Dr. Kremer addresses some common questions about specialists below:

1. What is the difference between my vet and a specialist?
A specialist is a vet who has completed veterinary college and obtained a DVM degree, and then gone on to complete an additional 3-5 years of formal training in a specific field, such as internal medicine, surgery, ophthalmology, etc.  To become board-certified, the vet must complete a 3-5 year program of an internship and residency, and then pass a very rigorous exam process.  


2.  Isn't a specialist really expensive?
Well, it depends on one's perspective.  Yes, specialists often (but not always) charge more for some of the same tests that a regular vet offers.  Why?  There are many reasons.  First, a specialist has usually completed an additional 3-5 years of extra training, and thus has invested more into their education than a regular vet.  In addition, a specialist usually sees fewer patients than a regular veterinary practice because their patients typically have complicated problems that require more time to address.  The equipment and medications that are offered at a specialty clinic are also often more expensive than what is available at a general practice. Finally, and most importantly, a specialist possesses a greater level of expertise in evaluating a problem within their area of specialization, and in then performing and interpreting various tests and procedures - clients will often spend less than what was spent at the regular veterinary office because the specialist is able to identify and target the pet's problem more effectively. 


3. My vet can do an ultrasound (or some other special procedure), so why should I take my pet to a specialist for the same procedure and spend more money there?
A veterinarian does not need to obtain any advanced certification in order to offer any specialized testing, such as ultrasound or endoscopy.  This means any licensed vet can legally perform virtually any of the same procedures and tests that a specialist offers.  However, training and experience play a vital role in knowing when a certain procedure is actually needed, as well as in performing that procedure safely and effectively.  Generally speaking, a specialist  has superior training and much more extensive experience in performing a number of different procedures that are not routinely performed by a general practitioner.  A veterinary internist such as myself will routinely perform a thousand or more ultrasound exams in a year, and probably several hundred endoscopic procedures as well every year, whereas a general practice will in all likelihood perform a fraction of these numbers if they offer these same procedures.  Please read the quote below regarding remote ultrasound...

Quote from "Vet Confidential" by Louise Murray, DVM, copyright 2008, page 107:

Remote Ultrasound
"An increasingly popular method in veterinary medicine is for someone in a practice to perform an ultrasound scan of the abdomen or heart, and then send pictures to a specialist (such as a radiologist, internist, or cardiologist) for interpretation. Although it may be convenient for veterinary practices, my concern with this method is that looking at a picture is not the same as actually performing a scan, particularly depending on the training of the individual and the quality of the images.
To closely examine the liver, for example, a specialist performing a scan will sweep through the whole organ several times, looking for any abnormalities. What happens instead with the remote method is that the specialist ends up the interpreting a few pictures that may or may not include any abnormal areas. The specialist can only interpret the images that are given to her, and often she will feel uncomfortable about informing the practice if images are of poor quality.
If a subtle abnormality such as an enlarged lymph node, localized intestinal thickening, or small lump in an organ is not noted and recorded, the specialist doing the interpretation will have no knowledge of its existence. Imagine if you were thinking of buying a house and could only see photos. If you wanted to know what the living room looked like and someone sent you a picture of just one cornerr, you would have no way of knowing that there was a crack in the plaster in the opposite quarter and a water stain on the ceiling.
I believe this method should be reserved for situations when it is the only option - there is no specialist available to perform the scan. If there is a qualified specialist in the geographic area, the pet owner should be advised of this option."
 

4.  If I must see a specialist, does my pet have some fatal disease?
No!  We see many, many pets with serious but treatable conditions, especially those with chronic illnesses that require ongoing therapy. 

5.  How can my pet have cancer if it has normal blood test results?
This is a very common misperception, and unfortunately it occurs all the time.  There are essentially no lab tests that definitively indicate cancer other than histopathology (biopsies examined by a pathologist).  As I often say, a patient can look great on paper (lab test results) but have major problems on exam.  There is no substitute for an accurate history and thorough exam.

6.  If my pet just needs a procedure, why do I have to come in for an appointment first?
First, let's think of it this way....do you think a physician would schedule YOU for an anesthetic procedure without first meeting you and giving you an exam?  Absolutely not.  There are many reasons for this. You do not want an unnecessary (and probably expensive) procedure performed on your pet if it doesn't need it, right?  You also wouldn't want the wrong procedure performed, right?  A specialist who performs these procedures regularly is going to know when a specific procedure is needed and when it isn't.  I cannot begin to list the number of times a planned procedure has been changed or cancelled after reviewing the pet's medical record and examining the pet.  One of the major benefits to seeing a specialist is the opportunity for a second opinion to be given regarding the pet's problems....before proceeding with further tests.  It is simply not good medical practice, nor is it ethical, to schedule an anesthetic procedure without first examining the patient and its medical record.  

More content coming soon....