Veterinary practices receive 40% of their calls outside business hours, and most go to voicemail. The standard solutions (DVM on-call, rotating staff, ignoring the problem) all fail at scale. For multi-location veterinary groups, after-hours is not a coverage problem. It is a routing problem. Here are four models that actually work, with the data to help you choose.
Table of Contents
- The 40% Problem: Why After-Hours Matters
- The Four After-Hours Models
- Model 1: DVM On-Call with Answering Support
- Model 2: Triage-First with Emergency Routing
- Model 3: Virtual Triage Nurses
- Model 4: Telemedicine Hybrid
- Cost-Benefit Analysis by Location Count
- Emergency Hospital Partnership Integration
- Implementation Considerations
- Measuring After-Hours Performance
- Key Takeaways
The 40% Problem: Why After-Hours Matters
Pets do not get sick on a schedule. A dog that starts vomiting does so at 10 PM, not 10 AM. A cat that stops eating does not wait until Monday. The result: a significant portion of veterinary call volume occurs when practices are closed.
After-Hours Call Distribution
Typical multi-location veterinary groups see this pattern:
| Call Type | % of After-Hours Calls | What They Need |
|---|---|---|
| True emergency | 15% | Immediate routing to emergency clinic |
| Urgent (needs care within 24 hours) | 30% | First available appointment + guidance |
| Routine inquiry | 40% | Scheduled appointment + reassurance |
| Non-medical (hours, directions, pricing) | 15% | Information or message |
The critical insight: 85% of after-hours calls do not require a veterinarian. They require informed triage that either captures an appointment or routes to emergency care.
The Cost of Getting It Wrong
DVM burnout: On-call responsibilities are a leading driver of veterinarian turnover. A 2023 AVMA study found that excessive on-call burden ranked among the top three reasons DVMs leave practices.
Lost revenue: Callers who reach voicemail often call the next practice on the list or go directly to emergency clinics. A 15-location group losing 30 after-hours calls per night across all locations leaves substantial revenue on the table.
Poor patient outcomes: Callers without guidance may wait too long on true emergencies or rush to the ER for routine issues, leading to worse outcomes and unnecessary costs.
Inconsistent experience: When each location handles after-hours differently, patients receive inconsistent care and the group cannot build operational excellence.
The Four After-Hours Models
Each model represents a different philosophy and cost structure. None is universally best; the right choice depends on your group’s size, philosophy, and resources.
| Model | How It Works | Best For | Cost Level |
|---|---|---|---|
| DVM On-Call + Answering | Answering service takes message, pages DVM | Small groups, low volume | $ |
| Triage-First | Trained staff triage, route appropriately | Medium groups, mixed urgency | $$ |
| Virtual Triage Nurses | Credentialed VTN provide clinical guidance | Quality-focused, liability-conscious | $$$ |
| Telemedicine Hybrid | Video triage with DVM escalation | Tech-forward, high volume | $$-$$$ |
Model 1: DVM On-Call with Answering Support
How It Works
An answering service takes calls and collects basic information. If the caller has a medical concern, the service pages the on-call DVM who returns the call. The DVM provides guidance: come to emergency clinic, wait until morning, or home care instructions.
Workflow
- Caller reaches answering service
- Agent collects pet info, concern, and urgency assessment
- Non-medical calls: handled directly or message taken
- Medical calls: DVM paged with callback number
- DVM returns call within 15-30 minutes
- DVM provides guidance and documents outcome
Advantages
- DVMs provide clinical judgment for medical calls
- Lower cost than credentialed triage services
- Maintains direct DVM-client relationship
- Simple to implement
Disadvantages
- DVM burnout from frequent pages
- Inconsistent response times depending on DVM
- DVMs woken for calls that did not need clinical judgment
- No scalability as call volume grows
- Quality depends entirely on individual DVM
Best For
- Single-location or small multi-location groups (under 5 locations)
- Low after-hours call volume (under 10 calls per night total)
- Groups where DVMs accept on-call as part of role
- Markets without nearby emergency clinics
Estimated Cost
- Answering service: $200-500/month per location
- DVM on-call compensation: Varies by arrangement
- Total: $300-800/month per location
Model 2: Triage-First with Emergency Routing
How It Works
Trained (non-credentialed) staff answer calls and use protocol-based triage to route appropriately. True emergencies go to ER with warm transfer. Urgent cases get first available appointment. Routine calls get scheduled appointments and reassurance.
