How Clients are Experiencing Equine Veterinary Sustainability Issues
The Equine Network and AAEP Horse Owner Education Committee surveyed horse owners to gauge knowledge of issues facing today’s equine veterinary industry.
Vet talking to horse owner
Many survey respondents observed or discussed industry issues with their veterinarians. | Getty Images

In June 2023, the AAEP Horse Owner Education Committee partnered with the Equine Network family of publications to survey horse owners about their experiences with veterinary services during this time of difficulty in attracting and retaining equine veterinarians in the profession. The survey was distributed as a MailChimp survey sent out individually by email to registered users of TheHorse.com, PracticalHorsemanmag.com, EQUUSmagazine.com and HorseandRider.com. The survey questions were developed in partnership by Kimberly S. Brown of the Equine Network; AAEP Horse Owner Education members Drs. Sarah Reuss and Erin Denney-Jones; and AAEP Director of Education Karen Pautz. There was a total of 2,384 completed surveys. 

The different magazines’ subscribers have some differences, although they all share a deep interest in horses. Readers of The Horse describe themselves as hands-on horse owners and also include veterinarians. These subscribers are focused on horse health. Subscribers to Practical Horseman are entirely English riders, focusing primarily on dressage, hunter/jumper and eventing. EQUUS magazine appeals to a broad audience fairly evenly split between English and Western riding, about half of which compete and most of which are very involved in the equestrian lifestyle and have a keen interest in horsekeeping. Horse&Rider readers are strictly Western riders, including pleasure, ranch horses and competition. Only nominal differences were present between subscribers of the different magazines. 

Demographics of Respondents 

Survey respondents were almost entirely female (91.2%). The most prevalent age group among respondents were those aged 61-70 years (41.3%), followed by those aged 51-60 years (24.4%) and those greater than 70 years of age (22.9%).  

Survey questions included the zip code of those answering the survey. Results indicated good participation across all regions. Zip Code Zones 2 and 9 had the highest number of respondents. Both of those regions have robust equine populations. Zip code Zones 0 and 6 had the lowest number of participants. Zone 0 encompasses a fairly small, primarily urbanized region, and Zone 6 includes many more sparsely populated agricultural acres (see Figure 1). 

Zone 0 ME, VT, NH, MA, CT, RI, NJ 6.2% 
Zone 1 NY, PA, DE 7.3% 
Zone 2 MD, WV, VA, NC, SC 16.4% 
Zone 3 TN, GA, FL, AL, MS 11.6% 
Zone 4 MI, IN, OH, KY 11.6% 
Zone 5 MT, ND, SD, IA, MN, WI 7.0% 
Zone 6 IL, MO, NE, KS 6.1% 
Zone 7 TX, AR, OK, LA 8.0% 
Zone 8 ID, WY, CO, UT, NM, AZ, NV 8.9% 
Zone 9 OR, WA, CA, AK, HI 16.9% 
Figure 1. Respondents’ Zip Code Zones 

Figure 2. Zip Code Zones in the United States 

In addition, questions were asked about the number of horses each respondent owned or was responsible for, the type of veterinary practice used by respondents, and how many equine veterinarians were available in their region.  

Although over a quarter (29.2%) of respondents owned, leased or cared for 3-5 horses, fairly equal percentages of respondents reported having care of 1 horse (22.5%) and 2 horses (24.7%). While 13.9% reported having responsibility for 6-15 horses, a much smaller number (2.8%) cared for 16-25 horses, and a surprising number (4.3%) said they made decisions for more than 25 horses.  

Vets and Services 

The most common response to the question “How many veterinarians offer equine services in your area?” was 2-3 DVM, made by 35.1% of survey participants. This was followed by 28.3% who answered 4-5 DVM. There were a few respondents (1.5%) who reported no equine veterinarians, and 6.5% who reported just a single equine practitioner. Almost 80% of respondents reported that there was an equine-exclusive practice in their area.  

