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In a recent editorial in Veterinary Medicine magazine, a California veterinarian named Dr. Robert Miller had a thing or two to say about the red-headed stepchild of the veterinary profession that is “behavior medicine.”

In it, he bemoaned the dearth of knowledge and available services at the high end of the spectrum—at all levels of the behavior spectrum, in fact.

While more and more veterinarians are availing themselves of advanced training in surgery, oncology, cardiology and even dentistry, behavior takes a back seat for its fuzz factor.

One only has to read the recent article in the July 13th edition of the New York Times Magazine to get a handle on why (see below for a link to my bash). Proof that pop cultural social commentary often runs afoul of the discipline.

Meanwhile, even those of us in the profession seem to reserve a certain level of barely grudging respect for those who elect this softball field of practice.

As in…

A surgeon? Worth referring my patients to for things I can't do.

Internist? If I can’t figure it out I guess my patients deserve another set of eyes.

Behaviorist? Puh-lease.

Now, this is a sweeping generalization, of course, as not all vets roll their eyes in response to behavior medicine (even fewer would admit to it). But the numbers of vets entering this specialty speaks to the reality: low demand. As a service that relies on referrals from general practitioners that means low interest from within the profession.

And that would be OK as long as our clients were getting the services they needed. Instead, it’s my opinion that few of us provide good comprehensive behavior services.

I know I don’t. When I have a challenging behavior issue I’ll either work with a trainer or I’ll refer to a veterinary behaviorist (ninety minutes away, unfortunately). I can’t possibly do these cases justice. Why? I haven’t sought the additional training necessary to give me confidence that I can do so.

Sure, vets should keep up with the basic and emerging issues in this subset of medicine, especially given the extremely common nature of behavior issues, but that doesn’t mean we do so on par with, let’s say, new approaches to gum disease.

And that begs the question: Why? Is it merely the smushiness of behavior as it compares to the satisfying crunch of anatomy and physiology?

I think it’s more. Honestly, I think it comes down to dollars and cents—as in, fewer of each. Considering the time spent in dark conference rooms getting versed on new issues in veterinary medicine, behavior seems less likely to earn its keep.

After all, behavior medicine takes time, patience, excellent client communication skills and yes, all the soft stuff we often like to avoid if we can. And then there’s the issue of profitability. A cat bite abscess? I can bring in $300 in 30 minutes with about $100 in supplies. An anxious dog with severe thunderstorm phobia? 30 minutes isn’t enough to do it justice. And $200 is far and away more than most are prepared to pay. See what I mean?

Nonetheless, we do our patients and our clients a disservice when we’re not well-trained in the basics or when we fail to refer cases deserving of a specialist. As Dr. Miller argues, this is one area where vet medicine might need to get some remedial training.

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Here are the links:

Dr. Miller's article:http://veterinarymedicine.dvm360.com/vetmed/Medici...

post on NYT article:http://www.dolittler.com/index.cfm/2008/7/13/dog.c...%20York%20Times%20Magazine.Animal%20Pharm
# Posted By Dr. Patty Khuly | 7/22/08 10:43 AM
Interesting... I don't know if I'm in the minority or what - but I don't go to my vet for behavior advice, ever, nor would it even cross my mind to do so. My general physician is not also my psychiatrist, so I don't really expect vets to be a jack of all trades... I just expect them to be well-versed in their specific trade. I do obedience, reactivity courses, and have done a private session with a qualified APDT certified behaviorist (note I did not say trainer). I don't even see how it's possible for a vet to be able to take in all of the knowledge necessary for being both a medical vet and an animal behaviorist and be able to stay up to date with both of them - seems like it would be boat loads of endless reading.
# Posted By Carissa | 7/22/08 11:52 AM
I wish there were more behaviorists. There is only one actual behaviorist that has any credentials worth mentioning and is three hours away. There's a lady who is local that attends a lot of behavior seminars...but she isn't certified in anything. Then there are the folks who just decided to hang a sign over their door and offer training and behavior services.

So many times trainers try to play the role of a behaviorist but they have no actual education in the field. They know what they've experienced and that's pretty much how they approach any given problem.

As someone involved in rescue I refer people to trainers all the time but I hate that I have to remind them that a trainer is NOT a behaviorist or a miracle worker. Their pet MAY have a behavioral issue that won't respond to training or may get worse if the wrong approach is taken.

When people are actually willing to take the extra steps needed to keep a pet within their family instead of rehoming or dumping it at a shelter I'd like for them to be able to contact someone who really is qualified to help them, not just some word of mouth referrall.
# Posted By Kristie | 7/22/08 12:50 PM
When I adopted a blind, feral kitten, his behavior was a bit- rough- to say the least. I've owned animals all my life and I am a certified veterinary technician. I thought I was well prepared to take on this cat and found out very quickly that I could not control him. He would bite without warning and with true desire to inflict injury. He had panic attacks and chased his own tail for hours.

My vet's advice? Put him down. When I told her that wasn't an option for me, she replied that it should be.

Instead I took him to see a behaviorist team at the University of Penn. The advice they gave was simple, down to earth, and produced immediate results. It took effort to produce the changes and if we slip up the cat lets us know, but he is so much better. I can handle him without fear and he has shown himself to be smartest animal I've ever owned- which is what the behavior team felt was his real problem. He was so smart and needed so much stimulation that major changes had to be made to his world.

