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Commentary: A case for specialists in veterinary medicine
Blurring lines between specialists and untrained generalists demand reckoning.
I have had the opportunity to watch the evolution of veterinary medicine for over 21 years now. Most of that time has been spent as a board-certified small animal surgeon, but since most of my practice is mobile and I own a small animal general practice with my wife, I believe I have had a unique perspective, a bird's-eye view, so to speak, and I would like to share some thoughts.
When I started my surgical residency in 1995, there was a clear and defined difference between specialists and general practitioners. There seemed to be a healthy level of mutual respect between the two groups and a collegiality that served the client and patient to an exceptional level. Of course there were practitioners who had by choice or necessity picked up plates, pins and wires in an effort to alleviate pet suffering, but for the most part, it was not a huge issue.
Photo source: Getty ImagesIn the early 2000s, an unprecedented expansion in the number of companies offering equipment and implants occurred. It soon became clear to the suppliers of these innovative and expensive tools and tricks that the real market was not specialists but the other 80 percent of veterinarians who were also eligible to do these procedures. Never mind that their training would take place over hours or days compared with years for specialists-this was capitalism. It's an hypocrisy for which I have yet to find words that the very specialists who would take money hand-over-fist to teach a specialty procedure to a general practitioner in a few hours' time are the same who will tell a resident they aren't capable of performing the same procedures for years. It may also be dangerous to the patients whom we have vowed to protect.
In Malcolm Gladwell's book Outliers, he introduces the idea of the “10,000-hour rule.” This rule dictates that it takes 10,000 hours to become an accomplished master at a particular skill. Examples include Bill Gates, Mozart and the Beatles, driving home the idea that skill and mastery come only from an intense period of repetitive action. Let's apply the 10,000-hour rule to veterinary surgery and compare the general practitioner to the board-certified surgeon. On the surface each is an accomplished doctor with years of schooling, but on deeper investigation, there is a distinct difference.
The board-certified surgeon has completed a three-year residency laser-focused on surgery. If that resident commits 60 hours weekly to surgery-and taking into account time off for research and out rotations-a surgical resident will spend about 7,000 hours during his or her residency focused on surgery. In addition, if that newly minted surgeon spends 40 hours weekly in a specialty practice committed to the practice of surgery, it will take at least another year and a half to reach the 10,000-hour mark. That is a total of four and a half years to gain mastery even when that person is immersed in the field. If we limit our discussion of hours to those spent strictly at the surgery table, then the number of years really start to adds up.
How long will it take for the general practitioner who spends his or her surgery time in between the other pressing issues in the course of a busy day? Does it take three times longer? Five times longer? Now factor in the idea of service to our clients and patients and imagine how they might best be served.
I have looked long and hard for the origins of this problem and my search has led me to four possible causes:
1. The American Veterinary Medical Association (AVMA). It's failed to modernize its view of the veterinarian and use its representative arm, the American Board of Veterinary Specialists, to increase the awareness of the value of specialists to the pet-owning public. It has, in my opinion, done more to oppress the visibility of specialists than it has to enhance it.
2. State veterinary boards. They have the power to help enact legislation designed to protect pets and pet owners. Until these governing bodies see the value of specialists and the need to promote referral in the name of pet welfare, we can expect to see this discussion swirling about for years.
3. Manufacturers and corporate conglomerates. These are the groups who sell the ways and means to perform advanced procedures. It's time for these companies to back specialists.
4. Specialty colleges and members. We're neither the beginning nor the end of this horrific chain, but we're an essential cog in the wheel that's running our profession off the rails. We've chosen to call ourselves specialists while trying to prove that what we do isn't really that special. Why would it be special if I can teach anyone how to do it in a couple of hours or days? The colleges have failed to promote the role of specialists. They turn a blind eye to the weekend-warrior mentality that blurs the line between mastery and mere knowledge transfer.
I still believe we can have a collegial and collaborative relationship between specialists and general practitioners. It begins with the acceptance that there's a difference between specialists and general practitioners. It's followed by communication that promotes the health and well-being of the patient, protects the interests of the client and serves the profession going forward.
Mark Davis, DVM, DACVS, CCRP, is with Northwest Veterinary Surgery Inc., a mobile small animal referral surgical practice serving the Puget Sound area and western Washington state.