Although 85.4% reported that their regular veterinarian sees after-hours emergencies, many respondents also stated that they live close to a referral facility that offers more intensive specialized care in an inpatient setting. Just 1 in 10 live farther than 100 miles from such a practice (see Figure 3).  

This is good news for horse owners, as equine practitioners are finding it harder to attend to emergencies as the workforce shrinks in some areas. What we don’t know is whether the respondents, who self-selected to share their views, are actually representative of the average horse owner. It is certainly possible that more rural equine enthusiasts who are less likely to be near a referral center are also less likely to participate in surveys. 

Distance in Miles Percentage  Number 
1-10 16.3% 388 
10-50 49.4% 1,177 
50-100 23.8% 568 
More than 100 10.5% 251 
TOTAL 100% 2,384 
Figure 3. Miles from the closest clinic or hospital facility that offers equine surgical/medical/overnight intensive care 

Are Owners Aware? 

About three-quarters (76.7%) of the survey respondents said they were aware of the difficulties that equine practices are having in hiring and retaining veterinarians, and more than a third (37.3%) correctly answered the percentage of students coming out of veterinary school who go into equine practice (either to an internship or to start working as a veterinarian). When adding those directly entering associate positions (1-1.5% of the graduating class) and those entering internships (3-4% of the graduating class) the total is 4.0-5.5%.  

Only 1 in 4 respondents had little to no knowledge of the current crisis in attracting and retaining equine practitioners.  

Difficulty in Getting Routine Care 

Respondents were asked if in the past year they had experienced difficulty scheduling a veterinarian to provide routine services (general exam, vaccination, dental care, lameness, etc.). In order to determine if there were regional differences, these answers were divided by zip code zone.  

Of those respondents who did try to schedule an appointment, most had no difficulty. But in Zip Code Zones 5, 8 and 9, only about half answered “No problem.” While the most common difficulty was simply needing to wait longer to see their preferred practitioner, there were others who had to use a different veterinarian, either from their usual practice or another practice entirely.  

Some respondents indicated that they just gave up and did not continue to pursue the desired elective care. This was most prevalent in Zip Code Zones 7,8 and 9 (see Figure 4). 

 Zip Code Zones 
Answer ALL 0 1 2 3 4 5 6 7 8 9 
No problem  58.8% 61.2% 66.7% 61.4% 66.9% 56.9% 52.7% 56.9% 65.0% 52.0% 51.1% 
Took longer than usual to get an appointment, but I was able to see my normal veterinarian 32.5% 30.6% 31.5% 31.1% 26.6% 35.8% 40.5% 40.7% 25.6% 34.1% 38.1% 
Able to get in with my normal clinic, but I had to see a different veterinarian than I prefer 3.0% 4.8% 0.0% 2.7% 2.8% 3.4% 2.7% 0.8% 1.3% 3.9% 3.7% 
Had to call other clinics/veterinarians to get an appointment 3.8% 3.4% 1.2% 3.8% 2.8% 2.6% 4.1% 0.0% 5.0% 6.7% 4.0% 
Had so much trouble I just gave up 1.8% 0.0% 0.6% 1.0% 0.8% 1.3% 0.0% 1.6% 3.1% 3.4% 3.1% 
Figure 4. Difficulty in obtaining routine elective veterinary care by Zip Code Zone. Those not seeking routine elective veterinary care were not included in these calculations. 

Difficulty in Getting Emergency Care 

Those who participated in the survey were also asked about their difficulty in obtaining emergency services (see Figure 5). Thirty-six percent of respondents reported that they did not seek any emergency services in the previous year. Of those who did seek emergency services, less than half (46.1%) reported they had “no problem” with their usual veterinarian coming out to attend to their animal. However, about 16% had to wait longer than usual for service, and about 9% saw a different doctor from their usual practice.  

Notably, almost 1 out of 10 respondents reported that her/his usual practice participates in an emergency sharing group, so a veterinarian from that group was dispatched to see the horse.  

Calling around to different providers was relatively common at almost 7%. As time-strapped equine veterinarians increasingly limit the horse owners to whom they provide emergency services, it is likely that this option will become less viable.  

