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The Daily Vet is a blog featuring veterinarians from all walks of life. Every week they will tackle entertaining, interesting, and sometimes difficult topics in the world of animal medicine – all in the hopes that their unique insights and personal experiences will help you to understand your pets.

 

What’s a Veterinary Specialist ... and Why You Might Just Need One

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October 26, 2011 / (7) comments

When people find out I’m a veterinarian, they often say to me, "I used to want to be a veterinarian, but I wouldn’t be able to deal with euthanizing animals." Well, if you must know, that actually annoys us. It’s not like we like euthanizing animals either, but sometimes it just comes with the job. Much to these people’s surprise, euthanizing animals isn’t the reason why we wanted to become veterinarians either. Seriously.

 

What people do really want to know (and we’re happier about answering) is what it takes to become a veterinarian. To become a veterinarian, one must take a science-dominant, "pre-med" course load (including anatomy, physiology, organic chemistry, biochemistry, and physics) during undergraduate — which typically takes 2-4 years. Some veterinary schools allow you to apply as a sophomore or junior in undergraduate school, which allows you to enter veterinary school 1-2 years early (I personally don’t agree with doing this, but that’s a whole other story). Once getting into veterinary school, you undergo a rigorous four year graduate-level training (more "-ology" classes, like pharmacology, physiology, toxicology), with your last year acting as your clinical year in the hospital. Once finishing veterinary school, you are a "full-fledged" veterinarian and can practice as a general practitioner or family doctor.

In the United States, there are currently about 90,200 total veterinarians (including small animal [dogs and cats], exotic [birds, zoo animals], large animal [cattle, sheep], equine, and other), with approximately 41,400 exclusively in small animal practice. Of these 90,200 veterinarians, approximately 15,300 are in public or corporate employment (including research, government, academic, etc), while approximately 10,210 are veterinary specialists.

So, what’s the difference between a veterinarian and a veterinary specialist? Well, as human medicine has gotten progressively more specialized, veterinary medicine has been slower to do so … until the past few decades. Veterinary specialists have advanced training beyond veterinary school — it’s someone who has gone on to complete secondary training through a rigorous internship and further training in a residency or fellowship (typically 2-4 additional years). In order to be board-certified following your residency, you have to publish a scientific research paper (in a peer-reviewed, scientific, accredited research journal) and pass an intense 2-3 day exam (similar to a lawyer’s bar exam). So, not easy at all!

There are currently multiple specialties, such as veterinary anesthesiology, behavior, cardiology, dentistry, dermatology, emergency critical care, internal medicine, neurology, nutrition, ophthalmology, pathology, radiology, surgery, wildlife/zoo medicine, etc. So, why would you need to see your regular veterinarian versus a veterinary specialist? Specialists typically see referral cases that may be more complicated or critically ill, or need advanced procedures performed that your veterinarian doesn’t routinely perform. For example, if your dog or cat requires advanced surgery (a total hip replacement, for example) or an ultrasound of his heart, he may need to see a board-certified veterinary specialist in surgery or cardiology, respectively. If your pet is in advanced kidney failure, a consultation with an internal medicine specialist may be imperative. If your animal needs 24-hour care and is critically ill, he may need to be evaluated by an emergency critical care specialist. More information on specialists can be found at the AVMA's veterinary specialists page, or specifically at the specialties website.

The best way to tell who the specialist is, is by looking for extra letters behind a veterinarian’s name (e.g., Justine Lee, DVM, DACVECC). These letters stand for something. For me, it’s Diplomate of the American College of Veterinary Emergency Critical Care. That said, more recent "specialties" have been popping up, some less "rigorous" than others (i.e., some not even requiring additional training nor a publication). I worry about where this is going, so don’t be deceived when you see alphabet soup behind your veterinarian’s name. When in doubt, ask your veterinarian for advice or how to find the best specialist who fits your needs — or more importantly, your pet’s needs.

