Whether it is strategizing a plan for transporting a patient in respiratory distress over an hour to the nearest ICU or managing a complex diabetic patient, having access to veterinary specialists for guidance and support can feel like a lifeline for general practitioners. This support often happens through a phone consultation or referral, but it is not always available, leaving general practitioners in an uncomfortable position. Dr. Welch evaluates diagnostic results and history during a synchronous ECC consultation. Photo courtesy Kristin Welch When referral isn’t an option General practitioners are used to discussing a range of options with their clients, ranging from specialty referral for advanced diagnostics and treatment to a stepwise diagnostic approach in the GP office to empirical therapy or palliative care. In recent years, this has been termed spectrum of care or collaborative care. Veterinarians work with clients to identify potential barriers to care, including finances, scheduling limitations, transportation, and individual preferences and beliefs, and develop care plans that work within these barriers. In many cases, specialty referral is considered “gold standard care”—the most intensive, and often most expensive option available. In some cases, specialists take over case management entirely; more often, specialists and primary care clinicians collaborate to manage the case, with documented improvements in outcomes. Dogs with congestive heart failure managed collaboratively by a GP and board-certified cardiologist lived longer.1 Another study found referral to a board-certified dermatologist within the first six months of treatment improved long-term outcomes of dogs with chronic otitis.2 While collaborative care improves outcomes and offers high-level care, specialty referral is not always possible for clients to pursue. Finances are the largest barrier to specialty care. Eighty percent of pet owners stated they were concerned about the costs of specialty and emergency care in a 2024 survey.3 This survey found for the majority of pet owners, concerns about cost equaled concerns about the pet’s outcome, and for 50 percent of pet owners, a bill of $1,000 or less would cause stress.3 Cost is not the only barrier to specialty care. In some locations, particularly rural areas, the location of available referral centers is a barrier, with clients being unable or unwilling to travel to the referral center despite interest in having specialty care. Another barrier is the availability of specialty appointments. For patients that require urgent care or may need specialty diagnostics before undergoing an anesthetic procedure with their primary veterinarian, an extended wait until an appointment is available can lead to poorer outcomes. When clients decline referrals, general practitioners are left to create care plans based on available evidence, past experience, and recommendations of colleagues. In some cases, these care plans are highly empirical and may be based on limited diagnostic information, depending on the client’s budget. While there is a growing body of evidence of spectrum-of-care options in some diseases, such as pyometra and parvoviral enteritis, there are many conditions where this evidence remains anecdotal or nonexistent. Even when the literature is available, personal comfort with treating based on limited diagnostics or trying a new medication protocol may be low, especially for early-career veterinarians with more limited experience.4 A recent survey found while the majority of veterinarians were aware of the concept of spectrum of care, fewer practiced it to its full extent.5 Thirty-three percent of veterinarians in this survey agreed providing below “gold standard care” was at least somewhat distressing.5 When asked why they may not provide multiple treatment options, the most common responses were, “I’m aiming for the best possible outcome” (39 percent) and “I’m trying to follow recommendations from my education/continuing education” (24 percent).5 These responses show many veterinarians still associate the best outcomes with what they were taught during their education and are uncomfortable when asked to modify treatment plans. What is teleconsultation? Teleconsultation enables general practitioners to collaborate with a board-certified specialist when client limitations are at play and textbook approaches may not be feasible. Veterinary teleconsultation connects the managing veterinarian with a board-certified specialist for case-specific clinical guidance, delivered either in real time or within a defined turnaround window, all without the client leaving the general practice. It is a structured, specialist-driven consultation built around the actual case record. The teleconsultation equips the general practitioner with a range of options to discuss with the client, including the pros and cons of each diagnostic and treatment option, based on the specialist’s recommendations. Synchronous consultation connects the GP with a specialist immediately, which is particularly valuable for emergency and critical care cases where management decisions cannot wait. If a patient is crashing and the clinical picture does not add up, having a board-certified criticalist available in real time is invaluable for immediate case management guidance and client communication support. Asynchronous consultation allows the practitioner to submit case history, diagnostics, and imaging through an online portal to receive a written specialist report. Since case submissions can be made online at any time without interrupting the day’s appointment schedule, asynchronous consultation enables specialist collaboration in any general practice, increasing the number and complexity of cases that can be managed in-house. For practices in areas without nearby specialty hospitals, and for clients who cannot pursue referral, teleconsultation brings specialists into any practice, anywhere. It also expands the range of diagnostic and treatment options general practitioners may feel comfortable offering in practice after receiving direct input and support from their specialist colleagues. Filling the void Most veterinarians already rely on a version of informal consultation. You text a specialist friend, post a case on VIN, or call a colleague at the referral hospital down the road. These habits exist because the instinct to seek input is good medicine. Whether you have been in practice for two months, two years, or two decades, every veterinarian benefits from the second opinion from specialist collaboration. What makes teleconsultation fundamentally different from calling a colleague or posting in a forum is the structure behind it. Structured teleconsultation is built on medical record review. The specialist has the full picture, and the guidance comes back in writing, designed to be