Is it true that minimally trained veterinarians perform surgery on beloved pets?
Let me disclose an insider’s secret: your pet -just maybe- is being used to help general veterinarians (also called “primary vet”, or “family vet”) who did not obtain advanced surgical training to learn surgical procedures without your knowledge or permission!
It is far too common for a general veterinarian to take a weekend class and return to work Monday ready to put scalpel on skin. I am frightened by this way too frequent issue and this is why I am reaching out to you with this blog. To understand let’s look at the ways veterinary surgery is currently taught!
How is veterinary surgery taught?
In veterinary school there certainly is surgical training, however many would argue that the training is inadequate. Most new graduates need additional supervision and guidance upon graduation for even what are considered routine procedures like spaying or lump removal.
Every person with a veterinary degree is legally allowed to do any procedure they feel able to do or want to do. The question you should ask yourself is: is your loved furry family member the 1st or the 1000th?
But, how can advanced training that ensures your pet is not the 1st, be acquired?
Well, the traditional manner is through residency training. I completed a small animal internship (University of Missouri) and then a 3-year small animal surgery residency (University of Minnesota), after graduating from veterinary school (Colorado State). I did not take the next step and take the surgery boards.
GVH doctors Wheeler and Rohn both took and passed these surgery Boards and are allowed to call themselves surgery specialists and are thus Diplomates of the American College of Veterinary Surgeons (https://www.acvs.org ) – I am not allowed to use that title. All three of us spent as much time training for surgery as we did training to be a veterinarian: college (2-4 years), veterinary school (4 years), internship/residency/advanced surgical training (4-5 years)! This is at least 4 more years of surgery training than any general veterinarian receives – often in an extremely challenging and stringent fashion. Ask yourself who might thus be better trained to do surgery on your pet?
Also look at the following link: https://www.acvs.org/what-is-a-veterinary-surgeon
How else can surgery training occur?
Often weekend classes are used to teach new and additional procedures. Implant manufacturers frequently put on a course and hire those with advanced training to teach. Think about this model!! A company with a vested interest in selling implants is training veterinarians in a new procedure that generates implant sales for that company. There is little to no regulation to protect your furry best friend. So while some veterinarians spend 4 or more years undergoing stringent advanced training, others spend a weekend learning to do a surgical procedure.
I have taught weekend classes and many who attended had no business putting a scalpel on a live patient to perform that new procedure. For this reason, I no longer am willing to take a paycheck to teach a surgical technique, when it seems to be in fact more about selling implants. I will continue to teach continuing education to other veterinarians, as there is always more to learn. I just feel to be really well versed in a specialty surgery technique, it requires more than a weekend – unless those attending already have advanced training.
How can you protect yourself and your loved one from surgery by an inappropriately trained “surgeon”?
Ask about experience. How did the person doing the procedure get trained? How many of this or similar procedures have they done? As an aside I learned to do TPLOs from Dr. Barkley Slocum, the inventor of the TPLO procedure, personally in 1998, one of the first 50 he had taught. It was a 3 day class with 6 residency and specialty trained surgeons. A TPLO stands for Tibial Plateau Leveling Osteotomy and has many times been shown to provide the best long-term outcome to stabilize a cranial cruciate ligament rupture (called ACL-tear in humans). At GVH we often perform 4-6 TPLOs per week. Dr. Slocum said at the time the learning curve was at least 100 cases. I have had owners go elsewhere because Dr. So and So has done almost 100 cases. Dr. So and So learned on a weekend and is slowly climbing that learning curve, but to many 100 sounds like a lot of cases. At this point I have lost count about how many TPLOs I have done, but am confident in saying several thousand.
What questions should you ask the surgeon prior to committing to surgery?
Long ago I told owners that we were climbing the learning curve but having done a residency I had a bit of a leg up over many. Is the person doing surgery on your pet telling you they are on the learning curve? Have they offered referral to those with more training? Who will address and fix any complications? What complications have they seen? I have heard of some who recommend amputation for anything they can’t fix, including failed TPLO surgery. Better options exist but far too frequently those options are not offered. It is up to the pet owner to ask questions and to advocate for the best possible care for their pet. If you hear from your regular veterinarian that a “surgeon” is coming in to do the surgery, ask the same questions – they may just be a weekend warrior looking to learn on your pet.
Closing comment!
Please don’t assume that all board certified and residency trained surgeons have performed thousands of every kind of surgical procedure- TPLO is an extreme example.
Some surgeries are just not that common, but a board certified or residency trained surgeon is better prepared and equipped to perform less common procedures due to their training, experience and clinical acumen.
And most surgeons are comfortable sharing the number of times they’ve performed a procedure if asked, so don’t be afraid to find out. A confident, competent surgeon will refer you to someone else if they feel that another surgeon can provide the best treatment for your friend.
I am aware that this blog might sound impolite or based on personal issues with other veterinarians. Rest assured, the reason for having written this is that too frequently I have seen animals suffering from inadequately performed surgical procedures by inappropriately trained colleagues, who failed to give owners the complete picture. There is no regulation or advocate for pets other than owners and hence I feel I have to share the inside story. Do yourself and your beloved 4-legged friend the favor and challenge somebody who calls him/herself a “surgeon” using the suggestions above. I am convinced that doing this will result in a much better outcome than what unfortunately seems too often the case.
Please note, the above was edited and is supported by other colleagues of mine, and all are listed below.
Keeping the best interest of your pet in mind as top priority,
Yours truly
Mark Albrecht, DVM, Practice Limited To Surgery
Co-authors:
Doug Rohn, DVM, Diplomate ACVS
Mike Edwards, DVM, MS, Diplomate ACVS
Dirsko von Pfeil, Dr.med.vet, DVM, DACVS, DECVS, DACVSMR