The veterinary shortage in equine practice is no longer pending; it has already arrived

When my terminally ill senior mare, Claire, went down in her field earlier this month, I knew it was time. I reached for my phone, and within 20 minutes our loyal veterinarian had arrived to end her suffering. I lost my horse, a heartbreaking tragedy most horse owners must endure at some point—yet I’m one of the lucky ones. In my case end-of-life care was available instantly, with one simple tap on a screen. I don’t take that for granted.  

If you’re less fortunate, you might have found yourself in an emergency situation like mine, desperately calling all veterinary practices within a hundred-mile radius, hoping someone will help. That’s the real tragedy. Scarcity and unavailability have become the harsh reality of equine practice in parts of our country. And the future looks bleak if we don’t take drastic and collective action now.  

The Current Crisis: We’re Losing Our Horse Doctors  

For horse owners, few situations are scarier than having a veterinary emergency on your hands and no one available to save your horse. The consensus from a 2021 survey by Amy Grice, VMD, MBA, founder of Amy Grice Veterinary Business Consulting, based in Virginia City, Montana, is that equestrians nationwide are understandably worried by the growing difficulty in obtaining consistent veterinary care when they need it most. It’s a fact: The supply of equine veterinarians is dwindling.  

“Keeping veterinarians in equine practice is perhaps the most significant issue ever faced by the profession,” said Carol Clark, DVM, Dipl. ACVIM, a partner at Peterson Smith Equine Hospital, in Ocala, Florida, during the 2022 American Association of Equine Practitioners (AAEP) Convention, in San Antonio, Texas. This shortage of practitioners is not caused by a single problem but, rather, an accumulation of barriers to entry for veterinary graduates, exponentially growing student debt, unfavorable working hours and conditions, and demand surpassing supply over the past two years.  

Only five out of 100 students graduating from veterinary schools in 2023 will choose to become horse doctors. By 2028 only two or three of them will be left in the equine profession. “The pandemic has reduced the veterinary workforce (due to depressed economic times, causing the equine industry to contract) and, yet, there is a greatly increased need for our services,” says AAEP immediate past president Emma Read, DVM, MVSc, Dipl. ACVS, associate dean for professional programs and a clinical professor at The Ohio State University College of Veterinary Medicine, in Columbus. “More newly graduated veterinarians are choosing small animal practice than ever before. Only 4.5% of graduating students are pursuing an equine internship, with another slim 1.3% bypassing this stepping stone and entering equine practice directly, totaling just 5.8% of an entire graduating class. And to make matters much worse, half of them will leave equine practice altogether within the first five years.”  

These statistics might just be the wake-up call our industry needs, she says. 

A Shortage That Hurts Everyone 

The current crisis affects the entire industry well beyond the hopeless owner who can’t find care for her horse that’s spiked a fever or come up lame: 

• Horses are the primary victims of this shortage. With owners’ inadequate or limited access to veterinary care, animals face an increased risk of morbidity (disease) and mortality. 
• Horse owners, especially those in remote rural areas, are feeling the strain of this crisis. “There are now weekends when there is not a single vet available for an emergency visit,” one horse owner noted in Grice’s survey. Nationally, Grice says, 30.5% of horse owners have a moderate or high level of concern about the availability of equine veterinary care. In times of dire need, some horse owners are left to their own devices, with few options available if they don’t have the resources to transport their animals to a clinic themselves (or a clinic in operation anywhere nearby). 
• With fewer veterinarians in equine practice, the pressures of providing services—especially emergency care—have increased. This pushes more practitioners into small animal practice, where pay is higher and on-call work is not expected, says Grice. But small animal practice is not immune to the shortage. In 2021 James Lloyd, DVM, PhD, of Animal Health Economics LLC, reported in one of his veterinary workforce studies that 40% of all veterinarians are considering leaving the profession, with 25% articulating serious exit plans. 
• Seventy-five percent of equine veterinary practice owners that responded to Grice’s survey reported some degree of difficulty in hiring and retaining new associates. “Presently, there are practices that can’t find veterinarians to hire,” adds Read. And time is not on our side. About 45% of AAEP members are over the age of 50, and about a quarter are over the age of 60 and approaching retirement. “As older practitioners retire, there aren’t enough new graduates to replace them, and the generation of practitioners in the middle is working harder than ever and burning out,” she says. Lloyd predicts that by 2026 the veterinary profession will have grown at a rate of 19%, three times faster than the 7% anticipated in other health professions. This means approximately 23,000 new veterinarian positions must be created and filled across all areas of practice. “So, will this shortage last, and will it worsen? The expectation is both,” says Read.  

Finding Solutions: Where to Begin? 

A decadeslong, multifaceted crisis requires a comprehensive, innovative approach. Here are seven steps our sources say we can collectively take to address the equine veterinary shortage crisis: 

Make equine internships sustainable.

Sustainability is a keyword in the solution to our dilemma. Its most basic definition is the ability to be maintained at a certain rate or level long term. Vets are humans. Humans burn out. Our sources say working conditions, schedules, and compensation that are sustainable for the individual veterinarian are nonnegotiable in moving the industry forward. Traditionally, veterinary graduates planning to enter equine practice have been expected to pursue yearlong internships. This is not the case in small animal general practice. “The perceived ‘need’ for an internship, which prolongs the period of debt accumulation and is very lowly paid, means many students are choosing to enter small animal because the salary is higher, there is no on call, and there are more colleagues to shoulder a busy caseload,” says Read. Currently, 32% of equine veterinary interns have a negative income surplus (Morello et al., 2022), meaning their salary is lower than the average cost of living in their area and, therefore, insufficient for basic necessities.  

