I’m writing this article sitting at a coffee shop preparing to kick-off our Spring Semester of Professional Development and Practice Management at one of the Veterinary schools at which I have the opportunity to teach. This topic is on the docket for lecture today and of all the presentations I deliver, this one tends to spark some of the most questions and discussion. For Veterinary students and veterinarians considering ownership, few decisions are as defining—or as misunderstood—as whether to start a new hospital or purchase an existing one.
This question has taken on new urgency in today’s Veterinary landscape. Corporate consolidation has matured, interest rates remain elevated (though they’re making headway), and younger veterinarians are approaching ownership with a renewed sense of interest, yet still with caution. Fueling this fire, and presenting opportunities for new owners, is the volume of existing hospital owners nearing retirement, accelerating the availability of practices for sale. Against this backdrop, the choice to start-up a hospital (whether ground-up construction or leasehold) or buy has become less about opportunity and more about alignment.
Despite how often the decision is framed as a financial calculation, the reality is more complex. Both paths can succeed. Both can fail. The determining factor is rarely the model itself—it is whether the ownership path aligns with the individual veterinarian’s leadership capacity, risk tolerance, and long-term vision.
The Appeal of Starting a Hospital
Starting a Veterinary hospital offers something that is increasingly rare in a mature industry: a blank slate.
Advantages of a startup begin with control. Founders can define medical standards, pricing philosophy, scheduling, technology adoption, and culture from the outset. There is no inherited way of doing things and no need to undo legacy systems or norms. For veterinarians with a clear vision of how they want to practice medicine—and how they want to lead—this autonomy can be a powerful motivator.
Startups also allow for intentional design. Facilities can be built, or built out, around modern workflows, efficient layouts, and integrated technology. When done well, this can translate into smoother operations, lower long-term maintenance costs, and an improved experience for both clients and staff.
Financially, startups offer clean beginnings. There are no historical pricing gaps, deferred maintenance issues, or underperforming associates to rehabilitate. The numbers are transparent and as solid as the work, thought and expertise you put into your financial projections and business plan.
The challenge with financial projections, no matter how thoughtfully researched and constructed, is that they are just that . . . projections. I’ve seen new hospitals blow their projections out of the water, and I’ve seen others fall short. It is not uncommon for new hospitals to operate at a loss during their early months—or longer—while client volume builds. Debt service begins immediately (depending on the lender), while revenue usually ramps gradually. Owners must be prepared for delayed personal income and greater financial strain during the early stages.
Beyond finances, startups demand significant personal bandwidth. Many new owners, operating on a shoe-string budget, make the mistake of trying to do everything themselves: hiring, marketing, design, technology setup, developing systems and training, and vendor relationships, to name just a few.
While we as owners are ultimately responsible for those outcomes, I encourage new owners to build a “team”—a CPA, an attorney, an architect, etc. around them so that the burden doesn’t land solely on their shoulders. Yes, building a team will likely require an investment, but allowing experts to do what they do best, with your guidance, often saves costly mistakes and lost time. Even with the right team around you, founders typically spend more time working in the business than they anticipate. For some, this intensity is energizing. For others, it becomes a source of burnout.
The Case for Buying an Existing Hospital
Purchasing an established hospital is often perceived as the safer path—and in many respects, it is.
The most compelling advantage is immediate cash flow assuming you buy the right hospital at the right price. An existing practice typically generates revenue on day one, which can support debt obligations, owner compensation, and reinvestment far sooner than a startup. This predictability can significantly reduce financial anxiety, particularly for veterinarians with family or lifestyle considerations.
Acquisitions also come with infrastructure. Established client relationships, referral patterns, and trained (hopefully!) staff are already in place. Financing has historically been easier for acquisitions, as well, especially when historical financial performance is strong.
However, these advantages come with tradeoffs.
Buying a hospital means inheriting its past. Culture, pricing strategies, team dynamics, and operational inefficiencies do not reset at closing. They become the new owner’s responsibility. When there is a wide gap between the buyer’s vision and the hospital’s reality, the transition can be challenging.
Change management is often the most underestimated difficulty of acquisition. Implementing new expectations, updating medical standards, or restructuring schedules requires emotional intelligence and patience. People tend to resist change more than they resist creation, and even well-intentioned improvements can be met with skepticism.
There is also the risk of overpaying. In competitive markets, buyers may overestimate growth potential or underestimate the capital required to modernize facilities, update pricing, or rebuild teams. Deferred maintenance and outdated systems can quickly erode projected returns.
The Question That Matters Most
The most common mistake aspiring owners make is choosing based solely on perceived financial safety rather than leadership fit.
Startups tend to reward high energy, comfort with ambiguity, and a willingness to delay gratification. Acquisitions favor operational discipline, emotional intelligence, and the ability to lead change within existing systems. Neither path is inherently easier; they are difficult in different ways.
Timing and life stage matter, as well. A younger veterinarian with a long runway and fewer personal obligations may thrive in the intensity of a startup. A mid-career veterinarian seeking stable income and balance may find greater satisfaction in acquiring a well-run, unremarkable practice and improving it incrementally.
Neither choice reflects ambition or caution. It reflects context.
Ownership as a Platform, Not a Finish Line
Veterinary ownership is not an endpoint—it is a platform for leadership, influence, and long-term impact.
Whether building a hospital from the ground up or stepping into an established practice, sustained success depends on clarity of vision, financial discipline, and the ability to build and retain a committed team. The decision to start or buy should not be driven by trends or external pressure, but by an honest assessment of what allows the veterinarian to lead most effectively.
The most important question is not “Should I start or buy?” Instead, I’ll at least submit, that the right question is “Which path allows me to be the best leader for my team, my clients, and myself, while helping me reach my personal goals—financial and time away from the hospital (for example)?”
Starting with the vision and end in mind, should help point you in the right direction.