CONTRIBUTOR(S): Jennifer Hamlin, Isabelle Desmas-Bazelle,
Second opinions and referrals in veterinary practice
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In veterinary practice, second opinions and referrals are essential tools to ensure your pet receives the best possible care. Understanding the differences between these options and the qualifications of veterinary specialists can help you make informed decisions about your pet's health.
What is a second opinion?
A second opinion involves seeking the views of another primary care veterinarian to confirm a diagnosis, explore alternative treatments, or provide additional insights. This may be done in consultation with your initial primary care veterinarian, but not always. It is beneficial to work with your primary care provider so they can supply all your pet’s records to assist in making a diagnosis. Seeking a second opinion does not mean your primary veterinarian has failed; it is a proactive step to ensure your pet receives the best possible care.
What is a referral?
A referral involves your veterinarian working with you to send your pet to a specialist for advanced diagnostics, procedures, or treatments that may be beyond the scope of your primary veterinarian. You cannot access specialists care from referral practice if you haven’t been referred by a primary care practitioner. Examples include dermatology work-ups and allergy testing, specialist radiotherapy/chemotherapy treatments, advanced imaging, complex surgeries, high-risk anaesthetics, or cardiology consultations. This approach allows the referring veterinarian to provide all your pet’s records, giving the specialist detailed information to help make a comprehensive diagnosis and treatment plan.
What is a specialist?
Veterinary specialists have undergone additional training and certification in specific areas of veterinary medicine. The Royal College of Veterinary Surgeons (RCVS), the American Veterinary Medical Association (AVMA), and the EBVS European veterinary specialist offer certification processes that recognise advanced expertise and specialisation for veterinarians, but there are some differences in their approaches and requirements.
RCVS Certification
To achieve RCVS Specialist status, veterinarians must hold a postgraduate qualification at Diploma level or above, actively contribute to their specialty, gain national and international acclaim, and publish widely in their field. They must also be available for referral by other veterinary colleagues and reapply for recognition every five years to maintain their status. RCVS Specialist status is a mark of high professional standing and expertise in a specific area of veterinary medicine in the UK. It ensures that the veterinarian has undergone rigorous training and has demonstrated a high level of competence and commitment to their specialty. AVMA or EBVS recognised diploma holders can obtain RCVS certification.AVMA Certification
The AVMA's certification process involves completing a residency program, passing comprehensive examinations, and demonstrating expertise in a specific area of veterinary medicine. The certification is granted by AVMA-recognised specialty organisations, such as the American College of Veterinary Internal Medicine (ACVIM) or the American College of Veterinary Surgeons (ACVS). AVMA board certification is considered the gold standard for veterinary specialists in the United States. It signifies that the veterinarian has met the highest standards of education, training, and expertise in their specialty, providing clients with confidence in the quality of care their pets receive.EBVS® European Veterinary Specialist
The EBVS grants European Veterinary Specialist status to veterinarians who have successfully completed European rigorous postgraduate training, education, and examinations through one of the 27 recognized veterinary specialist colleges (eg anesthesia, dermatology, internal medicine, oncology, surgery). EBVS® European Veterinary Specialists must demonstrate their proficiency every 5 years to maintain the status.Veterinary Technician and Nurse Specialists
Veterinary Technician Specialists (VTS) and Veterinary Nurse Specialists (VNS) are also recognised professionals with advanced skills and knowledge in specific areas of veterinary medicine. They undergo additional training and certification to become specialists in fields such as anaesthesia, emergency and critical care, dentistry, and more. These professionals play a crucial role in supporting veterinarians and ensuring high-quality care for patients. In summary, specialist certifications are highly respected and signify a veterinary professional’s commitment to excellence and advanced expertise in their field. While there are some differences in the various qualifications and speciality certification requirements, speciality certifications ensure that veterinary specialists provide the highest standards of care and professionalism in their respective area.Specialist Qualifications
PhD (Doctor of Philosophy): Veterinarians and veterinary nurses/technicians with a PhD contribute significantly to the advancement of veterinary science through research. Their work may lead to new treatments, vaccines, and a deeper understanding of animal health and diseases, directly impacting clinical practices and improving patient outcomes. While a PhD indicates a high level of expertise and research capability, it does not classify a veterinary professional as a board-certified specialist. However, it enhances their ability to contribute to evidence-based practices and innovations in veterinary medicine.- Example: A veterinary professional with a PhD in Veterinary Science might conduct research on infectious diseases affecting livestock, developing new vaccines or treatments to improve animal health and prevent outbreaks.
- Examples: A veterinarian might achieve a Diplomate of the American College of Veterinary Surgeons (DACVS), indicating advanced expertise in performing complex surgical procedures. Another example is a Diplomate of the American College of Veterinary Internal Medicine (DACVIM), specialising in areas such as cardiology, neurology, internal medicine, or oncology.
- Example: A veterinarian might become a Certified Veterinary Pain Practitioner (CVPP), which indicates specialised training in managing and alleviating pain in animals.
When is a referral or second opinion indicated?
Your veterinarian might refer your dog to a specialist if your dog requires specialised treatment or advanced procedures that are not available at the primary practice. If your dog's condition is complex or the diagnosis is unclear, a second opinion can provide additional insights and confirm the diagnosis. If your dog's condition is not improving with the current treatment plan, a second opinion can help explore alternative options. Alternatively, you can seek a second opinion if you have concerns about the diagnosis or treatment plan and would like reassurance and confidence in the care your dog is receiving. It is important to understand that getting a referral or seeking a second opinion does not mean your primary veterinarian has failed. In fact, it is a common practice in veterinary medicine to ensure the best possible care for your pet. Your veterinarian's goal is to provide the highest standard of care, and they will support your decision to seek additional expertise when needed.
How to request a second opinion or referral?
If your veterinarian has not already suggested a referral, requesting a second opinion or referral is a straightforward process. Here are the steps you can follow:
- Talk to your primary veterinarian about your concerns and the reasons for seeking a second opinion or referral. They should facilitate your request and provide the necessary information.
- Ensure that your dog's medical records, including test results and treatment history, are shared with the second-opinion veterinarian or referral specialist.
- Arrange an appointment with the second-opinion veterinarian or referral specialist. Your primary veterinarian may recommend a specific specialist or practice based on your dog's needs.
- After the second opinion or referral consultation, discuss the findings and recommendations with your primary veterinarian to determine the best course of action for your dog's care.
What to expect during a second opinion or referral
During a second opinion or referral consultation, the veterinarian will carefully review your dog's medical history, perform a physical examination, and may recommend additional tests or procedures. They will provide their professional opinion on the diagnosis and treatment options. If an animal has been referred to a specialist veterinarian, then the specialist will report back to the primary referring veterinarian. It is important to communicate openly and ask any questions you may have to fully understand the recommendations.
Conclusion
Second opinions and referrals are valuable resources in veterinary practice, ensuring that your dog receives the best possible care. If you have any concerns about your dog's diagnosis or treatment plan, don't hesitate to discuss them with your veterinarian and consider seeking a second opinion or referral.