Access to veterinary care has emerged as one of the most significant welfare crises in the United States, with major health and welfare implications for millions of companion animals across the nation (1, 2). This crisis also raises significant concerns for the well-being of those caring for pets, who may experience heightened stress when access to veterinary services is constrained (1, 3). In the last five years, dozens of scientific publications have addressed this issue (4), reflecting its growing recognition amongst major stakeholders, such as animal welfare scientists and organizations, veterinarians, and pet owners.

Several barriers documented in the scientific literature have reportedly contributed to the difficulties pet owners face when seeking timely and quality care for their animals. Among these are the rising costs of veterinary services and medications (5–7) which can create significant financial strain for pet owners, particularly those from lower-income households who may consequently choose to forego care (8, 9). Transportation is another key issue which is frequently linked to financial constraints (10). For example, difficulties accessing veterinary care are often compounded for pet owners without access to a car or who rely on public transit, as animal restrictions on public transportation limit their ability to travel to clinics (6, 11, 12). Similarly, challenges are also faced by those residing in rural communities or ‘care deserts’ where veterinary clinics may be few and far between, requiring pet owners to travel long distances to seek care (13, 14). The physical and mental health states of pet owners themselves, such as having a disability or experiencing hardship or psychological or emotional distress (e.g., due to a death in family), may further complicate their ability to seek and follow through with veterinary care (15–17). Additionally, cultural differences and language barriers can constrain access to care by impeding communication between veterinarians and their clients (18–20). Challenges related to the provision of culturally-competent care are observed in both human and animal health sectors. For example, one study found that 63% of African American patients perceived discrimination from their healthcare provider based on their race or socio-economic status, and this was correlated with reduced utilization of health services (21). Similar dynamics have emerged in veterinary care, as in some cases, clients from underserved communities have been overlooked by animal service providers because of concerns related to cost and cultural differences (6, 22). As a result, some pet owners have expressed resistance to utilizing interventions (e.g., low-cost clinics), in part because of stigmas surrounding their perceived quality of care. This has the potential to erode trust within the veterinarian-client-patient relationship (VCPR) and compromise animal health and welfare outcomes (6, 19, 21, 23, 24).

Although the volume of research on access to veterinary care is increasing, substantial knowledge gaps remain. For example, though some studies narrowly define ‘access’ in terms of service availability and affordability (25, 26), others have taken a broader approach, defining it as the availability of the economic, physical, social, mental, and emotional resources necessary to benefit from veterinary services (4). Consequently, it is still unclear how the term, ‘access to veterinary care’ is defined, perceived, and experienced by many stakeholders, including pet owners/families. The lack of a clear, widely accepted definition highlights several major concerns (4). First, it leaves room for different interpretations of what constitutes ‘access’, which can vary widely between stakeholders of different demographic backgrounds. For instance, some individuals or communities may focus on the availability and affordability of clinical services, while another may prioritize convenience of reaching a service provider, trust, or communication between service provider and client.

It is also unknown how pet owners’ perceptions of their ability to access care or the quality of veterinary care they have experienced may influence their subsequent willingness to seek care and their decision-making related to care-seeking. Evidence from one study suggests that pet owners’ expectations regarding treatment outcomes, along with the strength of the veterinarian-client relationship, can play a major role in pet owners’ decisions to utilize high-cost veterinary services and assume the associated financial burden (3). It is plausible that perceptions of access, prior experiences, and the veterinarian-client relationship may also guide future care-seeking behaviors. Insufficient knowledge about owner perceptions and quality of care experienced may contribute to confusion about what improving access to veterinary care means to the broadest group of veterinary care-seekers, which potentially complicates efforts to effectively address existing problems. Improved understanding of the interactions between all of these factors is therefore necessary to inform the development and implementation of targeted interventions that meaningfully improve both access to care and, in turn, animal welfare.

Better understanding of veterinary clients’ perceptions and experiences regarding access to pet care is also important because they (in addition to the animals for whom care is necessary) are the stakeholders most directly impacted. Greater insight in these areas, including further inquiry about barriers pet owners face and how they might relate to this population’s perceptions of veterinary care as well as their care-seeking behaviors could help inform proposed forms of client support. For example, alternative veterinary service providers, such as mid-tier veterinary health professionals, have been suggested as a possible option to bridge access gaps. However, these roles have not yet been established, the concept remains controversial in veterinary medicine (27, 28), and there is insufficient information available to gauge veterinary care-seekers’ perceptions of and willingness to utilize such providers. The objectives of this study were therefore to: (1) identify pet owners’ perceptions of access to veterinary care, their experiences seeking veterinary care, and their veterinary care preferences, (2) examine the effects of pet owner demographics on their perceptions of access to veterinary care and potential alternative care providers, and (3) understand how owners’ perceptions of access to veterinary care might influence their decision-making, including their willingness to seek care. Based on published literature, we hypothesized that some care-seekers would lack access to veterinary care, and that pet owners (particularly those encountering barriers) would hold favorable perceptions of alternative care options. We further hypothesized that pet owners’ perceived access to care, their perceptions of alternative providers, and their demographic characteristics would be related to their care-seeking decisions.

