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Can a DMD become a Vetinarian Dentist?

Discussion in 'Veterinary' started by Tedic, Dec 28, 2015.

  1. Tedic

    Tedic 2+ Year Member

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    I was wondering if a DMD/DDS dentist can practice Veterinary Dentistry? I understand that normally one would go through vet school and a dentistry residency, but this there a way one could go to dental school and do a vet residency?
     
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  3. Ashgirl

    Ashgirl Pokemon Academy c/o 2018! 2+ Year Member

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    As far as I'm aware, you would have to be a fully licensed vet (aka a DVM through 4 years of vet school) in order to pursue a dental residency in vet med. I mean it could possible be a DDS/DMD and a DVM and then a residency.... but most people wouldn't pursue that due to the ridiculous amount of school/debt involved, not to mention at the end of the day most people that I've heard of with dual degrees (DVM and a MD), normally choose to work in one of the fields, not both.
     
  4. DVMDream

    DVMDream Don't disturb the snowflakes Veterinarian 7+ Year Member

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    No.

    You would need to be a fully licensed vet. Dental care on animals does not and is not equal to dental care on humans.
    Also, veterinary dentists can be responsible for anesthetizing animals or they may use a veterinary anesthesiologists. Even if you are not anesthetizing animals, you will need to be aware of veterinary pharmacology and medications prescribed to animals before, during and after dental care.
     
  5. SnozzBerry

    SnozzBerry 5+ Year Member

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    Last edited: Dec 28, 2015
  6. CalliopeDVM

    CalliopeDVM 7+ Year Member

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    You can only do a veterinary residency if you're a already a veterinarian.

    Thinking about this, it's kind of an odd question.......as if asking whether one could practice veterinary ophthamology or neurology by taking a residency after their MD.
     
  7. Minnerbelle

    Minnerbelle Moderator Emeritus 7+ Year Member

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    There are certainly human dentists that help out with zoo animals and maybe even some lab animals (same with surgeons), but as a consultant/expert on case by case basis. You wouldn't be able to have a veterinary dental practice.

    every animal dental patient has to undergo full general anesthesia (prolonged multiple hours long anesthesia in many cases), and you would be responsible for that. Many cases referred to dentists are referred due to high anesthetic risk on top of difficulty of dental procedure.
     
  8. Tedic

    Tedic 2+ Year Member

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    http://www.dailymail.co.uk/news/article-2341563/The-dentist-travels-world-fix-ANIMALS-teeth--deadly-hippos-adorable-little-hedgehog.html

    It's not a silly question. This article sparked my curiosity. Dr Gerhard Steenkamp is a "a trained dentist and maxillofacial surgeon."
     
  9. Minnerbelle

    Minnerbelle Moderator Emeritus 7+ Year Member

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    He's a trained "veterinary" dentist and maxillofacial surgeon. He was a veterinarian first who went in for advanced veterinary dentistry training.

    http://www.vetdentsa.co.za/Dr-Gerhard-Steenkamp.html
     
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  10. CalliopeDVM

    CalliopeDVM 7+ Year Member

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    "Silly" isn't really what I meant -- I meant "odd" in the sense that it looked like you saw little difference between human and animal dental care, which made me wonder if you also saw little difference between human and animal medical care. As Minnerbelle said, he is a veterinarian from South Africa who took specialty training in the UK ("Gerhard qualified as a veterinarian from Onderstepoort in 1994. He then pursued his special interest in dentistry and maxillofacial surgery in the UK, where he attended the inaugural course in Veterinary Dentistry at the European School for Advanced Veterinary Studies.")
     
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  11. rdc

    rdc Veterinarian 10+ Year Member

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    The differences in the actual practice of 'dentistry' between small animals and humans are minimal. Note I said 'small animals'; large animals and exotic species are a completely different scenario, so much so that equine dentistry is its own subspecialty within the AVDC. The pathology animals get is somewhat different than that of humans, but the technical/surgical skills to treat many of the pathologies are very similar. The principles of treatment of periodontal disease, endodontic disease, restorations etc. is the same in both humans and animals.

