US vs UK veterinary practice: the 6 key differences

I trained and worked as a veterinary technician in the United States. Now I live in the UK and spend my days working with British practices. The medicine is the same in both countries. The way practices run around it is not.

Most of the articles on this topic list the obvious things: pounds versus kilograms, dollar signs versus pound signs. The bigger differences are in what's legally required, what clients expect, and how money moves through a practice. Here's what I've learned working inside both systems.

1. The job titles don't translate

In the US, I'm a tech. Depending on the state, the credential is LVT, CVT or RVT: licensed, certified or registered veterinary technician. Every state sets its own rules, which is a theme you'll see running through this whole article. In the UK, the same role is an RVN, a Registered Veterinary Nurse, a legally protected title with one national standard under the RCVS.

The vets are different too. Americans say doctor or DVM. When I first got to the UK, I kept calling vets "doctor" and getting funny looks. Here it's vet, clinician or surgeon.

And the buildings: a UK practice will happily call itself a surgery, a word no American clinic would ever use. In the US it's a clinic, a practice or a hospital, and people have opinions. Large-animal vets generally want to be called a practice, and I've been corrected for getting it wrong.

Get these words wrong and people notice straight away. I learned each one by being corrected.

2. Kilograms vs pounds, Celsius vs Fahrenheit

The UK weighs patients in kilograms and takes temperatures in Celsius. The US uses pounds and Fahrenheit, with one sensible exception. Plenty of US specialty practices work in kilograms anyway. Drug doses are calculated per kilogram of body weight, so weighing the patient in kilograms means no conversion step at all.

Mostly the dosing itself is the same in both countries. The catch is on the label: the same medication can exist in both markets with its dosing written entirely differently, one per pound and one per kilogram.

3. Heartworm shapes so much about US preventative care

If you only learn one difference, make it this one. Heartworm barely registers in UK practice. In the US, it shapes the entire preventative care model.

Heartworm is spread by mosquitoes, and the adult worms live in the heart and lungs. Some US clinics keep a preserved heart in a jar, filled with worms, on the counter, to show clients exactly why they're being asked to keep up with prevention. It works.

It used to be a southern-states problem, and northern practices would relax prevention after the first freeze. That advice is gone. Warmer winters keep mosquitoes active longer, and rescue dogs are transported north from southern states in large numbers, carrying infection with them. The standard advice is now year-round prevention almost everywhere.

The prevention system has a structure UK vets find surprising:

• A monthly preventative, usually bundled with flea and worm cover, prescribed 12 months at a time
• An annual heartworm test, folded into the yearly vaccine visit before the next 12 months get prescribed
• A manufacturer guarantee: stay on the product and, if the dog contracts heartworm anyway, the manufacturer typically covers the treatment. The practice's records are the proof, which makes accurate dispensing history genuinely valuable
• Miss more than a month, and you're usually retesting before restarting

Treatment for an infected dog is long, expensive and hard on everyone. It means months of injections and strict rest, because worms breaking up in the bloodstream are dangerous when the dog's heart rate rises. That's why the whole US system is built around never getting there.

The UK's parasite conversation is different in emphasis as much as substance. The same products get sold, but the framing is "flea and wormer," with the wormer front and center. In the US, worming is bundled in almost as an afterthought; heartworm, fleas and ticks headline the product.

4. Rabies is a legal machine in the US

In the UK, formal rabies paperwork mostly comes up when a pet travels abroad. In the US, rabies vaccination is required by law in most states, and there's an administrative machine attached to it.

Every rabies vaccine generates a certificate, the legal proof of status. Many states and counties also issue a numbered rabies tag for the pet's collar, and some require the certificate to be filed with the state or county. Certificates get requested constantly. Daycare and boarding are enormously popular, and both demand up-to-date vaccines, increasingly with proof of flea and worm prevention too.

Then there's the part that surprises UK colleagues most. US euthanasia consent forms routinely ask whether the animal has bitten anyone in the previous 10 days. Rabies takes up to 10 days to become detectable, so a bite from an unvaccinated animal can trigger mandatory laboratory testing after death. It's also why the rabies conversation with owners of indoor cats, who often want to decline the vaccine, is taken so seriously in American practice. There is a lab-testing route called titer testing, which measures whether an animal still has protection from an earlier vaccine. In practice it's mostly used for dogs, because dogs legally have to be vaccinated, and a titer gives a kind of proof of coverage where a certificate isn't possible. It rarely helps with a declining cat owner: anyone unwilling to pay for the vaccine isn't going to pay more for the test.

5. Who chases the insurance money

Pet insurance coverage looks similar in both countries. Who does the paperwork doesn't.

In the UK, it's common for the practice to process claims on the client's behalf, and claims handling is built into how many practices run. In the US, clients almost always submit their own claims: the practice hands over an invoice and the medical records, and the client deals with their insurer directly. One large insurer that integrates directly with practice systems is the main exception.

The US fills the affordability space differently: medical credit lines, signed up for at the emergency clinic's front desk, that let an owner spread the cost of treatment. Every US emergency and specialty practice has that conversation daily.

6. Health plans are universal in the UK, but mainly corporate in the US

Health plans, the monthly subscription covering routine care, run the opposite way round. In the UK they're everywhere, offered by practices of every size as a client-retention tool. In the US they're mostly a corporate-group product, rolled out across large multi-site chains, though independents are catching on. I've watched US practice owners react with disbelief when they hear what UK practices earn from plan membership.

What this means if you work across both

Every one of these differences creates admin for the practice. Rabies alone needs certificates generated automatically and tag numbers tracked. The heartworm guarantee only pays out if the dispensing history is clean. Health plans, insurance claims and payment plans all live or die in the billing system.

After working in both markets, my conclusion is a simple one: the medicine transfers easily, and everything around it has to be rebuilt. It's also why software built for one market can't just be switched on in the other. Lupa runs practices in both the UK and the US, and operating in both markets is exactly why localization matters so much to us. Software should be an extension of how a team already works, from the words on the screen to the way a rabies certificate or an insurance claim gets handled, and that's the goal we're building toward in each market.

The animals, at least, are the same everywhere.