To Specialize or Not to Specialize: Are Internships and Residencies Worth the Time and Expense?
September 24, 2022
By Jinelle Webb, DVM, MSc, DVSc, Diplomate ACVIM (Small Animal Internal Medicine)
To Specialize or Not to Specialize?
Thanks for tuning in to a discussion on specialization! I am a small animal internal medicine specialist. Although this specialization has turned out to be perfect for me, my path to this career was not always clear. Specialization is a long and sometimes frustrating path, and it is not for everyone. I always knew that I wanted a career in veterinary medicine, but I initially wanted to be an equine veterinarian. It was during my first year at OVC that it became clear to me – while I love spending time with horses, small animal veterinary medicine was where I belonged.
There were several reasons why I made this change. I think the biggest reason was that I saw the ability to do more diagnostic testing in small animals while having a better chance of reaching a definitive diagnosis. Many clients seemed able and willing to pursue the recommended lab work and imaging options presented. Equine clients are very dedicated to their horses, but it can be hard to provide some of these advanced options, especially on site at the farm. Another reason was my own quality of life – there are some benefits to having your clients come to you in a heated vet clinic!
I tried my best to experience all facets of small animal veterinary medicine during pre-vet and vet school. I worked at a local small animal practice while also taking summer positions at OVC. By second year, I developed a strong interest in diagnostic imaging. However, by fourth year, I realized that while diagnostic imaging was where I wanted to spend my time, I was frustrated by the lack of follow up on cases. Once you finished your interpretation of the imaging that you performed, that pet went off to continue its diagnostic/therapeutic work-up with its primary clinician. Meanwhile, you have moved on to the next patient for imaging; it was not often that you got feedback on what happened to each patient. This led me to the field of small animal internal medicine, where there were greater opportunities to perform imaging such as ultrasonography and follow up on cases. It also opened up the fields of endoscopy and interventional procedures. I started down the path to specialization.
In order to become a board-certified specialist, there are many steps to complete. Almost all internships and residencies require application through the VIMRP matching program (https://www.virmp.org/). There is a lot of competition for these positions; the level of competition varying each year and by specialty. The first step is being accepted into a rotating small animal internship position, either in an academic or private practice. The competition for these positions can be particularly high some years - especially for those with a track record for successful residency placements. It helps to be very open to travelling for your internship and applying to as many positions as possible.
The internship year is a gruelling one. There will be long hours and hard work, but most programs provide a huge amount of learning in a short period of time. Internships are not only designed for veterinarians wanting to specialize, but also for those wanting to hone their skills prior to entering a progressive general practice or an emergency hospital. For all veterinarians, internships are a great way to increase confidence in procedures and the diagnostic process. For veterinarians planning to specialize, there is pressure early in the internship year to decide on a specialty. There is also pressure to impress the veterinarians at the practice that will write your reference letters, as applications for residencies are due within a few months of the internship starting.
In many specializations, it is uncommon to match to a residency after a rotating internship. Once the rotating internship is completed, there are specialized internship positions available for application. For example, if you want to become board-certified in surgery, cardiology, oncology, or ophthalmology, you can expect to have to complete at least one specialized internship and/or research degree prior to matching into a residency program. This is the case for other disciplines as well. There is usually stiff competition for these specialized internship positions. Completion of a specialized internship or MSc/PhD in that field does not guarantee acceptance into a residency program, although many completed specialized internship programs do result in acceptance into a residency program. Forming a relationship with as many specialists as possible in that field of veterinary medicine can help you to stand out amongst other candidates.
If you do manage to match to a residency program, expect several years of long hours and hard work, but a very rewarding experience if you have picked a field that you love and a program that is supportive. At the end of the process, you will need to pass your board certification examinations, which may take more than one attempt and will require a lot of studying. A good residency program should have prepared you for these exams, but that does not reduce the stress of writing them! Financially, you do get a salary for most internships and residencies, however they are often only enough to pay basic living expenses. I lived on a lot of Ramen noodles and peanut butter sandwiches in my internship and residency years.
Many veterinary students may be questioning whether they should consider pursuing the path of specialization, given the many challenges and uncertainty of achieving their goal. For most veterinarians that have attained board certification, they would say it was 100% worth the effort. Financially, salaries are higher for board certified specialists, although this may not make up for the years of a low salary when you could have been a practicing general veterinarian. There are quite a few career options available once you have obtained board certification. There are positions in academia as clinicians, instructors, and researchers, and many positions combine all these aspects. There are many private referral and emergency practices, both small and large. Some large general practices will have one or more board-certified specialists on staff. Mobile specialists are common in fields such as surgery, internal medicine, and cardiology, bringing their expertise into local general practices as needed. Telemedicine support positions are also available in many specializations, allowing the veterinarian to work from home. There are positions in industry and in government as well.