What specialities mix well together?

[SnowyRox]

Random thought for a Saturday afternoon.

I'm shadowing a vet who does both general practice & canine rehab. The combo works b/c the referring vets are surgeons who don't care about their clients switching to her for GP work. I remember a thread a while ago cautioning someone against doing nutrition & GP work b/c the referring vets would also be GPs and cautious of losing clients.

So... what else mixes with general practice besides rehab? Or what other interesting combos have you seen or thought of?

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[Lissarae06]

Random thought for a Saturday afternoon.

I'm shadowing a vet who does both general practice & canine rehab. The combo works b/c the referring vets are surgeons who don't care about their clients switching to her for GP work. I remember a thread a while ago cautioning someone against doing nutrition & GP work b/c the referring vets would also be GPs and cautious of losing clients.

So... what else mixes with general practice besides rehab? Or what other interesting combos have you seen or thought of?

I've seen GP and acupuncture work well together.

 

[pooter]

Emergency plays well with just about everything. The after-hours clinic I worked at shared space with an internist and an orthopedic surgeon. The GP's sent patients to us for overnight care, and most of the walk-ins took their animals back to the GP's in the morning. On the other hand, if we had a very sick patient, we referred to the internal med doc and any orthopedic injuries could go straight to the surgeon. It was convenient for us, but sharing space with a reg vet would have worked, too. I don't know how different the dynamic would have been if it had been a 24 hour ER, though.

 

[bbeventer]

I've seen GP and acupuncture work well together.

As well as chiropractics.

 

[krist]

The practice I work for is a large (19 practicing vets) that is gp/24/7 ER, and we have full time IM and a board certified surgeon (mostly ortho stuff) who comes to us once or twice a week to do surgery. It works out really, really well for everyone bc the IM vet gets all of the gp/ER case referrals, and, a lot of our clients see us for the first time on an emergency basis, and we tell them to recheck with us or their reg Dvm but they often end up staying with us.

Plus as a tech it's been awesome because you get to do the easy cute puppies and annuals etc but also fun cases and emergencies and such so it really never gets boring or repetitive.

 

[krist]

I should note that many of the other clinics in the city don't love us bc we end up with lots of business...and they never miss an opportunity to talk bad on us us

 

[bigkittinteef]

The practice I work for is a large (19 practicing vets) that is gp/24/7 ER, and we have full time IM and a board certified surgeon (mostly ortho stuff) who comes to us once or twice a week to do surgery. It works out really, really well for everyone bc the IM vet gets all of the gp/ER case referrals, and, a lot of our clients see us for the first time on an emergency basis, and we tell them to recheck with us or their reg Dvm but they often end up staying with us.

Plus as a tech it's been awesome because you get to do the easy cute puppies and annuals etc but also fun cases and emergencies and such so it really never gets boring or repetitive.

That sounds like a really great mix!

 

[Minnerbelle]

I should note that many of the other clinics in the city don't love us bc we end up with lots of business...and they never miss an opportunity to talk bad on us us

yeah... I'm sure the practice you're at is a fantabulous place to work, but I think it hits the jackpot on what the OP was talking about in terms of specialties that don't go together because it makes the rDVM weary (and I don't blame them).

 

[krist]

yeah... I'm sure the practice you're at is a fantabulous place to work, but I think it hits the jackpot on what the OP was talking about in terms of specialties that don't go together because it makes the rDVM weary (and I don't blame them).

Right, I guess it depends whose perspective you are looking at. We actually get a surprising number of referrals for people who need more advanced diagnostics or 24/7 critical care that a rdvm can't provide. In the perspective of our vets, and the guy who started/owns the practice, it goes very well together. We are insanely busy all the time and are able to provide a very high standard of care and quality medicine. We just got the int med guy 2-3 years ago so that is relatively new, but I love the idea of having a combined gp/er because we only have to refer out a relatively small number of cases who need to see a specialist urgently, at night or on a weekend, or someone other than int Med. Otherwise we hospitalize and they see our int med specialist the next day

 

[krist]

And we are able to see our regular clients as emergencies if they need to and we have all of their records right on file, and often they see a dr who they've seen before. And we are able to provide really good follow up care and case management of pets who do come in on emergency

 

[Minnerbelle]

I'm not saying there's anything wrong with the 24 hr GP/Specialty/ER business model. Like any other practice, their own business interest/practice philosophy is their own prerogative. Like I said, sounds like a great place to work. There are definitely great pluses for your clients to take their pets somewhere like that. In fact, that's the kind of practice my family took all of our pets to.

I was just pointing out that from the perspective of the rDVM (which is what snowyrox was asking about), it doesn't sound like the most harmonious of relationships.

 

[sunshinevet]

I'm not saying there's anything wrong with the 24 hr GP/Specialty/ER business model. Like any other practice, their own business interest/practice philosophy is their own prerogative. Like I said, sounds like a great place to work. There are definitely great pluses for your clients to take their pets somewhere like that. In fact, that's the kind of practice my family took all of our pets to.

I was just pointing out that from the perspective of the rDVM (which is what snowyrox was asking about), it doesn't sound like the most harmonious of relationships.

