One thing to consider if there is a shift in this behavior at a small independent practice you use (like dentist or veterinarian offices) is the aggressive acquisition of these firms by private equity over the last few years. Oftentimes the owners / partners get a huge payout and stay on as the face of the practice while taking marching orders from the new owners to maximize profit over quality of care. This acquisition is often invisible to patients / customers except insofar as quality of care declines, people at the office seem more stressed out, and more procedures get ordered that you don’t have the expertise to assess the need for.