Remember the old westerns, where the good guy (or bad guy) would say, “This town ain’t big enough for the two of us.” Something similar is happening in veterinary medicine. The “guys” are boarded specialists versus non-boarded but highly experienced generalists, and I’m not sure which one is the bad guy and which is the good guy. Actually, I’m not convinced that the town is too small for the two of them.
Recently at American Animal Hospital Association in Denver, I hosted a table called “Building Referral Relationships,” where up to 10 people who registered in advance got the opportunity to come brainstorm, share and learn from each other about a topic they selected. As people gathered at our table, silly me thought that I needed to find out whose camp they were in, the referrers or the referring. Turns out most of them wore both hats.
Several were generalists who may refer a patient on to a specialist in some instances, but they were also highly experienced (particularly orthopedic surgeons) so they received referrals from the community based on their reputation. Quite an interesting discussion took place.
It actually reminds me of the struggle the veterinary technician profession has always had, the credentialed vet tech versus the highly experienced but non-credentialed “technician.” A lot of folks would say that this second group can’t even use the position title of “technician” if they are not credentialed, which now requires graduating from an American Veterinary Medical Association accredited veterinary technology program. However, we allowed highly experienced people to “grandfather in” for a number of years, to say that if they passed the boards, then we would assume they have the knowledge and skill set necessary to be credentialed.
Wouldn’t it be interesting if we used the same philosophy in the discussion of the specialists versus highly experienced generalists? There are generalists that have been doing advanced procedures for 30-40 years, long before there ever were veterinary specialists. Do we negate that breadth of experience because they didn’t go on to school to become a specialist? Would there be any way to test their knowledge and skills to see if they could “grandfather in” to become fully boarded, or perhaps even a lesser title but still more credentialed than a generalist without that experience and skill?
So some of the main points brought out in our discussion revolved around how carefully these experienced generalists showcase themselves to the pet owners. One participant gave us his experience in this regard, where he explains the options to the pet owners. The conversation goes something like this: “I could refer you to the specialist, x number of miles away, who can do this procedure. However, although I am not a boarded specialist, I have done this procedure x amount of times and feel confident I can provide your pet with a high level of care,” or something of that nature. Is that enough of a disclaimer?
In reality, these generalists typically would not oversell themselves for a very obvious reason: If the surgery goes awry and you are not a specialist, there could be repercussions…particularly if you chose not to inform the pet owner of specialty care available. They wouldn’t want to mislead the pet owners any more than you would, because the standard of care has advanced so much.
In summary, a participant noted that he knew a generalist that performs 300-400 TPLO’s, for example, and a specialist who has only done 50 so far. He would choose the most experienced veterinarian to care for his pet if the situation arose.
Move on over, the town just got a little bigger!