When I was growing up, my life was dominated by a just a handful of facts that I knew to be universally true, including: Bubbalicious watermelon was the best ever, all the cool kids watched MTV and the vet was interesting. “The vet”—as though there was only one, like Cher, Madonna or “the doctor.”
What makes this odd is that I actually knew several veterinarians for most of my life. I grew up watching Dr. Fletcher develop incredible new surgical procedures for birds on our back patio. But he wasn’t, “the vet.” No, “the vet,” who I eventually knew as Dr. Goldman, was the guy with a clinic in town who would put my favorite barn cats on antibiotics when they got too beat up. He was an affable and intelligent guy. I loved staring endlessly at his posters of dog and cat breeds and dreaming of what type of kitten or puppy I would get first.
Fast forward, and Bubbalicious watermelon is still the best ever, the cool kids are checking out Snapchat and “the vet” is no longer just “the vet.” Veterinary medicine has become incredibly sophisticated in practice, while at the same time, evolving into an incredibly specialized clinical art. While this is interesting, what does it mean to the average pet owner? Not much! Many, if not most, pet owners and animal care professionals have no real understanding of the complexity of veterinary medicine today. Frankly, many veterinarians struggle to understand the multitude of specialists among their colleagues.
Beyond the Doctor of Veterinary Medicine (DVM) that veterinarians receive (except in Pennsylvania where a VMD is conferred), what is all that alphabet soup and does it really matter to the care of an animal?
I am sure many of you have noticed the slow evaporation of the general practitioner from the human health landscape. I do not know anyone who has a true general practitioner anymore, do you? Sure, people have doctors, but they have an Ob/Gyn, a dermatologist, a cardiologist or an internist that handles primary complaints, and acute illnesses may be handled by a walk-in urgent care site. I loathe this current system! I love a good GP. But, I am not so foolish as to fail to recognize the value of specialists when needed. My point is that the human healthcare ecosystem may be suffering from an imbalance of providers—too many specialists and very few general practitioners.
Thank goodness veterinary medicine has not yet lost the GP. “The vet” is incredibly important in the life and relationship of a pet and their owner. A DVM degree indicates a broad swath of knowledge appropriate for seeing primary presentations of animals from all environments. Indeed, a GP veterinarian is well-versed in internal medicine, surgery, preventive medicine, parasitology, pediatrics and more. However, for some cases, owners may desire a more focused approach for their pet. At that time, it is appropriate for “the vet” to make a referral to a specialist. While the referral is not obligatory in the majority of locations, it certainly can enhance the performance of the total care team in most circumstances, and is certainly the structure for care that I recommend, if feasible.
How many specialties and specialists are there in veterinary medicine?
How are the specialties determined and how does “the vet” earn those extra letters?
In the early 1950’s, two specialties were proposed in the AVMA: the American College of Veterinary Pathology and the American Board of Veterinary Public Health. Since that time, many more have been proposed and established. Currently, the AVMA recognizes 22 different specialty organizations, overseeing 41 different specialties with roughly 10% of veterinarians holding board-certification in at least one specialty, and fewer still being board-certified in two or more specialties.
Does the existence of specialties mean that “the vet” is unable or unqualified to perform surgeries, read x-rays, perform anesthesia or manage medical cases themselves? Is a referral to a specialist required? Of course not! GP veterinarians are more than capable of practicing the full scope of veterinary medicine and providing incredible medical care to patients. The specialist is simply another tool that the GP and animal owners can utilize to augment the animal care team in particularly challenging cases, or when an animal owner requests advanced care. Essentially, most specialties that exist in human medicine are available in veterinary medicine, plus a few extras.
Board-certified specialists are called “diplomates” of their board and their status is expressed as either Dipl. or with a “D” followed by the specialty abbreviation. Some examples include:
• Dipl. ACVS or DACVS: Diplomates of the American College of Veterinary Surgeons (ACVS) have typically completed at least a one-year internship and a three-year residency before completing a multi-day board certification exam. Diplomates may be focused on either small animal (SA) or large animal (LA) surgery and the focus is typically expressed as: DACVS (SA) or DACVS (LA).
• Dipl. ACVPM or DACVPM: Diplomates of the American College of Veterinary Prevention (ACVPM) are largely regarded as specialists in infectious disease, epidemiology, food safety, biostatistics, toxins, disaster response and public communication. The ACVPM originated as the American Board of Veterinary Public Health in 1950 and was renamed multiple times in its history, finally settling on ACVPM in 1973. The evolution explains why many refer to the ACVPM as the “public health specialists” and why many consider the Diplomates specialists in One Health. Diplomates must pass a two-day board examination, as well as certify a number of years engaged in public health management at a high level.
• Dipl. ACVIM or DACVIM: Diplomates of the American College of Veterinary Internal Medicine (ACVIM) are further sorted by cardiology, large animal internal medicine, neurology, oncology and small animal internal medicine, which is sometimes indicated in parentheses following the ACVIM abbreviation. Diplomates have completed at least a one-year internship, or equivalent broad-based clinical practice experience, followed by a three-year residency before passing the multi-day board certification exam.
Some veterinarians may list other designations after their DVM, including Certified Veterinary Journalist (CVJ), Certified Veterinary Practice Manager (CVPM), Certified Acupuncturist, Veterinary Orthopedic Manipulation (VOM) and a myriad of others. However, most of these are not recognized veterinary medical specialties and pet owners should be aware that some merely require an annual membership payment.
For a complete list of recognized veterinary specialties and more information on the rigorous programs to obtain board certification, check out the American Board of Veterinary Specialties (https://www.avma.org/education/veterinary-specialties).
After all this, what is universal—no matter the string of letters after the name or how the letters are obtained—is that veterinarians not only care for animals, but seek to protect that most incredible bond between humans and animals by assuring that both can live together without presenting a threat to the health of each other. Care and compassion requires no additional training, degree or letters to be visible to animals and to their owners. +