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This article was originally printed in the Sept/Oct 2025 issue of the California Veterinarian magazine.
Foreword: What Is Access to Care? By Dr. Peter Bowie, CVMA President
“Access to Care” is not just a trendy catchphrase—it has a long history. Common usage of the term began during the 1960s, primarily as a means to improve the availability of health care to the elderly and the poor. Related efforts to increase such access ultimately resulted in Medicare and Medicaid. Gradually, access to care has expanded to other groups that struggle to acquire adequate healthcare.
As veterinary costs have increased, access to veterinary care has become an issue for the veterinary community as well. Access to veterinary care refers to the ability of pet owners to acquire the care they want for their pet in a timeframe that meets their needs, overcoming barriers to that care like financial constraints, transportation issues, language barriers, cultural dissonance, and others.
The veterinary profession is already, sometimes unknowingly, familiar with access to veterinary care issues since veterinarians are confronted with client constraints on a daily basis. As veterinarians improvise to accommodate various client needs, it is important to recognize where the “ice gets thin” in order to avoid legal pitfalls that may ensue when trying to balance client needs with patient care that meets a minimum standard. This article serves to assist veterinary professionals in maintaining that delicate balance.
Within the overall rubric of “access to veterinary care,” several related terms become part of the veterinary vernacular: “Contextualized care,” “spectrum of care,” and “incremental care.” Spectrum of care refers to the wide range of care options veterinarians can provide.
Practicing across the spectrum of care involves tailoring evidence-based care options based on contextual factors, such as client goals, abilities, and resources, as well as patient, veterinarian, and practice factors. In practice, spectrum of care is used by veterinarians each time they outline all care options—from the gold standard to the minimum standard—to clients, and then work with them to choose the best fit for the given situation.
Metaphorically speaking, spectrum of care may be thought of as a food menu that includes a range of less expensive choices to more expensive choices. All choices are palatable (safe), and the client can choose whether they want a modest meal or a steak dinner.
Incremental care is a patient-centered approach that focuses on providing the best possible treatment within the constraints of limited resources and client needs. It emphasizes a practical, problem-solving approach to veterinary medicine, especially when full, “gold standard” care is not feasible. One may also think of it as a “step-by-step” approach to addressing an issue, using scientific knowledge and clinical experience to determine which therapy should be recommended and tried first.
Referring back to the menu metaphor, incremental care would be starting with one (likely less expensive) menu item, then determining if it is enough to complete the meal. If not, the consumer can then go on to order another menu item, and so on and so forth until they are satisfied.
Contextualized care is a way of delivering veterinary care that acknowledges different ways to approach the diagnosis and treatment of an animal, depending on the circumstances of the individual animal and their caregivers and the context in which the care is delivered. It builds on evidence-based veterinary practice, which combines clinical expertise with the most relevant and best available scientific evidence, patient circumstances, and caregiver/owner circumstances.
One example is running preanesthetic bloodwork on a geriatric or sick patient but omitting it for a young or healthy patient. Again using the menu analogy, contextualized care is akin to the server pointing out menu items that may be a better fit based on the dietary needs of the consumer. For instance, someone may be able to skip the appetizer course and go right to the steak dinner if they don’t need that much food.
By default, most veterinary practices tend to focus on striving to provide a “gold standard” of veterinary care, which does not always prioritize less expensive services. Gold standard veterinary medicine is expensive to provide, such that most services cannot be discounted or provided free of charge. Therefore, implementing some type of access model, whether it be incremental care or others, can benefit all parties.
Patients may be able to receive some quality form of treatment versus not being treated at all, thus enabling veterinarians to help more animals instead of being sidelined. When successful, a modified approach to how veterinarians manage their cases through access models can forge long-lasting and healthy veterinarian-client-patient relationships.
Should veterinarians choose to implement spectrum of care, incremental care, or contextualized care into their practice model, they should be mindful that falling below a minimum good and acceptable standard of care can have legal consequences. In other words, a veterinarian can only bend and give so much to accommodate a client’s constraints before drawing a line on what they must do in order to deliver a minimum standard of care.
A Legal Look at Access to Veterinary Care By Dan Baxter, CVMA Executive Director
The potential legal ramifications of the various access terms should not be underestimated. More specifically, for purposes of both license-related proceedings conducted by the California Veterinary Medical Board (CVMB) and civil actions initiated by aggrieved clients, terminology—and the standards of practice each relevant term connotes—is legally important. For example, “spectrum of care” is a CVMB-recognized term that is generally defined by the standard of “reasonable prudence”—that is, what a reasonably prudent veterinarian would do under similar circumstances. However, “reasonable prudence” is a legal rather than clinical standard, and thus the use of “spectrum of care” in the access to veterinary care context could introduce legal standards and requirements that constitute a trap for the unwary. Access to veterinary care is about creating flexibility for the benefit of the animal patient and its owner, not delineating a formal standard that defines liability, informs the debate of expert witnesses, and the like. For that reason, the term “spectrum of care” can be seen as a more generally applicable term linked to access to veterinary care.
