DVM, DACVS, CVJ
Phil Zeltzman, DVM, DACVS, CVJ, is a board-certified veterinary surgeon and serial entrepreneur, and he is Fear Free certified. His traveling surgery practice takes him all over eastern Pennsylvania and western New Jersey. He graduated in 1993 from the School of Veterinary Medicine at the University of Liege, in Belgium. He completed a 1-year internship at the University of Georgia, followed by a 3-year surgery residency at Surgical Referral Service in Buffalo Grove, Illinois. He is a certified veterinary journalist. Learn more at drphilzeltzman.com.Read Articles Written by Phil Zeltzman
Veterinary generalists often brag that their job is more difficult than that of their human medicine counterparts. And it’s true: Over the course of one day, generalists might practice internal medicine, dentistry, dermatology, surgery, ophthalmology, cardiology, oncology and radiology. They manage weight-loss programs, cognitive dysfunction and osteoarthritis. They advise on husbandry, behavior and contagious diseases. And of course, all of this is applied to multiple species.
Yet while trying to be jacks of all trades, at some point we must recognize that we can’t know everything. Over the years, specialties emerged and specialists were trained. Once they outgrew the boundaries of universities, specialists went out in the world and opened referral practices. They suddenly could justify investing in expensive, specialized equipment that others could only dream of: advanced imaging, sophisticated surgical equipment, endoscopy in the broadest sense and so much more. Specialty hospitals offered round-the-clock care and took on the practitioner’s burden of being on call after hours.
How can a generalist nurture a relationship with a specialist? How can they work together for the benefit of clients and patients? How can they perform as a complementary team? Here are 11 reasons to partner with a specialist
1. Better Care
Most specialty hospitals can’t provide it all. A generalist who assembles a strong referral team can provide standard of care regardless of patients’ needs. “Getting things done the right way the first time saves time, money and heartache,” said St. Louis concierge surgeon Jenn Wardlaw, DVM, MS, DACVS.
2. Covering Your Behind
If you find yourself in litigation, having offered a referral may be the difference between winning and losing the case. It is your obligation to provide clients with all their options, even if they seek care outside of your practice.
3. Client Retention
Pet owners become upset when they have to return for multiple visits because of the same issue. They may seek a second opinion, acting on the advice of a neighbor, breeder or groomer, if you don’t make a timely recommendation. You may never again see a client who got a second opinion — and a specialist referral — from a local colleague.
Giving clients the early option of a referral, when warranted, will show that you have patients’ best interests in mind and not your ego or pocketbook. In turn, doing this will build client trust in you and keep them coming back to your hospital.
4. Free Services
It’s not all about the money; it’s about relationships and service. Many specialists are happy to help referring veterinarians at no charge, whether it means discussing a patient’s situation, reading radiographs or recommending a medication. “My referring vets can call, text or email me anytime with any question,” Dr. Wardlaw said.
5. Looking Good
Studies and experience show that a significant number of patients diagnosed with hip dysplasia are acutely affected by a torn CCL. Another situation involves fractures that were thought to be traumatic when in fact they were pathological. Surgeons regularly review X-rays on behalf of general practitioners and steer them in the right direction before the wrong procedure is recommended or performed. This in turn makes general practitioners look good in front of their client.
6. Patient Advocacy
Occasionally, treatment of a disease is not possible or recommended. Cancer is a classic but sad situation in which clients wait too long. Specialists may have to gently explain that removing a large tumor is not possible. Or that excising a tumor is possible but may lead to a large wound that cannot be closed. Or that the patient’s quality of life would decrease to an ethically unacceptable point. Rather than jumping to euthanasia, proper pain management and hospice care should be discussed.
Not all referral facilities are created equal. The good ones help you learn from every interaction. They keep you and your client up to date with diagnostics, treatments and outcomes. This can provide an opportunity for you and your team to grow. You may be able to diagnose new conditions that you would not have recognized previously.
8. Overhead Control
Your hospital, team and operating hours can limit the services you provide. Introducing new equipment or offering additional services may not be economical for your practice. Working closely with referral facilities can provide your clients with the hours and services they need while not adding strain to your staff and wallet.
Many referral institutions provide free continuing education for doctors and sometimes for technicians. “This is a convenient and very affordable way to learn from colleagues you work closely with, typically about topics that are relevant to your everyday life,” said Boerne, Texas, mobile surgeon Justin Harper, DVM, MS, DACVS.
10. “Me” Time
Deciding to work with referral hospitals allows you to focus on your passion. If you love cats and would like to focus on lowering their stress in your practice, you can. No need to give up space to store new equipment you eventually may lose interest in. Focusing on the facets you enjoy will improve your staff culture. Your clients will notice and your patient care will be better for it.
11. Mobile Benefits
Many specialists travel to general practices. You can add a surgeon, ultrasonographer or cardiologist to your staff, but only when you need one. You can offer patients multiple specialty services without needing to add staff or equipment. This provides better patient care and the client doesn’t have to travel to a referral center.
Meanwhile, you retain ancillary services in your practice — anesthesia, radiographs and medications, for example — and thereby increase revenue. “It’s clearly a win-win-win situation,” Dr. Harper said.
Do you always have to refer? Absolutely not. Many general practitioners are proficient at providing additional services and love doing so. As long as you are proficient, and you can offer those services ethically, you may do so. It is, however, wise to educate pet owners about all their options, including specialty care opportunities, even when you are capable of handling the care in house.
Ultimately, clients decide who should take care of their pet once they’ve explored all options.
HOW TO REFER BETTER
- Fill in the specialist’s referral form.
- Include a summary of what you have done or administered.
- Send copies of bloodwork, X-rays and other tests.
- Specify any questions you may have.
- Provide directions and guidelines,
- such as fasting, to the client.
- Don’t refer clients who have exhausted their financial resources.
- Don’t give medications that may interfere with further treatment.