DISCUSS: News on Future veterinary schools

[SV88]

My concern with churning out this many new veterinarians is going to be having adequate support staff for them. We already have a huge technician and assistant shortage, staffing is a problem in the majority of clinics, so now we want more veterinarians without addressing the fact that they won't have any staff to support them? This is a gigantic issue in our field, and has been for some time, and my worry is more veterinarians will just make the disparity more apparent. 100% agree with concerns for the for-profit models, the money hungry schools (Chamberlain.... PLEASE DONT. Come on now) and debt the students will go into, and will the long term supply and demand remain the same as now.

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[SV88]

omg how did they know that I chose vet med over human med because of my inherent need to have more time to do housework at the end of the day?!? I didn’t tell anyone that this whole career was really just a smart ploy to let me live out my dreams of vacuuming more!!

Heard they also liked Harrison Butker's commencement speech.

 

[WhtsThFrequency]

I think previously a lot less people got their dogs veterinary care the way they do now. Kind of like how having a kid is very expensive because expectations on quality of life and stuff have shifted. I definitely remember babies raising babies when I was younger, but now that is VERY frowned on. Same with pets. Now, people are expecting to spend for knee surgeries, chemo treatments, eye tests, etc. That 25 years ago were not really seen as necessary for the majority of the pet owning population. That made owning 5 dogs way cheaper. You tossed the grocery store kibble in their bowl and euthanized when they got old or just let them die on their own, no extras. The has definitely changed.

Eh, I disagree somewhat because it's extremely dependent on locale. Sure, in richer/more educated areas of the county, views on these two things have changed. But in areas with low socioeconomic status and/or subpar education (which is a LOT of America) they have not.

Additionally, I'm more interested in not taking the MCAT than avoiding residency. I really think there are better ways of evaluating applicants than a standardized test. Dont know what, but it feels like a failure of immagination at this point. I very much would like to be a neurologist, and that has a more challenging path in vet med than human med. Your human neuro resident isn't going to rock up to the hospital at 9pm to do surgery, because that's a separate field of neurosurgery. Your veterinary neuro resident will though because we don't have the difference.

While I completely agree that the complexity and difficulty of veterinary medicine is often overlooked by the general public, this statement is nonsense. I'll be the biggest defender of our field I can be, but sometimes I do feel like we DVMs slip into having a weird inferiority complex when we start saying things like "our" medicine is somehow more challenging than "their" medicine. Same reason I hate that stupid "real doctors treat more than one species" tagline - I know it's supposed to be cute or something, but really? Take it from someone who teaches at both a DVM and an MD school - it's apples and oranges, and you can't compare one to the other in terms of perceived "difficulty". We are trained for breadth, they are trained for depth.

 

[WhtsThFrequency]

Where are you going to find enough boarded veterinarians to teach at 12 new veterinary schools who do not have a teaching hospital? Make it make sense. Veterinarians are not flocking towards academia when they can make more money in private practice or consulting at a larger company if they want out of a client facing position. The current schools are struggling to retain their own faculty and staff, how do they think this is a good idea? There isn't a small animal veterinary shortage, its a large animal/rural area veterinarian shortage and the majority of students who potentially will go to those schools will end up in small animal and won't solve the issue.

I’m glad somebody said this - this is a major issue. Although there is the benefit of PSLF if you need/want it, and generally good benefits packages….pay in academia is middling, especially for new assistant professors no matter how many specialty certifications or additional degrees you have. Collegiate and clinical prof appointments are often pretty thankless positions too, and students only see the surface of what we have to do - we are all burned out. Badly. All the time. We’re juggling curriculum design, on the floor teaching, clinical performance and patients, having our jobs depend on student evaluations and publications, all our required committees and service, somehow trying to do research in between everything, jumping through flaming hoops for annual reviews, all the while forcing ourselves through the meat grinder of academic politics. This is why retention is in the crapper right now, and new grads aren’t exactly excited to go spend years specializing, and in some cases even more years doing a PhD, and then start at 90k as an assistant professor at the bottom of the totem pole.

I don’t know where they think they are going to find all these new faculty either. I love parts of my job, but there are enough other parts that, after finishing my 10 years of PSLF employment, pure diagnostics is starting to look pretty good (although I would miss teaching - the students are what keep me here for sure.)

