Selling Your Veterinary Practice to Heartland Veterinary Partners: A Vet’s 2026 Guide

By Melani Seymour, co-founder, Transitions Elite.

When a vet hands me a Heartland offer over dinner, there’s almost always a second asset sitting in the room that nobody at the buyer’s table has talked about yet. It’s the building.

The owner has spent 20 years paying down a mortgage on the practice real estate, and the offer in front of them is for the practice. Not the property.

The two are different assets with different buyers, different tax treatments, and very different long-term value, and the line between them is where a lot of money quietly gets made or lost.

Heartland tends to surface that question more sharply than most buyers, because the real-estate dimension is baked into how the platform has actually done deals. In its acquisition of Family Vet Group, the selling family kept the underlying real estate and became a strategic property partner; that real-estate portfolio later traded as an 18-building net-lease deal across 10 states.

So the building isn’t an afterthought with Heartland. It’s a live part of the structure.

That’s the through-line of every Heartland conversation I have. Two related strategies sitting underneath the offer: a regional-density acquisition map that decides how badly Heartland wants your specific practice, and a real-estate dimension that decides how much of your life’s work value actually lands in your pocket versus stays tied up in a lease.

What follows is the same picture I’d lay out across a dinner table if you handed me a Heartland offer and asked what to do with it. Who Heartland is, how the Midwest-and-South density strategy shapes the deal, what the real-estate question really means for your number, where the negotiation leverage sits, and how Heartland stacks up against the rest of the US veterinary buyer pool in a properly run process.

Key takeaways

• Heartland Veterinary Partners is a private equity-backed general-practice consolidator founded in 2016 and headquartered in Chicago, Illinois, built around regional density in the Midwest and Southern United States.
• Gryphon Investors, a San Francisco-based middle-market private equity firm, has been the majority owner since a December 2019 recapitalization per public deal disclosures, with Tyree & D’Angelo Partners and management retaining minority stakes.
• Regional density is the strategy. Heartland builds deep clusters in secondary and tertiary Midwest and Southern markets that larger coastal-focused buyers often underweight, which means a practice that fits an existing Heartland cluster can be a higher-priority target than its raw financials alone would suggest.
• The real estate is a separate asset and a separate decision. Heartland has structured deals where the seller keeps the building as a net-lease investment, and the lease terms can be worth as much over time as several turns on the practice multiple. This is the single most overlooked value lever in a Heartland deal.
• The most reliable way to know what Heartland — or any major buyer — would actually pay for your specific practice is to run a structured competitive process. We call ours the Elite Selling System: we hand-select and vet every buyer who gets to bid, the way a doorman with a velvet rope lets in only the right people, then run a private bidding window inside that vetted group. Heartland gets invited inside that rope on practices that fit their density map, and when they bid against a curated group of qualified competitors, the number and the terms are reliably different from a direct, single-bidder conversation.

Quick facts on Heartland Veterinary Partners

Heartland Veterinary Partners is a private equity-backed veterinary practice consolidator headquartered in Chicago, Illinois. The platform was founded in 2016 by Dr.

George Robinson and has grown rapidly over the past decade.

Heartland operates as a veterinary support organization, providing affiliated practices with non-clinical functions — payroll, recruiting, HR, marketing, accounting, and accounts payable — so the doctors can focus on medicine per Heartland company materials. The platform’s network has grown to roughly 300 general-practice hospitals concentrated across the Midwest and Southern United States.

The footprint is the defining fact. Heartland concentrates in the Midwest and Southern United States, with its deepest clusters in secondary and tertiary markets rather than the major coastal metros that several larger buyers fight over. That geographic focus is deliberate, and it shapes which practices Heartland pursues hardest.

The ownership history is straightforward and recent. Heartland was first built up with backing from Tyree & D’Angelo Partners, a Chicago-based private equity firm.

In December 2019, Gryphon Investors — a San Francisco-based middle-market private equity firm that has managed more than $5 billion of equity investments since 1997 — completed a majority recapitalization of the platform per public deal disclosures at the time. Tyree & D’Angelo and management retained minority stakes, and Churchill Asset Management provided debt capital alongside Gryphon’s equity.

The most important practical fact for a seller. Heartland’s strategy runs on two rails — regional density and a recurring real-estate dimension — and both of them affect your outcome more than the headline multiple does. A practice that fills a gap in a Heartland cluster is worth chasing harder than its standalone financials suggest, and a building handled well can add a second stream of value on top of the practice sale.

