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Bluesky van

BlueSky At-Home photo

BlueSky At-Home uses branded vehicles in its mobile veterinary service. The company, started in December, is operating in a market that has proven difficult for large corporations.

Over the past two decades, large corporations have established a formidable presence in most facets of veterinary care, amassing sizable to dominant market shares in general practice, specialty hospitals, pharmaceuticals and diagnostics.

One domain, however, is proving hard for them to crack, seemingly providing a bastion for small, independent operators: house call practice.

Three startups that attempted to enter the United States mobile veterinary care market have disappeared in quick succession in recent years. The first, BetterVet, launched in 2020, was acquired in 2024 by The Vets, which abruptly ceased operations last year, taking BetterVet down with it. A third company, HomewardVet, rose from The Vets' ashes, taking on many of its veterinarians. But just seven months later, it, too, had gone out of business.

Now, a fourth company, BlueSky At-Home Veterinary Care, is trying to do what HomewardVet couldn't. It has picked up clients and practitioners stranded by the other closures, including some veterinarians who had worked at all three of those now-extinct companies.

Their fate remains on shaky ground, judging by the words of HomewardVet CEO David Hoe, who candidly told staff when closing that company on April 30 that "we've learned that house call veterinary medicine is not well-suited to a corporate model."

A fitting epitaph for corporate ambitions in the house call market? Veterinarians contacted by the VIN News Service offered mixed responses to that question. BlueSky, for one, is confident it has learned from others' mistakes, while some independent practitioners maintain that they'll always be able to run nimbler, leaner businesses.

BlueSky's Dr. Lyndsey Kingsley is keeping the faith, despite having had a front-row seat to the previous failures.

Kingsley's former independent house call practice, established in Austin, Texas, in 2015, was one of the first acquired by BetterVet. She went on to become chief operating officer at The Vets, a position she now holds at BlueSky.

"Some colleagues have been surprised I've jumped back in," she said. "But I joke that third time's a charm, [and] I truly believe in the model when it's done right."

The fact that she and so many others affected by the previous closures have joined BlueSky is partly why Kingsley believes the company can succeed where others haven't.

"There's a reason most of our doctors are doing the same thing I'm doing," she said. "They're saying, 'You know what? I'm giving it another shot because I believe it. I live it. I see the difference it makes for our patients, for our clients.' "

In the wings is a potential competitor to BlueSky that is applying a very different model. Pawssum, based in Australia, has for 10 years been offering a platform in that country that house call veterinarians can join — without losing their independence. Similar to relief staffing companies that offer locums casual work at bricks-and-mortar practices, Pawssum doles out house call jobs — a bit like a veterinary version of Uber.

The Sydney-based company, which expanded into New Zealand in 2022, is eyeing the U.S. market, having set up a U.S. website, its founder, Guy Sharabi, told VIN News. Pawssum isn't operational in the U.S. yet, though, and Sharabi declined to predict when it might be.

(The Australian market isn't immune to challenges, either. Aussie Mobile Vet, a house call company in Sydney that employs its own veterinarians and has its own vans, has "closed temporarily," citing "short-term staffing challenges," according to its website).

Avoiding scheduling, pricing roadblocks

The advent of corporate mobile veterinary services in the U.S. coincided with the Covid-19 pandemic and associated lockdowns, which confined many people to their homes and gave them plenty of time to dote on their pets. Demand for veterinary care has since moderated, though the demise of The Vets, BetterVet and HomewardVets can't be blamed solely on a testier economic climate, according to former staff.

Veterinarians who worked for The Vets have criticized its scheduling system, inventory management, pricing and communication — problems that HomewardVet apparently wasn't able to iron out in time to prevent its own demise.

Dr. Lindsey Kingsley

BlueSky At-Home photo

Dr. Lyndsey Kingsley has had a front-row seat to the challenges faced by house call companies. She was chief operating officer at The Vets, which abruptly ceased operations last year, and now holds the same position at BlueSky At-Home.

A chief complaint among The Vets employees was that it couldn't get its scheduling algorithm right, often leaving veterinarians with inadequate time to travel between appointments. They'd end up arriving very late or canceling, prompting irate clients to post damning reviews online. Former staff also said management failed to listen to their concerns and advice, overstocked the wrong types of medications, overspent on equipment that wasn't often needed and charged clients too much. For most of its existence, for instance, The Vets charged a house call fee of $199 on top of the price for services.