 

[WhtsThFrequency]

I get that schools are expensive to run, but I don't think students should be a cash cow. Maybe we can take the money used for college athletics and put it into professional programs? (I think collegiate level athletics is insanely out of hand)

Oh god, I wish. Problem is, athletic profits (if any) are earmarked to go directly back into athletic programs at many institutions due to how university budgets operate. Which can be anything from facilities, marketing, equipment and travel expenses, to propping up all the non-profitable sports (which is basically anything other than football and basketball). Football profits allow the other areas like tennis, swimming, lacrosse, golf, baseball/softball, and all the intramural programs to still exist. I do agree it’s gotten wild though, and I could think of so many other areas that money could go :/

Tuition increases (and class size increases) aren’t just happening because of greed, it’s also due to necessity when it comes to public land grant institutions (and please don’t take this as me defending it - the whole situation makes me livid - just giving context). State funding used to be a huge income stream for public universities, but year after year state funding has been slashed, slashed, and slashed again. Raising tuition was the only way to cover the gap for keeping schools afloat. Is it in excuse? Hell no because this has been a progressive legislative failure. Thats where a lot of the anger should be directed - at state budget offices and the federal programs ahead of them. But it’s an explanation. Of course this doesn’t apply to the private ones charging up the wazoo - that is a whole ‘nother dumpster fire.

 

[EB73674]

Would these positions even be eligible for PSLF if they're at private universities?

 

[BlackCatsRuleTheWorld]

Would these positions even be eligible for PSLF if they're at private universities? Rowan is a private institution in NJ, although to their credit they are setting up a teaching hospital...

most likely yes, majority of universities (even private) are classified as 501c3 nonprofit organizations

 

[Rejected Med_Vet_Students]

Would these positions even be eligible for PSLF if they're at private universities? Rowan is a private institution in NJ, although to their credit they are setting up a teaching hospital...

Do you know how hard it is to set up a teaching hospital? I ask because I don’t understand why some vet schools don’t have one. I am sure that makes the clinical year tough.

 

[JaynaAli]

Do you know how hard it is to set up a teaching hospital? I ask because I don’t understand why some vet schools don’t have one. I am sure that makes the clinical year tough.

Facilities alone are a major initial financial investment, and even the established schools are having difficulty maintaining staffing, because specialists can make significantly more in private practice and not deal with academia bureaucracy. Why would a new school go to that trouble and expense when it’s not required anymore by the AVMA COE to get approval? They can send students off to partner practices and make them someone else’s responsibility. I absolutely think that having a hospital helps further a student’s education and is an important piece of training, but I can absolutely see why schools don’t bother when it’s not a requirement anymore. Saves them a ton of money in annual salaries to staff the hospital and that associated headache, even above the initial facilities investment. Sure, a hospital is going to bring in revenue, but probably not enough to pay for itself and truly be profitable. The issue is, the schools that are distributive don’t seem to be passing those “savings” on to students…the new no-VTH schools are still some of the most expensive, which is where my issue with them lies.

 

[Rejected Med_Vet_Students]

By partner practices, do you mean private vet practices or other schools with teaching hospitals?

 

[JaynaAli]

By partner practices, do you mean private vet practices or other schools with teaching hospitals?

That’s going to vary from school to school. Most of the US based distributive places (such as Western, LMU, etc) seem to mostly send students to private/corporate GP and specialty hospitals not affiliated with any universities. Sometimes students make arrangements for a rotation at another school. Some schools might make arrangements for their students to rotate through another school, similar to how Ross and St. George’s do it…I think Puerto Rico has stated they’re going to have a teaching hospital but also have partnerships with UF, Missouri, Kansas, Michigan, Oregon, and Purdue for their students to rotate there (source: Puerto Rican veterinary school will open this fall), but even with that, there is theoretically a limit on how many spaces a school can support. Meaning I don’t think there’s enough capacity at current vet schools to absorb all the new programs for clinical year so that can’t be an option for everyone.

 

[Rejected Med_Vet_Students]

I agree about there not being enough spaces. I know a school like Ross pays a premium for their student spaces which is passed on to the student with I bet a little surcharge since they are a for profit school. I have been told the AVMA COE limits how many Ross students can go to each school. Also I heard University of Illinois is no longer going to take Ross students.