Some respondents, when they were unable to reach emergency help, hauled their horse to a regional referral hospital or university clinic. Others attempted to treat their animal themselves when they couldn’t arrange care.  

Unfortunately, 20 individuals reported that their horses died after they were unsuccessful in reaching a veterinarian to provide treatment.  

It is important to consider that some of the respondents that had difficulty finding a veterinarian to provide emergency service might not have had a primary care relationship with a practice. If veterinary care is only sought when urgent care is required, it might be difficult to obtain. This survey did not determine the nature of such a relationship. 

Answer % # 
No problem—my usual veterinarian came right out 46.1% 702 
Had to wait longer than usual, but I was able to see my normal veterinarian 15.8% 240 
Was able to see my normal veterinarian, but I had to haul in to the clinic 5.5% 84 
Was able to get in touch with my normal clinic, but I had to see a different veterinarian from that practice than the one I usually prefer 8.8% 134 
My preferred veterinarian shares on call with another practice/veterinarian(s), and I was automatically routed to them take care of my horse immediately 9.3% 142 
My preferred veterinarian/clinic was unavailable, so I called around until I found someone else 6.9% 105 
Was unable to reach anyone, so I hauled my horse to local referral hospital/university clinic 2.7% 41 
Was unable to reach anyone so I gave up and tried to treat my horse myself 3.6% 55 
Was unable to reach anyone and unfortunately lost my horse 1.3% 20 
TOTAL 100% 1,523 
Figure 5. Difficulty obtaining emergency service among respondents who had an emergency with their horses 

Among respondents in different Zip Code Zones, there were differences in the ability to arrange care (see Figure 6).  

In Zones 7 and 8, only 35.5% reported no problem with their veterinarian promptly providing service. In Zones 3, 4, 5 and 9, about 4 in 10 respondents reported no difficulty.  

Zones 0 and 1, both areas with a large number of equine veterinarians in a concentrated space, reported the least struggle with emergency care, with 58.3% and 52.1% reporting no problem, respectively.  

Hauling to the Vet 

Hauling the horse to the practice was widely variable among Zip Code Zones. In many regions of the U.S., it is common to regularly trailer to appointments at the veterinarian, the farrier, or even to a facility or trailhead to ride. The Zip Code Zones in areas where this is the prevalent culture not surprisingly showed higher percentages of hauling for emergency care. Those areas that are quite sparsely populated and primarily rural could be expected to show higher percentages of use of referral centers and university facilities, and this was seen in Zones 4, 5 and 6.  

It should be noted that Kentucky is in Zip Code Zone 4, where many horses of great value go directly to a referral facility if they incur illness or injury.  

Perhaps because of shared geographic territories in the smaller spaces, veterinarians in Zip Code Zone 0 were much more likely to have a shared emergency arrangement with another practice. In areas with more equine veterinarians per county, this is much more feasible as a strategy to reduce on-call responsibilities.  

Not unexpectedly, respondents from Zip Code Zone 8, which includes very large, remote areas surrounding centralized, highly populated cities, reported the highest number (6.6%) of horses that died when their owners were unable to arrange for emergency care.  

It is likely that some areas are in a “veterinary care desert” due to a low population of people and horses. Encouraging these horse owners to have access to transportation and educating them to recognize critical emergencies could minimize these tragic outcomes. 