BlueSky's Kingsley said her previous employer hadn't fully grasped how difficult it is to seamlessly coordinate multiple house call appointments across more than a dozen cities.

"At The Vets, there were just some inherent and fundamental flaws with the booking system," Kingsley said. "I think HomewardVet came in and thought they were just going to pick up the ball and keep running with it, when really, they needed a longer runway. There needed to be some rehab, if you will."

BlueSky was launched in December, founded by Sean Miller and Brent Profenno, former executives at Idexx, a veterinary diagnostics giant, and Rarebreed, a veterinary practice chain.

BlueSky's senior management team has more than 100 years of combined experience in the veterinary industry, Kingsley said.

"We have a better understanding of the logistics that go into making all of this work: making sure you have teams on the ground where they're needed when they're needed," she said, "and making sure you're accommodating different appointment types and equipping a vehicle in a way that's going to work for those appointments."

Leaders at the company headquarters emphasize good communication with employees, she said. "You need to ensure that when HQ makes changes that'll affect how teams are doing their jobs every day that everyone is informed and knows what to expect. You build trust that way."

BlueSky prices a "basic wellness visit," which includes the cost of the house call, at $200. Additional fees are charged for items such as vaccines and diagnostics. Alternatively, clients can opt for a canine or feline wellness visit that includes vaccines and "comprehensive bloodwork" for $210 to $510, among other pricing options.

The company is profitable, Kingsley said, at the same time acknowledging that it's been in business for only six months. Higher gasoline prices owing to the war in Iran have pushed up operating costs, but those have been mitigated, Kingsley said, by optimizing scheduling so veterinarians aren't having to drive long distances between appointments.

Attracting staff hasn't been an issue, she added. "The reality is that for some doctors, all they want to do is be a doctor. They don't want to have to deal with taxes, they don't want to deal with payroll." Moreover, being part of a larger corporation, she said, means staff can take vacations without having to leave the business unattended, unlike solo operators.

Lightening the load?

Platforms that link house call veterinarians to jobs are trying to offer them the best of both worlds. They take care of the marketing and scheduling work, enabling veterinarians to focus on providing care at a time that's convenient for them.

Still, participating veterinarians might have to bear more upfront costs than an employee at a company like BlueSky. In Pawssum's case, its more than 220 partnering veterinarians in Australia provide their own medical equipment, drugs and means of transportation.

"It's not your normal corporate where you buy them expensive tools and expensive vans, and then they're going to the home," Pawssum's Sharabi said. "So our model is a bit more lean in that regard."

Sharabi isn't entirely comfortable with comparisons to Uber, which sometimes puts jobs up for grabs. Instead, Pawssum's artificial-intelligence algorithm directly offers jobs to specific veterinarians. If a doctor says no, the job is offered to another one. Who gets an offer is determined by factors such as location, the kind of medication and equipment required and whether a veterinarian has an existing relationship with a client.

Pet owners pay Pawssum for the visit. The attending veterinarian then invoices Pawssum for their services. "For vets, the whole idea of Pawssum is, do what you want, when you want and how you want it," Sharabi said.

The platform, he added, is popular with parents seeking work-life balance, older folks who've sold their clinic but still want a few jobs, or burnt-out practitioners who've left clinical practice. Referring to the last group, he said, "They can keep their desk job, but after hours or on weekends, they can do what they love to do."

Sharabi said the company has been consistently profitable since 2017, a year after it was established. And he doesn't think the house call market is out of reach for companies in the U.S., even if they employ their own practitioners. But he cautions against overstretching.

"I think it comes down to execution. If you're trying to do too much, then your investment is high," he said. "Think about yourself. How many times are you going to a doctor and then ending up in a hospital? One of out 10? So why does a mobile veterinarian really need to stock their car with X-ray machine, an ultrasound?

Offering an even more limited service is seemingly working for companies in the U.S. that offer only end-of-life care. They include Lap of Love and BluePearl Hospice, the latter owned by Mars Inc., the world's biggest veterinary practice owner.

