Specialists: Clients' struggles impact DVMs

Specialists: Clients' struggles impact DVMs

State of the Profession 2009: General practitioners do more diagnostics, in-house services than before
Mar 01, 2009

National Report — Pet owners are shopping for price, veterinarians say, and it's impacting general practice and referrals.

In some instances, general practitioners are treating animals that in the past would have been referred to a specialist. As a result, many specialists are reporting fewer patients.

Dr. Bill Grant II, of the Community Veterinary Hospital in Garden Grove, Calif., and president of the California Veterinary Medical Association (CVMA), says his seven-doctor practice in Orange County has a number of specialists nearby.

Even though he is not board-certified, Grant handles a number of ortho-
pedic surgery cases himself and receives referral orthopedic patients.

He's not alone. Veterinarians today are providing more diagnostics, dentistry, diagnostic imaging and surgery in-house than in previous years, and they plan to expand their services.

According to an exclusive DVM Newsmagazine survey, 65 percent say they are doing more diagnostics, 57 percent are providing more dentistry, 53 percent are providing more diagnostic imaging and 42 percent are providing more surgery.

With the current economy, Grant's practice is seeing an increase in cases that may have otherwise gone to someone who was board-certified, he says.

He attributes the increase to the likely difference in fee structures.

"People are shopping around much more than they used to," he says. "They are calling about fractures and orthopedics now, where they really didn't before. They would just get a referral, or they would know somebody who would suggest a veterinarian and they would just go do that. Now, there is not a day that goes by where we don't get an e-mail or call about cost."

While a number of practices are having difficulties, particularly in Southern California, Grant considers himself fortunate that his practice is still "fairly busy."

"People are making more economic decisions than they used to," he says. "These are probably the worst times I've seen in this state."

With the growing number of specialists, Grant's practice still makes referrals.

More than one-third of veterinarians, or 36 percent, report they refer three to four cases to specialists outside their practices each month, according to the survey. Sixty-two percent say that is consistent with the number of cases referred three years ago.

Orthopedics and ophthalmology are most often referred to a specialist, according to the survey results. Nearly 69 percent of respondents referred orthopedic cases and 68 percent referred ophthalmology patients.

Oncology, neurology, cardiology, ultrasound or diagnostic were the next most-referred cases.

Surgery, internal medicine and dermatology were referred the least, with veterinarians sending just 26 percent of dermatology cases outside the practice.

"Specialist availability is significantly different from when I came out of school and the majority were at the universities," Grant says. "Today, that's not the case. We talk to the specialists all the time. They are willing to help the general practitioners, and the general practitioners call them on cases."

Still, the economy plays a big factor in pet owner decision-making.

"They are coming to us more often and even if we say 'see a specialist,' they are not willing to do that because of the economics," he says.

After talking to a couple of specialists recently, Grant says they reported a significant drop in clients, down 30 percent in some cases.

"There is not a lot of third-party pay in veterinary medicine," he says. "For most clients, this is discretionary income. When they don't have it, it makes it more difficult. So, when Plan A doesn't work, in a lot of practices, ours included, we offer Plan B and Plan C. It's a difficult time for a lot of people right now."

Dr. T.J. Dunn Jr., who has spent the past 10 years working as a relief veterinarian in small-animal clinics in Wisconsin and Florida, says the economy has affected practitioners and specialists across the board.

"General practitioners are not seeing the caseload they used to, and specialist referrals are down as well," he says. "Folks certainly have less to spend."

Still, Dunn, who has spent time in more than 25 veterinary hospitals throughout his career, definitely has seen an increase in specialists and referrals to specialists over the years.

"One big factor is availability," he says. "There are a lot more specialists practicing today. From a geographical standpoint, people don't have to drive as far as they did 15 years ago to find a specialty."

And general practitioners typically are more than willing to make a referral, with only a very small number who don't, he says.