The scope of general practice has been shrinking for decades. Slowly, quietly and sometimes with just a shrug, we GPs have allowed it to dwindle. Expanding or re-expanding the scope of veterinary practice isn’t just possible, it’s also necessary. Why? Because when we stretch ourselves clinically, we improve access to care, open new opportunities for our teams, strengthen the financial health of our practices and (maybe most importantly) reignite our passion for our work. And let’s not forget that one of the most significant contributors to burnout is a lack of challenge.
What Is the Scope of Practice Anyway?
A quick refresher. The scope of practice is what you’re legally allowed and professionally competent to do. Your state’s legislature defines it in statute, your licensing board sets rules, and your training and experience provide the skills. Licensed DVMs and VMDs are the only individuals who can diagnose, prescribe, prognose and perform surgery. That’s our lane. But under our supervision, with proper training, our teams can do just about everything else.
There’s no single cookie-cutter scope that applies to every GP or every practice. One clinician’s bread-and-butter might be another’s hard pass. That’s OK. Scope is dynamic. It evolves with experience, confidence and continuing education. The real question isn’t what’s allowed but what’s possible.
In Praise of GPs
Full disclosure: I’m biased. I love general practice and always have. GPs are the glue that holds our profession together. GPs are adept at building relationships, making do with less and achieving the maximal result with often limited means. Hippocrates said, “It’s more important to know the patient who has the disease than the disease the patient has.” We’re the ones who get the first call and deal with everything that follows. We see patients from birth to earth. We’re nimble, we adapt, and we make a difference.
Two-thirds of U.S. veterinarians are general practitioners. In human medicine? That number is closer to one-third. And here’s the deal: More primary care means better health outcomes at lower costs. It’s true in people and pets.
I’m not trying to throw shade on my specialist friends. I’ve got immense respect for our colleagues in specialty care. They trained long and hard, and they bring invaluable expertise to the table. I’m grateful for my ability to consult them and refer to them. But it’s fair to ask this: Are GPs sometimes outsourcing cases we can handle ourselves? Several specialists have told me they’d prefer that we not refer less complicated cases. They’re even happy to coach us on how to keep those cases in-house.
Why the Shrinking Scope?
Let’s unpack things. Why has general practice narrowed its focus? First, the rise of specialization. When I graduated last century, we had about 2,000 boarded specialists. Today? North of 17,000. The ratio of specialists to GPs has tightened from about 1-to-20 to 1-to-10. Add to that an explosion in medical knowledge, rising client expectations, a fear of social media and state boards, and a lack of confidence.
We’ve also internalized some often-unhelpful messaging. Many of us were trained at referral teaching hospitals, where the default belief was, well, refer cases to them. Combine that with dwindling mentorship from retiring boomer-era GPs who came of age in a time when GPs, by necessity, did everything. It’s no wonder we’ve backed away from complex cases.
The result? General practitioners are leaning hard into wellness care, preventive care, chronic disease management and first-line diagnoses. These are all worthy and necessary, but they’re not the whole story. We can — and should — do more.
Say Hello to Secondary Care
Between the familiar territory of primary care and the rarified air of tertiary care lies an exciting middle ground: secondary care. Let’s break it down shown in the table below.
Now, here’s the beauty of it all: GPs get first dibs on secondary care! It’s ours to claim and is tailored to our interests, teams, skills and clients. You define what secondary care looks like in your practice. How cool is that?
What’s in Your Column?
If you’re a GP, you don’t need to do it all. But you can do more than you think. Here are a few ideas:
- Surgical cases: Uncomplicated fracture repair, extracapsular cruciate, enucleations, cystotomies, foreign-body removal, gastrotomy, enterotomy, gastropexy, pyometras, BOAS repair
- Internal medicine: Diabetes mellitus management, hypo/hyperthyroidism, chronic kidney disease, IMHA
- Dermatology: Allergy management, chronic otitis
- Ophthalmology: Simple corneal ulcers, cherry eye
- Dentistry: Full-mouth radiographs and extractions, basic periodontal management, complex extractions
- Diagnostic imaging: Abdominal ultrasound, thoracic radiographs
- Other: Behavior, rehabilitation, exotics, urgent care
Where can you start? How about with confidence, continuing education and case selection? Do you want to grow your skill set? Then invest in training and technology for you and your team. Attend that wet lab. Buy the equipment. Shadow a colleague. Start small and scale smart.
Workflows matter, too. Delegation is key. Let your team shine. Strengthen client education. Collaborate with specialists and bring them into your practice whenever possible.
In short, do more sick care and less well care. Rely on your team for well care. Help more pets. Challenge yourself.
Everybody Wins
We all win when we expand the scope of general practice and reclaim secondary care. For example:
- Pets and families gain broader access to quality care, without added costs or referral logistics.
- Teams are empowered to work at the top of their training.
- Practices grow revenue and relevance.
- Clinicians find renewed purpose and professional joy.
We GPs are more capable than we give ourselves credit for. Let’s rise to the top of our training and challenge ourselves. Pets need us, clients trust us, and our teams are ready. Secondary care is our job if we want it.
So, what’s in your secondary care column?
LEARN MORE
Check out the American Animal Hospital Association’s 2025 AAHA Referral Guidelines at bit.ly/4mqWrQW.