 

[spayallday]

Rowan is public, not private. They are building a SA teaching hospital and using local partnerships and ambulatory services for large animal, exotics, etc.

 

[battie]

Sure, a hospital is going to bring in revenue, but probably not enough to pay for itself and truly be profitable.

The vast majority of teaching hospitals operate in the red. Back in 2018, my school held a town hall about VTH expansion coming in 2019. Illinois was one of 5 or 7 vet schools with profitable VTH where it paid for itself.

 

[SkiOtter]

Also I heard University of Illinois is no longer going to take Ross students.

Where’d you hear this from? Also only Ross, or all island students in general? I’m nosy

 

[Rejected Med_Vet_Students]

I heard this from Ross students. Are you an island student? If so, what school?

 

[SkiOtter]

I heard this from Ross students. Are you an island student? If so, what school?

I’m not. I’ve already graduated. I went to Illinois, so I was curious.

 

[Benjamin Scalera]

*cries in 1500/mo* but seriously we are the most expensive in town but honestly it's not even that bad (compared to cities). I also thankfully have a decent SA load to help support a nice salary compared to the $3.50/head bangs vaccination and $25 bull castrations. I definately have a significant load of I only have $20 to fix this doc plus the exam fee (if that!). So I get to try and guess what 1 drug I get to give the pet and hope it lives/gets better. (Don't get me wrong I love most of the aspects of my job even the hard $ cases but it can be challenging sometimes).

$51 office visits plus whatever. We are also the only clinic with in house labs and x-rays and US at this time.
TBH Idk how the girl down the street pays her loans. She's a 2023 grad. Their office visit is $30. They do a dental to include extractions for 270-they're giving away time and money! (granted they don't have dental x-ray. we charge for basic dental to include rads, extractions are extra). She just graduated but went home to practice with her dad so I'm sure she had money from before (shes a nontrad student)/her family is helping her.

Salaries are one problem. The on call life is definately another huge factor. Followed by living in BFE. There's alot of reasons TBH. I don't have any solutions that anyone seems to want to take seriously yet/my ideas probably require major govt involvement and lets be honest they don't care enough yet to make it happen.

A lot of these posts are funny to read, Im actually applying to vet school with the ambitions to help the rural/food animal field in any way I can

 

[supershorty]

A lot of these posts are funny to read

What's funny about them?

 

[chacha1652]

I heard this from Ross students. Are you an island student? If so, what school?

You seem to have a lot of info on Ross in general are u a current student/ know a current student?

 

[Rejected Med_Vet_Students]

I know current students. I don’t like how they are not upfront with all the information so I want to get the information out there as much as possible so students can make a good decision. Especially considering the amount of money the students are investing for a chance to become a vet.

 

[chacha1652]

I know current students. I don’t like how they are not upfront with all the information so I want to get the information out there as much as possible so students can make a good decision. Especially considering the amount of money the students are investing for a chance to become a vet.

Wasn’t criticizing was just curious to your connection! I appreciate knowing the information as well

 

[Rejected Med_Vet_Students]

Wasn’t criticizing was just curious to your connection! I appreciate knowing the information as well

No worries. I didn’t take it as you were criticizing me. 😁 The one thing I find interesting is the advisors I have talked to have never been to the island but act like they know about it. They definitely don’t like it when you call them out on it. Lol.

 

[katiemcat]

Do you know how hard it is to set up a teaching hospital? I ask because I don’t understand why some vet schools don’t have one. I am sure that makes the clinical year tough.

Well I’ve been told by multiple faculty our teaching hospital actually loses money so there’s that aspect if that’s true.

 

[TheDogFather]

With respect to finding faculty for the new (and existing) vet schools: a fair number of my instructors were not diplomates and I think they did a pretty good job of teaching the more practical aspects of the trade. The board-certified were far more likely to be the ones perpetuate the "only specialists will be performing this procedure, but you need to be exposed to it as it may come up on your licensing examination" aspects of the curriculum. I don't think instruction provided by experienced but non-boarded instructors would be quite the disaster some might believe it to be.

Regarding attracting and retaining support staff (at least at the GP level): as long as "there is no time in the curriculum" to better teach skills and procedures that might bring in more clinic revenue (TTAs, TPLOs. corneal and conjunctival surgeries,, fracture repair, ultrasound, more in-depth radiographic interpretation, for example) we're going to have a hard time "paying our support staff what they're worth". I think the ceiling to what we can charge for giving shots, squeezing anal sacs, and pushing preventatives and WSAVA approved diets has pretty much been reached.

