The online dictionary “Ask Oxford” defines the word “omnicompetent” as meaning “able to deal with all matters”.  This term is used to describe veterinary surgeons on the very first day that they graduate after 5 or 6 years of training at veterinary school.   This principle is enshrined by the Royal College of Veterinary Surgeons (RCVS) which is the “watchdog” responsible for setting standards in the veterinary profession and acting on behalf of the animal owning public. The principle is that all veterinary surgeons, from the very moment that they graduate are theoretically allowed to perform any act of veterinary surgery.  Imagine the same situation in human medicine; the fresh out of the box, still wet behind the ears, new graduate with no specialist qualification to their name, calling themselves a “Specialist” and performing your hip replacement, or dealing with you when you have a severe kidney infection, heart failure or perhaps cancer.  Matters are complicated further in veterinary medicine by the range of species that veterinary surgeons have to deal with.  Cows suffer their own particular set of medical and surgical problems as do sheep, horses, dogs, cats et cetera.  Each species is as unique as we humans are; our doctors have enough difficulty dealing with one species, let alone being asked to be “omnicompetent” in such a wide range of species.

Of course it is nonsense to actually think that any veterinary surgeon is truly omnicompetent at any stage in their career, certainly not on day one after qualification.  Veterinary surgeons specialise in a similar way to our colleagues in human medicine and surgery and obviously gain experience over time.  The first level of specialisation is usually to focus on a single species or small group of species (for example pet animal practice – often referred to as “small animal” practice).  Within this there is the potential for further specialisation just as there is in human work, including all the disciplines one might expect such as dermatology, cardiology, orthopaedic surgery and so on. 

In human medicine and surgery, of course, these specialists are easily recognised.  The National Health Service has a structured career programme so that if you are seeing a consultant in a given speciality you can be very confident of that consultant’s credentials.   Furthermore, if you are “referred” to someone by your GP, you can be absolutely confident that the referral is to a suitably qualified and expert individual.

Sadly, it is not so easy to recognise suitably qualified and expert specialist veterinary surgeons.  As a result of the principle of omnicompetence, absolutely any veterinary surgeon can claim to be an “expert” a “consultant” or a “specialist” with no constraints whatsoever.  There are no particular qualifications required for a veterinary surgeon to have before he or she can accept referrals from veterinary general practitioners in the same way that a specialist in human medicine or surgery will accept referrals from General Practitioners:  Absolutely any vet can do this, again under the auspices of “omnicompetence”.   

The only constraint in the UK is on the use by a veterinary surgeon of the term “RCVS Recognised Specialist”.  Individuals claiming to be “RCVS Recognised Specialists” must satisfy a number of stringent criteria, including qualification at the highest standards of examination in their speciality, demonstration of suitable experience by working for five years in their speciality before being recognised and undergoing ongoing re-accreditation to show that they are still truly expert in their field.  This all seems well and good, but would you be smart enough to spot the potentially very large difference between an “RCVS Recognised Specialist” and a veterinary surgeon who claims to be a “Specialist”?  The first has to have a proven level of experience and satisfy many stringent criteria that will give you quality assurance on the standard of specialist care that your animal receives.  The second might have nothing more than a basic veterinary degree and could have graduated only yesterday, but might conversely be a quite highly qualified Specialist like your own hospital consultant – you have no way of knowing from the title “specialist”.

What makes this even more difficult for the general public to comprehend is that there are various post-graduate qualifications that veterinary surgeons can achieve to demonstrate various levels of specialist competence below that of “RCVS Recognised Specialist” status.  The structure of these qualifications is so complex that they are not always fully understood within the profession itself, so there is little hope that members of the public will understand them!  The pdf Veterinary Qualifications is an extract from the RCVS website on this matter from 7^th July 2011 – have a read of it and see if you can work out the difference in the different levels of specialisation. 

