindest thing we can do is help an animal at the end of its life, and I’m equally comfortable with that being part of my job. Ending suffering matters just as much as treating disease.
Apparently, though, “I like fixing problems” still wasn’t enough of an answer for my friend.
So we carried on talking.
Why would you choose a career where your patients can’t tell you where it hurts? Where you’re dealing with an animal someone loves enormously? Where sometimes you can fix the problem and sometimes, despite everything, you can’t?
And then there’s another part of veterinary medicine that I don’t think any of us went into the profession particularly looking forward to.
Talking about money.
The elephant in the stable
There has been a lot of discussion about veterinary fees recently, particularly on social media.
And actually, I don’t think that’s necessarily a bad thing.
Owners should be able to ask what something costs, why a particular investigation is being recommended and what their options are. Veterinary practices should be able to explain those things clearly.
But when you read some of the discussions online, veterinary fees can sometimes look quite simple from the outside: the owner receives a bill, the veterinary practice receives the money, and that’s the end of the story.
The reality behind that bill is a little more complicated.
So rather than arguing with what’s being said online, I thought it might be useful to explain the other side of the story – what happens behind the scenes in an independent equine veterinary practice, where some of that money actually goes and why talking about cost is sometimes such an important part of looking after your horse.
Because when we’re standing beside you with a poorly horse, there are usually several things happening at once. You’re worried about your horse. We’re trying to work out what’s wrong, what we can do about it and what the options are.
And somewhere in that conversation, however uncomfortable it may be, we also have to talk about what that help is going to cost.
So where does your vet bill actually go?
Rather than talking about veterinary practices in general, let’s use Little Rock as an example.
Imagine you receive a £120 veterinary bill.
For simplicity, let’s assume everything on that particular bill is subject to VAT at the standard 20% rate.
Here’s what that actually looks like:
Veterinary charge before VAT: £100
VAT at 20%: £20
Total paid by you: £120
The important point is that the £20 VAT isn’t Little Rock’s income. We collect it and account for it to HMRC.
So:
You pay £120 → £20 is VAT → £100 comes into the practice
And that £100 isn’t profit.
From it we have to pay the people who provide your horse’s care, employer National Insurance and pensions, medicines and consumables, vehicles and fuel, equipment, insurance, IT, clinical waste, professional fees, training and all the other costs involved in running an equine veterinary practice.
A significant proportion goes towards our people. We believe in paying our team properly for their skills, knowledge and responsibility. A salary isn’t the whole cost of employing someone either – the practice also pays employer National Insurance, pensions, training and other associated costs.
Then there are medicines.
This is another part of your bill that we don’t have complete control over. We don’t make the medicines ourselves. We buy them through veterinary wholesalers, who are part of the much bigger chain that gets a medicine from the manufacturer to us and, ultimately, to your horse.
Some of the biggest veterinary wholesalers are themselves part of much larger companies. MWI Animal Health, for example, is part of Cencora, while National Veterinary Services (NVS) sits within the Patterson corporate structure.
That’s not a criticism of those companies. It’s simply worth explaining because Little Rock is a small independent veterinary practice sitting at the end of a much bigger supply chain.
We don’t decide what it costs to manufacture a drug or the wholesale price we have to pay for it. When that price increases, unfortunately that’s a cost we have to deal with too.
Then we have to get the vet to your horse.
As an ambulatory practice, our vans are effectively our consulting rooms and surgical suites on wheels. They need buying, insuring, servicing, maintaining and fuelling.
Inside them is equipment we’ve invested in so that we can bring high-quality diagnostics to your yard – including digital X-ray, ultrasound and endoscopy. All of that equipment has to be purchased, maintained, serviced and eventually replaced.
Behind the scenes are the less obvious costs: insurance, clinical waste, IT and administrative systems, phones, computers, accountancy, professional registrations, continuing education and the infrastructure needed to make sure someone is there when things go wrong.
Only after all of those costs have been paid do we arrive at profit.
And a practice does need to make a profit. Not because every pound of that profit disappears into someone’s pocket, but because without it we can’t replace equipment, invest in our team, buy the next van or make sure the practice is still here next year.
So that £120 looks rather different when you see what happens behind the scenes:
£120 paid by you
− £20 VAT
= £100 practice revenue
− the costs of actually providing your horse’s care
= whatever profit, if any, remains
That’s a very different £120.
“Is your horse insured?”
Now we come to one of the most awkward questions in veterinary medicine.
