General practitioners vs. emergency doctors

General practitioners and emergency doctors are in this veterinary health effort together, right? Absolutely. But beneath the shared goals lurk several misunderstandings that can lead to resentment. Let's look at some of the reasons why these doctors of different stripes sometimes don't see eye to eye.

Diagnostic dilemma

General practitioners often think that emergency doctors perform an excessive amount of diagnostic testing. Well, emergency doctors do run more tests and that costs clients money. But the increased testing is necessary.

First, when clients come to the emergency room, they're seeking a quick solution to a serious problem. A general practitioner can stretch out testing for a chronic condition over time, but in the emergency room, these tests must be done all at once to rule out problems as quickly as possible. In addition, state veterinary boards hold emergency doctors to different standards than they do general practitioners. Like emergency physicians at human hospitals, emergency veterinarians are expected to presume the worst to ensure the patient's safety. Emergency doctors need to perform extensive tests to rule out serious medical problems.

On the flip side, some emergency doctors may think a family veterinarian has failed to properly "work up" a patient when testing in the emergency room uncovers a serious health condition. But some of these emergency doctors have never worked in general practice and may not recognize the impracticality—or even the questionable ethics—of recommending extensive diagnostics to every client when it's more likely that an individual patient will respond to basic symptomatic therapy. In a general practice setting, it's appropriate and within standards of care to delay diagnostics in certain stable patients.

Fee feud

Many general practitioners also wonder about the high fees that emergency clinics charge. These family doctors understandably care about their clients and don't want them to be taken advantage of in a time of crisis. General practitioners also face the additional frustration of trying to provide continued medical care after an emergency visit that has quite likely drained clients' financial resources.

But there's no mystery to why emergency room fees are higher. Both general and emergency practices are driven by the average client transaction and the number of clients seen. Because emergency doctors see fewer patients but need to maintain staff on hand around the clock, higher fees are necessary to cover salaries and overhead. Team member and doctor salaries must inevitably be higher for emergency practices to attract skilled staff members willing to work more difficult schedules. Also, in order to meet the challenges related to patients in crisis, specialty and emergency clinics must invest in more expensive equipment and supplies. That raises overhead, too.

We need each other. Without the support of general practitioners, the emergency practice couldn't keep its doors open. Without the support of the emergency practice, the general practitioner would face many sleepless nights, interrupted weekends, and heightened concern over liability and patient supervision. Together we share the privilege, challenge, responsibility, and satisfaction of serving shared clients with a standard of care that neither alone could achieve.

Jim Clark, DVM

Dr. Jim Clark, MBA, owns several emergency and specialty practices in the San Francisco Bay Area. Please send questions or comments to ve@advanstar.com