 

[battie]

With respect to finding faculty for the new (and existing) vet schools: a fair number of my instructors were not diplomates and I think they did a pretty good job of teaching the more practical aspects of the trade. The board-certified were far more likely to be the ones perpetuate the "only specialists will be performing this procedure, but you need to be exposed to it as it may come up on your licensing examination" aspects of the curriculum. I don't think instruction provided by experienced but non-boarded instructors would be quite the disaster some might believe it to be.

Regarding attracting and retaining support staff (at least at the GP level): as long as "there is no time in the curriculum" to better teach skills and procedures that might bring in more clinic revenue (TTAs, TPLOs. corneal and conjunctival surgeries,, fracture repair, ultrasound, more in-depth radiographic interpretation, for example) we're going to have a hard time "paying our support staff what they're worth". I think the ceiling to what we can charge for giving shots, squeezing anal sacs, and pushing preventatives and WSAVA approved diets has pretty much been reached.

The caveat here is that the majority of the schools won't be able to retain the average DVM either. CSU was offering 90k for an ER doctor about a year ago that has clinical and teaching duties. Yeah, no. If I'm moving my family from Denver to FoCo, it's not for 90k.

More over, I don't understand where this perception that specialties say GPs can't do "advanced" procedures is coming from. I see this in VIN but don't actually see this in real life. I was taught the theory of all sorts of procedures from a variety of specialists. I just didn't get the surgical exposure because 1) I didn't go out of my way to get them and 2) COVID clinics really limited exposure in hospital to begin with. Follow that up with the majority of new vet schools following the distribution model, then it's really up in the air what the exposure is.

The vast majority of the specialists at my school emphasized that GPs could do a ton of what they refer. My vet school bestie did a TECA her first week on the job.

 

[MixedAnimals77]

With respect to finding faculty for the new (and existing) vet schools: a fair number of my instructors were not diplomates and I think they did a pretty good job of teaching the more practical aspects of the trade. The board-certified were far more likely to be the ones perpetuate the "only specialists will be performing this procedure, but you need to be exposed to it as it may come up on your licensing examination" aspects of the curriculum. I don't think instruction provided by experienced but non-boarded instructors would be quite the disaster some might believe it to be.

Just echoing bats that my board-certified instructors were awesome, I understand not everyone has the same experiences but I do think having board certified instructors is VERY important. Like sure there's certain things I will never do, but my internal med and many other instructors were great champions of learn this so it's 99% worked up before sending it to us and therefore you might not need to send to us because you can do xyz as a GP. As far as instruction I do think certain aspects NEED to be taught by board certified vets. I guarantee you don't want me teaching radiology, but why teach when they can remote work and make bank ya know. One thing I have noticed through distribtive models is some of those grads lack the ability to keep working things up basically up to the gold standard because they lacked exposure on what CAN be done because they're not getting the exposure to the speciality level like they should be. Not saying other grads don't also have those short falls but I find it more apparent with distributive models and less specialist exposure. I also have found that sometimes those students are more "cavalier" in doing something they probably shouldn't be doing that should have 100% been referral only and have seen the bad outcomes of those because that's how so and so did it at x practice.

The problem with saying experienced but non-boarded is who is defining what experienced means? Like my boss is more experienced than I, but I usually run circles around them regarding complex IM cases but I'm not "experienced" by many standards considering I'm only 2 years out. That's where board certification really sets the standard imo.

Unless we lengthen vet school, students will have to continue to pursue their interests for things like TPLO, TTA, etc outside of the standard curriculum. Just like MDs, they can't learn everything in 4 years, why else do they bascially require internship and residency? Vet med is moving in the same direction-not saying it's good or bad, just fact. I got alot of exposure to ultrasound during school because that was an interest so I still do alot of ultrasound in my daily practice, but I also know my limits and when a patient needs more. There's still alot of opportunities for advanced learning in school if one takes it-I can drive a scope and was doing a few advanced surgeries day 1 due to time I spent in my skills lab, but I chose to develop those skills.