    The big difference between human dentists and veterinary dentists is that veterinary dentists are more akin to human oral and maxillofacial surgeons in our scope of practice. I would say that primary dentistry only accounts for 40% of our caseload. The remaining caseload is comprised of oral tumors, developmental conditions (cleft palates etc), maxillofacial trauma, salivary gland diseases (sialoceles etc), among other conditions. To treat those, you need an intimate knowledge of veterinary anatomy. Further, human dental GPs do not receive the necessary surgical training to be able to perform any of these major operations.

    Finally, as many others have said, you need to be able to treat the whole patient... which means that you need to be able to manage all the co-morbidities that come with many of the patients we see.

    The AVDC (the college that is responsible for certifying dental specialists within veterinary medicine) used to grant some credit to DMD's who had gone and done a DVM and wanted to specialize in veterinary dentistry; the alternate training pathway with the AVDC has since been removed and all DVMs who want to specialize in veterinary dentistry must go through a residency program.
     
  12. Minnerbelle

    Minnerbelle Moderator Emeritus 7+ Year Member

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    I'm pretty sure my regular dentist would faint if she saw an x-Ray for a broken mandibular canine in a Great Dane or a mandibular canine of a 5 lb chihuahua with almost no jaw bone left and was told she has to extract it. My endodontist might be intrigued. He did tell me he did a root canal in a tiger once.
     
  13. cowgirla

    cowgirla Oklahoma 2014 Veterinarian 7+ Year Member

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    I faint at those too. Hate hate hate canine extractions.
     
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  14. CalliopeDVM

    CalliopeDVM 7+ Year Member

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    LOL - me too.
     
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  15. Minnerbelle

    Minnerbelle Moderator Emeritus 7+ Year Member

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    The last couple vet dentists I spoke to said they hate hate hate hate canine extractions (especially mandibular) as well and will push for root canal if at all possible.
     
  16. Minnerbelle

    Minnerbelle Moderator Emeritus 7+ Year Member

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    It's actually pretty amazing and scary what is expected of veterinarians when it comes to dentistry (especially with how little mandatory formal training we receive in it). Explains why many dentals being performed are bordering malpractice in terms of the quality of dental care provided. Just anesthesia alone for dental patients is a huge feat in itself to do safely... especially for the hospitals that don't have proper equipment to monitor blood pressures and safe warming devices.

    How common are pathologic and/or iatrogenic jaw fractures in people? And how often during 'routine' extractions do regular human dentists need to really perform serious oral surgery? My understanding is that even for wisdom teeth, if they need to be surgically extracted they tend to get turfed away to an oral surgeon.
     
  17. rdc

    rdc Veterinarian 10+ Year Member

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    You highlight a systemic problem with veterinary medical education; it illustrates why being a good GP is so difficult to do.

    The problem with dentistry is that so many GPs view the service as lucrative, and therefore are reluctant to refer these cases to a specialist. A 4 hour periodontal treatment with extractions is likely a money losing venture in general practice, as there's no way to charge appropriately for your time and the complexity of the procedure. Furthermore, there are so many vets out there that are not equipped (i.e. They don't have the capacity, or simply don't take, dental radiographs routinely) that your comment about malpractice is unfortunately true.

    Iatrogenic mandibular fractures are not acceptable complications of extracting teeth, and it unfortunately happens with some degree of regularity. We get a number of these cases referred every year, and unfortunately most of them come with no preoperative imaging. It's difficult to defend those vets actions to clients, and most of those clients are understandably upset.

    A huge part of our speciality is centered around educating students and practicing GPs on how to recognize, diagnose and treat periodontitis. It's probably one of the most challenging skills to master in practice, and as you said, is often done very poorly.
     
  18. Minnerbelle

    Minnerbelle Moderator Emeritus 7+ Year Member

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    Oh I totally agree with you. I lose money on all my dentals (8-10 procedures/month). I am at negative production every week on my surgery days because we don't charge appropriately for dentals. But I do them because I believe strongly in the importance of good dentistry, and I put 120% of myself in every dental case and do as much as I safely can to the best of my abilities no matter how little money I make on them (pricing is out of my hands, but quality of care I provide is not).

    I spend probably 25% of my free time outside of work reading up on dentistry, and learning from other dental savvy people. I do as much dental CE as I can afford even if it means paying out of pocket. I even spent a day observing at a dental practice to get information on what tools I'm missing that I should have as well as to see the flow in procedures from set up to equipment care to compare to the procedural flow at my hospital to make improvements.

