Specialists: Clients' struggles impact DVMs

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.

Significant, not dramatic

Neil Shaw, DVM, Dipl. AVCIM, and chief medical officer of BluePearl Veterinary Partners with locations in Florida, New York City and Kansas City, says the economy has impacted his practices.

"We typically look at cases in two categories — specialty referrals and after-hours emergencies," Shaw says. "In general, I would say the economy has affected referrals more, and they have been affected more in the Northeast. Overall the effect has been significant, but not necessarily dramatic for both specialty referral and emergency."

He doesn't know if that is disproportionate to the number of cases general practitioners are seeing or not.

"What is more significant than the drop in caseload is that owners are less likely to approve an estimate," he says. "Pet owners are having a tough time from an expense standpoint, so they are not coming through our door for emergency and referral."

On the emergency side, Shaw has noticed a slight decrease in cases, but more interesting is that the animals brought in are presenting a little sicker.

"It appears owners are taking longer to take animals to the vet, so when we see them it is a little more dramatic than what we are used to."

Shaw has been in practice since 1996 and the economic conditions are the worst he has seen. More and more resumés are coming in from recent graduates looking for work and he is seeing fewer job advertisements for specialists.

All the while, the number of active board-certified diplomates with the American Veterinary Medical Association's (AVMA) American Board of Veterinary Specialists (ABVS) continues to increase.

As of December 2008, there were 9,305 diplomates, up from 8,885 in 2007 and 8,510 in 2006.

Dr. Kristopher Sharpe, DVM, of Michigan Veterinary Specialists in Grand Rapids, Mich., has an interest in internal medicine and says the demand for specialty services is great.

He sees four to five cases a day, four to five days a week, and those numbers are slowly increasing as the new clinic develops a presence.

The area has never had a specialty veterinary hospital, and it's driving demand, Sharpe says. Despite the costs involved in specialty care, pet owners want to be more involved in the care of their animals.

Shaw agrees. "The market is strong, and I'm optimistic. I believe there will continue to be a strong need for speciality medicine. In a manner of speaking, this is a cleansing process."

While veterinarians told DVM Newsmagazine's survey they plan to expand specialty services, Shaw hasn't seen much growth in what he calls "the hybrid practice" in the past year.

"I saw more general practices expanding into specialty services when times were stronger," he says.

Communication between veterinarians is key to survival, he adds.

"We recognize that 100 percent of our caseload is dependant on referrals," he says.

"For that reason, we do not accept non-referrals. We don't carry vaccines in any of our facilities. We provide continuing education regularly every few weeks for area veterinarians."