Not long ago, a solo equine practitioner was expected to marathon through a full day of appointments after being jarred out of bed late at night to treat a colic, repair a laceration, or deliver a foal. Emergency service is a crucial aspect of equine practice. But providing 24/7/365 access to veterinary care comes with challenges and sacrifices, especially for self-employed ambulatory doctors.
Today, equine practices are increasingly joining forces to create emergency cooperatives, hiring dedicated relief veterinarians, and strategically restricting emergency availability. Sustainable emergency coverage is becoming more achievable. Let’s dive into the pricing, policies, and client education required to make it happen.
Different Structure Options
Being on call all the time is no longer the default setup. Here are three common alternatives that are becoming more widely adopted in equine medicine to relieve the burden of emergency coverage.
1. Starting or joining an emergency cooperative
Marc McCall, DVM, founded Cherry Creek Equine in Elizabeth, Colorado, in 1985. Nine years later, he and three other solo practitioners formed what is believed to be one of the country’s earliest equine emergency co-operatives—an arrangement in which doctors from neighboring equine practices share on-call duties for all their clients on a rotating schedule.
“Everyone is on call one night Monday through Thursday, and we all rotate weekends,” McCall explains. “Each practice bills for services rendered while on call, and clients pay at the time of service. Then, we call the referring practice to transfer cases back to the primary doctor,” a standard practice within emergency co-operatives. When reflecting on the past 30+ years with this system in place, McCall admits it was initially difficult to give up some control by sharing clients. While some have switched practices over the years, he says those changes have largely balanced out over time. “The advantages definitely outweigh the disadvantages,” he concludes. In a time where hiring and retaining associates is increasingly difficult, McCall has recognized that limiting on-call responsibilities is a huge asset, reporting that the emergency cooperative was a factor in his last four hires choosing Cherry Creek Equine.
2. Restricting emergency availability
McCall, who has watched equine practice evolve over the span of four decades, is increasingly seeing overworked practitioners elect to restrict after-hours access to horse owners who have chosen to support their practice in nonemergent situations. Indeed, to keep their emergency caseload manageable and encourage horse owners to maintain regular preventive care, many practices elect to come out only if a current client in good standing calls with an emergency.
Others are further restricting availability based on time of day. Rob Franklin, DVM, DACVIM, is a partner at Fredericksburg Equine & Small Animal Veterinary Services, in Fredericksburg, Texas, and past American Association of Equine Practitioners (AAEP) president. Franklin, whose rural clientele primarily hauls their horses into the clinic rather than relying on ambulatory visits, says his practice stops overnight emergency coverage during hours when call volume has historically been extremely low—between 9 p.m. and 6 a.m.
Between those hours, Fredericksburg Equine defers to a veterinary teletriage service to help clients assess the urgency of after-hours situations. This remote, paid service can advise whether an in-person examination is warranted and direct owners to an appropriate referral hospital if needed. “While uptake of the teletriage service has been very slow, our clients have been generally happy to make the drive to those hospitals when they are dealing with true emergencies,” Franklin reports.
And a few years in, his feedback is positive. “There is tremendous peace that comes from knowing that once a certain hour arrives—9 p.m. in our case—you truly can get some rest,” Franklin says. “It’s amazing the stress that vets endure being on call, waiting for that phone to ring.”
Rather than assuming 24-hour availability is the only option, Franklin encourages practices to analyze their own emergency call patterns and build coverage around actual demand. “Restricting overnight coverage didn’t really affect financial statements because these calls never contributed materially to our revenue,” he says.
3. Outsourcing emergency coverage
Lastly, practices can opt to delegate some or all emergency coverage to a relief veterinarian. Under this model, a contracted outside veterinarian or veterinary team assumes responsibility for handling a practice’s emergency calls during designated times. This allows practitioners protected time off and a predictable schedule while ensuring clients continue to have access to urgent care. The main downside is the loss of emergency-related revenue for the primary practice and, potentially, a perceived lack of continuity for clients.
What Does Emergency Readiness Actually Cost a Practice?
Horse owners sometimes experience the dreaded sticker shock when billed for an emergency vet visit. The main reason is they don’t always realize everything that goes into ensuring a doctor is available to answer the phone at any hour of the day or night.
“There are the obvious costs,” begins Amanda McCleery, DVM, owner of McCleery Equine Veterinary Service, in Archer, Florida. “Responding to an emergency call requires a stocked vet truck, controlled-substance licensing and storage, insurance, restocking, and drugs that expire whether or not they’re ever drawn up. Some of those costs exist whether or not a practice provides emergency coverage (on a particular day).”
