The need to clarify specialist status in the veterinary profession
‘Confusing’ and ‘opaque’ to the profession and the public should not be words that apply to the structure of veterinary specialisation – yet these terms were used in Philip Lowe's 2009 report, ‘Unlocking Potential – a Report on Veterinary Expertise in Food Animal Production’. This finding acted as a catalyst for the RCVS to set up a working party to examine the structures and routes to veterinary specialisation. The working group is chaired by Kenneth Calman, a former Chief Medical Officer for England and Scotland, and a past-president of the British Medical Association. It has now reported, and its proposals have been put out for consultation to a wide variety of veterinary bodies and organisations, including insurers and animal charities.
Actions to simplify routes to veterinary specialisation
Although there are constraints imposed by the Veterinary Surgeons Act 1966, the working party considers that there are a number of actions that the RCVS could take to simplify and improve the routes to, and structures for, veterinary specialisation. These proposals could have a far-reaching impact, and the RCVS is seeking the views of the veterinary profession and animal owners before the consultation deadline of December 9.
The situation surrounding specialist status is outlined by Professor Calman in his introduction to the working party's report: ‘The RCVS has been running examinations leading to specialist postgraduate diplomas since 1967 and has operated a List of RCVS Recognised Specialists for 20 years,’ he says, adding: ‘The College has also been awarding non-specialist certificate qualifications since the 1980s and a growing number of veterinary surgeons have worked towards these qualifications to develop their clinical expertise. But the public – and even some vets – appear to be confused about what the various qualifications signify, and what level of expertise they can expect from their vet.’
"As the term ‘specialist’ is not a protected title, any registered veterinary surgeon can call themselves a specialist without holding any formal specialist qualification"
The report explains how this confusion has arisen. As well as veterinary surgeons recognised as specialists by the RCVS, and those with non-specialist qualifications, there are also ‘experts by reputation’. These vets may have no additional qualifications after their first veterinary degree and include, for example, some subject association presidents/chairmen, and other well-known subject experts. As the term ‘specialist’ is not a protected title, any registered veterinary surgeon can call themselves a specialist without holding any formal specialist qualification, as long as they do not practise beyond their area of competence, although they must be able to justify their claims if they are not to be guilty of misrepresentation.
As Professor Lowe commented in his report, this has led to the development of two distinct systems, and, ‘given these shortcomings it is perhaps unsurprising that formal veterinary specialisation is so weakly developed, certainly in comparison with professions such as human medicine and dentistry.’ Clients seeking referral may not have the reassurance that someone who claims a specialism is professionally sanctioned to do so, and the variety of systems in place can be confusing to the public, insurers, animal owners and vets.
The working group proposes that more veterinary surgeons should be encouraged to become RCVS-accredited specialists: there are currently only 319 RCVS Recognised Specialists out of some 17,400 veterinary surgeons registered as practising in the UK. There are, however, a further 282 holders of the RCVS fellowship and 379 RCVS diploma holders, and achieving these qualifications is the usual route on to the specialist list. For those holding other high-level qualifications, the working party suggests that, for a limited period, it may be appropriate to bring on to the list individuals who may be practising at specialist level and who have the necessary experience and expertise but who, for various reasons, have not taken a diploma or other equivalent qualification.
"To further encourage vets to apply for specialist status, it is proposed that accredited specialists would also become fellows of the RCVS (FRCVS)"
To further encourage vets to apply for specialist status, it is proposed that accredited specialists would also become fellows of the RCVS (FRCVS) – a status currently only held by those who complete a thesis or examination, or who qualify on the basis of ‘meritorious contributions to learning’. Both diplomas and fellowships would be set at a university doctorate level. The working party has provided an expanded definition of this level, which would guide any credentials committee when determining who could be accredited as a specialist.
Quality assurance integral to the system
Although there is a plethora of routes and qualifications leading to RCVS specialist recognition, simply being able to check that someone is on the list obviates the need for vets and clients to try to further interpret or check a practitioner's qualifications. When accepting a vet on to the list, the RCVS checks that they hold the relevant qualifications at the right level; that they are up to date in their field; that they have continued to contribute to developing the specialism; and that they are passing on their skills and knowledge for the benefit of the profession. To remain on the list, accredited specialists must revalidate every five years, making quality assurance integral to the system. The working party proposes that specialists should continue to be listed, as now, under various species/discipline headings, with any new headings being approved by the RCVS as required, as specialisms develop.
To encourage professional development, a separate, middle tier, below full RCVS Recognised Specialist status, but likewise subject to periodic revalidation, is also proposed. This might be called ‘advanced practitioner’, and would be set at a university Masters level, as is the current RCVS Certificate. A list of accredited advanced practitioners could be maintained under broad species/discipline headings, such as small animal practice, equine practice, farm animal practice or general practice. However, the use of more specific discipline headings, or any implication of specialisation, should be avoided.
Importance of client communication
Communicating clearly, to clients in particular, what specialists are is key to the proposals, and one suggestion is that the term ‘RCVS Recognised Specialist’ should be replaced with the much simpler term ‘specialist’ or ‘veterinary specialist’. The working party points out that using terminology and titles within the new RCVS Code of Professional Conduct that are clear to the public and the profession itself should be important to specialists and non-specialists alike.
Any use of the term ‘specialist’, or any term that implies specialist status or expertise, by someone taking referrals who is not accredited as such by the RCVS would be in breach of the Code. Although there is little prospect of being able to protect the term ‘specialist’ by creating a statutory register, veterinary surgeons should be in no doubt that this would be a matter of professional conduct. More on the consultation can be found here.