Workflow
- Caller reaches triage agent
- Agent follows triage protocol based on symptoms
- Emergency: Warm transfer to emergency clinic
- Urgent: Book first available appointment, provide interim guidance
- Routine: Schedule appointment, reassure
- All calls logged and synced to practice system
Advantages
- Most calls handled without DVM involvement
- Consistent triage across all calls
- Appointments captured immediately
- Scalable across locations
- DVMs only contacted for true clinical questions
Disadvantages
- Non-credentialed staff cannot provide medical advice
- Protocols must be comprehensive and well-maintained
- Liability concerns in edge cases
- Requires training investment
- May need DVM backup for complex situations
Best For
- Medium multi-location groups (5-20 locations)
- Moderate after-hours volume
- Groups with nearby emergency clinic partnerships
- Cost-conscious operations wanting improvement over voicemail
Estimated Cost
- Triage service: $500-1,000/month per location
- Protocol development and maintenance: One-time + ongoing
- Total: $600-1,200/month per location
Model 3: Virtual Triage Nurses
How It Works
Credentialed veterinary technicians (VTN) or nurses provide clinical triage over the phone. They can assess symptoms, provide guidance, and make clinical recommendations within their scope. Complex cases escalate to on-call DVM or emergency referral.
Workflow
- Caller reaches credentialed triage nurse
- VTN conducts clinical assessment
- Within scope: Provides guidance (watch and wait, home care, appointment needed)
- Emergency: Directs to emergency clinic
- Complex/outside scope: Escalates to on-call DVM
- Documentation flows to practice system
Advantages
- Clinical judgment on most calls without DVM involvement
- Higher quality triage than non-credentialed staff
- Reduced liability through credentialed staff
- Pet owners appreciate clinical expertise
- DVMs protected from most after-hours contact
Disadvantages
- Higher cost due to credentialed staff
- Availability of qualified VTN staff
- Still requires DVM backup for edge cases
- May not be available in all markets
Best For
- Larger multi-location groups (15+ locations)
- Quality-focused brands
- Groups with high liability sensitivity
- Markets with competitive veterinary landscape
Estimated Cost
- VTN service: $1,000-2,000/month per location
- DVM backup arrangement: Additional
- Total: $1,200-2,500/month per location
Model 4: Telemedicine Hybrid
How It Works
Technology-enabled triage combines AI-assisted intake, video consultation capability, and human escalation. Initial intake identifies urgency. Non-urgent cases may receive video consultation. Urgent cases route to emergency or schedule appointments. Complex cases escalate to on-call DVM.
Workflow
- Caller/user initiates contact (phone, app, or web)
- AI-assisted intake collects symptoms and photos/video
- Triage determination: self-resolve, video consult, emergency, or appointment
- Video consult (if applicable): Technician or DVM provides guidance
- Emergency: Direct routing with information transfer
- Documentation integrates with practice system
Advantages
- Visual assessment possible (photos, video)
- AI assists with initial triage consistency
- Multiple contact channels (phone, app, web)
- Can monetize some consultations directly
- Data-rich documentation
Disadvantages
- Technology investment and maintenance
- Client adoption may vary by demographic
- Not suitable for all client populations
- Requires robust technical infrastructure
- Complexity to implement and maintain
Best For
- Tech-forward veterinary groups
- Groups with younger client demographic
- High call volume justifying technology investment
- Groups wanting to monetize after-hours consultations
Estimated Cost
- Platform and technology: $500-1,500/month per location
- Staffing for consultations: Varies
- Total: $800-2,500/month per location
Cost-Benefit Analysis by Location Count
The economics shift as location count increases:
5-Location Group
| Model | Monthly Cost | After-Hours Capture | DVM Burden |
|---|---|---|---|
| Voicemail (baseline) | $0 | 10% | None |
| DVM On-Call | $2,500 | 40% | High |
| Triage-First | $4,000 | 65% | Low |
| VTN | $7,500 | 75% | Very Low |
Recommendation: Triage-First offers best value at this scale.
15-Location Group
| Model | Monthly Cost | After-Hours Capture | DVM Burden |
|---|---|---|---|
| Voicemail (baseline) | $0 | 10% | None |
| DVM On-Call | $7,500 | 35% | Unsustainable |
| Triage-First | $12,000 | 65% | Low |
| VTN | $22,500 | 75% | Very Low |
Recommendation: Triage-First or VTN depending on quality positioning and DVM retention priorities.