This study aimed to understand U.S. pet owners’ perceptions of access to veterinary care, their experiences and preferences in seeking care, and examine relationships between these, demographics factors and decision-making relative to care-seeking behavior. Our hypotheses that these factors might interact with each other and demographic variables to influence care-seeking decisions were largely supported, although some of the results were unexpected.

An interesting finding was the large discrepancy between the number of participants who identified as the primary caregiver of their pet (68.4%) (i.e., being responsible for their feeding, exercise and daily care) and those identifying as the primary care-seeker (3.9%) for veterinary services or as the primary for both (19.1%). This discovery highlights the importance of delineating between these sub-populations as doing so offers the opportunity to gauge whether and to what degree responses to surveys about perceptions of veterinary care and access to it are based on direct experience, and are more likely to accurately represent the experiences of the broader population of care-seekers. Studies that overlook this distinction may risk under-representing the perspectives of those with the greatest level of direct experience in trying to access veterinary care in favor of representing the broader category of pet owners’ perceptions, some of which may not be as relevant to the questions of interest. This may result in data sets and conclusions that do not optimally inform efforts to improve access to veterinary care.

In regard to conceptions of ‘access to veterinary care’, the finding that respondents most frequently identified service availability (78.1%), ease of communication (77.9%), and affordability (74.7%) as key components in defining access mirrors what is observed in the human healthcare literature (38, 39), where some definitions also include service availability, affordability, utilization, as well as social and cultural barriers (38). Clear understanding of veterinary-client definitions of access is essential for identifying and addressing potential gaps and solutions needed by pet-keeping households.

Our hypothesis that a large proportion of care-seekers would report lack of access to veterinary care was not met. Similar to the findings of King et al. (5), a large majority of care-seekers in this study agreed that veterinary care was accessible in their communities. However, this conflicts with previous studies (1, 6, 40). Our results may differ from previous findings because our study was specifically designed to identify the perceptions of individuals with experience seeking veterinary care, whereas other studies may reflect the experiences of both care-seekers and non-care-seekers. Another possible explanation is that care-seekers’ responses may have reflected some degree of social desirability bias, as a desire to appear more capable of accessing and providing veterinary care for their pets could have deterred some from reporting challenges they experienced (41). This suggestion is supported by our finding that for each barrier listed, 22.1% or more of care-seekers indicated they had experienced it, despite most respondents indicating good access to care. Additionally, 35.5% reported foregoing care to prioritize more urgent needs, such as their own medical care.

Although surprising, no relationships were observed between care-seekers’ perceived access to care and any demographic factors. This outcome is likely due to the small subsample size which successfully targeted the most relevant participants, but may have limited our ability to detect differences between demographic groups. Future studies could mitigate this limitation by recruiting through multiple channels or extending the survey’s administration period to ensure a larger and more representative sample. Alternatively, the sub-population of interest (e.g., pet owners, primary care-seekers, or care-seekers who experience barriers) could be targeted at the onset of future studies.

Notably, over 20% of respondents experienced difficulties in getting an appointment and indicated a desire for more time with their veterinarian. More than a third reported being frequently dissatisfied with the interactions they had with their veterinarian despite being satisfied with the care their pet received. Identifying that one in five care-seekers face these challenges in accessing quality veterinary care highlights the need for further investigation into whether such difficulties are concentrated in specific regions of the United States or disproportionately affect certain demographic groups. As there are direct implications for animal welfare if clients cannot access veterinary care, and human well-being (e.g., excessive stress) as noted by Applebaum et al. (15), future studies should explore these patterns to better inform interventions targeted to improve accessibility and equity in veterinary care.

