In my first year of practice, I was presented with a stray cat with acute traumatic diaphragmatic hernia. The nearest surgical specialist was several hours away, so I had to rely on peer mentorship, a video tutorial, and a surgical textbook to perform the procedure myself. The patient survived and now thrives in his indoor-only home.
Years later, I wonder if I would feel comfortable performing that surgery again. As veterinary medicine becomes increasingly specialized, the role of the general practitioner (GP) continues to evolve. Questions around how surgery fits into general practice range from “What surgeries can be performed in the clinic?” to “Am I less of a clinician if I choose not to perform surgery at all?”. As in many areas of veterinary medicine, the answers to these questions are complex but worth exploring.
Following are some common questions that arise around surgical confidence for general practitioners.
Is performing nonroutine surgeries in general practice acceptable?
With specialists increasingly available, it can be argued that complex soft tissue and orthopedic cases should be referred rather than managed in the clinic.
This question lacks a clear yes or no answer, as the decision to refer a patient can be influenced by many factors, including:
Client factors (eg, finances, ability to travel, interest in having the procedure performed)
Patient factors (eg, comorbidities that may affect safety of anesthesia and surgical recovery)
GP factors (eg, training, skill level, comfort)
Clinic factors (eg, availability of appropriate anesthetic drugs and monitoring equipment, supplies, appropriately trained support staff, scheduling availability [especially during surgical emergencies])
Availability of board-certified specialists (eg, proximity, cost, wait times)
GPs are capable of performing some specialized procedures, but the above factors should be considered and discussed with the client. To reduce liability risks, GPs should educate clients on the pros and cons of surgery performed by the primary GP versus a board-certified specialist, be honest about their level of experience with the procedure, and obtain informed consent.
If a life-saving surgery is required but referral is not an option, a GP should not feel pressured to perform a procedure outside of their training and comfort zone. It may however be appropriate to move forward if the GP feels they have the necessary skills and resources and the client understands the risks, provides informed consent, and has been offered referral to a surgeon experienced with the procedure.
How can I improve and expand my surgical skills?
Training for surgical cases can be obtained through various methods. Most important is surgical mentorship from a specialist or experienced GP in the local area. Surgical textbooks and tutorial videos can be helpful for reviewing or learning procedures but do not replace hands-on learning and guidance from an experienced surgeon. If mentorship is not an option, conferences often offer wet labs and surgical training courses.
It is also important to ensure the clinic is willing to purchase the necessary equipment to perform procedures and to evaluate whether the expected surgical frequency is sufficient to maintain clinical proficiency.
For those new to small animal practice or hoping to improve efficiency with spay and neuter procedures, many high-quality, high-volume spay and neuter clinics offer training programs or may allow shadowing of staff veterinarians.
What if I do not want to perform surgeries?
Some GPs find satisfaction in surgery while others find surgery to be extremely stressful. Deciding not to perform surgeries is absolutely okay. Choosing to focus on medical cases and/or preventive care does not diminish one’s value.
GPs are often characterized as a jack-of-all-trades, but this does not mean one person must be able to do everything. Playing to individual strengths can increase job satisfaction, improve employee retention, and enhance the client experience. Although this concept may be easier in large practices with many GPs, it can be workable in practices of any size.
When discussing clinical responsibilities with a current or future employer, honesty regarding the decision to forgo performing surgical procedures and discussion of how cases needing surgery will be managed—whether via another doctor in the practice, referral, or a traveling surgeon—are needed.
Conclusion
As veterinary medicine continues to evolve, each individual must determine how they want to incorporate surgery into their career. There is no one correct path, which is part of what makes veterinary medicine such a dynamic career