NEWStat talked to Jennifer Tjepkema, DVM, DAVDC, a veterinary oral surgeon at Animal Dental Center in York, Pennsylvania, about how primary care veterinarians can optimize their relationship with dental specialists.

Start by talking to them when they call you if you’ve referred a case to them.

She says her biggest problem is getting past the receptionist and actually getting the referring doctor on the phone. “I can’t get past the receptionist at 90% of the referring GPs that I call,” she said. “I’ve had to spend 30 to 40 minutes on hold, waiting.”

This is especially frustrating when the referring doctor hasn’t given her enough detail in the referral letter. 

She said this difficulty getting through was true before COVID and it’s not at all uncommon; she says her practice has seven doctors at four locations and getting through to a referring vet has been an ongoing issue for all of them.

Another tip: if oral tumors are involved, take chest radiographs .

Tjepkema told NEWStat that this is a common issue with many referrals. She says she doesn’t have the equipment necessary to take a chest radiograph. “Most dentists don’t, unless they work in a specialty hospital and have access to an x-ray machine.” What she does have is a $150,000 cone beam CT machine to take digital images of teeth, but she relies on the primary care vet to supply regular chest and dental radiographs when they call for a consult or do the work up for a referral.

These radiographs are important to check for metastatic disease. “If the pet’s coming in for a huge surgery and has a big tumor and I’m going to take out the whole jaw, it’s important to make sure that the tumor hasn’t spread to the lungs,” she said. “If the overall prognosis is poor, then moving ahead with a five to six hour surgery at 6 or 7 thousand dollars may not be the best idea. Not a lot of owners want to do that.”  

Another big frustration is the lack of complete presurgical workups. “They’re something I can’t do in my office.” 

And that’s frustrating all around: She said most of her clients drive up to an hour and a half to see her—one client recently flew his dog all the way from Alaska—so it’s frustrating for everyone when she has to cancel a scheduled surgery because something unexpected popped up or wasn’t included in the presurgical workup.  She said it’s not uncommon for her to have to send a patient back to the referring vet to get more information before a procedure. 

Tjepkema said she’s happy to consult with GPs. “I give them my honest opinion on how to approach the case,” but that it can be difficult to do that over the phone. “I’m not sitting there looking at the patient.”

“There’s definitely things I can talk them through, but others I can’t.” For example, a vet will call her and say they just broke a patient’s jaw while taking out a canine, what should they do? “I can’t really help them with that.”

She said she gets calls like that every week, and does her best to talk them through it, but in about half of the conversations, the vet decides the procedure is too complicated and tells her they’re going to refer it instead.

“We do our best on the phone and try to guide them, and try to answer questions.” She said what it usually comes down to is the experience and capability of the vet she’s talking to. For example, talking to a vet who’d good at more advanced dental procedures versus a vet who’s never extracted a canine. “Those conversations are going to be very different conversations.”

Tjepkema said a lot of specialists are willing to work with referring vets if cost is an issue. “I did a consult with veterinarian today who had a dead canine they were really uncomfortable taking out. The owners were financially strapped. For me, it wasn’t a complicated procedure. In those cases I’m going to work with the vet and the owner to get it into a price range where I can at least break even on my cost and help out the pet and the vet.”

A big frustration when primary care vets call for consults? “They don’t know how,” she said. It happens a lot. They can take the x-ray, but they have no idea how to send it. Or they have one technician who knows how, but they’re not working that day. “I can’t tell you what to do if I have no concept of what I’m looking at.”

“They’ll start taking photos of the x-rays with their phone,” she said. They text them to her but they’re so blurry she can’t read them. She recommends general practitioners get comfortable with sending dental radiographs before they’re in the middle of a procedure and have to figure it out on the fly.

Tjepkema said the best way to establish a good relationship with a specialist is through open communication. “Just call me and ask me a question and I’ll get back to you within 24 hours.”

Just make sure you have the call put through. And don’t forget to send the x-rays.

“I’m here to help you,” Tjepkema said. “I’m not your enemy. I’m not going to steal your cleanings. I’m not going to judge. I’m here to facilitate and help your clients.”

“I have two clients,” Tjepkema added. “My first is the pet owner who walks through the door. The second is the general practitioner. If I don’t help both of them, then I can’t help anybody.” 

Find more great advice on dental care in the 2019 AAHA Dental Care Guidelines for Dogs and Cats

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