 

[MixedAnimals77]

The caveat here is that the majority of the schools won't be able to retain the average DVM either. CSU was offering 90k for an ER doctor about a year ago that has clinical and teaching duties. Yeah, no. If I'm moving my family from Denver to FoCo, it's not for 90k.

This is crazy to me that their ER doc was posted for that...like I make more in podunk town in mixed GP and my living costs are a fraction of FoCo... Out of curiosity I looked at WSU and their large animal surgery/equine lecturer salary is 80-120k, onco&IM positions were 145-190k and it's cheaper to live in Pullman than FoCo. I hope they increased it when they got 0 applicants to be more on par with their other speciality salaries and even have a chance of attracting and retaining someone in the ER field.

 

[EB73674]

Rowan is public, not private. They are building a SA teaching hospital and using local partnerships and ambulatory services for large animal, exotics, etc.

Learn something new every day, I grew up near campus & my mom got her teaching degree there, I always thought it was private! Will update my post to reflect.

 

[TheDogFather]

Just echoing bats that my board-certified instructors were awesome, I understand not everyone has the same experiences but I do think having board certified instructors is VERY important. Like sure there's certain things I will never do, but my internal med and many other instructors were great champions of learn this so it's 99% worked up before sending it to us and therefore you might not need to send to us because you can do xyz as a GP. As far as instruction I do think certain aspects NEED to be taught by board certified vets. I guarantee you don't want me teaching radiology, but why teach when they can remote work and make bank ya know. One thing I have noticed through distribtive models is some of those grads lack the ability to keep working things up basically up to the gold standard because they lacked exposure on what CAN be done because they're not getting the exposure to the speciality level like they should be. Not saying other grads don't also have those short falls but I find it more apparent with distributive models and less specialist exposure. I also have found that sometimes those students are more "cavalier" in doing something they probably shouldn't be doing that should have 100% been referral only and have seen the bad outcomes of those because that's how so and so did it at x practice.

The problem with saying experienced but non-boarded is who is defining what experienced means? Like my boss is more experienced than I, but I usually run circles around them regarding complex IM cases but I'm not "experienced" by many standards considering I'm only 2 years out. That's where board certification really sets the standard imo.

Unless we lengthen vet school, students will have to continue to pursue their interests for things like TPLO, TTA, etc outside of the standard curriculum. Just like MDs, they can't learn everything in 4 years, why else do they bascially require internship and residency? Vet med is moving in the same direction-not saying it's good or bad, just fact. I got alot of exposure to ultrasound during school because that was an interest so I still do alot of ultrasound in my daily practice, but I also know my limits and when a patient needs more. There's still alot of opportunities for advanced learning in school if one takes it-I can drive a scope and was doing a few advanced surgeries day 1 due to time I spent in my skills lab, but I chose to develop those skills.

Yes, everyone will have different experiences, and maybe in some programs things have changed since I graduated 14 years ago. And yes, in a number of cases board certified instructors can be important. Radiology, with its countless variations on normal and all but infinite very subtle abnormalities is one of them. The same with ultrasound. For that reason, radiology is one of the core skills that should be emphasized for all four years. Not just a year, a rotation, and maybe a handful of FAST examinations. Ditto for surgery. There is plenty of room in four years to teach the TPLO, TTA, and so on. It's just not a priority. Somehow the various organizations such as AO, Viticus Center, the NAVC Institute, Sound, WAVE, Sonopath and so on convey a huge amount of practical information in a matter of days. Yes, I know that none of these programs make one a diplomate overnight. No need to tell me that. No one has to buy what I think, but I believe that 90% of our clients would be better served by more focused training in a few areas--reinforced over four years--than by cramming a bunch of the quickly-forgotten, non-clinical trivia conveyed in most of the "-ologies" and being forced into courses in large animal medicine (or, obviously, vice-versa for the large-animal types). For sure those courses are available post-graduation, but they cost thousands to attend and that leaves out lost clinic revenue during your attendance.

More later. Time to head off to the clinic.

 

[battie]

This is crazy to me that their ER doc was posted for that...like I make more in podunk town in mixed GP and my living costs are a fraction of FoCo... Out of curiosity I looked at WSU and their large animal surgery/equine lecturer salary is 80-120k, onco&IM positions were 145-190k and it's cheaper to live in Pullman than FoCo. I hope they increased it when they got 0 applicants to be more on par with their other speciality salaries and even have a chance of attracting and retaining someone in the ER field.

