Specialization Versus General Practice: What Graduates Need To Know

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The decision of whether to specialize or go into general practice after graduation is a difficult one. Either path has pros and cons that need to be considered before making a decision that will affect your future in veterinary medicine.

 I was a general practitioner for over 30 years. I spent most of those years in private companion animal practice and the past 7 years in academia. I found my career to be fulfilling, challenging, and never boring. I truly loved almost every minute of every day. That being said, the practice of veterinary medicine is becoming more and more technically advanced. Disappearing are the days when a general practitioner is truly a “jack of all trades.” With the explosion of knowledge and availability of post-DVM training, the capability to deliver the most technically advanced medicine and surgery has become commonplace. There are currently 21 American Veterinary Medical Association (AVMA)–recognized veterinary specialty organizations comprising 40 distinct specialties, according to AVMA’s American Board of Veterinary Specialties (ABVS). More than 10,200 veterinarians have been awarded diplomate status in 1 or more of these specialty organizations.

Today’s young graduates are fortunate to have so many career options available to them, but which option to take is not always clear-cut. The road to specialization can be long and expensive and, with ever-increasing student debt, finances will certainly play a role in any career decision. According to the AVMA 2011 annual salary survey, almost 90% of graduating students have educational debt.1 The mean educational debt at graduation is $142,613, while the mean new graduate starting salary is $66,469. This does not, however, include those who go into postgraduate educational programs. Compare that new graduate general practitioner salary of $66,469 with the mean salary of $29,166 paid to a graduate during an internship in an advanced study program and it is obvious that the cost of obtaining board certification is substantial considering the extra 3 to 5 years it takes to complete the specialty program. The question that begs to be answered is whether it is worth the cost.

Pros and Cons
Let’s put the financial discussion on hold for now and address some other pros and cons of specialization. On the positive side, being a specialist comes with a certain amount of status and respect that is above and beyond being “just a general practitioner.” Most of the role models in veterinary colleges are specialists and students see them take on the toughest cases with great success. Specialists may also write books and lecture nationally and internationally, garnering almost instant credibility and admiration because of their expertise and position in the profession.

Specialty practice is challenging and that is a good thing. Your limits are tested almost daily and because of that you must stay abreast of the most advanced information and techniques. Solving the most complex diagnostic cases or performing advanced surgical procedures keeps one sharp, stimulated, and satisfied. General practitioners experience some of the same inspiring challenges, but as a specialist you are the “doctor’s doctor.”

Specialization is a long educational journey. You will be committing anywhere from 3 to 6 years or more of advanced study after the 7 or 8 you have already put in to get your DVM degree. Questions to ask yourself include: Are you already “burned out” with school? How does your family or partner feel about this commitment? What jobs will be available in your chosen field in the area where you want to live? Can you make a living in your chosen specialty field? All specialties are not equally compensated. Top-end specialists in the most technically challenging disciplines can do very well financially, others not as well.
According to the 2009 AVMA Report on Veterinary Compensation, most specialists surpass their generalist counterparts in mean annual income.2 There is a large initial financial burden, including tuition and associated costs of veterinary school and choosing a lower-paying training position, but the eventual payback can prove to be significant over the long-term. Can you afford to ride out the early downside until you attain that threshold? Ophthalmologists ($215,120), lab animal medicine veterinarians ($175,034), and surgeons ($163,690) topped the 2009 compensation list, while the generalists came in at $111,063. Those with zoological medicine board certifications earned less than generalists ($97,355). Although this survey is almost 3 years old, it stands to reason that the trends are similar today.

Today almost 50% of graduating veterinary students are pursuing advanced education and approximately 37% of those want to go on to specialty training.1 Is the specialty field becoming overcrowded? There is lots of debate on that subject but at this time there are no reliable data to answer that question definitively. When speaking with specialists, they tell you anecdotally that we are heading toward saturation.

The Price of Specializing
A conservative estimate of the price of an internship was calculated in a commentary published in the Journal of the American Veterinary Medical Association.3 The price was calculated based on the lost earning power plus the accrued interest on outstanding student loans and other associated costs, such as relocation for a 1-year position. The lost earning power would be the salary earned in private practice ($66,500) minus the salary earned during the internship ($29,000). The cost difference would be approximately $37,500. Of the graduates in 2011 who reported educational debt, 86.6% had a mean educational debt of $142, 613.1 The accrued interest on that debt would continue to accumulate during the internship year and could be as much as $10,000. That could make the cost of a 1-year veterinary internship approximately $40,000 to $50,000. A second internship, such as a surgical internship, and each year of a residency could cost an additional $40,000 to $50,000 annually. Therefore, the cost of 5 years of postgraduate specialty training could be as high as $200,000 to $250,000 in real dollars. Can you make that up over your career?

Follow Your Passion
You do not have to be board certified to pursue your special interest areas. The amount of quality, hands-on continuing education that is available increases every year. The key is to know your limits and when to refer.

The most important reason to become a specialist is to fulfill your passion and dreams. I truly believe that regardless of the obstacles and challenges that may stand in your way on that journey, you should follow your vision. Pursue your goal with knowledge of the pros and cons and your eyes wide open. You know what they say—if it were easy, everyone would do it. | EVT  

Specialization Versus General Practice-Mark Russak, DVM

References
1. Employment, starting salaries, and educational indebtedness of year-2011 graduates of US veterinary medical colleges. Shepherd AJ. JAVMA 239:953-957, 2011.
2. AVMA report on veterinary compensation. 2009 ed. AVMA—Schaumburg, IL: AVMA, 2009.
3. A call for internship quality control. Geller J, Bartels A, Wilson J, Pion P. JAVMA 240:939-942, 2012.
4. Comparison of long-term financial implications for five veterinary career tracks. Gordon ME, Lloyd, J W, Harris-Kober DL. JAVMA 237:369-375, 2010.