 Zip Code Zones 
Answer 0 1 2 3 4 5 6 7 8 9 
No problem—my usual veterinarian came right out 58.3% 52.1% 50.0% 44.0% 47.6% 43.0% 50.0% 35.5% 35.5% 40.4% 
Had to wait longer than usual, but I was able to see my normal veterinarian 10.4% 18.8% 14.9% 13.5% 19.0% 16.1% 15.9% 12.9% 18.2% 17.8% 
Was able to see my normal veterinarian, but I had to haul in to the clinic 0.0% 5.1% 3.6% 5.7% 4.1% 7.5% 1.2% 14.0% 10.7% 6.7% 
Was able to get in touch with my normal clinic, but I had to see a different veterinarian from that practice than the one I usually prefer 6.3% 8.5% 9.3% 12.8% 8.2% 9.7% 7.3% 8.6% 9.9% 8.2% 
My preferred veterinarian shares on call with another practice/veterinarian(s), and I was automatically routed to them take care of my horse immediately 15.6% 6.8% 11.3% 9.9% 4.1% 7.5% 8.5% 6.5% 9.1% 8.2% 
My preferred veterinarian/clinic was unavailable, so I called around until I found someone else 4.2% 5.1% 7.7% 5.7% 8.2% 6.5% 4.9% 9.7% 7.4% 9.1% 
Was unable to reach anyone, so I hauled my horse to local referral hospital/university clinic 1.0% 0.9% 0.5% 3.5% 4.8% 4.3% 6.1% 3.2% 2.5% 3.4% 
Was unable to reach anyone so I gave up and tried to treat my horse myself 3.1% 2.6% 2.1% 2.8% 3.4% 3.2% 6.1% 5.4% 6.6% 4.3% 
Was unable to reach anyone and unfortunately lost my horse 1.0% 0.0% 0.5% 2.1% 0.7% 2.2% 0.0% 4.3% 0.0% 1.9% 
Figure 6. Difficulty obtaining emergency equine veterinary service among respondents who had an emergency with their horse, by Zip Code Zones 

Limiting Emergency Equine Veterinary Services 

Equine veterinarians have begun to limit their emergencies by a variety of policies. Survey participants were asked which of these methods their veterinarian had implemented (see Figure 7.)

About two-thirds reported their veterinarians had increased fees for emergency care, and just over 38% said emergency care was only offered for established clients. About a third of practices were reported as requiring clients to make payment at the time services were rendered, and almost one in five reported they were required to have credit cards kept on file for payment. About 10% said their practice required patients to be enrolled in a wellness program or receive annual health maintenance services to qualify for emergency care, and 15.5% of practices required the patient to be brought to the facility for after-hours care.

According to respondents, most nonclients that receive service do not get charged higher fees. Almost 18% of respondents chose “Other,” and they used this choice almost exclusively to make comments about their experiences with emergency services.

Policies for Emergency Care (Select all that apply)%#
Only see emergencies for established clients38.2%910
Charge higher fees for emergencies65.8%1568
Charge higher fees for non-clients12.2%290
Require haul-in for after-hours emergencies15.5%369
Require credit cards on file18.7%446
Require payment at time of service33.5%798
Require annual wellness plan enrollment9.6%229
Other (please specify)17.9%427
TOTAL RESPONDENTS2,384
Figure 7. Policies Surrounding Access to Emergency Care

How Owners Can Be More Prepared 

Following up on the shortages in availability of equine veterinarians, respondents were asked about proactive steps they might have taken to be more prepared (see Figure 8).  

A majority of respondents indicated that they had access to transportation for their horses through ownership of a trailer. Four in 10 had established relationships with more than one practice in order to have wider options for care. Two thirds indicated that they had obtained medical supplies in order to do more care themselves if needed.  

Less than a quarter were vaccinating their horses themselves, a behavior which could actually decrease their chances of being able to obtain emergency care.  

Just 9.1% had enrolled in a wellness program.  

Alarmingly, 15.3% had turned to non-veterinarians to provide health care for their horses—the equivalent of asking your daycare provider to diagnose your child’s rash, which could be highly contagious measles or chicken pox, or might simply be poison ivy.  

