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The curious conundrum of the wayward snowbird
The state of practice is literally the issue when a snowbird veterinarian helps a neighbor's dog in need.
In a bad state in the Sunshine State. (Image courtesy of Getty Images) Lee James has been a veterinarian for 38 years. He's well respected in his New Hampshire veterinary community. He's built a practice with five veterinarians and 18 team members. Dr. James feels he can work for many more years if he cuts down his load a bit and escapes the New Hampshire winters. He used to love snowboarding and ice skating, but now in his 60s the cold and the ice are difficult to bear.
His answer: the warm shores of northern Florida during the winter months. He buys a condo in the Sunshine State and spends more time down south each year. At first it's two weeks, then he transitions to the entire months of January and February.
Dr. James is an outgoing man and makes friends easily. He's a favorite in his Florida condo community. He mixes a mean martini, and everyone likes the congenial veterinarian from New England. People often ask him questions about their pets, and he makes suggestions and recommendations that are both neighborly and helpful.
A friend in need
On one occasion his neighbor knocks on his door. She's quite upset, because her 9-year-old Labrador Molly has taken ill. She's rushed Molly to the local vet, where they diagnosed a possible brain lesion and recommended a MRI at the local veterinary specialty center.
Dr. James is sympathetic and tries to console his neighbor. He offers to examine Molly at his neighbor's house to ease her anxiety. Molly exhibits a marked head tilt with nystagmus present in both eyes. She stumbles and walks in circles. But she's still willing to take a treat.
Dr. James auscults her chest, examines her ears and performs a thorough evaluation. He concludes that it's highly unlikely that this is a brain tumor. It's more probable that it's an idiopathic vestibulitis.
He explains that this condition often mimics stroke-like symptoms, but is in fact an inflammation of the inner ear. This inflammation causes these distressing symptoms. The good news is that in most pets it's self-limiting. It generally improves and resolves over the course of several days.
He explains that many veterinarians do nothing and let the dogs get better on their own, but he's more comfortable using a low dose of an anti-inflammatory drug for several days. He offers to call a prescription in to the pharmacy for Molly so she can start her medication right away.
The good deed
Needless to say his neighbor is ecstatic. She goes to the pharmacy and picks up the prescription. Over the next three days Molly recovers, just as Dr. James predicted. To keep the local veterinarian apprised of the situation, the neighbor returns for a follow-up exam and brings the medication Molly has been prescribed.
Her veterinarian is quite thrilled at Molly's progress. He mentions that this condition was part of his differential diagnosis, but he wanted the MRI to rule out the chance of a brain lesion. He notes Dr. James' prescription and asks his client where she's seen the other veterinarian. She says he's a snowbird neighbor who lives in her condo community.
Her veterinarian isn't happy that her snowbird neighbor evaluated his patient in a nonmedical setting without the pet's medical records and without a license to practice veterinary medicine in Florida. Fortunately, Dr. James' diagnosis was correct, but if he was wrong it was unfair for the pet, pet owner and the local veterinary community.
The veterinarian files a complaint with the Florida veterinary board and the New Hampshire board, stating that Dr. James is practicing without a valid Florida license. The law is the law.
Was Dr. James out of line? And did the neighbor's veterinarian respond appropriately?
Rosenberg's response:
The letter of the law clearly indicates that Dr. James was practicing veterinary medicine in Florida without a license. This doesn't mean he's not capable. It means if there's a problem with Dr. James' diagnosis, the public has no recourse or ability to sanction him as a licensee in that state.
In reality Dr. James was simply using his expertise to assist a neighbor. He had no intention of practicing veterinary medicine in Florida. Nevertheless, a licensee should both be aware of the law and play by the rules.
It's perfectly legal for an unlicensed veterinarian to be used as a consultant by a licensed veterinarian in need of a special service. In that situation the pet owner can be assured that the licensed doctor is participating in the treatment.
I know the neighbor's veterinarian was aggravated. However this isn't a battle I'd choose to take on. The board will likely advise Dr. James to cease practicing veterinary medicine in any state where he is unlicensed. A lesson learned!
Dr. Marc Rosenberg is director of the Voorhees Veterinary Center in Voorhees, New Jersey. Although many of his scenarios in "The Dilemma" are based on real-life events, the veterinary practices, doctors and employees described are fictional.