Dr. Lillian Baker

Photo by Dan Baker

Dr. Lillian Baker, a solo house call practitioner in Texas, applies cold laser therapy to a patient.

Happy traveling solo

Corporates like BlueSky also have to compete with the many small, independent businesses that still comprise the vast majority of house call operators in the U.S. and elsewhere.

House call practice, by its mobile nature, evokes a sense of freedom — a benefit that some practitioners may find incongruous with working for a big company.

Dr. Lillian Baker launched a house call service in 2020 after having worked in a bricks-and-mortar practice for a corporate consolidator. The decision was prompted, in part, by the birth of her son, which motivated her to seek a better balance between work and her personal life. She also grew tired of working for a chain.

Baker's one-practitioner mobile business, based on the outskirts of Houston, has been a roaring success, and she now services around 3,000 pet owners with her husband, Dan Baker, the practice's director of operations and veterinary technician. The business has been consistently profitable, she said, even drawing the attention of the nationwide television program Good Morning America and a Houston TV station.

Newshounds haven't been the only people interested in the business. About a year after she'd established it, Baker started getting takeover offers, including from The Vets and BetterVet. For her, rebuffing the advances was a no-brainer. "I didn't want to be a part of a corporate umbrella anymore," she said. "I wanted to have the freedom of flexibility with my schedule. And most of all, I just wanted to remain independent from a larger party that would come in and dictate everything and take a chunk of our earnings."

Baker maintains that solo operators have a competitive edge because they don't face the same scheduling complexities as large corporates. Essentially, she said, she can choose where she wants to go, when she wants.

"I think the biggest advantage of being independent, though, is the client connection," Baker said. "You're not exposed to this time crunch of, 'I gotta see 10 pets a day to make the numbers,' like you do at a corporate. When you're not focusing on numbers, numbers, numbers, you can practice better medicine, and in practicing better medicine, the numbers will automatically come."

Dr. Bill Larson

Photo by Dr. Bill Larson

Providing house calls in western Washington state can be a breeze for Dr. Bill Larson. "Driving, for me, is delightful," he says. "It's beautiful here. I can stop at the beach and stare at bald eagles for 10 or 15 minutes if I'm running ahead. If I was doing this in L.A. or New York City, it would be a very different story."

Baker posits that not having to worry about investing in sophisticated scheduling algorithms or making money for corporate higher-ups means she can offer a full-service proposition at a reasonable price. She charges a house call fee of $68.50 (having recently nudged it up to cover higher gasoline costs) and exam fees ranging from $65 to $140 — plus extra for treatments, including surgery.

Dr. Bill Larson, who runs a one-doctor house call service in Poulsbo, Washington, a small city near Seattle, also wonders whether large corporations can compete on price.

"If you've got veterinarians on a reasonable salary and you've got executives on top of that who are also drawing a reasonable salary, which is only fair, it just makes it really difficult in a house call model to have the finances work," he said.

Larson was inspired to set up a mobile practice in 2005 when he was assisting people affected by Hurricane Katrina. While in New Orleans, he spotted a 26-foot mobile veterinary clinic. One year later, he bought a similar vehicle of his own, equipped to handle everything from simple preventive care to dental surgery and lump removal.

A few months ago, with retirement approaching, Larson decided to limit his offering to in-home euthanasia. Clients of his dismantled full-service offering are having a hard time contemplating switching to a corporate-owned practice, he said. "They're asking me, 'Which alternatives aren't corporate?' "

Larson suspects large companies might be able to improve on their scheduling systems. At the same time, he notes that driving and scheduling can vary greatly from place to place. Getting around his home county of Kitsap, for example, is much easier than in a metropolitan area like Los Angeles.

City-specific challenges notwithstanding, he reckons demand for mobile services is growing, and he encourages young practitioners to consider taking the house call path. "People are busy and over-scheduled," he said. "If they can have somebody come to their house, particularly if they have multiple animals, they will opt for that, I think, because it sure beats hauling all their cats to the vet at the same time."

For veterinarians, visiting households evokes a "James Herriot-type feeling," Larson said, using the pen name of the famed English veterinarian and author, Dr. James Alfred Wight. "You get to know people in their homes. When I go in, I'm a guest at the same time as being their vet. You develop really good relationships."