A change once viewed with suspicion, the rise of referral practices and the creation of veterinary communities is rapidly
gaining acceptance. Craig Woloshyn, DVM, owner of Sun Dog Veterinary Consulting, thinks the referral practice "is probably
the best thing to happen to our profession in the past 15 years." Link Welborn, DVM, DABVP, who worked on the American Animal
Hospital Association (AAHA) accredited referral practice task force and served as AAHA president from 2003 to 2004, thinks
both primary care veterinarians and specialists genuinely appreciate the medical benefits of joining forces.
The road to transition has not always been smooth
Neil Shaw, DVM, DACVIM, is Dr. Welborn's referral partner in Tampa, Fla. Dr. Shaw is the founder of Florida Veterinary Specialists,
a referral practice with 50 veterinarians. They work together often, and both extol the benefits of their collaboration. But
that doesn't mean everyone sees the rise of referral practices the same as these two colleagues.
"The role of the traditional practice is changing dramatically," Dr. Shaw says. "There has been, in recent years, growth in
specialty and referral practices. Some veterinarians, especially in high-quality primary care practices, aren't sure if this
is good or bad for the profession."Dr. Shaw says those who might be reluctant to refer are "denying the obvious." The body of veterinary knowledge is ever expanding,
and referral practices have become an extension of the primary care hospital. As Dr. Woloshyn puts it, "Everybody wins." By
practicing in partnership, primary care veterinarians and specialists provide the best care possible for a pet—enabling the
pet to live a longer and healthier life. And a longer life span translates into several things: it increases the owner-primary
care practitioner bond, nurtures the owner-pet bond, and creates a longer patient-practitioner relationship (which results
in more income for the primary care practice).
Referral practices were unheard of 25 years ago. In those days, most specialists practiced in academia within university veterinary
hospitals. Later, some specialists emerged in large primary care practices in mostly urban communities. While many veterinarians
sent difficult cases to the university, sending clients to another for-profit practice across the street ran against the grain.
Specialty and referral practices emerged for many reasons. Some say specialists tired of practicing in the academic atmosphere.
In recent years, veterinary care has followed in the footsteps of human health care—changing from a one-doctor-fits-all mode
to that of a primary care physician providing overall care and referring patients to specialists when appropriate. "To a large
degree," Dr. Welborn says, "public awareness that different specialties are available made demand for this change in veterinary
practice necessary." Increased awareness (via the Internet age), is only accelerating that change.
The professional relationship between primary care practitioners and specialists is still in transition, Dr. Welborn says.
That's where the 10-person AAHA task force came in.
"Both primary care veterinarians and specialists in local communities have concerns, and sometimes the two parties are not
open to dialogue. The task force filled the void when it developed the guidelines. In the end, it's all about communication
among the parties involved—primary care veterinarians, specialists, their respective practices, and their mutual clients."
The guidelines adopted by AAHA in March 2007 address key points:
- Guidelines on when to refer
- A call for mutual respect between primary care veterinarians and specialists
- Discussion on duplication of diagnostic tests and maintaining good communication.
However, the thorny issue of returning clients to the original practitioner still concerns primary care veterinarians.
Increasingly, Dr. Shaw says, the issue is rendered moot by the organization of specialty practices as freestanding entities.
In his experience, referral practices work best this way because it's difficult for a doctor to effectively be in a room with
a client as a specialist, then walk down the hall into another room to treat long-term clients as the primary care veterinarian.
Playing a dual role doesn't always mesh easily and efficiently. But both the primary care practitioner and the specialist
can develop practices that are stronger, more viable, and consequently, offer the best health care for pets—if they concentrate
on what they do best.