With the above as a preface, it is incumbent on the veterinary profession and those who support it to encourage the adoption of a legal framework that does a better job of accommodating the realities of access to veterinary care, especially as such initiatives become more widespread. The goal of providing clinical treatment to broader sections of society is laudable, but if the application of access to veterinary care concepts (for example, “contextualized care”) represents a departure from legally articulated standards of care, then the clinician is faced with the untenable choice of (a) providing the care at a less than “gold standard” level and risking liability, or (b) not providing the care at all, to the detriment of the animal patient.
In that regard, while the CVMB has been vocal in messaging that it does not view the Veterinary Medicine Practice Act as requiring a “gold standard” level of care, the existing legal framework needs to be adjusted to more explicitly align with that understanding, so that all individuals operating within that framework (veterinarians, animal owners, and subject matter experts) have a clear understanding of the standard of care that does—and does not—apply. Relatedly, it is important for veterinary schools to better educate students on access to veterinary care methodologies so that the concepts are known to practitioners from the very beginning of their careers. After all, if the only clinical standard new veterinarians know is the “gold standard,” then this does no favors to (1) clients unable to afford the gold standard, (2) animals unable to receive the gold standard, (3) practitioners not used to delivering something different from the gold standard, and (4) enforcement personnel evaluating whether something less than the gold standard was appropriate.
In short, if the profession continues to recognize access to veterinary care as a viable, normalized part of the profession, all relevant parties—veterinarians, patients, regulators, and educators—need to fully commit to its success. It needs to be solicited, explained, taught, and defined. It needs to be accounted for, both in the veterinarian’s evaluation of what is reasonably deliverable to the animal patient at the front end and in the legal framework under which the clinician’s conduct may later come to be evaluated. Only in this holistic manner are the economic, clinical, and legal interests of client, patient, and veterinarian adequately protected.
“If the profession continues to recognize access to veterinary care as a viable, normalized part of the profession, all relevant parties—veterinarians, patients, regulators, and educators—need to fully commit to its success.”
Mitigating Liability When Providing Spectrum of Care Options By Dr. Grant Miller, CVMA Director of Regulatory Affairs
As mentioned previously, the CVMB has been vocally supportive of veterinarians offering spectrum of care options to clients to increase access to veterinary care. Given that access to veterinary care problems are rooted in the inability of many animal owners to afford even basic veterinary care, most veterinarians knowingly or unknowingly already apply some level of contextualized or incremental care to their cases on a daily basis. However, veterinarians at all times have an affirmative duty to deliver veterinary treatment in a competent and humane manner, with all aspects of that treatment being performed consistent with current veterinary medical practice in this state. So, for example, if everyone else is running bloodwork on geriatric patients prior to anesthesia, it is incumbent on veterinarians to “keep up with the Jones’” and do the same.
Since so much of what the California veterinary profession strives for on a daily basis is the “gold standard” of care, one may ask: “How can I protect myself when spectrum of care intersects with my minimum standard duty to practice the way everyone else does?” When does the CVMB stop promoting spectrum of care and start enforcing a minimum standard of care? These questions do not have perfect answers. There is no doubt that veterinarians frequently help clients who cannot afford gold standard care for their animal.
Should that benevolence backfire in the form of a CVMB complaint, the veterinarian’s good deed could result in a tarnished reputation, CVMB investigation, legal costs, and disciplinary action, not to mention a severe disruption to the veterinarian’s life. In that manner, the process can be unfair, unbalanced, and unreflective of the veterinarian’s intent to balance the clinical and economic interests at issue.
To protect oneself in implementing spectrum of care in practice, a veterinarian must do three things above all else:
“Given that access to veterinary care problems are rooted in the inability of many animal owners to afford even basic veterinary care, most veterinarians knowingly or unknowingly already apply some level of contextualized or incremental care to their cases on a daily basis.”
In Closing
Access to veterinary care is becoming a more familiar concept with names now being given to case management strategies that most veterinarians have used since the beginning of veterinary medicine to meet client needs. But as times have changed, the good intentions of veterinarians to keep animals healthy have often resulted in legal peril and punishment for a good deed done. Thus, understanding recognized access to veterinary care methodologies, the legal ramifications of taking them too far, and how one can mitigate liability is paramount to successfully practicing in today’s changing times.
It’s Not About Politics….It’s About Your Profession. The CVMA-PAC is a bipartisan political action committee whose purpose is to educate state legislators and candidates on issues of importance to the veterinary profession
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