That was the increased rate, sadly. I saw it last year on the DVM moms Facebook page. The clinician advertising it on the page convinced the school their original amount wasn't adequate. Don't know what happened later.

 

[WhtsThFrequency]

Sounds unfortunately about right. Coming in as an assistant professor with specialty certification AND a PhD I started at about 115k. I know people with my credentials started at vet schools at even lower. Compared to a colleague of mine who went industry started at 160.

 

[KCgophervet]

Sounds unfortunately about right. Coming in as an assistant professor with specialty certification AND a PhD I started at about 115k. I know people with my credentials started at vet schools at even lower. Compared to a colleague of mine who went industry started at 160.

Yep. When I started (residency-trained but not yet boarded) I started at 100K. Passing boards got me a 6% raise. Resident-mate who went into industry started at 140K (pre-boards). Academia is not where to land for high salaries, need to find the silver linings (benefits, PSLF, etc)

 

[SV88]

The caveat here is that the majority of the schools won't be able to retain the average DVM either. CSU was offering 90k for an ER doctor about a year ago that has clinical and teaching duties. Yeah, no. If I'm moving my family from Denver to FoCo, it's not for 90k.

More over, I don't understand where this perception that specialties say GPs can't do "advanced" procedures is coming from. I see this in VIN but don't actually see this in real life. I was taught the theory of all sorts of procedures from a variety of specialists. I just didn't get the surgical exposure because 1) I didn't go out of my way to get them and 2) COVID clinics really limited exposure in hospital to begin with. Follow that up with the majority of new vet schools following the distribution model, then it's really up in the air what the exposure is.

The vast majority of the specialists at my school emphasized that GPs could do a ton of what they refer. My vet school bestie did a TECA her first week on the job.

I think part of the restriction of GPs doing more advanced surgeries is the facility supporting it. You need a hospital that's prepared (think instrumentation, blood in case of transfusion for a TECA, staff for post op care, etc). If you're corporate, you can't spend hours doing a procedure you aren't proficient in if you could do 3 COHATs during that time. You also have to have skilled support staff that can scrub in/assist/not contaminate things, especially for ortho, which creates a learning curve and adds more time to the overall procedure. For example, an average 25kg TPLO I can induce, radiograph, prep, move to the OR and be ready for the surgeon to cut in about 40 minutes without complications (epidural space, lookin' at you). I spent 7 years getting quick, and it could be quicker. If you had seen me when I started prepping TPLOs, that was my shave time alone. So that just slows down the whole conveyor belt of the procedure, plus that added time increases anesthetic risk. It's not that GP staff isn't necessarily capable of learning, it's finding the time to build that into a GP schedule that's already hectic. I think that creates a bottleneck between what a general practice vet and team COULD do, and what they realistically CAN do in the time they're given.

 

[JaynaAli]

I think part of the restriction of GPs doing more advanced surgeries is the facility supporting it. You need a hospital that's prepared (think instrumentation, blood in case of transfusion for a TECA, staff for post op care, etc). If you're corporate, you can't spend hours doing a procedure you aren't proficient in if you could do 3 COHATs during that time. You also have to have skilled support staff that can scrub in/assist/not contaminate things, especially for ortho, which creates a learning curve and adds more time to the overall procedure. For example, an average 25kg TPLO I can induce, radiograph, prep, move to the OR and be ready for the surgeon to cut in about 40 minutes without complications (epidural space, lookin' at you). I spent 7 years getting quick, and it could be quicker. If you had seen me when I started prepping TPLOs, that was my shave time alone. So that just slows down the whole conveyor belt of the procedure, plus that added time increases anesthetic risk. It's not that GP staff isn't necessarily capable of learning, it's finding the time to build that into a GP schedule that's already hectic. I think that creates a bottleneck between what a general practice vet and team COULD do, and what they realistically CAN do in the time they're given.