What Heartland actually pays for veterinary practices in 2026

The consistent pattern we see. When a multi-doctor practice receives a direct offer from any major buyer’s acquisition team — Heartland included — the offer reflects the leverage the buyer perceives in the conversation. A single bidder facing no visible competition has no structural reason to lead with their strongest cash percentage, tightest earnout protections, or most generous lease terms on the real estate in the first conversation.

Inside a properly structured competitive process, where the buyer knows other qualified bidders are underwriting the same practice in parallel, those dimensions tend to move, sometimes meaningfully. The pattern is not unique to Heartland.

It is the basic dynamic of how every major buyer in this market calibrates an offer to the room.

Heartland does not publish a standard price sheet for any specific practice profile. Per industry M&A commentary (Octus, Capstone Partners, 2025-2026), competitive outcomes for strong multi-doctor general practices in the $2 million-plus revenue range tend to land in the low-teens EBITDA range across the major buyer pool.

EBITDA here means what your practice earns in pure operating profit, before taxes and accounting choices; the multiple is the multiplier buyers apply to that earnings number to set the price. The actual number for any specific practice depends heavily on whether other buyers are at the table and on how well the practice fits the buyer’s strategy.

For Heartland specifically, there’s a second variable layered on top of the financials: fit with the regional-density map. A strong general practice that fills a gap in an existing Heartland cluster delivers more strategic value to the platform than the same practice would in a market where Heartland has no presence. That doesn’t mean Heartland publicly pays a premium for cluster-fit; it means a cluster-fit practice tends to draw more sustained interest and a more aggressive posture, which is exactly the kind of motivated buyer you want in a competitive process.

For practices below the $2 million revenue threshold or single-doctor practices, the buyer pool generally widens to include regional groups and individual buyers. Heartland is active in general practice across a broad range, and its density strategy means it sometimes pursues smaller practices specifically because they round out a local cluster, even when a coastal-focused buyer would pass.

For larger multi-location groups ($10 million-plus revenue, $2 million-plus EBITDA), the multiple range typically extends higher than for single-location GP practices, with deal sizes scaling into the eight-figure range. Heartland’s backing from Gryphon gives the platform the capital capacity to bid for larger multi-location general-practice groups that fit its Midwest and Southern geography.

The cash-at-close reality

Cash at close is the dollars that actually hit your account on closing day, before any contingent or deferred pieces. It’s the number that matters most, because it’s guaranteed.

Per industry M&A commentary across the major buyer pool (Dechert LLP, Holland & Knight, Capstone Partners 2025-2026), the typical offer structure allocates the majority of total deal value to cash at close, with the remainder split among earnout, rollover or partnership equity, and occasional seller notes. An earnout is part of the sale price paid later, only if the practice hits agreed performance targets after closing.

Rollover equity means keeping a slice of ownership in the new entity instead of taking all cash up front. Heartland’s specific allocation on any given deal is negotiated case by case under confidentiality.

For Heartland, the cash-at-close conversation can’t be separated from the real-estate conversation, and this is where most sellers leave value on the table. If the building is sold as part of the deal, those proceeds stack on top of the practice cash.

If the building is retained and leased back, the lease becomes a long-term income stream — but a lease that’s set too low quietly transfers value to the buyer for the entire term. The cash you see at close is only one piece of a two-asset picture, and pricing the building correctly is its own negotiation.

A note on deal structure types in the current market

The broader US veterinary M&A market has shifted measurably toward partnership and joint-venture structures over the past 18 months per MB Law Firm’s 2025 healthcare M&A commentary. In these structures, the buyer acquires a majority stake (commonly 60 to 80 percent), the seller retains a minority stake (commonly 20 to 40 percent) as direct equity in the practice itself, and a contractual put/call mechanism defines the buyout date and formula price for the retained equity.

Rarebreed Veterinary Partners, the legacy SVP playbook (now part of Mission Pet Health), and AmeriVet have publicly emphasized partnership variants in their company materials.

Heartland’s specific posture on partnership versus 100-percent acquisition structures is determined case by case under confidentiality and is not publicly enumerated. What’s distinctive about Heartland is that the partnership question can extend to the real estate, not just the practice equity.

