Exotic_animals

Bird photo by Dr. Sophia Yin, other photos stock

Some veterinarians who treat exotic pets want a specialty of their own. What they've come up with is ruffling feathers.

Frustration is simmering among some veterinary specialists over a new organization that began in 2022 to certify veterinarians as diplomates in "exotic pet medicine," bypassing established credentialing programs.

Diplomate status, which attests that a veterinarian has demonstrated extensive knowledge and experience in a particular practice area, typically is conferred by specialty organizations overseen by a single entity. For instance, there is one such governing body in Australia and New Zealand, another in Europe and another in the United States.

When it launched, the American College of Exotic Pet Medicine (ACEPM) sparked "ugly conversations," in the words of one detractor, that happened mostly out of the view of the veterinary mainstream. But a letter published (behind a paywall) in May in Veterinary Record, the journal of the British Veterinary Association, took the controversy to a wider audience. 

Eleven authors, all specialists, criticized the ACEPM without identifying it by name, saying "at least one group has circumvented the usual approval and accreditation processes, awarding specialist titles that are not regulated by any governing body … leading to an erosion of the tenets on which our profession and the public have relied."

Critics point to human medicine, where legal battles to restrict specialty credentialing have been fought and lost, leaving the profession awash in specialty boards with widely varying credentialing standards, confusing the public about what any of the certifications really mean.

Drs. José Biascoechea and Shachar Malka, who co-founded the ACEPM, told the VIN News Service that the profession needed an exotic pet medicine specialty. In joint emails, they said existing specialties, such as avian practice or zoological companion animal health, do not capture the full scope of the exotic pet niche and that their attempts to create a new specialty within the existing framework were rebuffed. Their response to the Veterinary Record letter was published (behind a paywall) on Aug. 2.

Both veterinarians are board-certified in avian practice. Biascoechea owns an exotic pet hospital in South Carolina, and Malka owns one on Long Island in New York.

The co-founders added that they might "explore collaborative opportunities" with established colleges and boards after their organization has more diplomates. Meanwhile, they say, "We are committed to moving forward with our plans because we are driven by our principles rather than the claims of others."

Challenging tradition

Specialists in the U.S. have been credentialed under the umbrella of the American Veterinary Medical Association for more than six decades. Today, the AVMA's American Board of Veterinary Specialties recognizes the 22 boards and colleges that confer diplomas in 46 recognized specialties. The ABVS continually evaluates the standards and practices of existing boards and colleges and reviews applications to recognize new organizations and specialties.

Europe, Australia and New Zealand have similar governing organizations, but they operate independent of a veterinary professionals' association.

The ACEPM, in contrast, is self-recognized.

Operating outside the norm is not what Biascoechea and Malka initially had in mind.

In 2020, ABVP diplomates received a letter outlining a proposal to replace three specialties — avian, exotic companion mammal, and reptile and amphibian practice — with a single "combined exotics" specialty. The letter said the ABVP board of directors "strongly support[ed]" the concept, in part due to concern about low numbers of diplomates in each of the three targeted specialties.

Asked recently about the proposal, Biascoechea and Malka said that the ultimate regulator — the AVMA's American Board of Veterinary Specialties — told the ABVP that it would consider an exotics specialty only if the three individual specialties were phased out. Prior to learning that proviso, they said, "many ABVP diplomates, likely the majority, supported starting the combined specialty group."

The advocates for the new specialty also challenge the notion that ABVS prohibits overlapping specialties, saying it has "allowed for similar colleges and boards with comparable characteristics." For example, they said, a food animal specialty coexists with dairy practice, beef cattle practice and swine health management.

ABVP representatives were not available or did not respond to VIN News questions about the issue.

Dr. Brian Speer, who is double-boarded in avian practice in the U.S. and Europe and owns an avian-only practice in Oakley, California, called the plan "quite disturbing" in an email to Malka, who was then an elected representative of ABVP. (Speer is also a consultant in avian practice for the Veterinary Information Network, an online community for the profession and parent of VIN News.)

He expressed particular concern for the avian practice training programs at his practice. "Should I tell our current resident that there may be no specialty in which to certify in one year?" he asked. "Should I tell our next two interns that in two or three years, their training program in avian practice will be for naught? How well-thought-out is this move, really?"

Recently, Speer said more than 100 ABVP specialists collectively wrote a letter to the board protesting the proposal. However, he said, opinions are nuanced, noting that informal internal polls showed about half of the diplomates supported creating an exotic pet medicine specialty so long as the individual specialties were maintained.

"I realized that there are many of my colleagues within the avian specialty that do want to obtain recognition in these other species groups," Speer said, adding that he was involved in a committee that created "a fast-tracking system" for ABVP specialists in one species to "more expeditiously" sit for the exam for a second specialty.

Dr. Stephen Divers, a professor of zoological medicine at the University of Georgia's veterinary school, said efforts to create an AVMA-recognized exotic pet medicine college have been around for many years, but over and over again, the view has been that the American College of Zoological Medicine "does indeed provide complete coverage for all exotic pet species."

He added, "If they're acting as a specialist, they could easily credential and take the ACZM exam, but they don't want to because this is easier."

