Family practice counters specialist expansion

NATIONAL REPORT — Dr. Al Schwartz likens general practice to a dying breed, consumed by a growing number graduates electing tracks in specialty medicine.

The evolution weighed on physicians a half-century ago when general practitioner numbers declined with the burgeoning of medical specialties. Last year, 8,216 veterinary specialists were licensed in the United States. Now armed with human medicine's experiences and nearly 200 like-minded colleagues, the small animal practitioner from California launches the Association for Veterinary Family Practice (AVFP) — the profession's first group geared toward elevating the status of general practice, boosting earning potential and eventually creating a new specialty distinction for the upper echelon of the field.

Gaining recognition of family practice as one of the American Board of Veterinary Specialties' (ABVS) approved specialties is an ultimate goal, Schwartz says, but the process can take more than a decade. Board-certified family practitioners would carry training marks, clinical values and unique practice philosophies setting them apart from general practitioners, he adds.

"Veterinary family practice is an evolution of general practice or primary care," Schwartz says.

Blueprint for success

It's the backbone of veterinary medicine, adds Dr. Mark Russak, assistant clinical professor at Mississippi State University's Animal Health Center. Like Schwartz, Russak aims to save general practice from being left behind by growing force of specialists. While the profession's outpour of general practitioners remains relatively flat, American Veterinary Medical Association (AVMA) reports more than a 10-percent increase in board-certified specialists between 2002 and 2005. Last year, 30 percent of all graduates went on to advanced study, AVMA numbers show.

When it comes to assessing the movement, 1960s human medicine offers a clear analogy, Schwartz says. To combat the shift, physicians created elevated levels of care in general practice, which allowed medical schools to develop residency programs. To date, family practice ranks human medicine's second largest board-certification program, and those who specialize in it report 70-percent higher earnings over general practitioners, he says.

Neglected education

The potential for higher salaries might appeal to practitioners seeking more income, but general practice is being viewed as mundane at the learning level, Russak says. As an educator, he wants students spending more time handling ear infections and stressed clients than working on feline kidney transplants. "Some veterinary schools don't even teach primary care," he says. That paradigm needs to change, he adds.

Where's the money?

"We are just as important as the specialists, if not more important," Russak says. "Yes, some things we do are routine, but we're the gatekeepers; we do all the wellness, sickness and go way beyond that to include grief counseling, client communication and the art of practice. We need students better prepared for that."

Going the specialty route

Developing family practice as a specialty would strengthen the field, Russak says, yet plans are preliminary. At presstime, ABVS had not received a letter or intent from the family practitioners, which is the first step in the recognition process. From there the ABVS reviews the applicant's proposal, mission and looks at the profession's existing specialties for a fit. Veterinary medicine currently supports 20 recognized specialty organizations, each determining education, training and examination requirements for the specialties under its purview.

"It's not real easy to start a new specialty," says Dee Ann Walker, executive director of the American Board of Veterinary Practitioners, which certifies veterinarians in species medicine and ranks the profession's fourth-largest group with 810 members. Family practice isn't a logical fit into ABVP subsets, which plans to soon include distinctions for experts in small exotic mammals, ferrets and reptiles and amphibians, she says.

To gain ABVS recognition, applicants must provide a body of knowledge to draw from for testing. From there, public need is assessed as well as potential membership.

"I have concerns about all these specialties with very low numbers," Walker says. "The last thing you want to do is start a specialty and have it fail."

Introducing AVFP

Family practice as a specialty hasn't had time to crash; its association hasn't even been officially announced. Next month, AVFP founder Dr. Richard Timmins intends to roll out association details during AVMA's annual convention in Honolulu. Sessions will be devoted to veterinary family practice within the meeting's human-animal bond track. Timmins, slated to kick off the day-long program with a speech on veterinary family medicine's evolution, plans to outline social and economic forces that have affected the way primary-care companion animal practitioners do business. Sessions also are scheduled to highlight community interaction, behavior management and communication, he says.

"We'll be discussing the specific skills, knowledge and aptitudes and attitudes that are essential for success in primary-care veterinary medicine," Timmins says. "We're very excited. I really think veterinary family practice is going to grow significantly in the very near future."