    I do full mouths on all dental patients and all post-extraction sites. When I first started, we only had a diptank for dental rads and my techs were not comfortable taking them. So I taught them and made them do full mouths on a majority of patients even without digital until our digital unit arrived. Now it's standard of care to do the full mouth rads in my practice and my techs are very efficient with them.

    I talk to each owner about the procedure in depth ahead of time and tell them that I might not be able to finish in one procedure (and they can actually have it finished at a later date for super cheap), that if there is way too much compromise and I don't feel comfortable after taking rads, I may have to refer for some teeth due to risk of jaw fracture. I ask owners if for canines or carnassials if problems are found that may be amenable for endodontic treatment, if they will go for that. I go over all rads with the owners and explain why we did what we did. There are certainly cases where I push my limits and kind of regret it when I'm struggling mid-procedure (I'm pretty aware of what I'm capable and incapable of), and luckily have not had a poor outcome. I know it is absolutely below standard of care to break the jaw during a procedure (and the PLIT newsletter from this summer reinforces this), but it IS a risk with many of our patients. I've never heard of a person worrying about such a complication from dental extractions.

    If I break a root, I almost always get it out. There was one case where I had a horrible Kitty mouth with resorptive lesions where i just could not (sorta resorbing but parts of periodontal ligament space definitely present). Owners couldn't afford referral, and I just had to be upfront with them about the retained roots and the problems that may result from them. I lost so much sleep over that one, and I felt awful.

    I feel like I do everything I possibly can to do right by my dental patients, and I truly believe that my quality of dental care is above par compared to many of the practices around me, which I'm proud of as a recent grad. And I am as passionate as can be about dentistry.

    But there are so many things that can go wrong, and I'm sure I could be doing better. That is quite unnerving to me. My dentals take way more skill, knowledge, and adaptability/ability to work on the fly than any other surgical procedure I do. I feel like it's a ticking time bomb before some complication happens mid-procedure that I personally cannot address, and that is scary. I'm waiting for the day I inadvertently shove a root tip in the mandibular canal and can't get it or something like that. The resulting trip to the dentist and the costs/stresses associated with it is a recipe ripe for a lawsuit/board complaint. All I can keep doing is to continuing to learn as much as I can and doing the best I can for each case... and pray.

    But GPs are stuck between a rock and a hard place. The reason why the horrible mouths (that arguably should be referred) come to us is because they couldn't afford years of recommended routine dentistry until it became an emergency. Just as I wouldn't plate a fracture myself and refer that, there are certain things I know I shouldn't attempt in dentistry. But for fractures that can't afford referral, amputation is usually an option. For dentistry, sometimes it comes down to me trying, patient continuing to suffer horribly, or euthanasia. It can be really rough. No matter how much "informed consent" I try to get, we all know how ugly things can get with complications. I hate the anxiety that comes with many dental cases. And even for more routine things, clients expect that their GP can provide dental services at a "reasonable" price. That price is always going to be lower than my services are worth at the level I am performing them. I won't lower my standard of care. But I don't want to price myself outside of being able to provide dentistry for my patients. As their primary care doctor, I need to be able to provide their care. Some people will argue that 20% of your clients generate 80% of your revenue, and so you offer the best and be okay if 80% of your clients decline. I'm not okay with that approach. Dentistry is a huge dilemma in most GP hospitals.
     
  19. Kpowell14

    Kpowell14 Mizzou c/o 2017 5+ Year Member

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    Hey @rdc I noticed you are a resident, are you a Dental resident? Just curious because I am very interested in pursuing veterinary dentistry as a specialty and would love to talk to you if you are on that path! Thanks!
     
  20. rdc

    rdc Veterinarian 10+ Year Member

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    Hey, yes i'm in my last year of my residency; I'm happy to answer any questions!

    You are welcome to PM me and I can give you my email.
     
  21. Kpowell14

    Kpowell14 Mizzou c/o 2017 5+ Year Member

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    Shooting you a PM now!
     
