The scope of general practice has been shrinking for decades. At the same time, the specialist’s role has grown. The space between GPs and specialists is emerging as the next big opportunity in veterinary medicine. It’s full of new roles and practice models. Examples include dental only, spay/neuter, feline-exclusive, exotic, complementary medicine, well care, telehealth, concierge, nonprofit community services, vaccine clinics, urgent care, home euthanasia, technician-delivered care and mobile practice. In addition, we could soon see midlevel providers such as veterinary professional associates (VPAs).
The shrinking scope of general practice, coupled with the difficulty in accessing specialists, has left a fertile middle ground to explore. Exciting times! But before we go down that road, let’s back up a bit.
What led to the reduction in the scope of general practice and the expansion of specialty practice? The answer lies largely in the ever-strengthening bond between pets and families. Cats and dogs have become family members, moving from the barnyard to the backyard to the back porch to the living room to the bedroom to the bed to under the covers. (Credit to my friend Dr. Marty Becker.) With that, clients’ expectations and their willingness to pay for advanced care have grown.
Veterinarians are products of their educational systems, which until recently relied almost exclusively on specialty referral hospitals for clinical training. The university teaching hospital, while a great place to observe the best of the best, offers a subliminal (or perhaps overt) bias toward referral. The growing human-animal bond, the explosion of new knowledge, new equipment, advanced procedures, special diagnostics and rising client expectations have led to growth in the amazing specialties we enjoy today.
Looking across the fence at what’s happened in human medicine can be instructive to our profession. In human health care, the proportion of U.S. generalist physicians has declined for decades. We have the lowest percentage of primary care physicians of any developed country. Some observers believe the imbalance between generalists and specialists is a major cause of America’s high health care costs, its dependence on technology and consumer dissatisfaction. Others argue that specialists provide superior primary care and that the decrease in generalists isn’t a problem.
What can veterinary medicine learn from the human health care experience? You got me. The human and veterinary systems are so different that I’m not sure we can draw conclusions.
But let’s go back to vet med. At one end is the generalist, who does all things for all creatures, and on the other is the specialist, who does a few things very well for a select group of patients. And now, the new middle is where pet owners may pick from a variety of lanes that best fit their needs, middle lanes that are neither specialist nor generalist. These lanes are possible, in part, because of advances in technology and online learning that have democratized many of the skills and knowledge previously unique to specialists.
Better for Everyone
Full transparency: I’m a generalist curious enough to learn a little bit about a lot. I lack the attention span necessary to learn a lot about a little. As a baby boomer, I sometimes miss my old general practice days, when specialists were few and far between, clients were a little less demanding, and social media hadn’t been conceived. Those were the days when a generalist tackled cases that we typically refer out today.
That said, today’s access to specialty care is far better for pets, clients, generalists and specialists.
Layer on top the workforce shortage. We don’t have enough generalists, specialists or credentialed veterinary technicians. The shortfall and pet owners’ difficulties in finding veterinary care further enable the move to the middle.
Did you know that every companion animal general practitioner in the United States can fit into an average-sized college football stadium? Around 62,453 of us are in companion animal practice, according to a 2022 report from the American Veterinary Medical Association. In comparison, specialists can fit into a good-sized college basketball arena. That’s about 15,000 active board-certified diplomates across all disciplines.
Thriving Independently
The debate over the superiority of the specialist versus the generalist has raged for generations and seems silly to me. One need only look to nature for examples of specialists and generalists. The raccoon, an omnivore, is a generalist adapted to almost any environment and will eat almost everything. Conversely, the koala consumes only eucalyptus leaves and lives in a very specific geographic range. Is one better than the other? No, and the same goes for specialists and general practitioners. Both are critical in delivering the best pet care.
The path to becoming a generalist (whether one is a veterinarian or a credentialed veterinary technician) is well known. I’m encouraged to see the University of Arizona and other new veterinary schools moving to three-year programs, as well as the growing number of online technician degrees. Let’s remove the barriers to entering our profession wherever we can.
Could we develop alternative specialty paths? A challenge for veterinarians who might aspire to become a specialist several years after graduation is the difficulty of the traditional path of internships, residencies and board certification. Returning to school, forgoing income and balancing family obligations are significant barriers for new graduates and seasoned practitioners.
It seems to me the desire and need exist for new specialty paths. I’ll leave it to others, better versed in the specialty world than I, to solve that one.
But I digress. Individuals developing the emerging middle share the traits of both specialists and generalists. Enhanced with a particular area of focus, they possess the core skills of generalists. This approach helps individuals adapt to our ever-changing profession, allowing them to pivot in their careers, remain fresh, stay curious and continue as lifelong learners.
As the world evolves, those in the emerging middle will be ready and excited to shift with it. I’m fired up to see the innovative solutions emerging between specialty and general practice, allowing for better access to care, additional career paths and more consumer choice.
Specialists are important. We couldn’t have gone to the moon without them. Generalists are critical, too. They keep the wheels turning here on Earth. Stay tuned and open to where those in the emerging middle take us. There is space for everyone. The future is bright!
DID YOU KNOW?
The American Board of Veterinary Practitioners provisionally recognized fish practice as a specialty in March 2023.