Inconsistency in veterinary medicine?
When most people go to the veterinarian it is assumed the veterinarian is trained in the skills that are needed. Graduation from a veterinary curriculum means “trained and ready to serve your pets.”
Any veterinarian can provide any service. There are specialty services that may require additional training, like orthopedic surgery or spinal manipulation, but none of these services require the veterinarian be board-certified.
Some veterinarians find they have a special interest in a particular field and want more depth to their training. Be it dermatology, behavior or herbal medicine, these doctors return to school, perform research and publish their results before sitting for the board exam. Once the board examination is passed, that veterinarian is a specialist in that area but can still practice all other areas of medicine if she or he chooses. An internal medicine veterinarian can still perform surgery, as an example.
On the other side of the coin, a general practice veterinarian can provide any service as already mentioned, like surgery or internal medicine. The purpose of board certification is twofold: Provide the doctor more training in a specialty field and increase the body of knowledge in that field—both of which benefit more pets.
Some pet owners may need the services of the board-certified veterinarian to resolve their pet’s health issue. Some general practitioners may consult with a specialist on a case.
At no point is the generalist precluded from practicing in the specialty field.
Except for the field of veterinary nutrition. For some reason, the American College of Veterinary Nutrition is different.
While every veterinarian in this country is considered capable of practicing all aspects of veterinary medicine upon graduation and passage of the national veterinary board exam, general practice veterinarians are strongly discouraged from giving nutrition advice to their clients.
It would be possible to argue it’s because veterinarians receive little to no training in nutrition in school, but the same can be said for orthopedic surgery. (Either field would be an elective for further training.) Therefore, lack of training isn’t the explanation for why general practice veterinarians are discouraged from giving nutrition advice.
Is it about control? Is it that ACVN wants to change the entire veterinary health care system in this country and model it after human medicine where only specialists can practice? Can pet owners afford such a paradigm? Is this an unfair practice behavior opening ACVN and veterinary medicine to libel?
If the veterinary nutrition industry were open to growth like every other specialty area, ACVN would offer courses in continuing education for the general practitioner. They do not.
ACVN is a closed association. What, or who, is behind this?
— Cathy Alinovi, DVM, MS, MBA, Pine Village, Ind.
Dr. Alinovi, a retired holistic veterinarian, is certified in veterinary spinal manipulative therapy and as a traditional Chinese veterinary medicine practitioner.
Veterinary nutrition is open to everyone
Dr. Alinovi appears to be trying to make a distinction between the American College of Veterinary Nutrition and other veterinary specialty organizations where none exists. Simply put, ACVN is a private educational organization with absolutely no policy, never mind any authority, to limit the scope of veterinary practice of non-ACVN diplomates.
ACVN operates as a fully recognized veterinary specialty organization under the auspices of the American Board of Veterinary Specialties within the American Veterinary Medical Association. Not unlike other specialty colleges, our primary objective is to advance the area of specialty and increase the competence of those who practice in the field by establishing and implementing requirements for board certification. However, other aspects crucial to our mission are to encourage continuing professional education, promote research and enhance the dissemination of knowledge of veterinary nutrition.
In fulfillment of that mission, many ACVN diplomates are directly involved in the training of veterinary students on the principles of veterinary nutrition. Unfortunately, not all veterinary schools in the United States employ the services of an ACVN diplomate. For those that do, the veterinary nutritionists often provide didactic teaching in veterinary nutrition to underclassmen as well as support and training of veterinary students during the clinical phases of training.
ACVN continually encourages the other institutions to consider the benefits of nutrition training for all veterinary students, not just those seeking specialization. To that end, we have developed and shared with veterinary institutions and educators our recommendations for minimum competencies in veterinary nutrition, i.e., what knowledge, skills and abilities all veterinary students should have upon completion of their veterinary degree.
Thus, contrary to Dr. Alinovi’s assertions, we simply do not discourage the practice of veterinary nutrition by non-diplomates. Rather, we view it as a critical component of the practice of veterinary medicine and see the appropriate application of veterinary nutrition precepts by general practitioners to be of important benefit to their patients.
Further, we are puzzled by the assertion that ACVN does not offer any continuing education efforts for practitioners. For decades, we have sponsored sessions—alone or in conjunction with the American Academy of Veterinary Nutrition—at the AVMA annual meeting, NAVC and the American College of Veterinary Internal Medicine Forum. Diplomates are encouraged to (and often do) share their knowledge at many other national and regional veterinary conferences as well. This includes participation of diplomates and their residents in the AAVN Clinical Nutrition and Research Abstract Symposium, held each year in conjunction with the ACVIM Forum.
All veterinarians who are interested in nutrition, not just specialists, are eligible for AAVN membership. Members in good standing are invited to attend the symposium and enjoy the other benefits of association with like-minded veterinarians.
For those veterinarians unable to attend major veterinary conferences, many ACVN diplomates also contribute to local and regional continuing education programs and webinars so as to provide nutrition education to those interested.
Also, ACVN sponsors “Timely Topics in Nutrition,” a quarterly review feature published in the AVMA journal. There, general practitioners can learn about important new developments in the field of veterinary nutrition, which in turn can help them convey this information to clients.
ACVN also worked with the American Animal Hospital Association to develop its “Nutritional Assessment Guidelines for Dogs and Cats.” It is intended to assist the general practitioner in assessing the nutritional status of the animal, evaluating the food and uncovering problems with feeding management. The publication is freely accessible on the main page of our website.
Similarly, we assisted in the development of the Global Nutrition Toolkit for the World Small Animal Veterinary Association, intended to provide practicing veterinarians from all over the world with practical aids in making nutritional assessments and recommendations.
Admittedly, ACVN encourages veterinarians and animal owners who are looking for help with veterinary nutrition questions to seek the services of our diplomates. This is the same as the American College of Veterinary Surgeons posting the page “Why seek a veterinary surgeon?” or the American College of Veterinary Dermatology stating “Your ACVD specialist can help you with many of your pet’s skin and ear problems” on their respective websites. After all, board certification is definitive and reliable evidence of expertise in that aspect of practice.
However, encouraging engagement of services from a specialist in veterinary nutrition is a far cry from “discouraging” other veterinarians from implementing sound nutrition services as a component of their practices, any more than suggesting that general practitioners give up performing ovariohysterectomies on their patients or referring all cases of suspected flea allergy to a board-certified veterinary dermatologist.
On the other hand, just like in a complicated orthopedic case or with a patient with dermatological signs unresponsive to standard treatments, in the best interest of the client many cases requiring intervention via veterinary nutrition modalities may be referred to a specialist in that area. We believe that the more the practitioner understands the importance of veterinary nutrition as a part of practice, the more likely that veterinarian will seek the services of or refer a client to a veterinary nutritionist when needed.
Thus, having the ACVN website available as a resource in finding a specialist in the field is only helpful to the practice of veterinary medicine at large. Numerous requests for nutrition consultations received on our website from both veterinarians and animal owners speak to the value of this approach.
Dr. Dzanis is secretary of the American College of Veterinary Nutrition.
Originally published in the July 2016 issue of Veterinary Practice News. Did you enjoy this article? Then subscribe today!