The Family Vet Group transaction is the clearest public example: the selling family kept the underlying property and became a strategic real-estate partner to support Heartland’s facility footprint per Highland Ventures press materials. Sellers evaluating a Heartland offer should ask explicitly what structures are available on both the practice and the building.

Our PE pricing guide covers the structure-by-structure comparison in depth.

How Heartland’s acquisition team operates

Heartland’s corporate-development team sources practices with the regional-density map as the organizing principle. Per Heartland and Gryphon company materials, the platform prioritizes practices that deepen its presence in markets where it already operates, because recruiting reach, relief-vet coverage, marketing, and back-office support all get more efficient when a new acquisition sits inside an existing cluster.

The team works the standard mix of channels: direct outreach to owners identified through industry data and broker relationships, participation in structured competitive sale processes run by qualified sell-side advisors, and inbound inquiries from owners reaching out independently.

A practical implication for sellers. If your practice sits inside or adjacent to an existing Heartland cluster in the Midwest or South, you are likely a higher-priority target than your standalone financials alone would indicate — and that strategic value is exactly what a competitive process is designed to surface and convert into better terms.

The Heartland team, like the rest of the institutional buyer pool, tends to engage more substantively and bid more aggressively when the deal materials reflect a sophisticated sell-side process rather than a casual one-on-one conversation.

How Heartland integrates the practices it acquires

Heartland positions itself as a veterinary support organization, which means the integration is built around centralizing non-clinical work while leaving the medicine and the local identity with the practice.

Local brand and culture preservation. Per Heartland company materials, the platform’s stated approach is to let affiliated practices keep their branding, culture, and clinical autonomy. Acquired practices typically retain their original name and customer-facing identity.

This positions Heartland alongside the brand-preservation buyers rather than the more brand-consolidating Mars-affiliated entities (VCA, Banfield), which more commonly transition acquired practices to a network brand over time.

Centralized non-clinical support. Per Heartland company materials, the platform provides payroll, recruiting, HR, marketing, accounting, and accounts payable across its network. The recruiting reach in particular is a meaningful benefit in the secondary and tertiary markets where Heartland concentrates, because staffing is often the hardest operational problem in those geographies.

Regional-cluster efficiencies. Heartland’s density strategy isn’t only an acquisition lens; it’s an operating model. Clusters of nearby practices can share relief-vet coverage, recruiting pipelines, marketing, and management support more efficiently than scattered single sites.

For a seller, that can mean real staffing relief post-close — and it’s worth understanding which decisions move to the regional level as part of that.

The real-estate dimension. Because Heartland has done deals where the building stays with the seller as a net-lease asset, integration of the practice and handling of the property can run on separate tracks. The practice joins the Heartland network while the real estate remains a distinct investment the seller continues to own and lease.

That separation is a feature for owners who want continued real-estate income, and a negotiation surface that needs careful lease drafting.

Doctor relationships. Per industry M&A commentary on PE-backed veterinary acquirers, selling owners commonly stay on as medical director or in a continuing clinical role for a multi-year post-close period — typically 3 to 5 years — with compensation structured as base salary plus production bonus. Heartland’s specific post-sale employment terms for any given deal are negotiated case by case under the definitive purchase agreement.

Heartland’s recent activity in 2025-2026

Heartland enters 2026 as a steady, acquisitive platform in the US veterinary buyer pool. Capstone Partners‘ April 2026 Pet Sector M&A Update documents the broader sector acceleration heading into 2026, with both PE-backed and strategic acquirers running active pipelines.

Heartland-attributable activity in trade press and Octus’s 2025-2026 sector coverage suggests a cadence consistent with a platform continuing to build out its Midwest and Southern density, though specific acquisition counts are not publicly itemized by Heartland in real time.

The clearest public marker of the platform’s strategy in this period is the real-estate dimension. The Family Vet Group transaction, in which the selling family retained the real estate and a multi-property Heartland net-lease portfolio later traded across 10 states per Highland Ventures press materials, illustrates how the building can be carved out and held as a long-term investment in a Heartland deal.

The practical takeaway for an owner receiving 2026 Heartland outreach: this is a buyer running a sustained, geography-driven acquisition program with a real-estate dimension most buyer profiles ignore. Both of those features — the density map and the building question — are the lens through which the offer in your hand should be evaluated.

