Healing Pets and People (Part 1)
Healing Pets and People (Part 1)
Comparing the different worlds of human and veterinary medicine
Dear Readers,
After my recent experience in the hospital with pneumonia, I was struck by the similarities—and differences!—between human and veterinary medicine. I thought this would be a great topic for a newsletter, so I started putting together a list of areas to compare and contrast. I also asked my subscribers for their suggestions and several of you asked great questions that I’ve included; some will be saved for the next part of this series. I hope my diverse readership that spans veterinarians & vet techs, human doctors/nurses, and pet owners enjoy and find this educational.
—Eric
Caveat 1: Some of the following information on human healthcare may be specific to the United States; I am less familiar with comparable systems internationally.
Caveat 2: To state the obvious—I am not a physician! This information is what I’ve gathered from my own research and conversations with medical professionals in my social circle. If any of my readers in human medicine notice an error, please don’t hesitate to chime in so I can correct the mistake!
How does the training between MDs & DVMs compare?
Both vets and physicians in the US have to go to medical/veterinary school after an undergraduate bachelor’s degree for a total of 7-8 years of education (with rare exceptions). The student debt for both is astronomical, stretching into the mid to high six-figures. To practice, each must complete certifying exams and obtain one or more state licenses. Both have to complete ongoing continuing medical education to stay licensed. One big difference is that physicians generally have to complete post-graduate medical education (internship/residency), whereas veterinarians do not. There are some ways physicians can work without a residency, including military service, education, or working in research. Additionally, some states have recently opened up alternate licensing pathways, and during the COVID-19 pandemic some requirements were eased up to increase the supply of practitioners in a crisis.
While veterinarians have options for post-graduate training, including traditional internships/residencies as well as supervised mentorship programs, the vast majority of vets in the US are in small animal general practice and don’t complete any such program. Their scope of practice is legally much wider than a typical family physician. Many vets routinely perform surgery, dentistry, manage complex medical conditions, and more.
According to the most recent statistics I could find, there were 16,291 board-certified veterinary Diplomates (specialists) in the US in 2023, or ~13% of all vets in the country. For my own specialty of clinical pathology, there are a mere *595* of us!! In contrast, roughly 90% of physicians in the US are board-certified Diplomates of the American Board of Medical Specialties; it is fast becoming an expectation more than a superlative.
There are also some unique quirks in the pathways for training between the two fields. Many physicians who are board-certified in Internal Medicine practice in a primary care setting or follow-up with further subspecialty training, whereas in veterinary medicine, those who complete an American College of Veterinary Internal Medicine (ACVIM) residency are the go-to for treating complex conditions or advanced procedures like endoscopy, laser lithotripsy, placing stents, internal organ biopsies, etc. The American College of Veterinary Emergency and Critical Care (ACVECC) certifies vets practicing the highest standards of those two fields, although many DVMs practice in ER clinics without this credential. In human medicine, Emergency Medicine is distinct from Critical Care (which is often combined with Pulmonology).
In summary: Most vets in the US are general practitioners similar to your family doctor. Board-certified veterinary specialists are fairly rare and have the highest level of training in one specific niche. Some vets who have completed a residency but either did not pass the board exam or complete one of the other requirements may refer to themselves as “Practice Limited to” Internal Medicine, Surgery, etc.
What are differences in working up patients??
You may have noticed that it is much more common for your vet to order blood tests, urinalysis, and x-rays (among other tests) than at your own doctor. This is not a cynical money grab, there is a fairly straightforward reason: Our patients don’t talk! Not only can they not speak for themselves, animals evolved to hide signs of illness, lest they become easy prey. So our patients may not show symptoms their owners could notice until quite late in the game. In some ways, I think vetmed has a lot more in common with pediatrics than adult medicine.
In my experience as both a vet and a patient, DVMs also rely much more on their physical exam skills than our colleagues in human medicine. This is partially related to the point above, but also due to the fact that we often face much more significant financial barriers to testing. Many people can’t afford to pay for x-rays, ultrasound, or CT scans (and they may not even be available in some parts of the country). So we have to get really good at listening to heart and lung sounds, palpating abdominal organs and masses, looking for clues of disease on neurologic exam, etc.
