If a member of your (human) family got sick or hurt or had a condition that demanded expert care, you’d ask your doctor for a referral to a specialist—someone who could offer treatments beyond what your GP could provide.
And now, if your dog needs care beyond the scope of your regular veterinarian’s practice, you can do the same thing for him.
Specialists can take over where standard veterinary care leaves off because they have specific education and hands-on experience over and above that of most general practice vets, says Nancy Kay, DVM, a board-certified specialist in small animal internal medicine in Rohnert Park, Calif., and author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life (2008). “Veterinary specialists have spent two or more years of in-depth residency training, often receiving one-on-one guidance from clinicians who are experts in their fields,” she says. “That’s where they learn how to deal with challenging cases.”
Veterinary specialists—experts in everything from anesthesia to zoological medicine—were all but unheard of when most of us were young (and romping with the dogs of our childhood). The first specialties were recognized by the American Veterinary Medical Association (AVMA) in the 1950s, when the association established the American Board of Veterinary Specialties (ABVS) to serve as an umbrella organization for all AVMA-recognized specialty groups.
Today, the ABVS represents 39 distinct specialties, which are practiced by members of 20 specialty organizations, some of which encompass several disciplines (for example, the American College of Veterinary Internal Medicine, or ACVIM, covers large and small animal internal medicine, plus oncology, cardiology and neurology). More than 9,000 U.S. veterinarians—roughly 9 percent of all vets in the country—are card-carrying members, or board-certified diplomates, of these organizations. To obtain diplomate status, a vet must complete postgraduate coursework and residency and pass a certification exam. In some cases, that means several years of additional training after vet school.
In addition to the AVMA-recognized specialty groups, a few organizations offer specialized training and certification to vets who have added physical rehabilitation and various types of alternative medicine to their practices. (See sidebar.)
While the specific requirements for diplomate status vary, virtually all require a veterinarian to take additional coursework and complete an internship (or its equivalent in active veterinary practice).
The expertise demanded of specialty veterinarians is especially important in veterinary medicine, because vets—unlike human doctors—can legally perform any accepted procedure on your dog, says Mitch Robbins, DVM, a diplomate of the American College of Veterinary Surgeons (ACVS) who practices at the Veterinary Specialty Center in Buffalo Grove, Ill. “If you needed surgery, your doctor is required to refer you to a surgeon,” he says. “He can’t just operate on you himself. But if your dog needs surgery, your regular vet can do it himself. The question isn’t whether he can perform the procedure—it’s whether he is the best person to do it.”
Another issue is equipment—high-tech radiology, neurosurgery and diagnostic machines that specialists have (and general practice vets almost never do). Specialists have received training on this equipment and are well versed in the latest therapies and technologies, says Patty Khuly, VMD, a general-practice veterinarian in Miami, Fla. “They’ve invested in the kinds of equipment that I wouldn’t buy for my practice,” she says. “Of course, there are good and not-so-good specialists just like there are good and not-so-good general practitioners, but, generally speaking, specialists are at least four years ahead of everybody else. Veterinary medicine is advancing very quickly, so four years represents an awful lot.”
Specialization in veterinary medicine is definitely growing, as more pet owners are looking for advanced care and more veterinarians are choosing to tackle it: According to the AVMA, almost 40 percent of 2007’s veterinary school graduates enrolled in targeted post-graduate coursework, internships and residencies, up from just 15 percent in 1995. And despite the current economic situation—and the fact that a specialist will almost always cost more than a family veterinarian (generally about twice as much, says Dr. Robbins)—owners are keeping them busy. They can be found throughout the country, at major veterinary teaching hospitals as well as clinics, many of which offer a few different types of specialty care along with 24-hour emergency services.
When to Get a Specialist
Most often, a specialist will see clients who have been referred by their primary veterinarians, although owners also wind up there after bringing their dogs into a specialty hospital for emergency care.
Most general practice veterinarians will readily suggest a specialist in cases that are beyond their area of expertise, says Dr. Khuly. “A few vets might want to do everything in-house, or they might feel that the client wouldn’t want to see a specialist for financial or other reasons, but most routinely make referrals,” she says. The phenomenon is much like the one in human medicine, she says. “The general practitioner is your go-to person for everyday issues, but the specialist is who you see for more complicated problems.”
For example, your family vet might suggest you see a specialist for treatment of a known disease or condition (such as heart rhythm abnormalities or diabetes), says Dr. Kay. You also might be sent to a specialist if your dog isn’t getting better—or is getting worse—despite the treatment he’s currently getting. Dr. Kay also recommends seeking a specialist for a second opinion, or if you just want to feel more certain about your dog’s care or have a “gut feeling” that he might need more than your family vet can provide.
You also might want to consult a specialist if your dog needs diagnostic procedures beyond the run-of-the-mill temperature readings and blood work that your regular vet provides. For example, endoscopy—a nonsurgical method of evaluating a dog’s respiratory, gastrointestinal or urinary tract or removing growths or tissue for biopsy—is generally left to the specialists, says Dr. Kay. “Some general practitioners perform endoscopy procedures, but unless they’ve received extensive training, they won’t have nearly the experience that a specialist in internal medicine does.”
