dvm360: To Cut or Not to Cut - A Q&A to help general practitioners build their surgical skills

I firmly believe that general practitioners are an amazing type of veterinarian who often has an untapped pool of clinical potential. One of the great joys of our profession is that it continually asks us to grow and hone our knowledge and skills throughout our careers.

After 16 years in small animal general practice and 4 years as a full-time mentor to early career veterinarians, I have grown my own surgical skills and supported dozens of new grads and clinical students as they’ve worked on building their own surgical repertoire. We all expect general practitioners (GP) to perform spays and neuters, and we all know large dog spays are no joke, but what about all the patients we diagnose with surgical problems? How do we decide which of those patients to cut ourselves, and how do we build up our surgical skills to ensure the best outcomes for our patients?

To explore these questions, I’ve asked 2 of my colleagues to share their perspectives on surgery in general practice. Philippa Pavia, VMD, DACVS-SA, Thrive Pet Healthcare’s vice president of medical field operations, Central Region, and who is passionate about supporting her colleagues in their surgical endeavors. Danling Ye, DVM, a 2021 graduate of the Cornell University College of Veterinary Medicine and currently practices as a small animal GP at Bayview Animal Hospital in Webster, New York, part of the Thrive Pet Healthcare community of hospitals.

Pavia: There are as many answers to this as there are surgeons and GP. My personal feelings are as much about perioperative management as the surgery itself. I have known many extremely skilled surgeons in non-specialty environments, but the limitation on procedure types is often the ability to care for a critical patient. Could I teach an excellent GP surgeon to do a thoracotomy – of course – they likely have much better tissue handling skills than I did as a resident, but do they have an anesthesiologist, critical care specialist, and an overnight licensed veterinary technician (LVT) team in case that dog has re-expansion pulmonary edema or a problem with their chest tube?

The answer also depends on where you are practicing and what access to care looks like. I would have a different perspective on a non-boarded veterinarian doing tibial plateau leveling osteotomies in urban Los Angeles, where there are multiple specialty hospitals and multiple mobile boarded surgeons within a 2-mile radius, compared to a rural town where you must drive 4 hours to get to a specialist.

The most important things are your support network, level of training (not just going to a lab and trying it out on a live patient), and self-knowledge of what you can and can’t handle.

Fish: As a GP who loves surgery, I’ve realized there’s an innate algorithm I think through when I face the opportunity to perform a non-routine surgery. Is referral to a 24-hour specialty center an option and in the patient’s best interest? If yes, that must be part of the conversation with the clients. Have I performed the surgery before? Do I agree that this patient is a good candidate, and that the hospital (facility and team) is equipped to provide good perioperative care? If the answer to any of those questions is no, I start to consider what I can do to set my patient and team up for success. As you mentioned, Pavia, it’s so important to have a means of assessing what you can and can’t handle. Some cases are an immediate hard no because I either don’t have the skill or necessary peri-operative support. And then, for some, I need to learn more, so I dig into my resources. I think it’s imperative that we go through this inner monologue and, even better, have the conversation with a more experienced surgeon (boarded or GP).

Dr. Katie Fish received her undergraduate degree at the University of Buffalo and her Doctor of Veterinary Medicine from Cornell University. She was a small animal general practitioner for 16 years before transitioning to becoming a full-time mentor for Monroe Veterinary Associates in the Rochester, New York area, which later became a Thrive Pet Healthcare partner. There, she was responsible for on-boarding and providing one-on-one medical, surgical and leadership coaching support to new graduates at 18 hospitals. In 2023, Dr. Fish became the Director of Mentorship Programs for Thrive, which includes “Meant to Thrive,” a one-year medical mentorship program that meets doctors where they are, offering a unique, individualized approach that positions each veterinarian for success in the profession they love.

Dr. Philippa Pavia is the Vice President of Medical Operations – Central Group at Thrive Pet Healthcare. She works with senior leadership to cultivate a positive hospital culture, support team growth and development, and ensure exceptional medical care and client experience. A veterinary industry expert, educator, and board-certified surgeon, Dr. Pavia has extensive experience in clinical and leadership roles across various veterinary hospitals. She holds an undergraduate degree in English literature from Yale University and a veterinary degree from the University of Pennsylvania School of Veterinary Medicine. As a Diplomate of the American College of Veterinary Surgeons specializing in small animal surgery, she is dedicated to making veterinary medicine a sustainable career for all hospital team members.

Dr. Danling Ye is an associate veterinarian at Bayview Animal Hospital in Webster, New York, part of Thrive Pet Healthcare’s community of veterinary hospitals. She earned her Doctor of Veterinary Medicine from Cornell University College of Veterinary Medicine after completing a bachelor’s degree in veterinary and biomedical sciences at Pennsylvania State University, where she also minored in French and Francophone Studies. During veterinary school, Dr. Ye gained hands-on experience working at the Tompkins County SPCA and volunteering at the Janet L. Swanson Wildlife Hospital and the Southside Healthy Pet Clinic. She is passionate about preventative care, surgery, and shelter medicine and is committed to providing compassionate care for all her patients.