Answers (Select all that apply) % # 
Bought/already own a trailer so I can haul to a clinic 53.1% 1266 
Established relationships with multiple veterinarians in my area so I have options 43.2% 1030 
Enrolled in a wellness program with my veterinary clinic 9.1% 218 
Stocked my own “first aid kit” to better be able to handle my own care 66.8% 1592 
Engaged in telemedicine whereby my veterinary visit was all done via phone/email/video and was charged for those services 6.2% 148 
Relied upon a trainer/friend/lay-person to provide health care to my horse 15.3% 364 
Vaccinated my horse(s) myself using vaccine obtained from a local store (not provided by a veterinarian) 22.9% 545 
Other (please specify) 13.3% 318 
TOTAL respondents  2384 
Figure 8. Proactive steps taken by respondents 

Talking to Your Veterinarian 

Many respondents indicated that they had observed or discussed a number of industry issues with their equine veterinarians (see Figure 9).  

Among the most common topics they reported were work/life balance struggles, burnout and being overwhelmed by emergency duty responsibilities.  

Sadly, 70 respondents had an experience of observing or discussing suicide.  

However, over a third chose “Other,” and comments almost exclusively indicated that they had neither observed nor discussed any of these issues with their veterinarians.  

It is common for veterinarians to maintain a professional persona and keep their struggles hidden. The fact that so many survey participants observed or discussed these topics with their veterinarians could be an indication of the overwhelming nature of these problems, the closeness of their relationship with their horse’s doctor, or their awareness of the current state of the equine veterinary industry.  

All of these possibilities could foster an effort to show increased patience and understanding to veterinarians.  

In fact, 82.6% of respondents indicated that they respect their horse doctor’s boundaries, including no non-emergency phone calls or texts after hours. Almost all (93.9%) pay their bills promptly, and 8 out of 10 regularly express appreciation for their efforts.  

Some provide drinks and snacks, baked goods, gift certificates, and tips to show their gratitude.  

Many comments indicated that respondents regularly make an effort to make the work lives of their veterinarians more efficient, pleasant and less stressful.  

It is possible that these engaged, thoughtful clients are over-represented among the survey respondents, as most equine veterinarians regularly encounter a few entitled, rude horse owners. 

Answers (Select all that apply) % # 
Work/life balance struggles 47.0% 1120 
Burnout 28.6% 681 
Compassion fatigue 18.2% 434 
Mental health struggles 9.1% 218 
Suicide 2.9% 70 
Financial stress due to income 7.8% 187 
Financial stress due to student loans 5.4% 129 
Cyberbullying or social media attacks 2.5% 59 
Feelings of failure, imposter syndrome 2.2% 53 
Inability to meet the needs of their current clients 17.4% 416 
Overwhelmed by too many emergencies 20.4% 486 
Dissatisfaction with current employment 5.1% 121 
Other (please specify) 38.8% 925 
TOTAL respondents  2384 
Figure 9. Prevalence of Observation or Discussion of issues with Respondents’ Equine Veterinarian 

Future Equine Veterinary Care 

When asked, “How worried are you about your access to quality veterinary care for your horse(s) over the next 5-10 years?” 28.8% of all respondents indicated that they had no concerns, 35.2% said they were starting to be concerned, and 28.8% stated they were concerned but educated.  

A few (7.3%) said they were terrified that they would be unable to get veterinary care for their horses where they currently live (see Figure 10).  

Results among different Zip Code Zones varied widely. The Zone with the highest number of unconcerned respondents (40.2%) was Zone 7, which includes Texas and Oklahoma and is home to a very high number of equine veterinarians.  

About a third of respondents in Zones 0 (32.9%) and 3 (32.6%) had no concerns. The Zones that had the fewest number of respondents who were unconcerned were Zones 6 and 9. Zone 6 is primarily rural, with limited equine veterinarians and long distances for those doctors to travel, so increased worry is expected.  

Zone 9 includes California, Washington and Oregon, which are states with high horse populations, educated owners, but perhaps an inadequate number of horse doctors, as suggested by the data in Figures 4 and 5 that indicated more difficulty in accessing timely care.  

Among those terrified about future access to care, Zones 1, 4 and 9 were closely followed by Zones 2, 5 and 6.  

It is unclear whether this heightened sense of fear is due to local realities, increased awareness or a personal geographic location.  