incorporated directly into the patient record. When you text a question or post in a forum, you are often providing a compressed version of the case. You share what feels most relevant, frame the single question you need answered, and the person on the other end responds to exactly that. They do not have the full history. They have not seen the CBC trend or the radiographs and ultrasound. They cannot tell you that azotemia warrants a closer look before you start the drug you are asking about, because they do not know the azotemia is there. The guidance you get is only as good as the snapshot you provide, and in complex cases, snapshots often miss important details. Structured teleconsultation is intentional and thorough. Since the specialist has the complete medical record available, they have the full clinical picture. Instead of just answering the questions you asked, they can identify the things you may have overlooked and the concurrent issues that need to be addressed. The output is a written consultation report that documents the specialist’s findings and recommendations in a format that becomes a part of the medical record. It creates clear clinical documentation, supports continuity of care, and provides the primary practitioner with a resource they can refer to and share with the client. This more formalized consultation also facilitates an ongoing dialogue with the specialist. This allows the primary veterinarian to discuss new results and responses to initial therapies to continue guiding the case as it evolves, improving continuity of care. Dr. Welch performs mobile sonography services for local veterinary clinics. Photo courtesy Kristin Welch Legal and regulatory considerations The legal landscape around teleconsultation is less complicated than many veterinarians assume, but it does require understanding one foundational distinction: teleconsultation is distinct from telemedicine. Telemedicine involves a veterinarian providing clinical guidance directly to a client and is subject to veterinary-client-patient relationship (VCPR) requirements that vary by state. The AVMA Model Veterinary Practice Act, used by many states as guidance for preparing or revising their veterinary practice laws, defines the VCPR as requiring a timely physical examination of the patient, clinical oversight, and maintenance of patient records.6 The U.S. Food and Drug Administration (FDA) has confirmed a VCPR cannot be established solely through telemedicine.7 Teleconsultation, by contrast, is a veterinarian-to-veterinarian interaction, and this model is broadly supported by the AVMA and the American Animal Hospital Association (AAHA).8,9 In most states, it is legally permissible for a specialist to provide consultative guidance to a veterinarian regardless of the state in which the consulting specialist is licensed, provided the managing veterinarian holds a valid VCPR with the client and patient. Establishing and maintaining that VCPR is the GP’s responsibility. The managing veterinarian interprets the specialist’s guidance, applying it to the specific patient and clinical context, and communicating recommendations to the client. The GP remains the clinician of record, and the final clinical decisions rest with them. Practitioners should verify their state’s specific regulatory requirements before entering a teleconsultation relationship. One additional point warrants attention regardless of the teleconsultation platform. Any veterinarian providing consultative guidance to another veterinarian, including a referral hospital specialist taking a call from another practitioner, or a colleague answering a text or email question with clinical specificity, should confirm their liability coverage extends to that activity. It is good practice for the specialist to confirm coverage prior to any verbal or written case guidance through teleconsultation. Sample abdominal ultrasound consultation report from DVM STAT, a teleconsultation company. Photo courtesy Kristin Welch Conclusion When specialty referral is not an option, whether due to geographic distance, client financial constraints, or the urgency of a case that cannot wait, GPs are left making complex decisions without specialist support that could change the outcome. Teleconsultation is changing that by expanding access to specialty care for clients, as well as direct access to structured specialist support for general practitioners, who currently provide a range of diagnostic and treatment options in the clinic. Kate Boatright, VMD, is a small animal general practice and emergency veterinarian, speaker, and author in Western Pennsylvania. In March 2023, Boatright published the Veterinary Mentorship Manual, a resource for practices to help guide them in developing solid mentorship programs. Kristin Welch, DVM, DACVECC, is the founder of DVM STAT Consulting, a veterinary teleconsultation and continuing education company serving practices across the United States, Canada, and beyond. In 2019, Welch launched DVM STAT as a pilot teleconsultation service. Since then, it has grown into a virtual specialty hospital with 45 specialists supporting clinicians 24/7 across nine specialty disciplines. References Lefbom, BK and Peckens, NK. Impact of collaborative care on survival time for dogs with congestive heart failure and revenue for attending primary veterinarians. JAVMA 2016;249(1):72-6. Logas, D and 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)212-16. Veterinary specialty care: A synchrony lifetime of care study. Published 2024. Available at https://www.vetspecialtycare.com. Accessed April 22, 2026. Reinhard AR, Hains KD, Hains BJ, Strand EB. Are They Ready? Trials, Tribulations, and Professional Skills Vital for New Veterinary Graduate Success. Front Vet Sci. 2021;8. doi:10.3389/fvets.2021.785844 PetSmart Charities and Gallup. State of Pet Care Study: Veterinarian Perspectives on American Veterinary Care. Published online January 13, 2026. Accessed February 15, 2026. https://petsmartcharities.org/press-releases/cost-of-care-continues-to-strain-veterinary-care-access. AVMA Model Practice Act 2025. Published July 2025. Available at https://www.avma.org/sites/default/files/2025-07/Model-Veterinary-Practice-Act-2025.pdf. Accessed April 23, 2026 Federal requirements for the veterinarian-client-patient relationship. Available at https://www.avma.org/sites/default/files/2022-06/Federal-VCPR.pdf. Accessed April 23, 2026. American Animal Hospital Association. Section 7: Teleconsultation to enhance access to care. In 2025 AAHA Referral Guidelines. Published February 25, 2025. Available at https://www.aaha.org/resources/2025-aaha-referral-guidelines. Accessed Apr 23, 2026 Telehealth and the VCPR. Available at https://www.avma.org/resources-tools/animal-health-and-welfare/telehealth-telemedicine-veterinary-practice/telehealth-and-vcpr, Accessed Apr 23, 2026
