Writing I’ve done recently about how we need more bold general practice veterinarians has gotten a lot of attention. One of the criticisms I’ve heard on the piece is that we can just look at human medicine to see that advanced procedures (like surgeries beyond castrations) are going to increasingly go to specialists, and thus general practitioners should embrace their shrinking scope of practice and lean into referring cases away.
I want to be very clear up front: I really like veterinary specialists. I think GPs, clients, and pets are fortunate to have them and have access to them. I love working collaboratively with specialists and frequently do refer cases to them. I talked with an internist this morning about managing my own dog’s medical issues. Our clinic has multiple mobile specialists that stop by regularly to provide their services using our facilities. I think there will be great opportunities in the future for GPs and specialists to work together efficiently and effectively to make outstanding patient care happen.
I believe all those things, and also… specialists are not going to become the primary caregivers for sick pets.
In human medicine, the scope of practice for GPs is almost entirely wellness care, while referral to specialists for treatment of advanced cases is ubiquitous. This system has arisen for two reasons, and neither of them translate strongly to veterinary medicine: liability and insurance.
In human medicine, if care goes badly, there is a big incentive for patients to litigate. The average medical malpractice settlement in the US is somewhere between $250,000 – $500,000. Cases involving catastrophic injuries or wrongful death can go much higher. The risk to a doctor (and a doctor’s malpractice insurance) for providing care they are not fully and unquestionably qualified to provide is thus extremely high.
In veterinary medicine, at least for now, pets are still legally similar to property. Thus the economic damages of malpractice cases remain relatively small. Recent lawsuits have explored ways in which plaintiffs might be compensated above the amount of money they originally paid for the pet, but general practice veterinarians are not in the same stratosphere in terms of legal liability as general practice physicians.
Put simply, the risk and cost of a malpractice claim in human medicine made it impossible for general practitioners to keep cases instead of referring them to specialists, and this reality has altered the scope of practice for GP physicians. We do not have that liability or anything close to it in veterinary medicine, and that’s a very big deal when imagining how our profession is going to work in the future. Having enough liability to motivate veterinarians to be prudent and over-communicate with the client, but not so much to force them to refuse to touch tough cases, is the sweet spot where GP vet medicine currently sits.
Without the legal liability forcing referral away from GPs, care becomes based largely on affordability. Human healthcare is built on an insurance system. Health insurance is the only way that most people could ever afford to be picked up by an ambulance, diagnosed with an MRI, or repaired by a surgeon. In veterinary medicine, cash is king and there’s no reason to believe that won’t continue.
In recent years, we have seen real growth in pet insurance uptake in the US (and this is good!). The industry has grown about 10% per year since 2018, and that’s impressive. Drivers include peoples’ feelings that pets are family, and also the recognition that care is getting steadily more expensive.
Still, only about 5% of dogs and 2% of cats are covered. Also, the cost of having pet insurance is obviously climbing. Don’t get me wrong here. I’m a big fan of pet insurance and pay to have my own dog covered. But honestly, given what you know about American consumers, what percentage of people do we really expect to get on board with paying hundreds to thousands of dollars per year for insurance they are not required to have? [For a sloppy reference, my own premiums are increasing by 33% this year to $950]. Everything in finance appears to be moving towards payment plans, and away from planning for future expenses.
I will continue to both have and recommend pet insurance going forward. I’m going to get as many of my clients on it as possible because I think it’s generally a very good thing for both pets and families. But I simply can’t get my head around the idea that the industry is going to flip to an “insurance first” environment anytime soon, and that kind of flip would be required to support a model where referral is the primary option for healthcare.
Without a significant change in malpractice liability and pet insurance uptake, veterinary specialists will be utilized as the law of supply and demand dictates, just like everyone else. I think they will do very well, provide valuable services, collaborate with general practitioners, and mostly make the world a better place. Perhaps they will saturate the market and struggle to maintain the profitability they have to this point. I don’t know.
What I do know is that specialists will almost certainly continue to make a good living and be a fantastic part of veterinary medicine for those clients who are willing and able to utilize them. Also, the general practice veterinarian is going to be the center of care for the vast majority of sick pets for the foreseeable future. Veterinary medicine is not going to look like human medicine any time soon, and this is going to help keep our services both affordable for our clients and engaging for our general practitioners.
When I became a veterinarian, it was because I wanted to be an integral part of the care of patients and their families. I wanted to be able to use my hands and mind to help people, and not to refer them all away. As I look at the future of this profession and consider the rising cost of care, I see the role of general practice veterinarians becoming more important and more involved in helping families than it has ever been. That’s a good thing for everyone.