 

 

Dr. Justine Lee

 

 

Image: Kachalkina Veronika / via Shutterstock

 

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COMMENTS (7)
1
Specialists
by TheOldBroad on 10/26/2011 06:56am

I'm grateful to have access to a variety of veterinary specialists and don't hesitate to use them when it's necessary.

I currently have an HOCM (hypertrophic obstructive cardiomyopathy) kitty who gets yearly checkups with his cardiologist. The vet suspected it; the cardiologist confirmed and treated it.

My little Emma Jean (RIP) went to the ophthalmologist for 5 years for a chronic inflammation in her eye. Without him, I have do doubt she would have lost her eye.

We've used the emergency medicine specialists as well as the internists. Luckily my critters haven't needed the surgeons, dermatologists, etc (knock on wood).

I'm grateful for the ones we've seen as well as knowing the others are there if they're needed.

2
by julesb4isu on 10/26/2011 01:49pm

Working for an internal medicine specialist (hes double boarded in critical care and internal med.) and a surgeon (who is also boarded), I think many people don't realize the difference between a general practitioner and a specialist. In fact, in our area there are a few doctors that "specialize" in surgery, opthamalogy (there is a boarded eye doctor here in town), etc. but are not boarded...and it seems like many people dont even know that there are certifications that our doctors have that these doctors do not, much less the quality of care they can receive with us. Thats not to say that I dont feel like the "un-boarded doctors" are potentially wonderful and provide great care, I just feel like its a bit of a sham to say you specialize in surgery or take weekend classes that "trained" you to do advanced diagnostics. Its fine to be interested in those things, its a whole other thing to say you specialize in them. I also think Im a little peevish about it today because we just had to clean up a mess of a surgery one such doctor did that should have been referred to us on the second (or third) surgery (the same one repeatedly) he attempted on the same leg.

by Dr Justine Lee on 10/26/2011 01:54pm

Amen! In Minnesota, it's illegal to say you "specialize" as a veterinarian unless you are actually a specialist. When in doubt, the easiest test is to look for extra letters behind your veterinarian's name that start with a "D" (Justine Lee, DVM, DACVECC) - this stands for "Diplomate" (e.g., Diplomate of the American College of Veterinary Emergency Critical Care.

3
Check
by My5beagles on 10/27/2011 05:31pm

In Ohio I can check the status of any vet/vet tech license online. It only gives out the status whether they are active/suspended/retired etc. But after looking a little more carefully the guidelines were quite clear. They must be certified by a specialty organization approved by the American Board of Veterinary Specialists. Every specialist(too many) I've taken one of the pack to has so many letters behind their name that I'm not too sure where their last name starts and ends. :)
I love my specialists... They go above and beyond. It's the only time I take a pup in the city. (1 1/2 drive each way)

4
still new
by rockjdog on 10/28/2011 10:11am


I have had some veterinarians tell me specialists are there to charge big bucks and waste money. I have had other vets recommend specialists when it was not necessary. So far I have been lucky and my pets have not been so sick that they need the services of specialists.
It still seems that some vets don't know when to use specialists or how to best use them.

Is there animosity between GP’s and specialists?

For example: I took my dog to a new vet and she noticed he had two lumps. One on his leg and the other on his toe. The one on his toe she said was from stress due to his size. The other she said we should take a biopsy.
The one on the toe looked exactly like the one on his leg so I asked for a biopsy on the toe lump also.

She told me the cure is to remove the lumps if they are cancerous. Well they came back as cancerous. She then recommended I see an oncologist.

So I go to see the oncologist and she tells me we can't really tell much until the lumps are removed. Once removed we can see what stage they are. Her hospital wanted two grand to remove the lumps. So I call my old vet (not the new one) and he removed the lumps (whole thing cost about 600). Long story short one came back as a stage one, which means removal is the cure and the other came back as stage two. My vet recommended a further test on the stage two lump and it came back with low margins (he said allot of other stuff and I can't tell you what he was saying, it was all Greek to me). Anyway the stage two was low enough that at this point we do not need any further action.

