When I first read this month's question, I was struck by the fact that I had already addressed virtually the same issue (Can Vet J 1993;34:519–520). Puzzled, I phoned Dr. Tim Blackwell to determine if I was missing something, or if the duplication had been overlooked. Dr. Blackwell informed me that, in fact, new circumstances had emerged that I could not have been aware of a decade ago.
I argued that, when people hire a veterinarian, they are, in part, paying for the veterinarian's expertise in case unusual circumstances arise in the course of a putatively routine procedure. Twenty-five years ago, Dr. Bill Tietz, then dean of the Colorado State University, College of Veterinary Medicine, explained to me that one can quickly teach a high school student how to spay and castrate by rote, but that does not mean that he or she should be allowed to do so on their own, for they have no grasp whatever of physiological principles, principles of anesthesia, asepsis, and so on. If anything unexpected should occur, they are lay people. When one hires a genuine professional, one rightly expects that he or she has such expertise! Thus, I argued in 1993 that no technician should be allowed to perform a procedure that could conceivably go wrong in the absence of direct veterinary supervision.
I still stand by this principle, but certain social factors have changed the playing field. Whereas, in the past, recent graduates could be presumed to be willing to take up the arduous work of doing a routine procedure under bad conditions, such as inclement weather, today's graduates are not eager to do so. This is true across all professions. I know of an oncologist who refused to see an elderly patient suffering from complications of chemotherapy, referring her instead to his nurse, until a veterinarian friend of mine, diagnosing serious anemia in the old lady, threatened the oncologist with legal action! The work ethic has been eroded and, far worse, professional schools do not select for people having a work ethic, choosing to utilize safe (lawsuit avoiding) criteria, such as grade point average, which are “objectively” defensible.
The result is that many young professionals — veterinarians included — do not feel obliged to perform “scut work;” duties that recent graduates would have taken for granted 30 years ago. I hear complaints from practitioners all over North America that, if they mention nights or weekend work in the course of interviewing a recent graduate for a job, he or she will often walk out of the interview. So now the farm animal practitioner is faced with a dilemma; he or she may be over 50, suffer from a bad back, and not be capable or desirous of any longer doing what they have done for 30 years. On the other hand, recent graduates, to whom such work was historically axiomatic, no longer wish to do it. In an effort to escape such a dilemma, increasing numbers of veterinarians are training “pit crews” of technicians to do such jobs.
In my view, this is a poor solution, unless the veterinarian is on site. The bottom line is that the client is paying for professional expertise, and not getting it. Many ranchers already believe that they can do what a veterinarian does much more cheaply and the question under discussion buttresses the mischievous view. So what should be done?
In the short term, in my view, the veterinarian should always be present and directly supervising such technicians. In the long run, veterinary schools must move away from using grades as a sole or dominant criterion for admission and face the hard legal problem of using more subjective criteria. For example, people from a farm background, with a proven willingness to do such work, should be actively recruited. Many will not be “A” students; but many are likely to be “A” practitioners.