Eh, I agree and disagree. I do agree with your main point that corporate production demands and profitability do influence what people can and are able/willing to do, but where I disagree is that you need lots of special equipment. Sure, bells and whistles are nice and help efficiency, but not strictly necessary when it really comes down to it. I live in a very rural area and my vet friends here do a lot of “advanced” procedures by themselves out of necessity. I’m sure the splenectomy or amputation would be tons easier with cautery but instead they tie off vessels. The only “blood products” they have on hand is the vets own dog who may get grabbed to donate whole blood after the procedure if desperate. Once as a pre-vet I scrubbed in to pinch off the gut manually because the Doyen forceps were broken but the foreign body couldn’t wait. A dedicated anesthesia is almost a luxury at some practices. My best friend’s clinic is just her and a receptionist every day, though for really complicated stuff the clinic owner DVM also comes in to help. But they do these procedures because there is no emergency clinic within two hours and most people can’t afford referral anyway. So they McGuyver through it (after informed consent), because the only options are try or euthanize. But you’re right that a lot of people are not given time to do these things… it’s easy for practices in urban and suburban areas to just pass the patient down the line and maximize profitability and not do these procedures if they (they meaning both clinic and the vets) don’t want to because they don’t have to. Luckily there are still privately owned clinics that may be more open to it than corporate.

 

[battie]

I think part of the restriction of GPs doing more advanced surgeries is the facility supporting it. You need a hospital that's prepared (think instrumentation, blood in case of transfusion for a TECA, staff for post op care, etc). If you're corporate, you can't spend hours doing a procedure you aren't proficient in if you could do 3 COHATs during that time. You also have to have skilled support staff that can scrub in/assist/not contaminate things, especially for ortho, which creates a learning curve and adds more time to the overall procedure. For example, an average 25kg TPLO I can induce, radiograph, prep, move to the OR and be ready for the surgeon to cut in about 40 minutes without complications (epidural space, lookin' at you). I spent 7 years getting quick, and it could be quicker. If you had seen me when I started prepping TPLOs, that was my shave time alone. So that just slows down the whole conveyor belt of the procedure, plus that added time increases anesthetic risk. It's not that GP staff isn't necessarily capable of learning, it's finding the time to build that into a GP schedule that's already hectic. I think that creates a bottleneck between what a general practice vet and team COULD do, and what they realistically CAN do in the time they're given.

In my area (Denver), there are tons of GPs doing these procedures without issue. Hence why I don't understand this perception that GPs are being purposely taught they shouldn't be doing these procedures. That's just not the reality. I can name several GPs in Denver I refer clients to from my ER if specialty isn't an option (my ER is stand-alone, not attached to a referral center). A TPLO is worth 2.5-3.5x the average COHAT and definitely doesn't take 2.5-3.5x as long with a proficient surgeon and team, which most of these folks are.

Your points have merits. It just so happens that there are a ton of GPs that do these procedures already because they like surgery and put forth the time and money to learn these skills along with their teams.

I'll also add that learning these skills and getting the equipment is definitely sellable to corporate entities. Again, if a TPLO is worth 3.5x what a COHAT is and takes 1.5 COHAT amount of time, it pays for itself eventually. Just like any other CE and equipment expense (ultrasound being a great example)

 

[SV88]

Eh, I agree and disagree. I do agree with your main point that corporate production demands and profitability do influence what people can and are able/willing to do, but where I disagree is that you need lots of special equipment. Sure, bells and whistles are nice and help efficiency, but not strictly necessary when it really comes down to it. I live in a very rural area and my vet friends here do a lot of “advanced” procedures by themselves out of necessity. I’m sure the splenectomy or amputation would be tons easier with cautery but instead they tie off vessels. The only “blood products” they have on hand is the vets own dog who may get grabbed to donate whole blood after the procedure if desperate. Once as a pre-vet I scrubbed in to pinch off the gut manually because the Doyen forceps were broken but the foreign body couldn’t wait. A dedicated anesthesia is almost a luxury at some practices. My best friend’s clinic is just her and a receptionist every day, though for really complicated stuff the clinic owner DVM also comes in to help. But they do these procedures because there is no emergency clinic within two hours and most people can’t afford referral anyway. So they McGuyver through it (after informed consent), because the only options are try or euthanize. But you’re right that a lot of people are not given time to do these things… it’s easy for practices in urban and suburban areas to just pass the patient down the line and maximize profitability and not do these procedures if they (they meaning both clinic and the vets) don’t want to because they don’t have to. Luckily there are still privately owned clinics that may be more open to it than corporate.