So for me the point was that until we knew what we were really dealing with I do not feel an oncologist was really necessary. I did not mind going but it cost me 250.00 and I really did not need to see her at that point. When a dog gets sick every penny counts.

By the way the purely puppy blog has a Board Certified Veterinary Behaviourist blogging and I think there are only about 52 of them in the country.

by julesb4isu on 10/28/2011 01:29pm

Working for/with two specialists currently, I would certainly hope that there isn't any animosity between GP's and specialists! They have to refer cases to us!

That being said though, I find it very rude for a GP to say that specialists charge lots of money and are a waste of time...I would never bad mouth what they charged or their quality of work, especially having little to no idea what I was talking about.

For our clinic, the increased cost can be attributed to many things (these are just some of them). You are paying for our specialized doctors (of course), but also our specially trained technicians. We also have access to a wider array of medications (particularly for pain) and pain medications in our clinic are given as the rule, not the exception. We also have more advanced diagnostic tests (think CT, MRI, and advanced/specific blood tests), and access to a variety of other specialists that aren't even here in our clinic for consultation. Another thing worthy of noting, is at our clinic if a pet is going to have any sort of anesthetic procedure they get fluids...period...and I know a lot of rDVM's who base their gift of fluids off how long the pet will be under. Finally, with the anesthetics used we will never "gas" a pet "down", they always receive a catheter and some sort of fluid anesthetic agent (typically propofol) and are maintained under anesthesia with advanced monitoring equipment, specially trained technicians, and a gas anesthetic agent added to they O2 they receive to maintain the appropriate state of anesthesia.

That being said, for minor procedures (like small mass removals), the procedures themselves are likely not that different from a GP or specialist (if you ignore the fluids, anes, etc), but there are certainly times where you absolutely should see a specialist such as: if you wish to pursue any sort of chemotherapy/radiation protocol, if your large dog has ruptured its cruciate (please dont let you GP do this...please, please, please), if your dog requires advanced diagnostics like CT or MRI, or at the behest of your GP (most wont send you to a specialist unless they feel uncomfortable with your pet's issues or acknowledge that they require more advanced care)...those are just some examples. It is totally up to the pet owner rather they want to see a specialist, and if you ever feel pressured to see one when you don't feel it is merited get a second opinion for another general practitioner. On that same final note, you can always ask to see a specialist if you feel your pet would benefit from their care even if your rDVM hasn't said it yet. It is always the pet owner's who have the final say!

by rockjdog on 10/28/2011 02:04pm

You have a good point. The hospital I was refering to has board certified surgeons and I know the care there is the best. I dropped 6000 there when my dog bloated in the middle of the night and they saved him.

However in an emergency I did not think about looking to see which doctor was a specialist.You know i was just scared at that point.

What I was trying to say was I was sent to this specialist too early. Basically she showed me some pamplets and told me about different chemo options and costs but she said "all I am telling you at this point may be moot because we do not know that stage of the tumors.So you may not need any further treatment".The dog already had all the blood tests done so she did not even need to take blood.

The tumors were not in any difficult position and were dime size. I even took my dog home the same day.

Yes the vet that told me this was a waste of time and money was for a dog that had cancer. This vet mis-diagnosed the dog has having stomach cancer. I did seek a second opinion. It was found he actually had a tumor in the soft pallet but it was too big for removal.So the vet that mis-diagnosed Sandy at least did not cause any harm, because by that time the cancer in the soft pallet was too far along.

As for bad mouthing it never makes the person doing the bad mouthing look good and usually backfires anyway, but it does happen.

It just seemed to me that in my limited experience one bad mouthed and the other sent me too early to a specialist.
So that is why I wonder if there is a problem in the vet community about understanding what specialists do and when they are needed.

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