Moreover, our results highlight that ‘access’ extends beyond appointment availability and must also take into account the quality of care received by the client. This includes giving the client the time they need. Although most care-seekers reported spending an adequate amount of time with their veterinarian, many desired even more time, highlighting a need for increased veterinarian-client interaction and reiterating the importance of addressing gaps in access to care. It is plausible that this finding may be connected to some of the dissatisfaction with their veterinarians respondents reported. In the human healthcare literature younger patients’ satisfaction levels were found to be influenced by their perceptions that the physician was caring and did not rush the doctor-patient interaction (42). Similarly, in veterinary care, if clients feel that they are paying for care but not getting sufficient time with their veterinarian, their perceptions of the value of the service received, their trust in the veterinary-client relationship, and willingness to engage in future care-seeking behaviors may all be negatively impacted.

In exploring respondents’ experiences with care-seeking, our study revealed a surprising finding that more than half of care-seekers (54.7%) reported distrust in their veterinarian, which highlights a critical issue for the veterinary community. Because previous studies suggest that the public perceives veterinarians more favorably than other medical professionals [e.g., human physicians (43)] and veterinarians are among the most trusted sources of animal welfare information (44), our findings were unexpected. The lack of trust observed in this sample may be due to several factors which require further investigation. First, sampling only primary care-seekers may have allowed us to uncover insights that are obscured when those who never or only occasionally seek care are included in the data, especially if those individuals have a more positive overall perception. It is also probable that being unable to get an appointment without long wait times, then experiencing visits that appear too short, in combination with negative previous experiences, ineffective communication, and rising care costs serves to undermine trust. Future studies should explore these concepts to determine if trust in veterinarians may differ between care-seeker and non-care-seeker populations and whether it varies depending on clients’ previous experiences. Distrust in veterinarians among care-seekers poses a threat to animal health and welfare, impacting service utilization, treatment compliance, and client retention.

Relatedly, it is important to note that nearly half of respondents indicated a preference for seeking solutions regarding animal care from peers or online resources before seeing a veterinary professional. This finding may reflect a degree of distrust, especially for respondents who did not believe their veterinarian provided the best possible care. It is possible that it also indicates a desire to avoid veterinary costs unnecessarily or to ensure that time and money expended on veterinary visits are “well spent” or both. This reiterates the importance of bridging trust gaps and considering affordability and value of services as components of improved access to care, as seeking veterinary care solutions from inappropriate sources puts animal health and welfare at risk. Additional research should investigate whether care-seekers’ preference for obtaining animal care advice from peers or online sources is related to perceived convenience, the value of services, trust—or lack of trust—in their veterinarian, or a combination of these factors.

Among the most intriguing of our findings were pet owners’ perceptions of potential alternative veterinary care providers and care-seekers’ willingness to utilize these alternatives. We hypothesized that pet owners and care-seekers, particularly those who experienced difficulties accessing a veterinarian, would respond favorably to alternative care options. This hypothesis was somewhat met as many respondents reported positive perceptions of potential alternative veterinary care providers and expressed their willingness and preference to seek care from professionals other than veterinarians. The mid-tier veterinary professional role, often referred to as a Veterinary Professional Associate (VPA) has been the subject of contentious debate within the animal health and welfare communities (28, 45–47) and other major stakeholders. Proponents of this model highlight potential benefits, including increased access to care, improved care efficiency, and cost-effectiveness (48, 49), ensuring more pets receive necessary health services without overwhelming the existing veterinary workforce. However, opponents argue that the risks associated with such a role may outweigh the benefits, highlighting challenges related to appropriate educational preparation, student debt-to-income ratio, regulation, licensing frameworks, and potential confusion regarding the responsibilities of this role (28, 50). Such confusion could further undermine trust in the veterinary healthcare system, potentially leading pet owners to seek care from inappropriate sources, or avoid seeking care altogether.

In apparent contrast to our results, a survey conducted by the AVMA found that 79% of pet owners wanted a licensed veterinarian in charge of their pet’s care, and 80% believed it would be dangerous for any alternative care provider to make healthcare decisions for their pet (51). However, our findings suggest that a large majority of pet owners believe a well-trained veterinary technician/veterinary nurse (66.7%) or mid-tier veterinary professional (65.1%) could provide service of equal quality to a veterinarian. Most care-seekers who experienced barriers to veterinary care (e.g., cost of veterinary services or distance to a service provider) expressed both a willingness and preference to seek care from a potential alternative provider rather than forego care, highlighting the influence that barriers to care may have on care-seeking decisions. These findings closely align with those of Niemiec et al. (47), who found that most pet owners were comfortable with certified veterinary technicians (CVTs) and mid-level practitioners or veterinary professional associates (VPAs) performing treatment of non-urgent medical conditions (52.1, 49.7%), annual examinations (48.6, 41.3%), and vaccine administration (58.1, 46.7%), respectively.