30-Location Group
| Model | Monthly Cost | After-Hours Capture | DVM Burden |
|---|---|---|---|
| Voicemail (baseline) | $0 | 10% | None |
| DVM On-Call | Not viable | - | - |
| Triage-First | $24,000 | 65% | Low |
| VTN | $45,000 | 75% | Very Low |
| Telemedicine Hybrid | $36,000 | 70% | Low |
Recommendation: Hybrid models become attractive at this scale.
Revenue Impact Calculation
For a 15-location group averaging 45 after-hours calls per night:
- Voicemail: 4.5 captured (10%) = $675/night @ $150 average transaction
- Triage-First: 29 captured (65%) = $4,350/night
- Difference: $3,675/night = $110,000+/month additional revenue
Investment in Triage-First ($12,000/month) generates 9x return.
Emergency Hospital Partnership Integration
Effective after-hours management requires coordination with emergency hospitals.
Partnership Elements
Referral protocols: Clear criteria for when callers should go to ER vs. wait for your practice.
Information transfer: When routing to ER, pass caller information, pet history, and symptom details to reduce ER intake burden.
Reciprocal referrals: Emergency hospitals refer non-emergency follow-ups back to your practice.
Communication channels: Direct line or integration with ER for warm transfers.
Integration Workflow
- Triage identifies emergency case
- Warm transfer to ER with case summary
- ER receives pet owner with context
- Follow-up appointment scheduled at your practice
- Records transfer after ER visit
Partnership Benefits
- Better patient outcomes (faster emergency care)
- Reduced liability (appropriate emergency routing)
- Captured follow-up revenue
- Professional relationship with ER
- Staff confidence in routing decisions
Implementation Considerations
Timeline
| Phase | Duration | Activities |
|---|---|---|
| Assessment | 2-4 weeks | Call volume analysis, model selection |
| Vendor Selection | 4-6 weeks | RFP, evaluation, contracting |
| Protocol Development | 4-6 weeks | Triage protocols, scripts, escalation paths |
| Technology Setup | 2-4 weeks | Phone routing, integrations, testing |
| Training | 2-4 weeks | Staff and vendor training |
| Pilot | 4-6 weeks | Limited rollout, refinement |
| Full Deployment | 4-8 weeks | Phased rollout to all locations |
Total: 5-8 months for comprehensive implementation
Critical Success Factors
Protocol quality: Triage protocols must be comprehensive, clinically sound, and regularly updated based on outcomes.
Emergency partnerships: Establish relationships with emergency clinics before implementation.
Staff communication: DVMs and staff must understand and support the new model.
Technology reliability: Phone routing and integrations must work consistently.
Measurement infrastructure: Track metrics from day one to demonstrate value.
Measuring After-Hours Performance
Key Metrics
| Metric | Definition | Target |
|---|---|---|
| Answer rate | % of after-hours calls answered | 95%+ |
| Abandonment rate | % of callers who hang up | <5% |
| Triage accuracy | Appropriate routing vs. outcomes | 90%+ |
| Appointment capture | % of non-emergency calls booked | 60%+ |
| DVM contact rate | % of calls requiring DVM involvement | <15% |
| Emergency referral rate | % of calls routed to ER | 10-20% |
| Callback compliance | % of messages returned next day | 100% |
Quality Monitoring
- Call recording review (sample 5-10% of calls weekly)
- Outcome tracking (did emergency referrals confirm as emergencies?)
- Client feedback collection
- DVM satisfaction surveys
- Protocol adherence audits
Key Takeaways
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40% of veterinary calls come after hours. This is not a minor issue; it is a major operational and revenue consideration.
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85% of after-hours calls do not need a DVM. They need informed triage that captures appointments or routes emergencies appropriately.
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Four models exist, each with different trade-offs. DVM on-call, triage-first, virtual triage nurses, and telemedicine hybrid serve different needs and budgets.
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The right model depends on scale. DVM on-call works for small groups but breaks at scale. Triage-first offers best value for medium groups. VTN and hybrid models suit larger operations.
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ROI is compelling. A 15-location group can generate $110,000+ monthly in additional revenue from effective after-hours management, far exceeding implementation costs.
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Emergency partnerships are essential. Integrate with emergency hospitals for warm transfers, information sharing, and follow-up referrals.
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Measure from day one. Track answer rate, appointment capture, DVM contact rate, and triage accuracy to demonstrate value and identify improvement opportunities.
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