This post by
tackles the difficulty of working up patients in rural or suburban settings without all of the fancy equipment of the ivory tower, and how this intersects with medical costs, duty of care, and proposed legislation to enforce obligations to treat similar to EMTALA (the Emergency Medical Treatment and Active Labor Act):
How does the standard of care differ?
At the risk of overgeneralizing, it is higher in human medicine. There are simply many more tests and treatments available, and exponentially more research and development dedicated to diseases that affect people. For example, the standard of care for people with end-stage kidney disease is dialysis or kidney transplants. Patients with leukemia have their tumor cells sequenced and are prescribed small molecules that target the specific cancer mutations. Someone with terrible osteoarthritis in their hip might get it replaced with a space age implant. Miraculous new drugs have made horrible infections like Hepatitis C curable and HIV/AIDS a manageable chronic illness.
In contrast, there are numerous barriers to this type of care in veterinary medicine. Something like a kidney transplant can cost upwards of $30,000-40,000 or more, out of reach for all but the most extremely wealthy. There are also questions about the ethics of aggressive care that will not cure the underlying disease. While human medicine in America has issues with access to care, many patients with Medicaid, Medicare, or private insurance do not bear the brunt of costs for these medical marvels and don’t have to second guess each line item on an invoice.
“Do I really need that chemistry panel? Well, the doctor recommended it so OK” 🤷🏻♂️ → Not something we often hear as veterinarians!
These limitations in finances and technology mean we are also often forced to go with “empiric treatment” (essentially trial-and-error) more often than would be ideal. My recent hospitalization provided a great example of this: the CT report prompted an aggressive work-up to find the exact infectious organism through a broncoscopy, blood and lung fluid cultures, and antigen tests (which all came back negative, BTW). In veterinary medicine, we likely would have initiated empiric broad-spectrum antibiotic therapy and moved to those next steps only if the patient wasn’t responding and the owner was on board for the added costs.
Despite the barriers, veterinary medicine is continuing to advance. Increasingly available technology, new medications, and preventative care at your family vet are helping our pets live longer, better lives:
How do treatments for cancer differ between people and animals?
This is a great question from one of my readers that dovetails nicely with my points above. Many of the mainstays of modern human oncology are employed for treating pets, including chemotherapy, radiation, and surgery. As with people, the best chance for a cure or long-term survival usually comes when you can remove the tumor before it metastasizes (spreads through the body).
One big difference between human and veterinary oncology regarding chemo and radiation is the goal and dosing. For people who hope to live for decades after their diagnosis, doctors often swing for the fences with aggressive regimens designed to maximize the chance of a cure or prolong survival as much as possible. With our pets that live much shorter lives and cannot understand what they are going through, veterinarians primarily aim to optimize quality of life. Thus, the doses for many chemotherapy drugs are substantially lower, and as you would expect, so are the side effects. For example, it is very uncommon for pets to lose their hair during cancer treatment. The most common adverse events are often anorexia, vomiting, diarrhea, and decreased blood cell counts, which are managed aggressively with supportive medications to remove nausea, boost appetite, and treat pain.
Another big difference is that many of the newest miracle drugs in human oncology like checkpoint inhibitors are not yet available for pets. There are at least two reasons for this. One, they are suuuuuuper expensive. A single dose of some monoclonal antibodies may exceed the entire cost of regular chemotherapy for many tumors. Second, being more specific is a double-edged sword: Unlike a small drug molecule that often works across species, these targeted therapies often have to be re-engineered from the ground up to fit the different proteins and pathways in animal patients. That said, there is some progress being made here, and a small number of these drugs are being tested in clinical trials and hitting the veterinary market.
For more on this subject, I would encourage readers to check out
’s post on this topic:
Here is a difference I experience: my veterinarians tend to be less skeptical of my reports of my pets’ symptoms than doctors are of reports of my own symptoms. In general, my experience is veterinarians are better listeners.
I was surprised when I found out that the same treatment machines that we use to deliver radiation treatments to humans are also used on animals. The linac at NC State is a tip of the line Varian TrueBeam! Planning is obviously much more complicated due to the variety of anatomy. A surprising number of birds get radiation apparently. 🤷