Our hypothesis that relationships would be found between perceived access to care and willingness to seek alternative service providers was met. However, the types of relationships observed were somewhat unexpected. Among respondents with good access to care, a larger proportion preferred to seek care from a mid-tier veterinary professional rather than forego care. While this finding was surprising, it may suggest that even those with access to a veterinarian value having additional care options. This may be especially true if they perceive mid-tier veterinary professionals as more affordable or convenient. Similarly, of those who did not report good access to care, a majority (57.1%) preferred seeking a mid-tier veterinary professional to foregoing care altogether. It should be noted, however, that 42.9% of care-seekers with constrained access to a veterinarian disagreed that they would choose seeking an alternative provider over foregoing care. This finding suggests that interventions aimed at offering services from individuals other than veterinarians may not appeal to all care-seekers who lack access. These findings also demonstrate that there is substantial interest in alternative service providers extending beyond Colorado and the western United States to a national sample, particularly among care-seekers with access to a veterinarian. Whether those in our study truly understand the potential animal health and welfare implications of choosing a care provider who is not a veterinarian remains unclear, however.

A majority of pet owners indicated a preference for a competent veterinary technician/veterinary nurse or mid-tier veterinary professional who demonstrated greater cultural sensitivity than their current veterinarian, and whose demographics more closely aligned with their own. This finding underscores the high priority many U.S. pet owners place on accessing culturally competent care. Agreement with related statements was frequently associated with demographics, with younger participants (under 45), those without a graduate or advanced degree, and those earning under $100,000 annually reporting higher levels of agreement. This aligns with reports of growing demand for culturally competent care (52) and suggests that pet owners within these demographic groups may be more likely to seek alternative providers when these needs are unmet. In this regard, it is possible that veterinary clients may be responding similarly to human patients surveyed, whose responses indicate that those with higher levels of education often feel more respected by their physicians compared to those with less education (53). Many human patients also report being treated unfairly or with disrespect by their doctors due to their race, ethnicity, or ability to speak English (53). The degree to which cultural competence and demographic identification with one’s veterinarian might also influence trust and the veterinarian-client relationship should be further examined (52, 54). However, it should be noted that in our study, 62.8% of care-seekers reported culturally sensitive interactions with their veterinarian, suggesting that veterinarians are generally effective in providing culturally competent care. Given the importance of cultural competence to pet owners and the finding that a minority (9.9%) of care-seekers did not experience culturally sensitive interactions with their veterinarians, future research should examine whether primary care-seekers’ level of trust in veterinarians is influenced by shared demographic characteristics or perceived cultural competency, and how these relationships may differ across demographic groups.

This study revealed new insights related to U.S. pet owners’ perceptions of access to veterinary care. Focusing on the specific subsamples of caregivers and care-seekers enabled us to capture the direct experiences of those actively seeking veterinary services that may be obscured in surveys that broadly target the population of pet owners, regardless of their role. While most reported having ‘access’, a considerable proportion still encountered barriers and care-seeking experiences that were unsatisfactory. Demographic factors, including age, education level, and income level were found to influence perceptions of alternative veterinary service providers and potential care-seeking behaviors. Our findings also identified trust in veterinarians as a critical area for improvement. Strengthening trust within the veterinarian-client relationship is therefore necessary to enhance the experience of the client and ensure future care-seeking decisions that support good animal welfare outcomes. These findings have practical implications for various stakeholders and policymakers, emphasizing that strategies to improve access to veterinary care should account for the social and relational factors that shape pet owners’ experiences.

Whether or not they had easy access to care, more respondents were willing to seek care from alternative providers than forego it, suggesting that there is a need to address some care-seekers’ desire for a broad range of care options. Failure to meet this need could have implications for animal welfare, as pet owners may turn to unqualified or unreliable sources to guide their care decisions. However, it remains unknown why some care-seekers who reported limited access to care were less willing to consider using alternative care providers. Future research is needed to determine if these pet owners prefer different solutions or are simply forgoing care altogether. It is also unclear whether specific barriers influence care-seeking behavior more than others, and if these barriers may differ between demographic groups. Understanding these nuances and regional variations in care constraints, could provide critical guidance to the veterinary community on how to address the most pressing obstacles to equitable, high-quality veterinary care. Ultimately, this study highlights the need to build on its findings and incorporate them into considerations of interventions that may enhance both access to care and willingness to seek it.