Insurance is a minor issue for vets, essentially none of the population has animal insurance. It's also not a super big deal for dentists, as I understand it, t

Insurance is a minor issue for vets, essentially none of the population has animal insurance. It's also not a super big deal for dentists, as I understand it, though I don't know as much about the back-end of dental practices (wife is pharmacist, sister-in-law is a vet tech, so I know those businesses pretty well). Insurance reimbursement from the monopoly PBM's (three of them control 80% of the drug insurance market) are what is killing independent pharmacies- you have to be one of the national chains to have the scale to effectively negotiate against the PBM's, otherwise reimbursement rates are routinely below your wholesale price. From talking to my wife it's not really compliance and government regulation in the pharmacy space (which is far more regulated than the vet space, naturally) that has forced consolidation. For the most part the regulations haven't changed that much in decades. What's changed is heavily reduced insurance reimbursement rates from those monopoly PBM's plus one other factor: educational debt. The idea that our intrepid young vets/pharmacists/dentists/doctors graduate with a huge pile of educational debt (200k or more), then have to take out massively more debt to start up a new business(1), at the same time they are also in prime child-bearing/rearing/caring age, that's a really hard sell for most. That's why being an employee is such an attractive thing. 1: And those loans have to be much bigger than before, because drugs are more expensive so your inventory costs are higher, people want nicer places offering more amenities, etc. They also need to be able to pay off those software licenses, which may not be individually expensive but are another new cost that wasn't present 30 years ago that has to be paid on the reduced reimbursement rates from the PBMs.