Then, there are the people. “This is where I’ve deliberately built a different model than the one I came from,” McCleery states. “As an associate, I never received a stipend for being on call—I never even saw my emergency fees. Availability was simply expected as part of my salaried position, with no additional compensation for being on call.”
In McCleery’s practice, whose veterinary team consists of herself and one associate, availability itself is paid work. “The on-call doctor receives a standby stipend whether the phone rings or not,” she explains. “When it does, my associate receives 100% of the emergency service fee—a compensation model that has become much more common in equine practice in recent years.”
McCleery Equine’s after-hours technician is compensated similarly: standby pay for every on-call shift, plus a call-in bonus on top of hourly pay when a call comes in. “The technician’s compensation is built into our emergency pricing, so part of what the client pays goes directly to the people who made themselves available and got out of bed,” she explains.
“Also, a quiet night is not a free night, as anyone who has been on call knows,” she adds. “The doctor and technician have to remain within minutes of the practice. Their evenings are structured around the possibility of a call; they can’t go out of town or have a few drinks with dinner.” McCleery’s takeaway is there’s real value in compensating people for the restrictions that come with being on call.
Setting Fees and Policies
With a more complete understanding of everything it takes for a veterinary team to respond to an emergency call, let’s look at what goes into setting emergency fees and policies. Emergency work might sound like a high-ticket item that brings in a lot of revenue, but for many associates and practice owners, it’s more of a “necessary evil” of equine medicine.
“For a small general equine practice, the goal isn’t to maximize profit on emergency work; it’s to make it sustainable for the people providing it,” McCleery says. “There’s no separate overnight team here. The person getting out of bed at 2 a.m. is the same person seeing appointments at 8 a.m., and the compensation has to account for that.”
Daytime emergencies have a cost, too. “A colic can dismantle a carefully routed schedule: Appointments are rescheduled, office staff rework logistics, drive time increases, and technicians stay late,” McCleery says from experience. “Our daytime emergency fees help offset that disruption and the revenue lost when an optimized schedule has to be abandoned.”
When it comes to policies and pricing, McCleery’s best advice is to define everything in writing before you need it. That starts with determining who can be seen when the phone rings with an emergency, under which circumstances, and at what price. For her, a “current client” means a valid veterinarian-client-patient relationship (VCPR)—a wellness or annual exam within the past 12 months. Because McCleery Equine is part of an emergency cooperative, that extends to partner practices’ current clients when they’re on call. “Nonclients are a different category: They’re seen at the doctor’s discretion and are never guaranteed services,” she explains. “We charge them differently because they don’t support the practice throughout the year in the same way our regular clients do. But the cooperative has reduced our individual call burden enough that saying yes to a nonclient emergency is much more manageable than it used to be. As a result, we’re able to provide emergency care to more horses.
“Nonclients are required to pay the emergency fee and farm call fee before we leave the office, and everyone gets at least a verbal cost estimate they agree to before we head out,” McCleery continues. “Many people—especially those without a regular veterinarian—have no realistic idea what an after-hours ambulatory visit costs. An owner who learns the real cost after services have been rendered isn’t in a better position to care for that horse. Clear information up front is the least bad version of a hard reality.”
Most practices have these policies on paper, she adds. “Burnout doesn’t usually come from lacking policies—it comes from constantly making exceptions to them. A policy only protects your team if the practice culture allows them to follow it.”
Client Education Encourages Cooperation
Anytime a practice transitions to a different emergency coverage strategy, proactive communication can avoid friction at an inopportune time: When a client is calling with a veterinary crisis. Fortunately, expectations are changing, with fewer horse owners demanding or expecting to see “their” veterinarian for any emergency, any time. Overall, practice owners have reported widespread client acceptance of emergency cooperatives with strategic client education aimed at helping horse owners understand that these incentives are created to provide a consistent, reliable, lasting emergency response.
Take-Home Message
There is no one-size-fits-all approach to emergency coverage. Some equine practices meet their needs by forming emergency cooperatives, while others limit overnight coverage, hire relief veterinarians, or reserve after-hours services for established clients.
With any system, providing life-saving care sustainably requires acknowledging the true cost of availability and readiness. This means creating and upholding clear pricing and policies, communicating them with clients, and ensuring veterinarians and support staff are adequately compensated for the demands and sacrifices required to provide on-call emergency work.
Related Reading
- How to Start a Subscription-Based Equine Emergency Practice
- Equine Veterinary Sustainability: Initiating Haul-In Policies for Emergency Care
- Equine Veterinary Sustainability: Daytime Emergency Policies
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