Mind Over Miller: Don't be so quick to specialize

I have never heard anyone suggest what I am about to say, and I realize that it will be offensive to many people: I don't think any doctor, MD or DVM, should be allowed to start a residency in a board-certified specialty unless he or she has a minimum of two years of general practice experience. Why do I say this?

Robert M. Miller, DVM

Two years of general practice would provide the individual with a foundation in medical practice, which will prove invaluable in the years ahead. From personal experience, I have observed "tunnel vision" in specialists. They are superbly qualified in their specialty but sometimes quite inexperienced in general medicine (please feel free to phone me if you disagree).

I have been a witness to some incredible mistakes by specialists because of this "tunnel vision" (for example, a patient with a regional manifestation of a systemic disease may end up with a regional diagnosis, thereby missing out on the basic etiological cause). Most of these mistakes have been made by specialists in human medicine rather than by veterinarians, probably because currently most veterinary patients see a specialist after referral by a general practitioner, whereas there's an increasing tendency in human medicine for a patient to go directly to a specialist.

A required two years of general practice would serve some other needs as well. The recent graduate would probably be attracted to areas that would provide maximum income in order to pay off the enormous debt incurred in acquiring a medical degree. And many such locales are in terrible need of general practitioners. Some of the doctors might actually like the area and enjoy general practice—they might even stay there. A good friend of mine, an MD, was a board-certified surgeon in Beverly Hills. After several years he moved to our rural area and was a family practitioner for the rest of his life. The nation needs more dedicated general practitioners.

Most important, the young doctor in general practice would find out if he or she has really selected an appropriate specialty. For example, I began veterinary school determined to practice large-animal medicine. But in my third year, I fell in love with the entire science of medicine and decided to do mixed-animal medicine. As a senior, I became enamored with the operating room, and had residencies in surgery been available back then, I may have elected to pursue one. And finally, once in practice, I learned that what I loved most was making a diagnosis. Consequently, subjects that I had little enthusiasm for as a student, such as clinical pathology and radiology, became very important to me and remained so for the rest of my career.

So I am not and never will be opposed to residencies. I just hope that, as is happening in human medicine, our profession doesn't end up with a shortage of good general practitioners.

Robert M. Miller, DVM, is an author and a cartoonist, speaker and Veterinary Medicine Practitioner Advisory Board member. His thoughts in "Mind Over Miller" are drawn from 32 years as a mixed-animal practitioner. Visit his website at robertmmiller.com.