Let me explain: When you take your pet to your regular vet you avail yourself of the services of a general practitioner. When your pet becomes infirm or gets injured in a serious way, most vets will steer you to a specialist. How quickly or how often that occurs is loosely termed a practitioner’s “referral rate.”

Some vets refer patients very quickly and very often, relying on the services of a specialist as a way to enhance the quality of care they provide by offering their clients a menu of services at different levels. It’s considered part of a full-disclosure scenario whereby vets can ensure their clients are aware of every possible treatment option.

Vets are legally bound from receiving gifts, money or other kinds of “kickbacks” when they refer patients to a specialist. Though they are allowed to take a financial interest in a specialty hospital and effectively receive payment when you go there, this setup is rare in our industry. So when you seek care elsewhere on your vet’s recommendation, that vet tends to lose the benefit of your financial patronage.

It’s no surprise, then, that some vets are loath to refer. And it’s not just the money thing—not by a long shot. Lots of vets are simply unused to the whole concept of referring patients away. They honed their skills in an era of DIY vet medicine and they’re accustomed to taking on the extreme challenge of cases that may be beyond their skill set. Some of it has to do with professional pride. And some of it has to do with the thrill of practicing tricky medicine—some cases are just fun.

The emergence of specialty vet medicine has been swift. Over the last ten years, specialization among vets has veered sharply upwards. A whopping 40% of current vet students say they would like to seek board certification in a specialty area. All this competition bodes well for our pets, but it also sets up a two-tier system that has its social drawbacks within our profession.

I’m setting this up as objectively as I can, though I’m sure you know where my bias lies. I’m with the younger crowd of vets—the ones brought up in the newly-specialized vet world.

Last night (at a seminar dinner on separation anxiety in dogs) I had the opportunity to debate this issue with a fellow vet. He decried the need for specialists in areas like behavior medicine and surgery, arguing that vets are getting soft for all their outsourcing. How is one to learn, stay engaged and prosper in this new paradigm if all our challenging cases get sent out the door? He, for one, would never let a client down by referring their pet to another vet.

I must have been catching flies with my mouth at that point. Still, I had the presence of mind to point out that only half of my clients have the cash or inclination to follow my referral recommendations. So I got plenty of practice, I assured him, in spite of my spineless habits and my willingness to disappoint my clients by shirking “supervet” status.

If I hadn’t been so taken aback, I might also have countered more rationally, with a discussion on quality care through a team approach and the merits of residency training, (not to mention the ethics involved in withholding information from his clients). It probably wouldn’t have helped, anyway.

Afterwards, I couldn’t help thinking how dichotomous vet medicine has become. This may be a gross generalization, but it seems it’s the established, wealthier vets (who never even suffered student loan debt) that persist in behavior that undermines the higher standards of medicine the more idealistic generation seeks to install (often to our own financial detriment). Sure, there’s no straight line between quality medicine and referral rates, but it’s one of those issues that definitely marks the gulf between two different kinds of vets. 

Now that I’ve insulted a sizable slice of my profession (no, I don’t feel better now that I’ve written this) I’ll leave it up to you to discuss the merits and pitfalls of high referral rates. I’m open to criticism.