I looked up who owns my vet

The dog was fine.

That is what the bill was for. A limp that turned out to be nothing, an X-ray to be sure, and a number at the front desk that made me do the arithmetic twice.

I paid it. Then I looked up who owns the clinic.

The sign outside carries a family name. The company behind the sign belongs to a fund, and the clinic itself helps service the debt from its own purchase.

That is the model. Buy independent practices at five to seven times earnings. Fold them into a platform. Sell the platform a few years later at twelve to fifteen times earnings. Borrowed money funds the buying, and the gap between those two multiples is the prize.

Private equity put $51.6 billion into American veterinary practices between 2017 and 2023, and another $9.3 billion in the first four months of 2024 alone.

Corporate owners now run roughly 25% to 30% of general practices, up from 8% to 10% a decade ago. In specialty and emergency care, where the bills are largest, they run about 75%.

Now the prices. American practices raised service prices by an average of 6.57% between 2024 and 2025, according to Vetsource, which tracks transactions across nearly 6,500 clinics.

Visits per practice fell 3.1% in 2025. Routine wellness appointments fell 3.8%. That was the fourth straight annual decline, after drops of 3.5% in 2022, 1.4% in 2023 and 2.6% in 2024.

The average gap between one appointment and the next has stretched to about 86 days, roughly 48% longer than three years earlier.

A 2026 Lovet survey of 2,000 American dog and cat owners found 46% had delayed or skipped care in the previous twelve months because of the cost. The same survey found 91% would take on debt to save their animal's life.

So people are not spending less because they care less. They are waiting.

A clinic can raise its prices. It cannot make you bring the dog in.

Debt does not wait. Thrive Pet Healthcare, the TSG Consumer Partners platform with 369 clinics, ran a distressed debt exchange in March 2025 that pushed its maturities out to June 2028 and bought it some liquidity.

S&P had the company at CCC+ by April 2025. It cited labour costs, staffing shortages and falling patient volumes.

I have no idea which platform runs into trouble next. But the arithmetic is the same at all of them, and it is sitting behind a lot of front desks with family names on the door.

Understanding this trade explains almost everything about how these businesses behave.

A single independent animal hospital is a small business. It sells for five to seven times its earnings, because a buyer of one clinic is buying one clinic's worth of risk.

Four hundred of them bolted together is an asset class. Advisers put platform deals with $10 million or more of adjusted earnings at a median near 11.5 to 12.5 times, and transactions in early 2025 ran anywhere from six to sixteen times depending on size.

Nothing has to improve inside the clinic for that to pay. The earnings can be identical. Scale alone moves the multiple, and debt supplies the cash to keep buying.

Mars set the reference point in January 2017 when it took VCA private for about $9.1 billion, roughly fourteen to sixteen times trailing earnings.

The selling vet usually takes 70% to 90% in cash and rolls the rest into platform equity, which pays out only if the eventual exit multiple holds up.

Most exits so far have been sales from one fund to another. The trade needs a next buyer.

And here's where it spreads.

These platforms did not borrow from banks. They borrowed from private credit funds, and those funds now hold paper on businesses whose customers are cutting back.

The research firm Octus looked at six of these consolidator credits earlier this year and found the performance gap between them widening.

One of the six had already restructured. In March 2025 Thrive Pet Healthcare exchanged its existing loans into a stack with a superpriority revolver, a first-lien first-out piece, a first-lien second-out piece and a second lien, moving every maturity to June 2028.

That kind of exchange does not repay anything. It reorders who gets paid and buys time.

Scale gives you a sense of the loads involved. PetVet Care Centers, owned by KKR, grew from about 125 hospitals in 2017 to more than 450, backed by a $2.3 billion unitranche loan arranged in 2023 that the clinics themselves service.

Octus also noted a structural point about staffing. In most of these platforms the veterinarians are salaried employees rather than partners with equity, which makes them easier to hire and easier to lose.

Meanwhile, the same consolidation happened in the United Kingdom, and a regulator went and measured it.

