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Board certification in veterinary nephrology-urology might be out of reach for general practitioners such as Dr. Sara Meiggs, near Cleveland. She recently performed a struvite cystotomy surgery on her YouTube channel "Everyday Vet."

The American Board of Veterinary Specialties has provisionally recognized a new specialty organization, the American College of Veterinary Nephrology-Urology.

The creation of the new specialty, one of 47 recognized by the ABVS, a division of the American Veterinary Medical Association, is intended to promote and advance the field, which proponents say has expanded in complexity and care, and requires some unique conditions of prospective residents.

To get into an ACVNU residency program, candidates must be board certified by an existing specialty college or have at least four full-time-equivalent years of experience in nephrology and urology, devoting their professional careers to diagnosing and managing conditions such as chronic kidney disease, glomerular diseases, urolithiasis, urinary tract infections, incontinence and urologic neoplasia.

Once a residency program is completed, candidates are eligible for one of two certifications: diplomate or affiliate member. Diplomate certification will be provided to qualified candidates with a background in the delivery of patient care. Candidates with a background in a non-patient-care-related discipline, such as clinical pathology, will become affiliate members. "Affiliate members have all the rights and privileges of membership in the ACVNU but are not designated or granted 'specialist' status in nephrology and urology," according to an executive summary of the ACVNU proposal. 

Asked why a high baseline of education and experience is required of ACVNU residency candidates, Dr. Larry D. Cowgill, ACVNU president and a professor of medicine and epidemiology at the University of California, Davis, School of Veterinary Medicine, explained that nephrology and urology issues traverse an array of clinical disciplines. The integration of various specialists into the ACVNU, he said, is intended to cultivate collaborative research on and treatment of urinary diseases and create an advanced level of expertise that is beyond the scope of general practice. 

The accommodation for nonspecialists, he said, is intended to provide an opportunity for veterinarians who have a dedicated interest in urinary disease without prior specialty certification. 

"The organizing committee believes that an internship alone would not be sufficient preparation for training in the complexities of the field," the executive summary says. "Alternatively, individuals who are not board certified in another specialty may be accepted into an ACVNU training program with four full-time-equivalent years of experience in nephrology and urology."

A website of the American Society of Veterinary Nephrology and Urology, an independent interest group with some ties to the ACVNU, explains that veterinarians who are members "may be able to offer some of the most advanced health care options for your pet" and often can "perform diagnostics and provide therapeutics that many other primary care and specialist veterinarians cannot."

"Such diagnostic tools include kidney biopsy, glomerular filtration rate testing, urethral pressure profiling, ultrasound, cystoscopy, fluoroscopy, and blood pressure measurement," the website reads. "Treatments can include hemodialysis, therapeutic plasma exchange, ureteral and urethral stenting, ectopic ureteral laser ablation, urethral bulking, subcutaneous ureteral bypass placement, renal transplantation and more."

Dr. Sara Meiggs, a general practitioner in Middleburg Heights, Ohio, posts on her YouTube channel bladder and other surgeries that she's performed and ends videos with analysis of her findings. Because she does not have board certification in another discipline, she said, it's unlikely that she will seek to become an ACVNU diplomate.   

"I think at this point, I don't necessarily want to go for a residency," she said, "and it sounds like there are a lot of requirements."

Nontraditional training and accommodations 

Cowgill, the ACVNU president, said the specialty college does not preclude general practitioners from performing common procedures such as bladder surgeries but would act as a resource of expertise for more advanced conditions and surgeries, such as laser ablations and ectopic ureters. Logistical and operational details of how the new college will train residents, he said, are in the works. 

"Our plan is that we would like to establish residency programs by the end of this year, or the very first of next year," he said, noting that members of the ACVNU organizing committee are in the process of solidifying a timeline, as well as the location for residencies and testing sites. "It might be 2024 or 2025 before we would start testing candidates."

The ACVNU plans to offer unique arrangements for instruction, providing both in-person and remote training options for residents. According to the college's officials, the ACVNU will provide a virtual core curriculum of more than 250 contact hours to be completed over two years, in an effort to create a consistent foundation among urology residency training programs.

The ACVNU also will provide an indirectly supervised and virtual training alternative with an off-site mentor for candidates who cannot relocate to a traditional training center. 

The education and training vision of the ACVNU was created to reflect the profession's evolving nature, according to the executive summary.

"Life and career requirements, educational debt, and demographics of the profession also have changed in recent decades. The ACVNU incorporates a training strategy to embrace these changes in the profession yet remain pedagogically robust and consistent with the advanced training standards of an ABVS sanctioned specialty college."

The ACVNU has between four and 10 years to petition the ABVS for full recognition to ensure that the specialty college is in compliance with ABVS standards. The earliest the specialty college can submit a request is 2026.