When a horse colics at 10 p.m., the owner’s first thought is panic. The second is: call the vet.
For the equine veterinarian who answers, the call may come after a full day of appointments, while eating dinner, attending a family event or finally getting to sleep. When the emergency is over, the next day’s scheduled work will still begin as usual.
After-hours emergencies have always been part of equine veterinary medicine. Increasingly, however, the profession is questioning whether the traditional model is sustainable.
“The number one issue is the lack of people that want to go into equine practice,” says Dr. Mike Pownall of McKee-Pownall Equine Services, an equine veterinarian who has spent years studying and speaking about wellness and mental health within the profession. “Recent surveys show less than two per cent of graduating students in North America want to enter equine,” he says. “That’s less than 200 people a year for all of North America,” which is not enough to replace veterinarians who are retiring or leaving the field.
Pownall says the recruitment problem is compounded by a retention problem. “Fifty per cent of equine vets leave the profession within the first five years,” he says.
The reasons begin with the realities of the job.
“There’s long hours, hard work, and emergency on-call,” Pownall says. Some of those concerns reflect genuine problems. Others, he believes, are based on an outdated picture of equine practice that fails to recognize changes being made by more progressive practices.
But young veterinarians making career decisions do not have to look far to see the differences between their options.
“You can work three days a week at an emergency clinic in a small animal practice and make more than you would in an equine practice working five days a week,” Pownall says.
But the comparison is about more than pay.
“One of the main issues for sustainability for equine vets is the necessity to do after-hours,” says Dr. Jenna a partner at Rotenberg Veterinary, an equine mobile practice based in Schomberg, ON and founder of Trillium Equine Veterinary Services. “We don’t have an option to just refer clients to an emergency clinic the way small animal vets do.”
In many urban areas, small animal veterinarians can direct overnight emergencies to a dedicated emergency hospital. Equine practices often do not have the same option. Although regulatory requirements vary by province, local equine and mixed-animal vets are frequently still responsible for providing or arranging after-hours care. In a case such as colic, a veterinarian may need to examine and stabilize the horse on the farm before deciding whether referral is necessary. Equine referral hospitals generally provide advanced emergency care, but many require the horse to be assessed and referred by a veterinarian before admission. As a result, the referral hospital is often the second stage of emergency care, not a substitute for the initial after-hours response.
That leaves equine veterinarians carrying an after-hours burden that is particularly difficult to avoid.
Sharing the emergency burden
Donaldson believed there had to be a better way to provide emergency care without requiring every veterinarian to remain personally on call night after night. In 2022, she launched Trillium Equine Veterinary Services, a subscription-based after-hours service for equine veterinary practices.
“There’s enough equine vets in this area that I knew there had to be enough work to sustain a practice that just does after-hours emergencies,” she says. “That’s why I started Trillium Equine.”
Trillium now provides after-hours coverage for 15 practices representing approximately 22 full-time veterinarians. Two veterinarians are on call during each shift, covering separate regions of southern Ontario on weeknights, weekends and major holidays. The horse owner still contacts their regular veterinary practice and depending on how the practice has arranged its emergency calls, the owner is then connected with the Trillium veterinarian covering the region.
“We work basically to support a client’s regular vet,” Donaldson explains.
The Trillium veterinarian examines and treats the horse, then sends medical notes and updates to the regular veterinarian. The regular practice maintains the client relationship and handles the billing.
The system is designed to overcome one of the barriers that has historically made veterinarians reluctant to share emergency coverage: fear of losing clients. “Trillium is set up basically as an independent third party,” Donaldson says. “It’s very understood that if a vet sees a horse, it’s just for that emergency, and they can’t take them over as a client.”
There are also agreed minimum standards for common emergencies, although each veterinarian continues to use their own professional judgment. “I don’t tell the vets how to practise,” Donaldson says. “They use their professional judgment at each case, but I do have minimum standards.”
Communication is central to making the arrangement work. When necessary, the emergency vet consults with the horse’s regular veterinarian, and referral is offered when appropriate.
“There’s a really, really strong communication side with the clients and with the regular vets,” she says. “That works out quite well.”
Trillium shows that solo and independent veterinarians do not necessarily have to give up their practices or client relationships to gain relief from emergency duty. They can share one of the job’s most punishing responsibilities while maintaining continuity of care.
Reinventing the working week
Shared emergency coverage is one solution, but Pownall says the profession also has to change the job being offered to young veterinarians.
“Progressive equine practices are instituting flexibility,” he says. “You don’t have to work five days a week. We were one of the first practices in North America to offer four-day work weeks,” Pownall says, adding that approximately 25 per cent of equine practices now offer that option.
Some veterinarians may want to work only two or three days a week. Practices that can accommodate those preferences may be better positioned to attract and retain people who would otherwise leave equine medicine entirely. Scheduling flexibility is especially important when dealing with maternity leave in a profession that is predominantly female.