Your horse is standing there unwell, you’re worried sick, you’ve called the vet and one of the first questions you hear is:
“Are they insured?”
I completely understand why that can sound wrong. It can feel as though the vet is asking:
“How much money can I spend?”
But what we’re usually trying to establish – sometimes rather clumsily – is:
“What options do we realistically have?”
Because veterinary medicine isn’t practised in a world without financial limitations.
There may be several perfectly reasonable ways forward.
One might involve extensive diagnostics or referral to a hospital. Another might allow us to gather enough information to make a sensible clinical decision while keeping your horse at home. Sometimes we may decide together to treat the most likely problem, monitor carefully and reassess if things don’t improve as expected.
The most expensive option isn’t automatically the only responsible option.
What matters is the horse in front of us, what we’re trying to achieve and your individual circumstances. Once we understand all three, we can work out the best way forward.
Talking about money doesn’t mean we don’t care
This can be difficult for all vets. You’ve spent years learning how to diagnose and treat disease. Then suddenly you’re standing on someone’s yard with a sick horse, a worried owner and the knowledge that what you would ideally like to do may cost considerably more than they can afford.
That’s hard – particularly when you genuinely care about the animal.
But discussing cost doesn’t mean your vet cares more about the invoice than the horse. In many cases, we’re talking about money because we care.
We don’t want you agreeing to something without understanding the financial implications. Equally, we don’t want you thinking that because the gold-standard option isn’t affordable, there is nothing else we can do.
If you’ve only got £500 left on your insurance, tell us. If you’re not insured, tell us. If something we’ve suggested simply isn’t affordable, tell us that too.
Having a budget doesn’t mean you care about your horse any less.
It simply gives us another important piece of information to work with.
Clear pricing. Honest conversations.
At Little Rock Equine Vets, we believe good veterinary care starts with good communication – and that includes being open about cost.
Our fees are clearly displayed on our website, and if your horse needs further investigations or treatment, we’ll explain what we’re recommending, why we think it’s necessary and, wherever possible, what it’s likely to cost.
You know your horse better than anyone. You also know your own circumstances and what is realistic for you. We bring the veterinary knowledge and experience, and between us we can work out what is achievable while keeping the welfare of your horse at the centre of the decision.
Sometimes that will be the gold-standard investigation or treatment. Sometimes there will be a different, more practical route.
Both are conversations we’re happy to have.
We’re human too
Perhaps that’s what I should have said when my friend asked me why I became a vet.
The truth is, we’re not machines working our way through a diagnostic checklist.
We’re human.
We think about cases when we get home. We wonder how that horse we saw earlier is doing. We question ourselves, talk cases through with colleagues and, sometimes, lie awake wondering whether we could have done something differently.
We also get the good bits.
The horse that looked dreadful a week ago trotting down the drive looking fantastic. The owner sending us a video months later of a horse we weren’t sure would ever be ridden again. Those are the moments that remind us why we do it. When we lose one, we feel that too.
But veterinary practices also have to function as businesses. We have a team to pay, medicines to buy, vans to fuel, equipment to maintain and all the other costs that come with making sure that when your horse needs a vet at 2pm – or 2am – someone is there.
And perhaps that’s the bit that’s easily lost when we talk about veterinary fees simply as a number at the bottom of an invoice.
There’s a lot behind that number – but that doesn’t mean you shouldn’t question it.
Quite the opposite.
Ask us what something costs. Ask us why we’re recommending it. Ask us whether there are other options.
We can care deeply about your horse and still need to explain what its treatment is going to cost. Those two things can, and should, sit comfortably alongside each other.
Which brings me back to the answer I gave my friend in the first place.
I became a vet because I like fixing problems.
And when your horse has a problem, everyone involved has the same aim – to do the best we can for that horse.
We’re not on opposite sides of the bill. We’re on the same side of the horse.
Sometimes that means celebrating the wins. Sometimes it means making difficult decisions. And sometimes it means having uncomfortable conversations about diagnosis, prognosis, treatment and, yes, money.
Those conversations don’t mean we care any less.
Those conversations don’t mean we care any less.
They’re part of caring for your horse properly.
So if there’s something you’re unsure about – a bill, an estimate, why we’ve recommended a particular test, what your insurance will cover or what other options might be available – talk to us directly.
Pick up the phone and ask.
That’s how we’ve always worked at Little Rock, and it’s how we always will.
We would far rather have a conversation with you than have you sitting at home worrying, wondering or feeling that you can’t ask.
We’re always happy to talk.