The ACEPM's co-founders say that creating an exotic pet specialty is not about avoiding difficulty; it's about fit. "While zoo veterinarians have attempted to address the needs of pet species through their zoological companion track, their training remains heavily centered on zoo animals," they told VIN News.

Case study: Human surgery

Alarm bells sounded for Dr. Scott Echols, an avian practice specialist in Utah, when he learned about ACEPM. Though a veterinarian, he has a particular understanding of how a proliferation of specialty boards and colleges with widely varying criteria can impact another profession.

Echols has been developing technologies for surgeon training in both human and veterinary medicine for the past six years. As he became immersed in the human surgery field, he was surprised to discover that no single organization controls specialty credentialing in human medicine, thanks to legal challenges over the past several decades.

"They've lost total control," Echols said, adding that new boards and colleges operating outside the traditional oversight groups often have less rigorous certification criteria. It's understood that surgeons who wash out of top-tier residency programs — something he said is much more common in human medicine than in veterinary medicine — go on to become board-certified through "lesser programs," he explained.

In cadaver simulations, he's watched in horror as board-certified surgeons bumbled their way through a surgery that would have seriously harmed living patients.

As these organizations and diplomates proliferate, he said, patients can no longer trust credentials.

That outcome concerns Dr. Sarah Gillings, who is boarded in oncology by the American College of Veterinary Internal Medicine and currently serves on the executive committee of the ACVIM's board of regents.

After reviewing the ACEPM website, Gillings said, "I can appreciate what they are trying to do. But it is going to get confusing. I saw one paragraph where they said they are not recognized, and everything else looks effectively like every other specialty. I think that's an important point: Even an educated consumer can't see the difference."

Gillings, like other boarded specialists who talked to VIN News, said the AVMA-recognized programs have challenges and could be more transparent, but she believes the current system is crucial to sustaining legitimacy.

"The RVSOs [recognized veterinary specialty organizations] are there to provide a stamp of approval," she said. "I think we have an imperfect system, but to abandon it is risky."

Calling on peer pressure

Aware of the precedents in human medicine and dentistry, veterinarians on both sides of the debate agree on this point: There's no legal avenue for forcing the ACEPM to stop calling itself an "American College" or awarding diplomas. Speer pointedly refers to it as a "club."

The only legal restrictions are related to the use of the term "specialist." Practice acts in most states, say that only veterinarians board-certified by AVMA-recognized organizations can be called specialists. (ACEMP does not use the term "specialist" for its diplomates.)

"It's an ethics violation to call yourself a specialist if you're not a recognized one," Echols said. "But the reality is, have any of these states acted upon that?"

He also voiced doubt that pet owners would have any idea that the term is reserved for practitioners in AVMA-recognized programs and what that might mean.

The future of the exotic pet specialty and others that might follow seems likely to be fought in the court of public opinion. Critics are focusing their efforts on publicizing their concerns to the wider profession, such as with their letter to Veterinary Record, and scrutinizing where the group's diplomates are coming from.

The bulk of the ACEPM's 48 diplomates (up from 22 last year, with most coming from Europe) are what the group calls "de facto" diplomates. That means they received the new credential on the strength of their status of being certified by specialist governing groups like ABVP, ACZM and boards in Europe, Australia and New Zealand.

Speer and Divers say the new organization is recruiting specialists from established boards and colleges to pad its ranks. They provided copies of emails showing that even they were invited to join.

Divers said he understands why fellow specialists would apply for the "multi-taxa" exotic pet medicine credential.

"I think the majority of them joined because they thought, 'Oh, it's a free qualification and actually helps me to advertise because I can say, I'm now exotics, not just avian, or not just mammal,' " he said. The trouble, he believes, is that "it devalues our currency as specialists. So that's where it's very upsetting and concerning."

The ACEPM's critics are concerned that some peers who apply for the exotic pet medicine diploma incorrectly believe it to be part of the AVMA's American Board of Veterinary Specialties.

Biascoechea and Malka said their organization does not pretend to be AVMA-recognized. The group's website states that "the ACEPM is not currently recognized by the AVMA but is not opposed to being recognized once circumstances allow for it." In addition, they also push back on the notion that "American College" implies a connection to the AVMA, arguing that everything from cosmetology schools to a professional association for rheumatologists uses the term.

The co-founders denied recruiting specialists. "We have guidelines, and people have applied," they said.

In addition, they said that three residents are in training programs in the U.S., at practices owned by Biascoechea or Malka, and that residencies are also under development in Europe.

Biascoechea and Malka maintain that the public relations campaign against the ACEPM is not widespread.

"The opposition primarily stems from one individual who has taken it upon himself to intimidate many colleagues into not supporting our initiative," they said, declining to name the individual. "He has circulated numerous letters and sent countless emails globally and is actively campaigning against us and expressing himself on social media."

How successful any public awareness campaign will be is an open question, according to Speer. He said that it's hard to get the bulk of veterinarians to care about the issue and figures many think that "it's just an exotics thing" or "a blip on the radar" that doesn't affect them.

Countering the idea that the matter is confined to exotics, Echols said: "The danger is that it opens the door for anybody. ... It's something that affects the whole profession."

The story has been corrected to identify the ABVP avian specialty as avian practice not avian medicine.