As an example, prior to certain surgeries, my wife offers drug A to the clients. It adds to the cost but increase the chance of survival. However, drug B is not an option because studies have shown in increases survivorship by 50%. She bakes it into the cost of the surgery and refuses to do the surgery without it. Clinic down the street offers both drugs as options, bringing the base cost of the surgery down.
So now she has a reputation of being expensive vet. If she offers drug b as an option, patients die more frequently and she has a reputation as a bad vet.
She'd much rather have the reputation as an expensive vet.
This is an emotionally charged industry where 99.9% of the customers have no clue what goes on business-wise behind the scenes. Yelp has been a curse, giving voice to these people.
Graduates who want to make money will go to commercial or fisheries operations, which pay better overall. We're in the bay area, one of the highest-demand regions in the highest-demand state. There aren't many people left to compete over. Corps are currently offering 5-6 figure sign-ons and bonuses in our area. Even if the salary can be matched and they accept, there's still the tech shortage snapetom mentioned. Those people are often commuting from places like Tracy to have reasonable housing costs and many have simply left the industry entirely. You can raise salaries, but there's still only a limited number of people with RVT licenses.
So why isn't supply increasing to meet demand?
They simply are not offering enough money. If 5 to 6 figure bonuses do not work, then they should be increasing pay to high 6 figures or 7 figures. I would be surprised if 7 figures does not solve their supply issue.
Of course, the "ideal" rarely happens, the point is, with every vet you add, issues of juggling staff, scheduling, and turnover skyrocket
To be fair to the companies, they do usually work to "maximize vet time" where they hire or outsource the other stuff the office does so the vet is spending most of their time vetting instead of paperwork and office work.
Like other forms of healthcare, people want to take care of their pets properly and that makes demand relatively inelastic. If one clinic isn't taking appointments, they'll go to another even if the prices are 20% or more higher, especially if that one is more convenient to access. Once they're there, they'll usually stay for a long time.