General practitioners may choose to add exotics to their practice for a number of reasons: additional revenue, dog- and cat- owning clients are asking where they can take their exotic pet and/or an interest in learning more about exotics.
But once the choice to add exotics is made, then what?
A good place to start is deciding which exotic species to add, says Laurie Hess, DVM, Dipl. ABVP (avian), owner of the Veterinary Center for Birds & Exotics in Bedford Hills, N.Y.
Most veterinarians who are used to treating dogs and cats feel more comfortable starting with mammals because they can extrapolate information from what they already know, Dr. Hess says. For instance, veterinarians can apply what they know about cats to ferrets.
A genuine interest in the animal is a must, says Larry Nemetz, DVM, owner of The Bird Clinic in Orange, Calif.
“If you don’t like the species, I believe you can’t get good [treating them],” Dr. Nemetz says.
Nemetz says he decided to leave birds of prey to other specialty veterinarians because he doesn’t have a lot of interest in them.
“Most veterinarians who are friends of mine who treat [birds of prey] are falconers so they like it and are into it,” he says. “It’s easier to adapt to the medicine.”
You just have to know where your interest is, he adds.
The next step is getting comfortable with the species. One way to do this is getting the type of exotic you want to add to the practice as a pet, Nemetz says. For example, if a general practitioner wants to add birds to his or her practice, adopt a bird.
Joining exotics-specific associations, such as the Association of Avian Veterinarians, the Association of Exotic Mammal Veterinarians and/or the Association of Reptilian and Amphibian Veterinarians, can be very helpful, both Nemetz and Hess say. Such associations offer educational seminars and conferences and provide networking opportunities, they say.
Building a good textbook library on exotics would also be very beneficial, Nemetz says.
Before a general practitioner starts seeing exotics, it’s necessary to assess what additional equipment the clinic will need.
General practitioners may already have some of the items, but not in the quantity necessary. For example, Hess recommends having an ample supply of small towels, insulin needles and micro blood tubes, items that are used much more frequently on exotics than with dogs and cats.
Having a centrifuge that can spin these small tubes, or an attachment to go on an existing centrifuge, is also useful, she says.
In addition, general practitioners may want to consider finding a lab that focuses on exotics or at least is used to handling small volumes of blood, she says.
“If I take a blood sample from a budgie or parakeet that weighs 20-something grams, I can only take about 0.2 mL of blood from him,” she says. “I have to have a lab that is comfortable running a whole panel on 0.2 mL of blood. You can’t really mess up because you can’t go back and take more [blood]. You have to wait several days before going back.”
Even in the lab there need to be cytologists and pathologists who are comfortable with the type of diseases you are looking for, Hess adds.
“If you send a tissue or sample in and they don’t have any background in exotic animals, they are not going to know what to look for or not even know what they are looking at,” Hess says. “People in the lab have to be comfortable with the types of samples you send them.”
This “comfort” rule applies inside the clinic as well. It’s important to have a veterinary technician who is comfortable working with exotics, Hess adds. Handling and restraining birds and other small animals requires a much different technique than handling dogs and cats, she says.
Other essential equipment: an infant stethoscope and a good gram scale.
“Birds change weight a lot as they get sick or get better,” says Nemetz, so it’s important to have an accurate gram scale.
If a general practitioner is going to be boarding exotics overnight, she may need to consider heat and humidity levels, buying incubators or exotic-specific cages. Feeding tubes and mouth retractors are also good to have on hand, he says.
And if there’s an instrument that you need that just doesn’t seem to exist, ask a manufacturer if the company can make it for you, says Nemetz, who has had companies make custom scissors among other instruments and equipment to suit his needs.
“Think outside the box by saying ‘I wish I had fill-in-the-blank,’” he says.
Although Nemetz says it’s hard to place a figure on it, he estimates that it could cost a general practitioner up to $30,000 to add exotics to a practice if he were to include exotics-specific surgical and endoscopy equipment.
How much it would cost really depends on what the general practitioner already has, what kind of treatment she wants to administer (basic versus complex procedures) and how much she is willing to spend on each item, Nemetz says. For example, a gram scale can cost anywhere between $400 and $2,300, depending on how precise it is, among other features.
When to Refer to a Specialist
Promoting the addition of exotics to colleagues and clients is a good move, but Nemetz and Hess also strongly suggest forming relationships with nearby veterinary specialists for referral cases. When should a general practitioner refer to a specialist?
Complicated cases, such as that involving surgery, or if the general practitioner is just not comfortable with the case at hand, is a good time to refer to specialist, Hess says.
General practitioners can extrapolate what they have learned about dogs and cats and apply it to certain exotics to some degree, but there are limitations, Hess warns.
“Exotics are not small cats and dogs,” she says. “You have to know the difference. You have to be educated.”
Don’t feel like you have to treat the animal to the Nth degree if you’re not comfortable, Hess adds.
“Then you end up doing a disservice to the client and to the patient,” she says. “Exotics is a specialty like any other specialty. If you don’t feel comfortable with orthopedic surgery you wouldn’t do it.”
Nemetz agrees. Choosing not to treat a patient because it’s too complex or it’s beyond your comfort zone is better than doing a procedure badly, he says.