Have an offer from Heartland? Get a Free Practice Value Estimate — send us the offer and we’ll decompose the terms, value the real estate separately, identify what’s typically negotiable, and project what your practice would likely clear in a structured competitive process with the broader qualified buyer pool. No upfront cost, no obligation.

How Heartland compares to the other major buyers

If you’re considering Heartland, you’re probably comparing them implicitly to the other major buyers who would compete for your practice. Here’s how Heartland stacks up across the dimensions that matter.

Versus Mars Veterinary Health (VCA, BluePearl, Banfield). Mars is the strategic family-owned exception in the US veterinary buyer pool per Mars company disclosures, distinguishing it from Heartland’s PE-backed structure. The brand-handling difference is meaningful — Heartland’s stated brand-and-culture-preservation approach contrasts with VCA’s historical brand-consolidation pattern under the VCA name.

Both may compete for qualifying practices in a structured sale process. Our Mars Veterinary Health buyer profile covers the Mars-specific dimensions in depth.

Versus NVA (JAB Holdings). NVA is owned by JAB Holdings, a privately-held long-hold investment vehicle distinguishable from PE-fund-cycle ownership. Both NVA and Heartland preserve local practice branding per their respective company materials.

The key structural differences are the ownership horizon — JAB’s long-hold posture versus Gryphon’s PE-fund cycle — and geography, since Heartland’s secondary-and-tertiary Midwest-and-South focus differs from NVA’s broader national footprint. Our NVA buyer profile walks through the NVA-specific dimensions.

Versus VetCor (Harvest Partners). VetCor is one of the longest-tenured PE-backed platforms, with more than two decades of integration history concentrated in the Northeast, Mid-Atlantic, and Southeast. Heartland is a newer platform (founded 2016) with a Midwest-and-South density focus.

The footprints overlap in parts of the South but diverge in the Midwest, where Heartland is deeper. Both preserve local branding.

Our VetCor buyer profile covers the institutional-depth dimensions.

Versus AmeriVet Veterinary Partners. AmeriVet has publicly emphasized partnership/JV structures with retained practice-level equity as a distinguishing feature. Heartland’s distinctive feature is its regional-density geography and its recurring real-estate-partner dimension.

The choice often comes down to whether the seller most values retained practice equity (AmeriVet) or the combination of cluster fit plus a real-estate carve-out (Heartland). Our AmeriVet buyer profile covers the partnership-model dimensions.

Versus Mission Pet Health (Shore Capital). Mission Pet Health, the post-merger entity formed from SVP and MVP per the July 2025 Mission Pet Health press release, concentrates in the Sun Belt and Southeast — a footprint that overlaps Heartland in some Southern markets. Mission Pet Health has emphasized partnership structures, while Heartland’s distinctive angle is density plus real estate.

Both may compete for qualifying Southern practices in a structured sale process.

Versus the other PE-backed groups (PetVet Care Centers, Thrive Pet Healthcare, Alliance Animal Health, VPP, others). Each has its own integration philosophy and target profile. Smaller and newer groups sometimes pay more aggressively for practices that fill specific geographic or strategic gaps in their portfolio.

The right way to evaluate which buyer pays most, and on the best terms, is to put all of them in a competitive process and let them surface their best offers in parallel.

What to negotiate before signing with Heartland

Seven priorities when negotiating with Heartland’s acquisition team, with the real-estate terms and the earnout protective provisions as the two highest-leverage categories given Heartland’s structure.

The real-estate decision and lease terms (highest priority). Because Heartland’s model frequently separates the building from the practice, decide deliberately whether to sell the property, lease it back, or hold it as a long-term net-lease investment. If you lease it back, the rate, escalators, term length, and renewal options can be worth as much over time as several turns on the practice multiple.

A below-market lease quietly transfers value to the buyer for the full term; a fair-market lease with reasonable escalators protects the second asset you spent decades building. This is the dimension most owners value incorrectly on their own.

Earnout protective provisions. If the offer includes an earnout, negotiate: no major operational changes without seller consent during the earnout period; a working capital floor; an explicit prohibition on shifting central services or regional-cluster costs onto your practice’s P&L; and a clear definition of what counts in the EBITDA calculation at the earnout date. Regional-cluster operating decisions can move practice-level EBITDA in either direction during the window, so the language matters.

