Implementing Spectrum of Care in Exotic Companion Animal Practice

Millions of households in the United States now have exotic companion animals as pets. Small mammals—including rabbits, guinea pigs, hamsters, ferrets, sugar gliders, and more—reside in 6.7 million households, birds in 6.1 million, and reptiles in 6 million.¹ These pets are valued similarly to dogs and cats, with a survey of small companion mammal owners finding that these pets were considered a family member (42%), like a child (17%), or a best friend (12%).²

Exotic pets have a wide-ranging lifespan from just 2 to 3 years for small rodents to over 50 years for some tortoises and parrots. A common misconception is that veterinary care for these smaller species should be more affordable, in accordance with their size and perceived value. However, with a limited number of veterinarians willing to treat exotic companion animals and the additional expertise and equipment required to effectively treat a wide range of species, costs of care may be significantly higher than for dogs and cats.

Quantifying the costs of veterinary care for exotic pets is difficult due to the wide range of species, variable lifespan, and geographic differences in costs of care. Many exotic pet owners underestimate total lifetime costs.² According to Synchrony’s Pet Lifetime of Care 2025 study, actual costs for small companion mammals over a 6-year lifespan were $7600 to $14 938, while owners estimated they would spend only $2977 over a 7.3 year lifespan.² Costs in this study included food, housing, enrichment, husbandry, grooming, and medical expenses, though some medical emergencies can easily cost several thousand dollars on their own, meaning some pet owners will spend more. There is little to no published data on lifetime costs of care for avian, reptile, amphibian, and aquatic species. In many cases, the cost of initial setup of an appropriate enclosure, substrate, furnishings, lighting, heat support, diet, supplements, and other necessities far exceeds the cost of the pet itself. Additionally, these setups must be maintained throughout the pet’s life.

Two out of 3 small companion mammal owners say they prepare financially, but 51% of these owners reported being stressed by an unexpected medical expense of $250 or less.² As economic shifts occur and spending tightens, companion mammal owners are tightening their budgets in areas such as food and nutrition, over-the-counter medications, professional services (e.g., teeth/nail trimming, grooming), and environmental control.²

For exotic companion animals in particular, husbandry is closely tied to health, with a large portion of medical concerns directly relating to underlying care issues. When expenses such as food and nutrition or environmental control are cut, health concerns experienced by the pet may increase. This in turn may increase the overall costs of care, putting both owners and veterinarians in difficult positions.

Expanding Care Options

One solution to the growing financial barriers experienced by pet owners is spectrum of care (SOC) practice, which has become widely recognized in canine and feline practice. SOC can, and should, be applied to exotic companion animal practice as well. The primary goals of SOC are to maximize patient quality of life within the individual contexts of the pet owner.³ Providing SOC allows veterinarians to uphold their legal and ethical duties to their patients, clients, and the profession.^4,5

To deliver SOC, veterinarians combine their knowledge of the patient—including history, signalment, and physical examination findings—with clinical experience and evidence-based medicine to develop differential diagnoses. These differentials are used to guide diagnostic recommendations. The tests that are pursued are influenced by the client’s individual context, including their finances, bond with the pet, individual values, experiences, and cultural norms.⁶

For any given condition, there are often multiple treatment options that vary in intensity, invasiveness, prognosis, and cost (both monetary as well as other resources such as time). Ultimately, veterinarians partner with clients to identify the best diagnostic and treatment options for the individual patient through shared decision-making.

See an example of how an SOC approach can be implemented in exotic practice in the CASE EXAMPLE sidebar.

Evaluating the Evidence

Much of the literature published in exotic animals examines a single course of treatment. In particular, emerging diagnoses are so uncommon in the literature that a single publication may direct the recommended approach to care for all patients with only a few cases. As more cases are diagnosed and treated, that approach may change.

For example, an initial case series on appendicitis in rabbits suggested that surgery was much preferred over medical treatment.¹⁰ This study set the precedent for surgical management but, as in other species, emergency surgery may be cost-prohibitive for many clients. At the 2025 Exotic365 conference, an unpublished retrospective study was presented that showed that 29 out of 30 rabbits managed medically fully resolved.¹¹ This provides evidence to support a broader spectrum of options for rabbits with this disease.

The exotics veterinarian must be able to discern when it is in the client’s or patient’s best interest to deviate from a recommended gold standard course of treatment. However, there is a paucity of data relative to small animal species, and veterinarians are often left to extrapolate from small sample sizes or from canine and feline medicine.

Critical Communication Skills

The success of an SOC approach is directly tied to how the veterinary team communicates with clients. Clear and compassionate communication is essential from all team members. Approaching each conversation with specific goals of what needs to be accomplished can help to keep communication on track.

These goals should include identifying potential barriers to care, engaging in shared decision-making with the client, and establishing informed consent for the diagnostic and treatment plans pursued. Throughout all conversations, veterinary team members must maintain empathy and withhold judgment. It is important to remain aware of nonverbal communication such as tone of voice and facial expressions, as these can inadvertently convey judgment to clients.

It is the veterinarian’s duty to establish informed consent for the option selected by the client.⁴ To accomplish this, veterinarians must educate the pet owner about the pros and cons of each option, what resources each requires (including owner finances and time), and the prognosis.⁴ These discussions must be held using language the client understands, and this understanding should be confirmed to obtain true informed consent.

In the rabbit with liver lobe torsion example (CASE EXAMPLE), the decision to proceed with surgical or medical management must be made in conjunction with the owner. Surgical liver lobectomy is considered the gold standard treatment based on the last decade of literature, but additional data has shown 42% to 80% of rabbits survived with medical management.^7-9 A number of components may factor into the decision-making process, including patient stability, duration of clinical signs, presence of comorbid conditions, and owner financial limitations. Prognostic factors such as degree of anemia and time to diagnosis should be accounted for and discussed with the pet owner, along with the likelihood of recovery and potential complications of both courses of treatment. These discussions should be had using plain language that is accessible to the pet owner.

Future Directions

As exotic pet ownership continues to grow, so does the evidence base for their veterinary care. The evidence base in exotic animal medicine is growing on nearly a weekly basis; therefore, it is vital that the exotics clinician stays up to date on current literature to ensure they are providing appropriate care recommendations. As the evidence grows, comfort with alternative treatment options is also likely to grow, expanding the available care options for these unique species.