Flexible schedules and equitable on-call rotations can make a meaningful difference, but they are harder to provide in regions with too few horses and too few veterinarians. The geographic problem is even more acute in food animal medicine.
Small group practices may provide part of the answer.
Donaldson’s daytime practice, Rotenberg Veterinary, has four veterinarians, including three owners and one associate. That gives the veterinarians enough depth to cover for one another, take vacations and respond when family responsibilities arise.
“We all support each other and back each other up,” she says. “If I go on vacation for a week, I don’t have a single concern that everything is going to get taken care of exactly the way that I would want while I’m gone.”
For Donaldson, that structure offers the independence and flexibility of practice ownership without leaving one veterinarian to carry the entire burden.
“The small group practice, in my mind, is the ideal,” she says. “Having a small group allows a lot of flexibility and makes sure that clients are all getting enough service and no one’s getting burnt out.”
Vets treating animals or running businesses?
Entrepreneur Bruce Bowser believes another contributor to veterinary burnout is the expectation that veterinarians must be clinicians, employers, accountants, marketers and business managers all at once.
Many small animal practices have been purchased by Venture Capital firms which often results in higher fees and reduced services. Bowser founded April Vets around a partnership model in which small animal vets retain majority ownership and control over clinical decisions, while a central organization provides business support.
“When we started April Vets, the goal was to create a model where the vets could have ownership,” Bowser says. “We do the business, make sure that each clinic has at least three vets so they have the support system, and that the vets weren’t employees for corporations.”
The model currently focuses on small animal practices, but Bowser believes its principles could be applied more broadly.
“In our model, the vets own the majority of the clinic,” he says. “We run the business.”
That includes helping with administration, marketing, purchasing and other operational demands while leaving medical decisions in the hands of the veterinarians.
“Everything clinically belongs to the vets,” Bowser says.
His central argument is that veterinarians should have meaningful ownership opportunities without being forced to perform every job required to operate a clinic.
“Veterinarians should not be employees,” he says. “They should be partners in your business.”
The approach will not suit every veterinarian. Some prefer employment, while others want to practise independently. But it raises an important question: how much highly trained veterinary capacity is being consumed by work that could be handled more efficiently by people with business, administrative or technical expertise?
“The burden of doing vet medicine and trying to run your own practice is incredibly hard,” Bowser says.
Why vets cannot simply charge more
An ambulatory equine veterinarian cannot see as many patients in a day as a companion animal veterinarian working from one clinic. Much of an equine vet’s time is spent driving between farms. Those hours must still be paid for through the limited number of appointments the veterinarian can complete. It would be easy to conclude then that veterinarians should solve the problem by increasing their fees, but the reality is more complicated.
At the same time, owners face rising costs for board, feed, farrier care, training, transportation and competition. Pownall notes that veterinary care is often one of the smaller components of the overall cost of keeping and competing a horse, but there are limits to what clients are willing or able to pay.
Equine communities also make pricing unusually visible.
Horse owners share barns, attend shows and compare what different vets charge. A practice that raises its fees may lose work to another practitioner who continues to underprice the same service. Pownall compares it with the dilemma facing trainers and barn owners.
“People aren’t charging what they know they need to charge for board or for lessons or training, because there’s always some other barn that will be cheaper,” he says.
The veterinary profession has also contributed to the problem by undervaluing its own work.
“We got into it because we love horses, and it meant nothing for us to work extra hours for okay pay,” Pownall says. “None of us in the equine world – including barn owners, trainers, vets and so on – are really getting paid what we should get paid for the amount of hours we put in and the expertise.”
To help manage the financial shock of an emergency, horse owners can purchase Major Medical & Surgical insurance for their horses, although this coverage is more limited than the pet insurance many people carry for their dogs and cats. Small animal medical plans generally cover regular veterinary visits, accident and illness treatments, diagnostics, and common surgeries. In contrast, equine major medical and surgical coverage cannot be purchased alone; owners must first buy a baseline full mortality policy and pay an additional flat fee of $300 to $700 annually to cover everything from lameness to complex procedures like colic surgery.
A problem the entire industry owns
There will not be a single solution to the equine veterinary shortage.
Donaldson’s Trillium model shows how veterinarians can share after-hours coverage while protecting existing practices and client relationships.
Bowser argues that veterinarians need ownership opportunities and professional business support, allowing them to concentrate on medicine instead of carrying every operational responsibility.
Pownall says progressive practices must make the career more attractive through flexible schedules, equitable emergency coverage, better compensation and a more realistic understanding of what veterinary expertise is worth.
Horse owners also have a role. That may mean calling before a condition becomes critical, respecting shared emergency arrangements, paying promptly and understanding that access to a veterinarian at midnight depends on supporting a viable veterinary system during the day.
Veterinary care is not a service that materializes only when a horse becomes sick. It is essential infrastructure for the horse industry. Preserving it will require more than training additional veterinarians. It will require creating jobs they want to enter, practices they can remain in and working lives that do not demand unlimited sacrifice.
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