Seeking Out Surgeons
By far the most common reason dog owners seek specialists (and the most common reason that general practice vets make referrals) is for surgery. “Most family veterinarians know that they can’t perform a total hip replacement, and they’re not about to take out a big scary cancer mass,” says Dr. Khuly. “They know that they have limits, and so they’ll refer those cases to a surgeon.”
If your veterinarian recommends taking your dog to a surgeon (or if you think you should see one for a second opinion), do your homework—on both the surgeon and the surgery that your vet has recommended—before the consultation, says Dr. Kay. Find out if he’s board certified, and ask about his experience in cases like your dog’s. Be sure to bring your dog’s medical records, including the latest x-rays, lab results and prescriptions, to the appointment.
When you meet with a surgeon, Dr. Robbins recommends asking the following questions:
•Are there any other options that we could consider? What’s the advantage of surgery over nonsurgical options?
•What can I do to ensure that my dog will be a good candidate for this procedure? Are there additional tests that should be performed (such as “staging” of cancer)?
•What are the risks and possible complications? What is the prognosis for my dog, considering his age and overall health?
•What will the aftercare involve? Will my dog need to remain in the hospital immediately after the surgery (and does your hospital provide 24/7 care)? Do I need to buy special equipment, like an orthopedic bed or baby gates for the stairs? How much post-operative rehabilitation will he need and what will it entail?
“In my opinion, any time you’re talking about a surgical procedure that has some complexity to it, the least you should do—at least, what I would do—is talk to a surgeon,” says Dr. Robbins. “The ‘second opinion’ is the basis of specialized medicine in humans, and it’s the best way for you to be an advocate for your dog. You always want to know if there’s something new or better that could be done to manage your dog’s condition and give him a better quality of life.”
Here are some of the more popular specialties, and the conditions that they address.
- Acupuncture. Vets are certified by the International Veterinary Acupuncture Society (IVAS) and can treat arthritis and other musculoskeletal problems, plus skin, respiratory and gastrointestinal problems.
- Behavior. Diplomates are certified by the American College of Veterinary Behaviorists (ACVB) and treat behavioral issues, such as aggression or anxiety, that are often tied to a dog’s overall health.
- Canine and Feline Medicine. Diplomates are certified by the American Board of Veterinary Practitioners (ABVP), which offers certification for general practitioners who focus on dogs and cats. (ABVP also certifies equine, dairy, avian and other practices.)
- Chiropractic. Vets are certified by Animal Chiropractic Certification Commission (ACCC) and treat various types of muscle, nerve and joint pain as well as digestive and other internal medicine problems.
- Dentistry. Diplomates are certified by the American Veterinary Dental College (AVDC) and treat conditions involving the teeth and mouth.
- Internal medicine. Diplomates are certified by the American College of Veterinary Internal Medicine (ACVIM) in small or large animal internal medicine, cardiology, oncology or neurology, and treat internal medicine disorders, such as diabetes, heart disease, cancer and neurological problems.
- Ophthalmology. Diplomates are certified by the American College of Veterinary Ophthalmologists (ACVO) and treat diseases and injuries involving the eye.
- Radiology. Diplomates are certified by the American College of Veterinary Radiology (ACVR) and provide imaging services or cancer treatment (radiation oncologists).
- Physical Rehabilitation. Vets are certified by the Canine Rehabilitation Institute and provide physical rehabilitation after accidents or surgery.
Second Opinion Etiquette
Going for a second opinion? Nancy Kay, DVM, Diplomate, ACVIM, and author of Speaking for Spot tells us how to serve our dogs’ best interests as well as maintain harmony with his health care team.
- If your primary-care veterinarian didn’t provide the referral, be sure to let her know what you’re doing. (Plus, how else will the specialist have access to your dog’s medical records?) Avoid the impulse to “sneak out” for a second opinion for fear of hurting your vet’s feelings. Unless she’s fresh out of school, this won’t be the first time a client has requested another opinion, and it won’t be the last. Remember, your vet’s foremost concern should be your dog’s health, not her own feelings. This is part of the oath we all take when we enter the profession.
- Arrive early for the appointment with the specialist. There will be paperwork to complete, which can be a 10- to 15-minute process, or even longer if the receptionist is busy.
- Have a legible copy of your dog’s recent and relevant medical records, including all laboratory data, imaging studies (x-rays, ultrasound evaluations, CT and MRI scans), ECGs (electrocardiogram tracings) and doctor’s notes. It really helps when this material is arranged in chronological order. Icing on the cake is a legible summary prepared by your family vet. Remember, a stack of invoices is not a substitute for your dog’s medical record.
- Bring all of your dog’s current and recent medications so the specialist can read the actual prescription labels. Just like human doctors, vets often have lousy handwriting, so details from a printed label are usually more reliable.
- As tempting as it may be to tell the specialist everything your family vet has told you, hold back and give her a chance to draw her own conclusions by asking her own questions.