There is a saying in veterinary medicine, “we don’t all live in the ivory tower.” Pretty much all of us know what this means. We learn the best of the best medicine in veterinary school and have access to the most diagnostic equipment, but unfortunately for 99 percent of us that isn’t a reality when practicing. It isn’t a bad thing. Those specialty hospitals are there for us when we do need to refer complicated cases and we appreciate the time they take with our patients. But there is an alarming number of veterinarians in general practice who are referring surgeries or cases because they were taught that only board-certified surgeons can do those surgeries, or they don’t feel like GPs should be dabbling in complicated cases. This is causing some veterinarians to feel like outcasts for trying and other veterinarians to feel like tattle tails for feeling uncomfortable about their colleagues doing these procedures.
When chatting with other veterinarians I hear a lot of stories about how their boss or the prior owner used to do some incredible surgeries like hemilaminectomies, PRAAs, ventral slot procedures, mandible resections… you name it, they did it. Those are all really complicated surgeries, but back in the day when you didn’t have a specialty hospital near you, you either learned or the animal suffered. But lately I’ve been hearing more and more stories that go: well before I started the clinic used to do pyometras or GDVs or enterotomies, but now we just send them to the ER clinic down the street. It makes my heart hurt a little. These procedures aren’t a walk in the park, but a general practitioner should be able to do them, so why are we sending these cases away?
1. Clients are sue happy.
We are seeing more and more clients take to Facebook or online complaint sites with half-truth stories about how a veterinarian experimented on their dog. Unfortunately, we cannot defend ourselves in these situations due to confidentiality laws. Many new veterinarians are afraid that even if it’s in the best interest of the animal to pursue a risky surgery that the consequences of it not ending well could terminate their careers.
2. Veterinary schools aren’t as hands on as they used to be.
This goes back to the legality issue again. Veterinary schools have their hands tied when it comes to allowing students to perform or watch complicated surgeries. Many schools have taken to creating interactive laboratories, but the models are plastic and don’t always reflect real life situations. Even when you get to see some interesting surgeries it’s usually the “zebra” cases, not the common occurrence operations.
3. In urban areas 24 -hour emergency clinics and specialty clinics are within minutes of GP practices.
A lot of the GPs have taken to using them instead of keeping the case and performing the surgeries themselves. Even those veterinarians who used to perform every surgery under the sun are now utilizing the ER clinics near them.
4. New graduates aren’t feeling adequate enough and don’t receive enough good mentorship.
If the boss sends those cases away then the new graduate will get into the habit of doing it, too. If your boss doesn’t help you gain the confidence you need to pursue those surgeries then you will feel inadequate and not want to pursue them yourself.
There may be more factors in this situation, but the main issue is we are seeing veterinary medicine become more specialized to the point that GP practices are basically glorified vaccine clinics. The general practitioner is losing out on some basic skills that we once had. The ERs are getting bombarded with cases that should have been dealt with at the regular clinic. The specialists are getting sent uncomplicated diabetics or hypothyroid cases that can easily be monitored and treated at a GP clinic. Yes, offering the highest quality of care should be a priority, but not all owners can or will chose that option. As GPs we can still provide high quality care. If we continue to just send them away then we will continue to diminish our skills. We are surgeons, behaviorists, oncologists, urologists, pediatricians, cardiologists, dermatologists, dentists, anesthesiologists – we are veterinarians and should be proud of our amazing range of skills.
The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.
Dr. Nicole Palumbo is a 2012 graduate from University of Illinois. She is originally from the south side of Chicago but chose to move to Northwest Pennsylvania for her first job out of veterinary school, where she currently is still employed. She works with small animals, exotics, and also volunteers her time at the local wildlife rescue, typically performing surgeries and exams on the many raptors that are admitted to the facility. With time she hopes to focus more time on wildlife medicine and also obtain specialization in feline medicine.