If I had listened to my vet, this animal would be dead. They are a referral heavy practice but no one ever mentioned behavior therapy to me. Bottom line is practices that don't refer for behavior are killing animals. They may not directly suggest putting an animal down for such issues, but by allowing the problem to continue they are contributing to the numbers of animals in shelters- the majority of which are given up for behavior reasons.
# Posted By Jenn Roth | 7/22/08 1:44 PM
I think this is a great post. It's good to remember how important behavioral health is to the dog. With things like thunderstorm phobia, working with a good behaviorist can really help the dog *feel* much better and more calm. It's about so much more than just having a dog the owner is able to deal with - behaviorists really improve the animal's quality of life, too.

It seems that mental and behavioral health are often devalued - in both people and dogs. It can be really difficult to get a person (or their insurance company) to pay for good mental health, let alone getting people to pay to help their dogs adjust better.
# Posted By Tara | 7/22/08 2:57 PM
I was just ranting last week about the trouble I had getting the new anxiety meds our behaviorist recommended. She's a PhD (not a DVM), so she doesn't have prescription writing abilities. It's a LONG story how it all went down, but suffice it to say I was bummed to learn that the veterinary teaching hospital where she consults would not approve the prescription because it wasn't "medically" managing the case. So, even at the highest levels of veterinary medicine, where a behaviorist works, where she teaches classes to veterinary students on behavior, I tumbled into a hole in the system. It took nearly 20 phone calls and nearly a week to get the medicine my dog needed.

I've written about veterinary medicine for various trade and pet magazines since 1995, and I've got to say I was really disappointed.

Here's a link if you want to read my real-time struggles:
<http://championofmyheart.com/2008/07/14/oh-im-rant...>

Funny that we're both blogging about the same things recently. One of my regular readers pointed out the similarity.

I'm not saying every practitioner needs to be a behavior expert, but I'd say they do need to be more open, more collaborative, and more responsive to people like me who are seeking genuine solutions to some tough behavioral challenges.
# Posted By Roxanne | 7/22/08 3:30 PM
I don't think the low number of behaviorists is a reflection of low demand, but rather the scarcity means few people have ever met a veterinary behaviorist or known somebody who has been helped by one. I would love to have had a behaviorist available to help me with my dog when he had some aggression problems a few years ago but didn't know how to find one or even that there was such a veterinary specialty.

Unfortunately trainers do not really fill this niche. Most trainers work on teaching commands and manners, and solving the more manageable problems like chewing, house training etc. They don't necessarily know how to solve true behavior problems like aggression, severe separation anxiety, phobias, and so on. I was fortunate to find somebody who could give me a good management program to keep my dog out of situations where he might have hurt somebody, but I always wonder if more could have been done for him. The ultimate solution for him has been old age - he's mellowed to an amazing degree.

And I'm not sure a busy vet practice allows for the kind of time and communication it takes to diagnose and treat behavioral problems - aside from writing prescriptions. I wish this kind of practice were more available to pet owners.
# Posted By Anne | 7/22/08 6:43 PM
I think there are two big issues here - training, and time. Yes, many vets do not have enough training in behavioral medicine. We had a one-credit course - that's 8 hours of lecture - definitely not enough. I was lucky to go to school at Penn and take the behavior rotation, but it was still just a taste - and students without my interest in the subject probably didn't get much out of it. Then there's time. A 20-minute appointment allows me to just barely scratch the surface of the problem. I can make up some of that on the phone, but it's better in person. Maybe my clients would be willing to pay more for more time - maybe I could talk my boss into scheduling double appointments for behavior issues. It's frustrating, because I'm one of those rare vets that are actually interested in behavior, but I don't feel like I'm always doing as much as I can for my clients and their pets.

There is finally a veterinary behaviorist here in New York City. Vets have been referring to a PhD for a long time, but he can't prescribe medications, which complicates treatment. I'm excited to be able to refer to a DACVB, and am hopeful that she'll be able to help my patients.
# Posted By Deborah | 7/22/08 10:44 PM
Anne: I think there's very high unmet, as-yet unperceived demand, as evidenced by some of these comments--and by the huge numbers of animals euthanized for treatable behavior problems.

The problem is that veterinarians, who are in a position to inform their clients of the benefits of these services, don't always offer them. We too often assume you're unwilling to pay for them.

With so many other issues we know how to focus on well, and because this new discipline is still baby-young, it's no surprise that we don't advance the services of behaviorists as a potentially life-saving approach. After all, the field is so small that most of us vets haven't seen or heard great stories emerging from behaviorist's work.

Again, the NYT piece did nothing to alleviate this misperception of the value of behavior services.
# Posted By Dr. Patty Khuly | 7/23/08 8:03 AM
I LOVE behavior cases. I briefly considered a residency in behavior after school (but also emergency medicine and dairy medicine which just didn't jive) before heading off to a mixed animal practice. However, in my area (incredibly rural) I don't think I can charge enough for the time it takes to work through these cases. Most involve long appointments and ideally tme at the home of the client together with LOTS of follow up. Furthermore it has been my experience that it is a rare client who is willing to truly dedicate themselves to behavior modification. It is hard work and it is forever. Most folks are looking for a pill to fix the problem. It becomes even harder to a) solve the problem and b) charge for my time if the client isn't valuing the effort required for behavioral problems.
# Posted By ralphsmydog | 7/24/08 7:22 PM
There are of course non-veterinary behaviorists to consider when referring (says the non-veterinary behaviorist).
# Posted By emily | 7/25/08 3:50 PM
Thank you, emily, for mentioning this. In my area I have a couple of good trainers I use for this but many areas offer MS and PhD level animal behaviorists who also work with vets.
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# Posted By dgfg | 8/2/08 3:53 PM
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