Cash at close percentage. Push for higher cash percentages. Every dollar shifted from contingent to cash is guaranteed money instead of conditional.

Gryphon’s capital backing generally supports flexibility on this dimension when the process is competitive.

Rollover or partnership equity terms. If Heartland’s offer includes rollover or a partnership stake, negotiate defined liquidity windows tied to specific milestones, governance rights including information and minority-protection clauses, and anti-dilution provisions. Understand the put/call formula and the exit timing relative to Gryphon’s fund cycle.

Non-compete scope. Non-competes commonly run several years and cover a defined geographic radius for all veterinary work. Negotiate shorter duration (1 to 2 years), a tighter radius (5 to 10 miles), or a carve-out for a specific modality if you might continue clinical work post-employment.

Post-sale clinical autonomy. Heartland’s stated model preserves clinical autonomy, but stated philosophy is not contractual commitment. Negotiate explicit language: you make medicine decisions, and clearly define which business decisions stay with you versus migrating to the regional-cluster structure.

Brand and culture preservation in writing. Heartland’s materials emphasize brand and culture preservation, and that aligns with the platform’s stated philosophy. Still, negotiate explicit brand-preservation language in the definitive purchase agreement — practice name, signage, website, marketing — rather than relying on general marketing-language assurances.

The real-estate question, in depth

For sellers evaluating Heartland specifically, the most useful frame is to treat the practice and the building as two separate assets with two separate decisions, because that’s exactly how Heartland’s deals can be structured.

Why the building is its own asset. The practice is valued on a multiple of EBITDA. The real estate is valued on entirely different math — typically a capitalization rate applied to the market rent the building can command.

The buyer pool is different too: practice buyers want the operating practice, while net-lease real-estate investors want a stable, long-term-leased property with a creditworthy tenant. Selling both to the same party at the practice-deal table, without separately valuing the real estate, is how owners under-price the building.

The three paths, in plain terms.

• Sell the building with the practice. Simplest, fully cashes you out, and the proceeds stack on top of the practice cash. The risk is leaving real-estate value on the table if the building isn’t separately appraised and marketed.
• Lease it back to Heartland. You keep the property and collect rent for the lease term. The entire value of this path lives in the lease: a fair-market rate with reasonable escalators and renewal options is a durable income stream; a soft lease is a slow giveaway.
• Hold it as a long-term net-lease investment. The Family Vet Group structure shows this is real with Heartland — a seller can retain the property as a strategic real-estate partner and potentially monetize a multi-property portfolio later, as the 18-building, 10-state Highland Ventures net-lease sale demonstrates per their press materials.

Why this is the most overlooked lever. Most buyer profiles, and most owners, focus entirely on the practice multiple and treat the building as a footnote. With Heartland, the building is structurally in play, and the difference between handling it well and handling it casually can run into seven figures over a lease term.

Getting an independent real-estate valuation, and negotiating the property terms with the same rigor as the practice terms, is the single highest-return piece of preparation for a Heartland deal.

Should I take a Heartland offer or run a competitive process?

For Heartland specifically, the value of the competitive process shows up in two places at once: the practice terms and the real-estate terms. On the practice side, the leverage works the same as with any buyer — without competition, no buyer has incentive to lead with their strongest cash percentage or soften the pre-set defaults in their standard template.

With other qualified bidders at the table, every term becomes negotiable because the seller has alternatives.

On the real-estate side, a structured process does something a direct conversation rarely does: it forces the building to be valued and negotiated as its own asset rather than folded quietly into the practice deal. When competing buyers are bidding for the practice, and a separate real-estate valuation anchors the property conversation, the lease rate or sale price for the building gets set on its own merits instead of on the buyer’s preferred default.

Heartland participates in well-run competitive processes when the practice fits its density map. And because Heartland’s strategic interest is partly geographic — a cluster-fit practice is worth more to them than its standalone financials suggest — a competitive process is the mechanism that converts that strategic value into better terms for the seller, on both the practice and the building.

What our Elite Selling System actually does

For a Heartland-affiliated transaction, our process runs on two parallel tracks, because the value lives in two assets — the practice and the real estate.

Phase one — the two-asset audit. Before any bidder packet goes out, we value the practice on normalized EBITDA and separately commission an independent view of the real estate. Normalized EBITDA means the profit number after stripping out personal expenses run through the practice (vehicles, family on payroll above market, owner pay above what a hired medical director would cost).

