Creative Disruption columnist Dr. Bob Lester is the chief medical officer at WellHaven Pet Health, a former practice owner and a founding member of Banfield Pet Hospital and the Lincoln Memorial University College of Veterinary Medicine. He serves on the boards of Pet Peace of Mind, WellHaven Pet Health and the Lincoln Memorial veterinary college. He is president-elect of the North American Veterinary Community.Read Articles Written by Bob Lester
Teddy Roosevelt once said that complaining and not offering a solution is whining. Fair warning: I’m about to whine. I recently spoke with a brilliant, young fourth-year veterinary clinical student. She is smart, driven, compassionate and eager to make a difference. (Come to think of it, all veterinary and veterinary technician students are determined to make a difference.) She will make a great addition to our ranks.
She shared with me a conversation with a much-admired faculty member at her college of veterinary medicine. Long story short, she indicated to the professor her intention to return home and pursue a career as a general practitioner (GP). She, like many of us, can imagine no higher calling than to care for her hometown pet families.
The response from the faculty member was disappointing. He none too subtly told her that she was not living up to her potential by “settling” for a career as “just” a general practitioner. He suggested that to live up to her potential, she would be wise to pursue a specialty.
What!? After several deep breaths and slowly counting to 10, and then to 20, I recalled similar conversations I had many moons ago. I’d hoped these kinds of discussions no longer took place. The student and I then went on to have a robust discussion about the numerous career paths offered by our profession, including the many rewards of a career in general practice.
Why discount the value of a GP? What’s up with the idea of “just” a GP? Perhaps I’m too sensitive, but does the word “just” aggravate anyone else? Fingernails on a chalkboard to my ears.
Take Your Pick
We are so fortunate to have an abundance of careers to pursue as veterinary professionals. Military, government, not for profit, for profit, specialty, large animal, small animal, mixed, academia, industry, general practice — the list goes on. All are important, all are worthy, all contribute to the good of society. For those of us who seek to make a difference in the lives of our neighbor’s pets and families, the GP is an honorable choice and the mainstay of our profession.
To imply that GPs and specialists are somehow two dramatically different alternatives, and to further suggest that one is somehow better than the other, is at best uninformed and at worst the height of hubris. If you’re smart, driven, enthusiastic and successful, you become a specialist. If not, you become a GP. Really? Deep breath. One, two.
As we all should know, GPs are in fact experts in much of preventive care, nutrition, parasitology, behavior, dentistry, surgery, internal medicine, oncology, dermatology, ophthalmology, pediatrics, geriatrics, psychiatry, end-of-life care and more. We like it all. GPs build deep and multigenerational relationships with pet families and the communities they serve. Additionally, GPs are most adept at making do with less, achieving the maximal result with often limited means.
The specialist versus “just a GP” mindset promotes the idea that GPs are not experts. Hippocrates said, “It’s more important to know the patient who has the disease than the disease the patient has.” Wise words. If GPs are termed generalists, shouldn’t specialists be called “partialists” or perhaps “limitedists?” The GP is the focal point around which academia and specialist revolve. Both of those are directly dependent on their professional existence to the GP. No GP, no specialist. No GP, no or fewer academics.
The Results Speak for Themselves
GPs, on the whole, do a better job at improving health outcomes at a lower cost than do specialists. Studies conducted in human medicine have demonstrated that an increase in the number of primary care doctors results in better health outcomes — a higher quality of health services at a decreased cost. An increasing number of specialists is associated with higher costs and poorer quality of care, including higher overall mortality.
The majority of veterinarians are devoted to primary care. American Veterinary Medical Association data indicates that somewhere around two-thirds of us are GPs (small, mixed and large animal), while GPs make up less than one-third of physicians.
I’m not denigrating my friends who choose to specialize. I have enormous respect for specialists and am grateful for the opportunity to refer to and consult with them. They have earned the respect they are given. Teaching hospitals, however, are overrepresented by specialists, brilliant clinicians who frequently have little or no GP experience. Primary care teaching is sadly undervalued at teaching institutions, which is one more reason to embrace hybrid distributed models of clinical education. It’s easy to see where the “just a GP” attitude arose. Any veterinarian involved in general practice can tell you, it’s not easy. It’s not “just.”
A similar phenomenon is taking place in the world of corporate veterinary medicine. Corporate organization charts have made clear that if you’re a good clinician, you might get the opportunity to be “promoted” to a management role. The middle-manager job is touted as more valued than a hospital clinical role. Doctors and hospital employees can move “up” to management. The further up the line, the more important the role. Hospital teams on the bottom, then managers, then directors, then officers and so on.
Hospitals on the bottom rung? Blue suits pushing white coats? Really? Up to corporate, down to hospitals? How is moving out of a hospital a promotion? I struggle to see how leaving the exam room for a desk and rental car is a move up. Yet that is how most multiunit veterinary organizations are built.
Hospital teams should be at the top of all organization charts. In my WellHaven Pet Health practice, we insist that anyone who works in the support office spend one day each month wearing scrubs in a hospital, helping hospital teams, answering phones, cleaning kennels and assisting those who truly belong at the top of every org chart.
For those of us who work outside of the hospital and in a support role, if we’ve not directly touched a pet today, we had better be helping those who touch pets. There is nothing more honorable than working in a hospital, side by side with pet owners, nurturing the bond between pets and families.
Let’s Honor GPs
I wonder, too, if the impostor syndrome, so common in our profession, plays a role in the “just a GP” phenomenon. Does a lack of confidence somehow support our colleagues’ acceptance of the “just a GP” designation?
Further, has the undervaluing of GPs in part resulted in our continued focus on sick care as opposed to a more productive focus on well care? Reactive care versus proactive care? Has preventive care suffered from the devaluation of GPs? I suspect so. Human and veterinary medicine are built on an economic model that monetizes sick care over well care and specialist over GP. By honoring GPs, might we better embrace preventive care, resulting in healthier patients, healthier doctors and healthier teams?
General practice is incredibly rewarding, challenging and varied. Every day is different. We have the privilege of caring for anything that walks, crawls, trailers or otherwise makes its way to our doors (or us to their home, farm, barn, stable or iPhone. From cradle to grave, we enjoy the benefits of supporting pet families and nurturing the magic bond that unites them.
All of us who chose to enter this profession, regardless of role, are critical. Veterinary nurses, receptionists, practice managers, generalists, specialists, support teams, academics — we’re all important and we all make a difference.
I chose to be a general practitioner, a choice I would make again. For many of us, there is no higher calling.
There is no such thing as “just” a GP.
Active board-certified specialists counted by the American Veterinary Medical Association as of December 2019. (Some belonged to more than one specialty.) The greatest number of diplomates, 3,091, earned their certification from the American College of Veterinary Internal Medicine.