Fear is a strong motivator, so it is possible that these horse owners will be proactive in preparing to travel for emergency care, will become versed in recognizing true emergent situations, and will have a plan in place to get required care should the need arise. In addition, they might become philanthropic toward scholarships for equine veterinary students, might support local practices through seeking regular wellness care, or might educate others about the challenges being faced.  

 Zip Code Zones 
Answers All 0 1 2 3 4 5 6 7 8 9 
No concerns 28.8% 32.9% 26.6% 29.8% 32.6% 24.3% 24.7% 19.2% 40.2% 22.8% 18.9% 
Starting to worry 35.2% 40.9% 40.2% 35.4% 33.1% 41.7% 38.7% 35.4% 31.7% 37.5% 38.8% 
Concerned, but educated 28.8% 18.8% 19.5% 23.2% 25.4% 21.3% 24.7% 33.1% 17.1% 29.3% 29.6% 
Terrified that I will no longer be able to get veterinary care for my horses where I live 7.3% 7.4% 13.6% 11.6% 8.9% 12.8% 12.0% 12.3% 11.0% 10.3% 12.7% 
Figure 10. Degree of worry about future availability of equine veterinary care 

Solutions? 

When asked “What possible solutions do you see for your local veterinarian to ensure access to quality health care for your horses?” a majority of survey participants felt it was important to make equine veterinary careers more attractive to veterinary students and to provide more financial assistance to help pay for the costs of a veterinary education (61.7% and 63%, respectively).  

Only about a third felt that higher pay was necessary for new equine veterinarians, a finding that suggests that the respondents did not have factual information about starting salaries in the equine veterinary field compared to the companion animal field, or about the staggering educational debt that many have from their professional education.  

In a response that could help many time-pressured equine veterinarians with their work, a majority of respondents (54.9%) felt that certain tasks could be performed by a technician or assistant, although a robust number of comments indicated that these veterinary employees needed to be licensed veterinary technicians.  

Equine Veterinary Emergency Coverage 

The AAEP Commission on Equine Veterinary Sustainability is initiating change in the equine veterinary industry through a coordinated effort with the five subcommittees. The Emergency Subcommittee has observed multiple models for providing emergency coverage.  

These models include: 

  • not offering emergency coverage,  
  • offering part-time coverage,  
  • offering emergency service only at haul-in facilities,  
  • utilizing referral centers for emergencies and tertiary care,  
  • solo practices offering emergency care in areas that have few to no options for sharing that responsibility,  
  • participation in emergency cooperatives,  
  • utilizing telemedicine for triaging and/or treating emergencies,  
  • utilizing veterinary technicians or mid-level practitioners for emergencies in underserved areas,  
  • utilizing relief veterinarians, and  
  • emergency-only practices.  

The subcommittee plans to establish case studies and tool kits for each of these models along with ways for members with similar models to form communities to support each other.  

It is impossible to be the veterinarian who sees every horse, every time a case arises. Providing your clients alternatives for care when you are unavailable and communicating this in advance shifts the responsibility to the client to pursue care when needed.  

By establishing clear boundaries with clients and communicating after-hours emergency expectations and protocols, equine practitioners can take an important step toward safeguarding their personal time, minimizing a source of stress and ensuring that clients’ emergencies are handled properly.   

These actions help prevent burnout, keeping horse doctors from leaving the profession while increasing the appeal of equine practice to the next generation of veterinarians.

Take-Home Message 

The results of this survey illustrate that efforts to educate horse owners about the current challenges in the equine veterinary industry have been fairly successful. The majority of respondents have awareness, although few are more than mildly concerned about their personal situation.  

Rural areas are feeling the pinch more than suburban areas due to longer distances and lower population density.  

Equine veterinarians are making adjustments in order to serve the needs of their patients while still trying to maintain a healthy amount of time away from work.  

Because horse owners who do not have an understanding of and appreciation for the challenges of equine veterinarians make the profession less appealing to possible new entrants, continuing to increase the awareness of all stakeholders in the equine industry of the current issues in the veterinary industry is a necessary part of ensuring that all horses can receive the care they need now and into the future.

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