Despite these numbers, the equine internship is widely regarded as an unmatched learning and growth opportunity, and our sources say eliminating it altogether isn’t the answer. Instead, organizations are striving to improve it. “We are creating an AAEP-branded internship program,” says Read. “Some internships in the past have focused on acquiring young veterinarians at a low pay rate to meet (the practices’) own needs.”  

Jackie Christakos, DVM, of Littleton Equine Medical Center, in Colorado, explained at the 2022 AAEP Convention that this redesigned experience will feature specific best-practice guidelines, defined learning outcomes, and opportunities for structured feedback. The focus will be on education and mentorship.  

Promote healthy compensation.

On the topic of sustainability are salaries. Plugging data into the AVMA Veterinary Salary Estimator reveals that all other ­factors—age, geographic area, and graduation year—being equal, a vet going into small animal practice receives a starting salary that is, on average, $24,000 higher than that of an equine veterinarian. This matters, especially when considering only 17% of veterinarians graduate debt-free—the other 83% come out owing an average of $186,430.  

“As the cost of a veterinary education has increased drastically, student debt has become a significant burden for many veterinarians, making a career in equine practice unsustainable,” says Deborah Spike-Pierce, DVM, MBA, president and CEO of Rood & Riddle Equine Hospital, in Lexington, Kentucky. Young graduates are giving up on their childhood dreams of becoming horse doctors simply because they can’t afford it. Veterinarians’ wages need to reflect their education and associated debt and adequately compensate them for their time, knowledge, and skills. But this is difficult to establish in practice, Grice adds, partially because clients tend to complain about costs associated with veterinary care. “This can be challenging for new graduates with low wages and large student debts to hear,” she says, which hurts morale. “Many people don’t realize how much schooling veterinarians have to undergo, how much that actually costs, and how little they actually earn.” 

Hire support staff.

“Utilizing even just one technician per doctor has been proven to increase the salary of these veterinarians,” reported Kelly Zeytoonian, DVM, MBA, CERP, owner of Starwood Equine Veterinary Service and Starwood Veterinary Consulting, in Redwood City, California, at the 2022 AAEP Convention. The industry is now advocating for licensed veterinary technicians (LVTs) to take more off veterinarians’ plates. “There are many tasks that technicians are trained—and licensed—to do, which are rarely part of their job description,” says Grice. However, utilizing LVTs to their full capacity is a win-win situation, she explains, because giving technicians more responsibility not only frees up overworked doctors’ time for billable tasks but also increases the techs’ career satisfaction.  

Form emergency cooperatives.

Practice owners recognize that in times like these, the need for collaboration trumps the fear of competition. That’s why equine practices are teaming up with neighboring practices—that are technically also their competitors—to split up emergency duties. These incentives allow vets at different practices to share after-hours on-call duties, reducing the time each must commit to being on call without compromising the availability of emergency care. An early adopter of this progressive practice is Mountain Pointe Equine Veterinary Services, in Long Valley, New Jersey. At the start of 2022, practice owner Michael Fugaro, VMD, Dipl. ACVS, entered into a cooperative partnership with a nearby full-service large animal clinic. The transition has been well worth the effort, he reports.  

“Given most veterinarians’ level of commitment, we often innately put the needs of our patients before our own,” he says. “Not only is this unhealthy, but it is also unsustainable long term, contributing to the high burnout and suicide rates in the veterinary profession. Our emergency co-op has allowed the participating veterinarians to adjust their work/life balance in a more manageable way.”  

Arguably, the main challenge of such an incentive is client perception. “Horse owners are used to seeing ‘their’ veterinarian and are not always keen to work with someone else,” explains Spike-Pierce. “This is changing, but we must encourage our clients to be comfortable with other veterinarians. This is already the standard in human and small animal emergency medicine.”  

Set boundaries.

Equine veterinarians need and deserve to be “off the clock” when they leave work. Solid boundaries around doctors’ time and accessibility are crucial to mitigating the burnout factor causing so many veterinarians to leave equine practice each year. “Even before entering veterinary school, applicants are hesitant to consider equine practice because they’ve seen the horse vets in their own lives suffer from burnout,” says Clark. 

Incorporate telemedicine.

When the supply of doctors is insufficient to meet patient demands, efficiency is key. Providing virtual veterinary care eliminates travel time for practitioners and grants every horse owner access to a veterinarian, even if they live in a secluded area. Same-day specialist consultation can save lives in rural, underserved areas. Telemedicine is growing in popularity in equine practice and for good reason (TheHorse.com/1101731), but this alternative form of delivering medicine comes with its own challenges, particularly regulations around forming the doctor-client-patient relationship virtually. 

Be appreciative.

Showing respect and gratitude toward veterinarians is everyone’s responsibility, from the practice owner to the client. In her own article (TheHorse.com/1115893) Read shared tips for horse owners: Be receptive to younger, newer veterinarians working on your horse; pay your bills on time; honor your doctor’s personal time; and show gratitude. The entire industry benefits from veterinarians who feel valued and appreciated. 

Take-Home Message 

There is hope. According to Grice’s survey, 35% of all veterinary school applicants say they plan to go into equine practice upon graduation. “Many of those entering veterinary school do want to work with horses,” Grice says. “The problem is that as these students progress through the four-year curriculum, this number dwindles rapidly. But this does provide optimism, because if we can transform equine practice to meet the needs of today’s veterinarians, those horse-loving students will once again choose our fabulous lives as horse doctors.”