Opinion: Charging for time, not just the exam

A recent post in the AAHA Community about accommodating fearful, anxious, and stressed patients generated quite the conversation. How can you give those patients the time and attention they require without causing all the following appointments to run late?  

And if your practice has become known as the best clinic in town for these types of patients—well, first, congratulations, because you’re doing something amazing. But also, how can you ensure that attracting more patients who require extra time and resources doesn’t have a negative impact on your bottom line? 

AAHA board member Melissa Magnuson, DVM, has experienced this firsthand, and offered to share the approach her practice has taken. Not only has it benefitted the clients and patients who need that extra time in the exam room, but it’s provided the doctors and staff with unexpected benefits, too. 

Different patients, different needs 

Veterinary hospitals everywhere are struggling with the same tension. We want to provide thoughtful, compassionate care for patients who need extra time, but we also have a schedule to keep and a business to run. 

Fearful pets are a good example. Many of us practice Fear Free or low-stress handling techniques, and as word spreads, those patients find us. That is a good thing for animals and their owners. But it also creates operational pressure inside the hospital. 

A dog with severe fear, anxiety, and stress does not fit into a 30-minute appointment. A fractious cat may take three technicians, strategic sedation, and a quiet room. Some clients arrive with long medical histories or complicated cases that require extended discussion. Anyone who practices medicine knows the reality. Not all appointments consume the same amount of time or team resources. 

For years, the typical solution has been to absorb that extra time. We squeeze it into the schedule, run late, apologize to the next client, and ask the team to push a little harder. That approach is not sustainable. It leads directly to burnout and operational chaos. 

In our hospital, we started asking a simple question. Why do we charge the same exam fee for visits that require very different amounts of time and expertise? 

Tiered pricing 

The solution we implemented was establishing tiered exam and consultation fees. Rather than labeling the tiers around behavior or specific diagnoses, we focused on time and complexity. Our doctors determine the appropriate tier during or after the appointment. 

• Tier 1 is the standard wellness or straightforward medical exam. No additional time or resources are required. 
• Tier 2 includes cases that require additional time, such as urgent care visits, mildly fractious pets, or appointments that naturally run longer.  
• Tier 3 includes complex medical consultations, difficult handling cases, or extensive client communication.  
• Tier 4 is reserved for visits that extend beyond an hour or require significant team involvement, such as complicated second opinions or very large fractious dogs. 

The value of time 

This model acknowledges a reality that veterinarians understand well but often fail to price appropriately: time is one of the most valuable resources in a hospital. 

Clients have generally been understanding. When the structure is transparent and the team communicates clearly, most people recognize that additional time and attention have value. In many cases, they appreciate that their pet is not being rushed through an appointment. 

An unexpected benefit has been internal. Doctors and technicians now have a shared language around time and complexity. Instead of silently absorbing difficult appointments, the team has more thoughtful conversations about scheduling, patient handling, and workload. 

This approach will not solve every scheduling challenge. Fearful patients still require careful planning and a skilled team. But aligning exam fees with time and complexity helps restore balance between compassionate care, team wellbeing, and financial sustainability. 

Veterinary medicine is evolving. If we want to practice high quality medicine while protecting our teams from burnout, we must be willing to rethink long standing assumptions about how we schedule and charge for our work. 

Photo credit: © Bordinthorn Loyrat via Getty Images Plus 

Disclaimer: Trends content is meant to inform, educate, and inspire by providing an array of diverse viewpoints. Any content published should not be viewed as an official stance, position, or endorsement by the American Animal Hospital Association (AAHA) or its Board of Directors.