I agree with this sentiment. There is a similar set up of an afterhours clinic here in perth. The biggest problem they faced was when another ER opened up relatively near them that WASNT a gp. Gp's hence are far more keen to refer to them - and in an emergency, most people call their vet first and then call whatever number they recommend. If you're not that number, you are going to lose a lot of business.

Something else that I've seen happen (and I'm not saying this is the case with your GP/ER) is that a lot of gp/er clinics have an er staffed by gp vets. Not that there is nessercerrily anything wrong with that, but if you want to refer a really complex place, you probably want specialist EMCC vet. Something else rdvms said thats better about an em/specialty practice than a gp/em is that they personally get more teaching out of it - they get to stay involved with their cases and learn from them with guidance from specialists - which they like too.

I think most em clinics are open as something else during the day - our one is a multi-specialty practice with surgery, IM, oncology, derm and imaging. So all complex cases get speciality referral, and more basic cases get referred back so vets dont lose business and clients don't have to spend heaps of money.

Also I know there was some difficulty with the em/gp place near us with them calling themselves an emergency hospital - apparently they're not allowed to because they don't have an EMCC specialist avaliable. So they HAVE to refer to themselves as a 24 hour GP. I think that might be local hair splitting though!

 

[JosephKnechtDVM]

If you cannot call yourself an emergency clinic/hospital unless you have an emergency medicine/critical care specialist, then the specialization has gotten out of hand. Is the next step that we have to have boarded anesthesiologists for every patient we anesthetize, surgeons for every abdomen we open and a dentist to evaluate every diseased tooth. The more specialists we add to every case, the more money it will cost and eventually people will have fewer pets. We cannot totally emulate the "human" medical model without leading to people having fewer pets due to the costs.

 

[sunshinevet]

If you cannot call yourself an emergency clinic/hospital unless you have an emergency medicine/critical care specialist, then the specialization has gotten out of hand. Is the next step that we have to have boarded anesthesiologists for every patient we anesthetize, surgeons for every abdomen we open and a dentist to evaluate every diseased tooth. The more specialists we add to every case, the more money it will cost and eventually people will have fewer pets. We cannot totally emulate the "human" medical model without leading to people having fewer pets due to the costs.

To play devils advocate though - is it really? I mean, GP's that are open during the day deal with emergencies as they come up - they rarely refer those emergencies straight to another clinic, because they are open and can deal with it. (They certainly do refer critical care though.). So if you are a veterinary hospital that is staffed 24/7 by GP vets, how does anything but your extended hours make you more than a GP vet? I don't believe that working extended hours automatically makes you a specialist emergency and critical care facility. I guess what they wanted to avoid was misrepresentation of services to referring vets - if I'm sending an EMCC patient to you, I expect for you to be able to pull out the works, and have superior knowledge and equipment and be able to deal with it better than me. With a "24/7 GP" that's not always what your getting - and I do think there needs to be a distinction - for both clients and owners. If I need a laceration on my pet stitched, I'm happy to go to the 24/7 GP. If my animal needs to be ventilated, I think I know where I'd rather go...

I guess what I'm trying to say is that the difference in name DOES acknowledge the difference in knowledge and skill base - and I think thats perfectly fair.

 

[JosephKnechtDVM]

My point is that in trying to completely emulate human medicine is GP going to end up being just a gatekeeper and providing only "commoditized" services like spay/neuter/and dental cleanings/extractions. EM really is mostly being a great GP who is quick about triaging and diagnosing the common things that occur commonly and end up as emergencies like your GI foreign bodys, pyometras and traumas where you win by rapidly diagnosing, stabilizing (especially ortho injuries), fixing what is fixable (and does not require specialized surgical expertise or equipment ie neurosurgery or complicated orthopedics). It is interesting that the initial diplomates of EM/CC came both from surgery,internal medicine, anesthesia or were ABVP canine/feline diplomates with a broader problem solving basis and didnt have any specialized training being the charter diplomates besides what they learned in their residency.

In the early 90s when EM/CC became a specialty there were already veterinarians who had been doing the job successfully for many years. I really do not think that veterinary medicine needs to become like human medicine where what you are allowed to do is largely determined if you have the credentials. EM is one of the few areas of practice where having a good knowledge of all of the common things that affect the whole animal serves you and your client well and that is the way a lot of veterinarians got into EM because they have both the knowledge and experience and successes to back it up. These people are often just as good and maybe better than some EM/CC diplomates especially if they have more surgical experience which may be hard to get in EM/CC residencies if all surgeries are being done by only boarded surgeons. If you want to require certification, the ABVP certification in canine/feline probably is a better measure of being able to handle the wider range of problems (simple to complex) that are seen in EM.

 

[SnowyRox]

I agree with this sentiment. There is a similar set up of an afterhours clinic here in perth. The biggest problem they faced was when another ER opened up relatively near them that WASNT a gp. Gp's hence are far more keen to refer to them - and in an emergency, most people call their vet first and then call whatever number they recommend. If you're not that number, you are going to lose a lot of business.

Yup, this is exactly the type of situation I was curious about avoiding. And I would be reluctant to go into emergency medicine purely because of the hours anyway.

I think chiropractics & acupuncture would face the same issues as nutrition in terms of getting a GP referral.