The Difference Between a DACVIM and a DVM
From time to time I’m asked, “Can my regular veterinarian do the treatments?” Or, “What’s the difference between what you do and what my regular vet does?” It’s difficult to provide an unbiased answer.
On the one hand, as a specialist I believe what I do is exactly that, specialized. I recognize that I know more than most veterinarians about oncology because it’s all I do. On the other hand, I have a rather unassuming personality and it’s hard for me to describe the benefits without feeling as though I’m “showing off.” It’s not an easy conversation to have with the average pet owner and I struggle with remaining neutral in my dialogue.
There are objective measurements one can make to “argue” that a board certified veterinary oncologist is more qualified to do oncology than a non-boarded person. Board certified oncologists are veterinarians who have completed an approved residency training program in medical oncology. Residency programs are completed following graduation from veterinary school, and after completing a one-year general internship program.
Residency programs are offered at veterinary teaching hospitals under the direct supervision of some of the most renowned experts in the field. During this time, residents spend thousands of hours obtaining direct experience in the diagnosis, treatment, and management of cancer cases. They also are required to complete rotations in other specialties such as radiation oncology, radiology, surgery, internal medicine, neurology, etc. During this time, candidates must also pass two separate rigorous specialization exams, and publish at least one original research study within their field.
Once these “tasks” are accomplished, individuals are granted the status of Diplomate of the American College of Veterinary Internal Medicine and will list the initials “DACVIM (oncology)” after his or her DVM degree. Only board certified individuals can list this credential after their names.
But really — big deal. All the qualifications and diplomas in the world may not be impressive enough to “convince” an owner to pursue treatment with me. They also don’t necessarily mean I’m good what I do, that I’m a nice person, or that I have a drop of bedside manner or compassion compared to another veterinarian.
Muddying the waters even more is the fact that (as I always say) there is no magic behind chemotherapy. In fact, one could argue it’s a “cookbook” type of science. Any veterinarian can purchase the drugs as easily as they can antibiotics or vaccines. Doses are standard and can easily be found in any veterinary textbook. The administration is fairly straightforward as drugs are typically given either through an intravenous or oral route. So what’s the benefit of visiting a veterinary oncologist when your pet is diagnosed with cancer?
If the specialized knowledge in the diagnosis of cancer, staging of tumors, development of treatment plans, and experience monitoring patients during the course of their treatment isn’t enough, maybe the most important one would be the fact that board certified oncologists have advanced training in the safe handling and administration of chemotherapy. Chemotherapy drugs are not only toxic to cancer cells, but to normal cells, and accidental or unknown exposure to pets and people can occur through many different routes, namely during the reconstitution and “drawing up” of the drugs.
Another key point is that board-certified veterinary oncologists often participate in clinical chemotherapy/immunotherapy trials, offering the highest and most advanced level of care for pets with cancer. We are required (and driven) to stay on top of new developments and therapeutics. This would be the “opposite of cookbook” argument I try and use.
I find there are two main reasons why owners ask about pursuing treatment locally: either because of distance or because of finances.
Of course not every owner has access to a board-certified specialist simply due to geography. Our numbers, though growing, are not large, and distance can be a burden for owners. I’ve heard extreme stories of a general vet colleague who administered chemotherapy to pets on the kitchen floor of their homes in what I will keep as an unnamed rural location of Canada. Should those pets be denied life-extending treatments because there are no oncologists nearby?
Some owners are dissuaded from pursuing consultation with a veterinary oncologist because either they, or their veterinarians, feel the expense is too great. I would urge owners to have their veterinarians contact the specialist and simply ask for a quote for services. I’m always happy to discuss cases with referring veterinarians before the owners arrive so that we can limit such “surprises,” and to also dispel some of the more common myths (e.g., that oncologists will only treat cases with biopsies or will only treat cases that have full-staging diagnostics performed). I think sometimes the perception of cost may be far greater than the reality, and I would not want to see pets denied treatment because of a lack of factual knowledge.
I’m fortunate to currently work in a region of the country where owners are typically highly educated, affluent, and expect a level of medical care for their pets on par with their own healthcare. Most people understand the value of coming to see an oncologist, and even more so, ask their primary veterinarians to refer them for specialized care. This wasn’t always the case, and I understand how the struggle of accessibility and the limitations of finances can play a big role in owners questioning the difference between the specialist and the general veterinarian.
Specialty medicine isn’t the right choice for every owner or pet, and I still will struggle with how to describe the pros of what I can offer when compared to primary care veterinarians.
The truth is we are all working to try and help pets live longer and healthier lives, and with that in mind, the best choice is the one that accomplishes this goal, regardless of who is administering the care.
Dr. Joanne Intile