I think the rural communities are a different ballgame, and I wish more training was done for veterinary students on what other options you have with procedures or even diagnostics. Yes, it's ideal to have the Doyens and yes it's ideal to have blood, which some GPs can access or will have available. But other practices, including in low income areas of cities, don't have that. My instrumentation comment was more towards orthopedics procedures (TPLOs, TTAs, etc) where you need very specific tools that are costly, nitrogen gas vs power tools, it's still a decent up front cost. And then cost of a range of implants can be giant, for example what if you think you can use a 3.5 regular when you plan, but in reality you need a 3.5 mini TPLO plate?

 

[SV88]

In my area (Denver), there are tons of GPs doing these procedures without issue. Hence why I don't understand this perception that GPs are being purposely taught they shouldn't be doing these procedures. That's just not the reality. I can name several GPs in Denver I refer clients to from my ER if specialty isn't an option (my ER is stand-alone, not attached to a referral center). A TPLO is worth 2.5-3.5x the average COHAT and definitely doesn't take 2.5-3.5x as long with a proficient surgeon and team, which most of these folks are.

Your points have merits. It just so happens that there are a ton of GPs that do these procedures already because they like surgery and put forth the time and money to learn these skills along with their teams.

I'll also add that learning these skills and getting the equipment is definitely sellable to corporate entities. Again, if a TPLO is worth 3.5x what a COHAT is and takes 1.5 COHAT amount of time, it pays for itself eventually. Just like any other CE and equipment expense (ultrasound being a great example)

I'm not saying they're unable to do it. I'm just saying doing procedures like this in GP require more than just the veterinarian's willingness to perform or to learn the procedures. I've worked in various GP settings, some privately owned, and while you have more leeway there with advancing skills it's still a big picture situation. It's not just the DVM, it's the whole team, and if you have a green team it will take longer up front to train them. If you're in a corporation, gooooood luck. I worked at a Banfield once where the DVM got crap from the PM because a dental that ended up as half the mouth needing extractions took all morning and she couldn't see patients. They defined success as pet count, not income or patient care. I think a DVM will have a harder time advancing skills in corporate settings, but honestly if you want to do procedures like that you probably won't seek out a big corporation for long term anyway. It's the same Banfield that she had to put up a strong argument to get hydromorphone, so it might have been a one off (it's the only Banfield I've worked at).

 

[battie]

I'm not saying they're unable to do it. I'm just saying doing procedures like this in GP require more than just the veterinarian's willingness to perform or to learn the procedures. I've worked in various GP settings, some privately owned, and while you have more leeway there with advancing skills it's still a big picture situation. It's not just the DVM, it's the whole team, and if you have a green team it will take longer up front to train them. If you're in a corporation, gooooood luck. I worked at a Banfield once where the DVM got crap from the PM because a dental that ended up as half the mouth needing extractions took all morning and she couldn't see patients. They defined success as pet count, not income or patient care. I think a DVM will have a harder time advancing skills in corporate settings, but honestly if you want to do procedures like that you probably won't seek out a big corporation for long term anyway. It's the same Banfield that she had to put up a strong argument to get hydromorphone, so it might have been a one off (it's the only Banfield I've worked at).

Banfield specifically as a corporate has a very specific model to be profitable while also relatively inexpensive. Folks like NVA and VCA don't function the same and are more hands off in my experience when it comes to day to day functions. Banfield is quite likely the most restricted. Your local and regional management makes all the difference in the world as well. My friend who did a TECA her first week after graduation did so at a NVA hospital.

All but one of the GPs I know doing these procedures are all in VCA, NVA, etc. corporate clinics/hospitals. The private practices in my area are really no worse or better based on my interviews with them. One was my worst offer; 85k in Denver with no benefits and the old doc retiring in 6 months. The new owner was a tech with no business experience whatsoever.

According to a local newspaper (just googled it cause I'm home sick with the stomach flu), 80% of the clinics in the Denver Metro Area are corporate. That number doesn't shock me at all. Nationwide, it's around 10% for GPs and 40% for referral practices, which is lower than I anticipated based on the freak out over the corporatization of vet med. The AVMA article is pretty interesting, actually. Goes into detail on why certain private practices are picked to be purchased. 1.2mil in revenue seems to be the sweet spot.

I agree overall that there are a lot of hurdles to a GP getting started with advanced procedures/diagnostics. I just disagree that corporations are adverse to setting up based on working in corporate hospitals with these set ups.