  22. theunraveler

    theunraveler Member 10+ Year Member

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    A friend of mine in vet school upon graduation went to work for a year then went to dental school. Apparently (dont quote me) in Australia if you have a degree in dentistry and a degree in vet medicine, the Fellowship in charge of veterinary dentistry will grant you specialist qualifications. Not sure how true is that since I never really bother to find out.
     
  23. orangecountyvet

    orangecountyvet

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    I actually went to HUMAN DENTAL SCHOOL before becoming a vet. I do have extensive dental knowledge and skill to do restorative composites, root canal, and of course exodontia. And I can tell you, a DMD/DDS should NOT be allowed to practice veterinary dentistry. In dental school you do not learn adequately about managing human diseases, and of course there is no way to learn about animal medicine/surgery/anesthesia without schooling and experience. Sure, DDS can cut teeth, extract, diagnose dental disease, BUT it is beyond their scope to anesthetize, read animals bloodwork, pretreat/manage systemic disease such as chronic renal disease. DDS should go to dental school and then do one year residency/internship with an accredited vet dentist or vet dental program.
     
  24. rdc

    rdc Veterinarian 10+ Year Member

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    Disagree.


    ... A DDS should go to dental school... and then do a complete DVM degree, and a full-time residency in veterinary dentistry and oral surgery, if they want to be a veterinary dentist/oral surgeon.
     
  25. orangecountyvet

    orangecountyvet

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    I meant: DDS should get a DVM degree, THEN do a one year residency in vet dentistry. Currently, even veterinarians don't have to do a 3 year vet dental residency to be specialized . But this is all conjecture as anyone even considering this must be insane.
     
  26. rdc

    rdc Veterinarian 10+ Year Member

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    This is completely incorrect.
     
  27. CalliopeDVM

    CalliopeDVM 7+ Year Member

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    That's pretty misleading - the minimum time for a residency is 30 months (2.5 years) if going full time, but that's the bare minimum. If they go part time, the minimum time is 3 years.
     
  28. rdc

    rdc Veterinarian 10+ Year Member

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    True the AVDC minimum training requirements are 30 months if enrolled as a full-time resident, however all the training programs are 3 years of full-time training. So in essence, you basically have to do a 3 year residency.
     
  29. CalliopeDVM

    CalliopeDVM 7+ Year Member

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    Plus the one year internship before that. A far cry from what orangecountyvet described.
     
  30. orangecountyvet

    orangecountyvet

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    These are from the dental college site:

    http://www.avdc.org/tryit.html

    1. Veterinarians who have successfully completed relevant forms of other extensive, formal, full-time training (e.g. a human dental degree or an approved veterinary surgery or internal medicine residency program, or training that has led to RDH certification) may petition AVDC for partial reduction of the AVDC training program time requirement. These applicants will be required to have an AVDC Diplomate Residency Supervisor and, at a minimum, complete 18 months of AVDC part-time or full time training, including a minimum of 36 weeks of directly or indirectly diplomate-supervised clinical veterinary dental and oral surgery service time, and to complete all other AVDC training program requirements (total case log, MRCL case log, Publications, and Anesthesia, Radiology and Surgery specialty hours [except if the equivalent was included in their previous training program]).


    Personally, I am working up to offer routine endodontics, composite restorations, possibly orthodontics. Good CE and determination goes a long way.

     
  31. CalliopeDVM

    CalliopeDVM 7+ Year Member

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    Yea, so how is petitioning for a partial reduction to a minimum of 18 months the same as doing a one year residency after completing a DVM? And that's hardly "even veterinarians", that's a special subset of some veterinarians with extensive post-DVM education.

    Face it, what you wrote was inaccurate and misleading.
     
  32. rdc

    rdc Veterinarian 10+ Year Member

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    I don't even know where to begin with this, suffice to say that these procedures, IMO, fall outside the scope of general practice.
     
  33. CalliopeDVM

    CalliopeDVM 7+ Year Member

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    I don't believe that certain procedures should be limited only to Specialists -- they should be able to be performed by someone who has the appropriate equipment and skill. A non-Boarded vet can not claim to be a Specialist, but I know several vets who have invested a lot of time and money in learning to do parts of a specialty particularly well (and succeed) - and a few who have been doing it since before becoming Boarded was an option for them.
     
  34. rdc

    rdc Veterinarian 10+ Year Member

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    With few exceptions, most specialists are not going to agree with this.
     