The Competition and Markets Authority published its final report on 24 March 2026, closing an investigation into a £6.7 billion market that serves roughly 60% of British households. The call for information drew 56,000 responses.

Two findings stand out. Fewer than 40% of practices publish any price information at all. And more than 70% of pet owners buy their medicines straight from the vet, largely because prescription fees make going elsewhere pointless.

The CMA named six large groups: CVS, IVC Evidensia, Linnaeus, Medivet, Pets at Home and VetPartners.

The remedies include standard price lists, a cap on written prescription fees, written estimates above £500, a price comparison website, and a rule that the large groups must identify themselves on the premises, the signage and the website. The binding Order is due by 23 September 2026, with compliance phased in over the following three to twelve months.

Sweden's competition authority published its own study on 27 February 2026 and found major problems with price transparency in non-preventive care. The Netherlands is looking as well.

America has gone case by case instead. The Federal Trade Commission made Mars divest a dozen clinics as a condition of the VCA purchase, forced JAB to divest twice during 2022, and imposed a standing requirement that JAB give notice before buying any specialty or emergency clinic within twenty-five miles of one it already owned.

A rule about signage is really a rule about knowing who you are paying.

Three more things worth keeping track of.

Almost nobody in America carries pet insurance. The industry body NAPHIA counted 6.98 million insured American pets at the end of 2025, up 9% on the year, which sounds healthy until you set it against the number of animals. Only 4.27% of American pets hold a policy, 5.99% of dogs and 2.29% of cats. About 95 million households own one, and Americans are projected to spend $165 billion on pet care this year. The bill almost always arrives as cash.

Japan had a bad week. MSCI Japan fell 3.33% in the week to 21 August, its worst in months, as the yen strengthened and punished exporters and semiconductor names. The Nikkei is still up 19.18% for the year, so this is a currency move rather than a change of story, and it is a reminder of how much of that gain rests on where the yen sits.

The crowded trade is emptying slowly. Bank of America's August fund manager survey still found long global semiconductors to be the most crowded position in the market, but the share of managers naming it fell to 53% from a record 82% in July. At the same time, 71% still expect no major hyperscaler to cut capital spending this year. Flows told the same mixed story, with $1.7 billion leaving one semiconductor ETF while about $670 million went into another. Managers are trimming concentration rather than leaving. We'll see.

In the 1990s, Wall Street decided doctors were a business.

The reasoning was sound enough on paper. American medical practices were small, independent and run by people trained in medicine rather than management. A company could buy them, centralise the billing and the purchasing, and keep the savings.

They were called physician practice management companies. PhyCor. MedPartners. FPA Medical Management. Coastal Physician Group.

Any practice of real size auctioned itself to the highest bidder. In 1997 alone the publicly traded firms raised $2 billion to keep buying. By 1998 the consultancy Sherlock Co. counted 39 public companies and 125 private ones in the business.

Then July 1998. MedPartners announced it was leaving the business. FPA Medical Management collapsed.

Eight of the ten largest listed firms in the industry were bankrupt within four years.

The wreckage was not only financial. Thomas-Davis Medical Centers in Tucson had been treating patients since 1920, and it did not survive being bought by FPA. The Burns Clinic in Petoskey, Michigan dated to 1931 and went the same way under PhyCor. In Charlotte, the Nalle Clinic was 79 years old when it folded.

In September 1999 the California Medical Association published a report warning that as many as 90% of the state's physician organisations were headed for bankruptcy or closure.

Shareholders sued, alleging false figures had gone to the SEC. Banks pulled their credit lines.

What ended it was simpler than fraud. Buying a practice does not make the practice earn more. It adds a layer above the practice, and that layer has to be paid for out of the same money the practice was already collecting from the same patients.

When patients came in less often, the arithmetic stopped working from the top down.

The clinics were mostly fine. What they could not carry was the company that had bought them.

Twenty-eight years is long enough for an idea to come back. We'll see.