Elizabeth A. Maxwell
DVM, MS, DACVS-SA, Collaborative Care Coalition
Editor’s Note: This is an excerpt from a white paper written by the Collaborative Care Coalition, a volunteer group dedicated to improving and expanding collaborative care. To learn more, visit the organization’s website.
The development of clinical specialties in veterinary medicine began with the recognition of the American College of Veterinary Radiology by the AVMA in 1962. From the 1960s until the mid-1980s, specialty practice was primarily confined to veterinary teaching hospitals. Since the mid-1980s, however, there has been an explosive increase in the number of private specialty practices, particularly practices that treat companion animals. Currently, the American Board of Veterinary Specialties committee of the AVMA recognizes 22 veterinary specialty organizations comprising more than 46 distinct specialties. More than 12,000 veterinarians are board-certified by one or more of these AVMA-recognized specialty organizations.
In a 2013 American College of Veterinary Internal Medicine survey, 85% of primary care veterinarians (pcVet) reported referring patients because of limitations relating to the capabilities or equipment available at their clinic, specialized surgical expertise, and 24-hour care or supervision. Other indications for consideration of referral to a specialist included in the AAHA Referral and Consultation Guidelines are unresolved or worsening medical conditions, an inconclusive diagnosis, or client dissatisfaction with the progress of a case under treatment by a pcVet.
A 2018 survey evaluating the referral patterns and behaviors of 242 pcVets revealed that the cases most commonly referred to specialists included lymphoma, fractures, surgery, and ophthalmic issues. This survey found that the most significant influences on the decision to refer to a specialist were the pet’s lack of response to treatment or a more favorable prognosis with advanced treatment. The pet owner’s urgency to find a diagnosis or begin treatment also influenced the decision to refer.
The Need for Primary Care–Specialist Collaboration
Unfortunately, many pcVets are unhappy with their treatment by specialists. They do not feel respected for their clinical knowledge or valued for their close relationship with the patient and client.
However, this veterinarian-client-patient relationship established with the pcVet is essential for the overall animal health and wellbeing. The pcVet is familiar with the animal’s entire medical history and can provide guidance, advice, support, and counsel for care. A pet owner’s reliance on and trust in his or her primary veterinarian is the cornerstone of good animal health.
However, pcVets cannot always offer the best treatment options for their patient with the rapid advancements occurring in veterinary medicine. Specialists offer advanced knowledge and skills in disciplines as varied as internal medicine, surgery, dermatology, preventive medicine, toxicology, dentistry, behavior, and pathology. Specialists play an essential role in ensuring optimal animal health and wellbeing.
The best specialist–pcVet relationships are based on trust and mutual respect. Specialists should appreciate the value of the client’s and the patient’s long-term relationship with the referring veterinarian. Ongoing communication between the specialist and pcVet can ensure consistent messaging with the pet owner and clear communication between all three parties. In this way, the pet owner’s trust in both the pcVet and specialist is ensured.
To provide longer, healthier lives for our patients is a goal all in the veterinary community share. A true partnership between pcVets and specialists will help us achieve this goal. Effective collaboration between the pet owner, pcVet, and specialist is essential to optimize outcomes for veterinary patients.
To optimize the referral experience for the pet owner, it is important they understand what a specialist is and why the pcVet wants them to consider referral. When presenting the option of referral, it is crucial to make sure the pet owner is familiar with the additional training and education associated with board certification to convey the value associated with the expense and how their pet may benefit. Collaboration between pcVets and specialists can involve direct referral of the patient, but also other services that specialists may offer, such as evaluation of digital images or phone consultations. Establishing relationships with specialists can help facilitate optimal referral decision-making as well as successful collaboration on medical care for patients. With the increase in the availability of veterinary specialists and increasing demand from pet owners for specialized care for their pets, the need to improve the working relationship and increase collaboration between pcVets and specialists is essential for the veterinary profession. Developing partnerships between pcVets and veterinary specialists who provide collaborative care and evaluating the outcomes of those partnerships will be necessary as the industry attempts to define the roles of primary and specialty care providers. The development of personal relationships between pcVets and specialists will be a vital factor in increasing levels of collaboration.
To learn more about how to optimize the referral experience and improve collaboration at your practice, please refer to the full white paper at collaborativecarecoalition.org.
About the Collaborative Care Coalition:
The Collaborative Care Coalition is a volunteer-based non-profit organization composed of primary care veterinarians, specialists, academicians, and industry partners. This group is dedicated to furthering collaborative care and our mission to “achieve optimal health care for animals, advance the veterinary profession, and evolve the relationship between primary care veterinarians and specialists.”