  35. Minnerbelle

    Minnerbelle Moderator Emeritus 7+ Year Member

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    Do you think someone who has a DDS wouldn't be able to do composite restorations? Isn't that like their bread and butter?
     
  36. CalliopeDVM

    CalliopeDVM 7+ Year Member

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    I really don't care.

    I'm a believer in skill over paperwork. I've met people with the certificates and education who are merely good at what they do, and I've met people without certificates and paperwork who are very, very good at what they doing many of the same things.

    Who gets to decide what is acceptable for non-Boarded vets to do, and what's acceptable for only Board-certified vets to do? And how can we assure those decisions are made without bias of personal interest?
     
  37. rdc

    rdc Veterinarian 10+ Year Member

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    Fair point.

    The indications for composite restorations in dogs and cats are basically limited to restoring root canal treated teeth, and basically class I restorations for carious teeth (which occur in approximately 5% of dogs, and don't occur in cats). Additionally, by the time a carious tooth is identified in a dog, its usually non-salvageable.

    But you're right - the technical aspects of a composite restoration are virtually identical.
     
  38. rdc

    rdc Veterinarian 10+ Year Member

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    Well I'm glad you don't care.

    Here's the issue. Who determines the minimal acceptable skill to perform a procedure? For a board certified specialist, its a rigorous extensive training process followed by an extensive examination process, that demonstrates the candidate possesses the minimum skill set to practice as a board certified specialist. Thereby board certification in itself establishes a minimum standard and skill level that the public can expect from the practitioner.

    For a GP? Its a weekend CE certificate and the money to buy the equipment. How is that even remotely equivalent?

    There are some procedures that specialists perform that are reasonable for GPs to also perform. However there are other procedures that are absolutely outside their scope of practice, and should not be attempted by non-specialist veterinarians.

    Having spent many hours fixing what someone thought was within their skill level and training, admittedly, biases my opinion.
     
  39. Minnerbelle

    Minnerbelle Moderator Emeritus 7+ Year Member

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    Actually, you might be able to answer this one for me. Would it be helpful to restore enamel wear? Like the rescue dogs who obviously had cage biting tendencies in their previous life but does not in their current home (obviously provided that the tooth is still viable and otherwise fine)? Will composite restoration help protect that exposed dentin?
     
  40. rdc

    rdc Veterinarian 10+ Year Member

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    Good question.

    Opinions will vary depending on which dentist you speak to.

    My opinion:

    A composite restoration isn't really indicated in situations like this for several reasons. Firstly, the wear to the tooth and the dentin has likely been slow and progressive, thereby allowing the tooth to produce tertiary dentin; if this has happened there should be no dentinal sensitivity. Secondly, composite restoratives are unlikely to withstand the forces placed on these teeth if they continue the behaviour. The other thing you have to consider is to prepare the tooth to receive the restoration, you have to remove even more tooth structure, thereby further weakening the tooth.

    In some circumstances we can fit these teeth with 3/4 onlay crowns (which basically covers the distal aspect of the tooth with the wear) - we uses these crowns in police dogs sometimes. But the crown won't withstand the continued abuse of cage biting either - in these working dogs we advise the officers to place plexiglass in their cruisers so the dogs don't hang off the bars with their 3K gold crowns. I have had enough police dogs pull off their crowns (likely due to handler compliance) that I have moved to placing full veneer crowns on these dogs rather than the 3/4 onlay crown.

    For the average dog with average wear to their canine teeth, I typically don't treat them unless there is a complicated crown fracture, or if there the wear has been so acute that the patient is displaying signs of tooth sensitivity (which in dogs is very difficult to prove).
     
  41. CalliopeDVM

    CalliopeDVM 7+ Year Member

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    (see my answers in red, above)
     
  42. Minnerbelle

    Minnerbelle Moderator Emeritus 7+ Year Member

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    That's interesting. What I had been told previously was that even with tertiary dentin, the porous nature of it made the tooth much more susceptible to disease, so that restoration would be the thing to do. Obviously if the behavior continues, that would be futile. But as you can imagine, in the wellness visit setting in a GP, referring for that tends to be way overkill.