On the real-estate side, we establish the market rent and the property value the building could command on its own, so the building never gets quietly absorbed into the practice number.

Phase two — the bidder mix. From the 42-plus named veterinary consolidators we actively track, we invite only the ones that legitimately compete with Heartland for this specific practice. For a Midwest or Southern general practice, that typically includes the brand-preservation buyers (NVA, AmeriVet, VetCor where the geography fits), the partnership-emphasis buyers (Mission Pet Health, Rarebreed), and the strategic family-owned alternative (Mars, where the practice fits Mars’s criteria).

The right mix is usually 5 to 7 invited bidders, each genuinely competing on a dimension that matters for your practice.

Phase three — the term-by-term comparison. Bidders return their full term sheets, not just the headline numbers. The seller sees side-by-side comparisons across cash at close, earnout structure and protective provisions, rollover or partnership equity terms, non-compete scope, post-sale role, brand-handling commitments — and, critically for a Heartland-style deal, the real-estate terms: purchase price if sold, or lease rate, escalators, term, and renewal options if retained.

The seller chooses on the dimensions that matter, with both assets priced honestly.

The economic result holds across deal types: practices in the qualifying revenue band that run our process consistently clear materially better total economic outcomes — typically multiple seven figures, sometimes more — than the same practice would have cleared by signing the original direct term sheet without exploring the field, and without separately valuing the building.

Closing thought

The honest read on Heartland: it’s a serious, well-capitalized buyer with a clear geographic strategy in the Midwest and Southern markets, and a brand-and-culture-preservation model that many independent owners find genuinely appealing. For an owner in a secondary or tertiary market that the larger coastal-focused buyers underweight, Heartland is often one of the most motivated bidders at the table.

What separates a well-negotiated Heartland outcome from a mediocre one is rarely just the practice multiple. It’s whether the regional-density value gets converted into better terms through competition, and whether the building — the second asset most owners undervalue — gets priced and negotiated as the distinct investment it is.

Handle those two things well and a Heartland deal can be excellent. Handle them casually and you can leave real money on the table without ever seeing it leave.

If you’ve received a Heartland offer, or if their acquisition team has reached out to start the conversation, the highest-leverage move is to understand how the rest of the field would structure the same practice — and to value your real estate independently — before committing to anything. Get a Free Practice Value Estimate and we’ll lay out the same two-asset comparison we would for a client across a dinner table.

Sources

Industry M&A research and valuation data

1. Capstone Partners. Pet Sector M&A Update — April 2026. Capstone Partners industry research. capstonepartners.com
2. Octus. Veterinary Services Roll-Up Coverage, 2025-2026. Octus credit research and industry commentary. octus.com
3. Dechert LLP. Healthcare M&A: 2025-2026 Trends and Outlook. Dechert healthcare practice publications. dechert.com
4. Holland & Knight. Healthcare Private Equity 2025-2026 Commentary. Holland & Knight healthcare practice publications. hklaw.com
5. MB Law Firm. 2025 Healthcare M&A Trends — Joint Venture and Partnership Structures. MB Law Firm healthcare publications.

Heartland Veterinary Partners, parent, and transaction materials

6. Heartland Veterinary Partners. Who We Are and veterinary partnership model. Heartland company materials, 2024-2026. heartlandvetpartners.com
7. Gryphon Investors. Gryphon Investors Invests in Heartland Veterinary Partners. Gryphon Investors news, 2019. gryphon-inv.com
8. Tyree & D’Angelo Partners. Announces Sale of Heartland Veterinary Partners to Gryphon Investors. 2019. tdpfund.com
9. Highland Ventures. Highland Ventures Finalizes Sale of Family Vet Group and Solidifies Strategic Real Estate Partnership with Heartland Veterinary Partners. Highland Ventures press materials. highlandventuresltd.com
10. Highland Ventures. Highland Ventures Completes Sale of 18-Property Heartland Veterinary Partners Portfolio. Highland Ventures press materials. highlandventuresltd.com

Veterinary practice operations, benchmarks, and profession data

11. iVET360. State of the Veterinary Industry — 2026 Industry Report. iVET360 industry research. ivet360.com
12. American Veterinary Medical Association (AVMA). 2026 AVMA Veterinary Economic Report. AVMA economic research. avma.org