Are you confused yet?  You should be, but just in case you’re not there is an added layer of complication.  The RCVS offers “Diplomate” standard qualifications as the highest possible qualification that can be achieved by examination.  This qualification is one that entitles the individual to apply for “RCVS Recognised Specialist” status.  The number of these “RCVS Diplomas” is by no means comprehensive enough to cover all specialities and is in fact reducing as the years go by.  Furthermore, there is no requirement for re-accreditation in RCVS Diploma examinations, only for RCVS Recognised Specialist status.   In Europe there is a well established and comprehensive Diplomate system which you can read about here

Just in case you are still able to follow this there is yet another layer of complexity.  The very first layer of postgraduate qualification offered by the RCVS is at the so-called “Certificate” level (For example, CertSAS = Certificate in Small Animal Surgery).  This was never intended by the RCVS to be used as a “specialist” qualification and on the attached pdf you can see the vast difference between the criteria for this qualification and that of a “Diploma” holder.  All the “Certificate” standard qualification indicates is that the holder has a minimum of two years experience and a degree of “competence” in a particular discipline.  Unfortunately, despite the intentions of the RCVS to not recognise the “Certificate” examination as a “Specialist” qualification,  individuals with a “Certificate” standard of qualification are able to advertise themselves as providing “Referral Services” and will label themselves as “Specialists” (though not, of course “RCVS Recognised Specialist”) because of the principle of being “omnicompetent”.  If they advertised themselves as “competent” rather than “Specialist” that might be more accurate, but perhaps less attractive to clients!
At Northwest Surgeons, we have “RCVS Recognised Specialists” in every discipline that we offer as a referral service and in our support services.  Our normal minimum entry level qualification for “Specialist” clinicians is a Diploma (RCVS, European or American) standard.  We have two Certificate holders working for us.  One is as surgeon in a team headed by two “RCVS Recognised Specialists” and he is training to sit his RCVS Diploma in surgery in the next year or two – Northwest Surgeons is one of only four private referral centres in the UK recognised by the RCVS to train surgeons to this standard.  The other is our Managing Director who also works in the team headed by two “RCVS recognised Specialists” and recognises that he is a dinosaur with a level of qualification that has been overtaken by the times!

As the body responsible for setting standards in the veterinary profession and the “watchdog” responsible for representing the interests of the animal owning public so far as the veterinary profession is concerned, you might be forgiven for thinking that the RCVS would be jumping up and down to have a clear and simple system for the public to recognise the level of training and expertise offered by anyone claiming to be a veterinary “specialist”.  You would think that transparency for the animal owning public would be top of their list, but that does not seem to be the case.  If you have found the above difficult to follow and think there should be a clearer system, perhaps you would like to directly ask the RCVS why the system is so unclear by contacting them from this page.  Maybe you can suggest that they read this blog for themselves.

And finally…

If you skipped to the last paragraph – this is it. If your general practice veterinary surgeon is suggesting referral for your pet to see a “Specialist” then you need to be savvy enough to ask a few questions about the specialist.  What are the letters after their name?  (Look for the “D” for Diploma (DSAS, DECVS, DACVS, DSAM, DECVIM, DACVIM et cetera) rather than the “Cert” (CertSAS, CertSAM et cetera) to be sure you are at the highest level of qualification.  If the individual has “RCVS Recognised Specialist” written after their name then so much the better.  Place no store whatsoever by any other accolade that the individual might claim such as “Specialist”, “Consultant” or “Expert” since none of these mean a thing.   Finally, you should be aware that more and more veterinary practices have internal “specialists” often not at the highest level of qualification and corporate financial pressures can dictate that clients are directed towards these rather than to perhaps better qualified people elsewhere.  Remember, this is your much loved pet and your money – it is your right to be referred to where you want to go (There is a separate blog on this) and if you want your pet looked after by someone with the best qualifications you should ask your vet to ensure that you are referred to a “Diplomate” or an “RCVS Recognised Specialist” and not just to any old specialist.