For many of us, working with a veterinary specialist in a referral manner is just part of our day-to-day routine. But for some veterinarians, the thought of working with a specialist can be troublesome due to a bad experience, lost client, unsuccessful outcome, or simply not knowing how to find the right specialist.
Having experience on both sides of the fence – as a referring and referral veterinarian – I can say with confidence that as with any relationship, the key to success is good communication. Working with a specialist should be an enhancement to your practice, not adversarial.
When to Refer
There are many reasons for a referral and each situation is unique. Whether you’re faced with a difficult case or simply to take care to the “next level,” being aware of specialty services and veterinarians in your area can enhance patient care and build client loyalty. Common reasons to refer include:
- A unique or difficult case that requires additional expertise, facilities or equipment
- An inconclusive diagnosis
- An unresolved or worsening medical condition
- An emergency situation
- A need for around-the-clock medical supervision
- Client dissatisfaction or request for second opinion
Dr. Steve Cribley, an equine practitioner based in Castle Rock, Colorado, has always been a proponent of using specialists and referral hospitals.
“As a solo ambulatory practitioner, there are some procedures I don’t have the equipment, expertise or financial capacity to do," said Cribley. "I work with other veterinarians and referral hospitals in my area as colleagues rather than competitors. Working in this manner ensures better service to the horses and clients.”
Specialists will also refer horses to others to ensure the best possible outcome for patients and owners.
“Even as a board-certified surgeon, there are procedures outside my area of expertise. I will refer to find the right care for that horse,” said Karl Frees, DVM, Dipl. ACVS, Wilhite & Frees Equine Hospital in Peculiar, Missouri.
Keys to Success
Communication, communication, communication! Whether you’re a referring or referral veterinarian, it all comes down to open communication and building relationships based on mutual trust and respect. Here are some tips on how to have the best communication in a referral situation:
- Establish a relationship; get to know one another
- Maintain open communication among all parties through all facets of the referral and care process
- All pertinent details of care (e.g., notes, test results, treatments, etc.) up to the point of referral should be provided in a timely manner
- Frequent updates on the status of the case should be shared with the referring veterinarian, and a summary report provided outlining next steps and aftercare
- Take great care in explaining the situation to the client as the case unfolds
- Make every effort to maintain and enhance the relationship the client has with both veterinarians
- Emphasize a team approach to equine care
Cribley said getting to know the veterinarian(s) he’s working with is critical. Referral clinicians must be willing to keep him informed and send that client back.
“I want to understand how they work, and I like to find a referral hospital that has philosophies that are similar to the way I practice,” said Cribley.
A Specialist’s Perspective
Frees says the cornerstones to success are always cooperation and communication.
“There would not be a need for referral if things are going well. By definition, you have a difficult situation, so everyone must be at the top of their game on the communication and cooperation front,” said Frees.
Much of the friction that can occur between referring and referral veterinarians happens because many specialists also offer general care services, a trend that will likely continue.
“The reality is that most equine specialists today cannot afford to operate only as referral centers; and there are more and more equine veterinarians pursuing specialties,” said Frees.
Priorities in any referral case, for both veterinarians, should always be:
- Best possible care and/or outcome for the horse
- Best possible service to the client
- Maintaining the best relationship possible between the two practices/veterinarians
“Regardless of the outcome, I’ve found clients are most satisfied when they realize their primary care veterinarian did everything possible to provide the highest level of care, including knowing when to refer," said Frees. "That is all that can be asked of any veterinarian. The specialist should take every opportunity to help the client realize that.”
Finally, Frees advises any veterinarian to avoid limiting the diagnostic and treatment options given to a client based on perception of the client’s budget.
“Almost every veterinarian has been surprised by the lengths a client will go to in certain circumstances," said Frees. "It is very important that we, as health professionals, present all the options at our disposal in this day and age, and let the client decide what he or she would like to pursue.”
Five Tips for Finding a Great Referral
- Discuss referral centers with other local veterinarians
- Look for an AAEP member
- Consider an AVMA-recognized board certified specialist
- Go in person to meet the referral specialist(s) you will be working with
- Discuss expectations, how the referral process works and the best way to get started
For More Information
The Guidelines for Equine Veterinary Case Referral is a great resource for further advice and guidance on finding and working with a veterinary specialist and is available at aaep.org. In addition, VetSpecialists.com was recently launched by the American College of Veterinary Internal Medicine (ACVIM) and the American College of Veterinary Surgeons (ACVS) as an education and awareness resource for clients.
About the Author
Earl Gaughan, DVM, Dipl. ACVS, is an equine technical services veterinarian with Merck Animal Health. He received his doctorate of veterinary medicine from the University of Georgia and his equine surgery residency at New York State College of Veterinary Medicine, Cornell University. Dr. Gaughan has extensive experience in both the classroom and field. He is a board-certified surgeon and has authored numerous research articles and book chapters.