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Earlier dermatology referral rewards primary care practice (part 2): boosting client perceptions

dvm360dvm360 June 2022
Volume 53
Issue 6
Pages: 36

Survey data from the American College of Veterinary Dermatology show that dermatology referrals have a major impact on clients’ confidence in the quality of care they receive.

Part 1 of this article series introduced survey data from the American College of Veterinary Dermatology and discussed how earlier dermatology referrals may impact client satisfaction, client costs, patient care, and revenue for the practice. Part 2 seeks to further examine this survey data and explore key takeaways that clinicians can put into practice.

Boosting client satisfaction

The American College of Veterinary Dermatology survey illustrated that 87% of clients have high confidence in a veterinary dermatologist’s diagnosis and 80% are highly satisfied with their pet’s treatment results provided by a veterinary dermatologist (Figures 1 and 2).

The survey also revealed that 82% of clients said they would have felt better about their primary care veterinarian if they had been referred to a veterinary dermatologist earlier, and 58% said they are more satisfied with and confident in their primary care veterinarian when they are referred to a board-certified veterinary dermatologist.

Thus, although the survey didn’t specifically explore this, perhaps even when clients choose to forgo referral, it’s reasonable to expect that simply offering referral confers a positive lasting impact for the primary care veterinarian. In addition, it’s helpful to note that 39% of survey participants reported they were aware of board-certified veterinary dermatologists before visiting their primary care veterinarian, which suggests clients know of the potential for referral, but they may not ask about it.

Client Satisfaction

82% of clients said they would have felt better about their primary care veterinarian if they had been referred to a veterinary dermatologist earlier.

Collaborative care rewards

Collaborative care—wherein primary care veterinarians and specialists work together effectively to provide optimal pet care options—can help pets achieve longer, healthier lives and therefore confer benefits to their owners and to primary care practitioners.1,2

In a separate retrospective study, dogs with chronic otitis had better long-term outcomes when primary care veterinarians collaborated with a board-certified veterinary dermatologist within 6 months of treatment.2 The longer a patient with chronic otitis externa was treated by a primary care veterinarian before referral, the more recurrences and longer the episodes of otitis, which results in more patient discomfort, more patient and owner distress, and higher owner expenses. The authors concluded that referral to or consultation with a veterinary dermatologist should be considered for canine patients with persistent or quickly recurring (within 30 days) otitis over 6 months. The otitis study also revealed that 18% of clients stopped visiting their primary care veterinarian and chose to visit a new primary care veterinarian because their dogs were not referred for specialist treatment sooner.3 That percentage coincides with the 15% of clients in this ACVD survey who reported they had stopped visiting their primary care practice altogether after reaching the tipping point of frustration.

Take-home considerations

The limitations of this survey include its reliance on observations made by clients who are not trained medical professionals and a lack of medical record and invoice review to verify case management and expenses. Nonetheless, these survey results are valuable because the data reveal clients’ real-world perceptions about their experiences with veterinary medical care for their dogs with skin disease.

In summary, this survey illustrated that primary care practitioners should talk with clients about referral to a veterinary dermatology specialist on or before a patient’s third visit for evaluation of a dermatologic condition. The results demonstrated that earlier dermatology referral could boost patient care efficiency and save clients 25% in veterinary care costs, improve client confidence in their primary care veterinarian’s level of care, and support client retention to preserve primary care practice revenue. Given that retaining clients and garnering positive online practice reviews and word-of-mouth recommendations are vital to the financial and emotional health and growth of veterinary practices and veterinary health care professionals, it’s reasonable to anticipate that collaborating earlier and effectively with board-certified veterinary dermatologists can help protect and support primary care practices.

Most veterinary primary care and referral centers are operating at full capacity in relation to the COVID-19 pandemic and to veterinary workforce shortages. Wait times for referral appointments have increased substantially and wait times for nonurgent appointments may be weeks to months.3,4 Therefore, discussing referral with clients earlier in a patient’s disease process has perhaps become even more important for primary care practitioners.

Clients ultimately decide what and how much veterinary care to pursue. Keep in mind that client caregiver burden can increase when their pet’s treatment is ineffective or when clients have inadequate understanding of their pet’s disease and the expected efficacy of treatment. Increased client caregiver burden can contribute to increased veterinary team workload and stress. By presenting clients with the facts about a range of veterinary health care options available—without judgment—primary care veterinarians and specialists can offer clients opportunities for the care for their pets that best matches up with their financial, emotional, physical, and time resources.


The author thanks Theresa Entriken, DVM, and David Senter, DVM, DACVD, for their writing and editorial assistance with this article.


The ACVD funded this research and received no financial support for the research, authorship, and/or publication of this article.


  1. Lefbom BK, Peckens NK. Impact of collaborative care on survival time for dogs with congestive heart failure and revenue for attending primary care veterinarians. J Am Vet Med Assoc. 2016;249(1):72-76. doi:10.2460/javma.249.1.72
  2. Logas D, Maxwell EA. Collaborative care improves treatment outcomes for dogs with chronic otitis externa: a collaborative care coalition study. J Am Anim Hosp Assoc. 2021;57(5): 10.5326/JAAHA-MS-7167. doi:10.5326/JAAHA-MS-7167
  3. Salois M, Golab G. Are we in a veterinary workforce crisis? JAVMA News. September 15, 2021. Accessed October 15, 2021. https://www.avma.org/javma-news/2021-09-15/are-we-veterinary-workforce-crisis
  4. Sinclair J. Vets in crisis: the perfect storm. Vet Times. September 15, 2021. Accessed October 15, 2021. https://www.vettimes.co.uk/vets-in-crisis-the-perfect-storm/
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