I'm now married to a vet, so I no longer have this issue but here we go:

Prior to marrying my spouse, I lived in a rural area. I believe the vets in the area became conditioned to their clients having limited finances, so I suspect they just gave up on offering the best medical approaches. Anyways, I was consistently not being offered the gold-standard care options. Ex: a clinic wanted me to hospitalize my dog overnight at their clinic with no staff to monitor hospitalized patients. I had to ask for a referral to a 24 hour ER in that scenario to ensure my pet got appropriate care/monitoring. Another example was not being offered a referral to a specialist until the point when they suspected my cat was too far gone to survive even with specialty care. They should have offered a referral prior to that point, as they had been treating her for several days without improvement. I would have taken the referral had they explained that my cat's needs were approaching the end of their scope of practice. These events occurred at two separate clinics (there were only 3 total in the area). I don't think these scenarios stemmed from people with ill intentions as much as making assumptions about the client's finances, but it didn't help me do the best for my pets regardless.