    I always warn people in advance, but nevertheless, I have clients who are disappointed because unlike tartar, these ugly wears remain post dental. That's when I bring up that they could speak to a dentist about it if it bothers them that much... and that's when they decide it doesn't bother them THAT much. But I bet there are people who would love it if it could be done by their GP, if someone like orangecountyvet offered it. People are so vein, they tend to shell out for this type of stuff willingly if they can afford it and it's a posh thing to do. I just didn't know how much of a true indication there was for it.
     
  43. JosephKnechtDVM

    JosephKnechtDVM 7+ Year Member

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    RDC, please understand that you are in veterinary medicine and not human medicine and should not confuse the standards of the two. Human medical licensing requires specialization through residency and board certification . Many states will not license a physician to practice without that board certification. Also liability for medical errors being of much greater importance for people, the tort system for negligence and personal injury also tend to hold physicians and hospitals to the higher standards of specialists for handling cases because of that liability. Interestingly, since veterinary patients are considered as property and not persons, veterinary medicine standards set by boards tend to be less stringent relative to human medical board standards. Rightly or wrongly, the educational standards for graduation assumes all DVMs are ready to practice on all species without the required post MD residency(minimum of three years). Specialists have tended to build barriers over the years by trying to model their professional practice like MDs in a profession educated/trained to tend to all species at the present time. If you don't like it, maybe you should have just become a human dentist/oral surgeon so you would not have to deal with the "poorly" qualified majority of the profession who try very hard to do their best in practicing multiple aspects of veterinary medicine without the benefit of any defined post DVM training program even for "GP".
     
  44. Minnerbelle

    Minnerbelle Moderator Emeritus 7+ Year Member

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    Right or wrong though, I think it's going to take more and more cajones for a non-specialist to take on what many people consider "specialist only" procedures. Sure, you can document that a referral was declined, but if things so south, no waiver in the world will protect you if you are found to be negligent/performing malpractice. And practicing outside the scope of your competency can be judged as malpractice. The worth of the animal itself may be low, but if a botched dental procedure results in a $5000 corrective procedure plus the cost of your procedure you need to comp, etc... it starts to add up quite a bit. All it takes is for the patient to end up at the dentist who tells the client, no GP should be doing this procedure, to get the ball rolling on that. And with expert witnesses being specialists themselves... Things start being stacked against you. I dunno, maybe I'm more fearful of law suits/board complaints than I should be, but the job is stressful enough, I personally don't want to increase my odds of things like this.

    It might be one thing if I practiced in an area without many specialists, but in an area like mine where there are so many specialty hospitals (and even GPs) with multiples of all sorts of specialists, I'd be way too scared to offer things like endodontics, laminectomies, and TPLOs. No matter how good I was at it, I doubt anyone would ever refer anyone to me for these things at least in my area, where we have all sorts of specialists crawling every which way.
     
  45. CalliopeDVM

    CalliopeDVM 7+ Year Member

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    It should continue to be malpractice if one practices outside the scope of his/her competency - my point was just that it should be competency that's judged, not simply whether one is a Specialist or not. I have done relief work in busy cities (with specialist options) and in small communities where the nearest specialist is 4-6, even 8, hours away. The non-specialists I know who are very good at what are often considered specialist procedures either started or still work in more remote areas where referral to a specialist was difficult, if not near-impossible. They didn't simply decide to offer X to their (and nearby patients), they decided to get very good at X, and put a lot of time and energy into it.

    No one has addressed the question of how to decide what actually might be considered a specialist-only procedure (if the profession were to go that way)........tooth extractions? enterotomies? chemotherapy? FHO? How do we decide? Who decides (and why them?)?
     
  46. Minnerbelle

    Minnerbelle Moderator Emeritus 7+ Year Member

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    Well that was kind of my point. It's murky what constitutes whether or not you're practicing outside the scope of your competency. How does a non credentialed person argue that they are competent at what they do, if there's an expert witness who may argue otherwise?
     
  47. Minnerbelle

    Minnerbelle Moderator Emeritus 7+ Year Member

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    There is no good answer... which is why it's such a gray zone. There's no way to make it uniform and it be okay for everyone. Which is exactly why we don't have set standard of care for most things across the board. I'm not sure it should be decided.
     
  48. CalliopeDVM

    CalliopeDVM 7+ Year Member

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    I agree.
     

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