Since veterinary medicine does not require residency and board certification in a given specialty to practice, the majority go into practice right from veterinary school and practice what is known as general medicine and surgery. This leaves a wide range of skills attained by the general practitioner, with some leaving most highly technical diagnostics, procedures, and surgeries to referral based specialists, while others utilize mentorship and continuing education to upgrade skills, knowledge, and diagnostic equipment in order to make it less necessary to refer highly technical cases.
In a depressed economic climate with the general populace having less disposable income and desire to spend, pet owners are increasingly saying no to referral specialized medicine, to a degree that I have heretofore not seen. Many of my colleagues agree with this assessment clearly witnessing this trend. Left no other recourse than just doing nothing or putting a patient to sleep, I, as well as many of my colleagues, feel inclined to offer these pet owners the alternative of letting us take a shot at some of these highly technical, referral based cases.
For example, just over two years ago (my home state of Florida was in recession before most of the country), a lady brought her cat to me because of chronic ear infections, which later turned out to be the result of a tumor deep in the ear canal. The necessary surgical procedure to resolve the problem, a total ear canal ablation (TECA), is a surgery that many GPs leave to the realm of board certified veterinary surgical specialists. With the owner unwilling not able to spend the kind of money necessary for the referral care, I offered her the option to have me do it. I explained her that I had scrubbed in on a few of these surgeries as a student, and felt that I may be able competently perform a TECA if I reviewed the anatomy well and re-studied the procedure. At any rate, it was a better alternative to simply electing euthanasia, especially since I was not going to charge for OR time, just for anesthesia and medications.
The end result of this case could not have gone better. The tumor had been contained and completely removed, and that patient is still alive and well. Since then, after having gotten a few more TECA procedures under my belt, I now feel justified in charging for my OR time when performing a TECA, which still saves the pet owner $1500 - $2000. when compared to what it would cost a surgical specialist to perform a TECA.
This is a very common story in the veterinary industry right now, whether GPs out of necessity venture into highly sensitive or technical surgery, or become proficient in advanced imaging like ultrasound and echocardiography. While the underlying reality of the cause for this trend is indeed quite sad and distressing, if we can weather this recession and come out survivors, we will have done so while as a side effect, creating a more highly skilled generation of general veterinary practitioners.