These days, “Which surgical procedures are you comfortable with?” is an interview opener you’ll never hear from a prospective veterinary employer. They know well enough that cutting has become an optional endeavor among veterinarians. But is this a bad thing? In 2026, a veterinarian can increasingly construct an entirely respectable clinical career around wellness, medicine, dentistry, urgent care, telemedicine, etc., while declining even the most routine soft-tissue surgery. This is perfectly reasonable for the individual veterinarian, but collectively, I’d argue, it represents an enormous change in what we think a general practitioner is and alters quite a bit about how we deliver veterinary care going forward. It starts with schooling Surgery is unusually unforgiving of the modern educational model because knowing how to perform a spay isn’t even remotely equivalent to having performed enough spays to keep your cool when a pedicle slips. Which is why most of us graduate having had surprisingly little independent surgical experience. Yet we’ve historically expected new graduates to have considerable proficiency in most core surgical skills. It’s a mismatch we all start feeling very acutely on day one of our careers. In defense of schooling, though, think of all the ways in which surgery is unnaturally expensive to teach. You need case volume (or cadavers), anesthesia, instruments and consumables, surgical facilities, technicians, and lots of faculty time. Every economic efficiency incentive works against this model. Bigstockphoto A broken surgical mentorship model In school, we learned how not to kill our patients. We learn how to actually operate once licensed. To get there, we require an experienced veterinarian willing to scrub in, watch, advise, rescue, and eventually step back. A short-staffed hospital has much less capacity for that. The workforce shortage hasn’t just made veterinarians scarce; it’s made mentorship unrealistically expensive. When every doctor’s production matters, watching the new associate struggle through a two-hour procedure becomes an economic luxury even a veterinarian-owner can’t afford to indulge. Plus, when your first job is in a big box superstore, surgery isn’t even on the menu. In a high-volume vaccine and wellness practice, you may get mentorship of a kind, but you’ll never learn to cut. By the time you land your first job in a standard practice years later, who wouldn’t be terrified? Referral medicine changed expectations We created extraordinary surgical expertise profession-wide—and that’s awesome, but surgeon availability changes things. When I started practicing, we had no boarded surgeons nearby. When we would get a surgery we had never done before, we would cut with the textbook propped up on a stand next to our instruments. Today, there’s rarely a surgeon less than an hour away. Which is how “I don’t do those” has become more than acceptable—it’s the new standard of care. The referral option is a total off-ramp from skill acquisition. Liability gets invoked I’ll concede that litigation, board complaints, and sophisticated client expectations matter … a lot. However, I’d also argue liability is a bogeyman we too often invoke when considering surgical procedures we’re legally and professionally trained to perform as GPs. Sure, a surgeon can always do it better, but they can also perform a spay at a higher standard of care. That doesn’t mean it’s reasonable to offload every abdominal surgery to a specialty facility. Liability is a cop-out. As long as we’ve offered options, we’re in the clear. Fear of mistakes You want to know what’s different about surgery? Any mistake is immediate, visible, and almost undeniably all ours. That’s scary, but we also prescribe dangerous drugs, manage unstable diabetics, and anesthetize geriatric patients. These should be just as scary. The uncertainty factor We can always run more diagnostics, wait to see how our patients respond to early interventions, and consult internists, but surgery always requires that we pick up the scalpel and commit to the first cut. That makes surgery unusually dependent on something our profession has recently become less comfortable cultivating: professional confidence under uncertainty. I’ve written about this here before: We like our tests too much. They make us money and defer decision making until we’re as safely sure as possible, but uncertainty is inevitable, no matter how many years you’ve practiced. We can gain confidence with practice, but to get there, we have to get comfortable with being uncomfortable. Action before certainty When a local ER doc balked at cutting my late-night patient’s bloat, I lost it. “Stop testing and get in there! This one won’t get better until you cut!” Uncertainty creates a vicious cycle: Fear, avoidance, fewer cases, less competence, more fear, and ultimately, worse clinical outcomes. And the cost of specialists means our economically challenged clients will receive no care. What I think we’d all prefer to see progresses more like this: exposure, supervision, competence, confidence, and increasingly challenging cases. It’s what we expect for ourselves in other areas of our practice. Why not surgery? Opting out is too easy “I don’t do surgery” should not become a mere scheduling preference. Why expect the practice to adapt around a doctor rather than develop a veterinarian? Once this becomes normalized, there’s little incentive for anyone to change it. Thus, the frog is boiled. What do we lose? 1) Income It’s not just the procedure you lose, it is the diagnostics, the meds, the rechecks, the expense of an unused surgery room, the goodwill from performing a procedure clients still expect and value highly in a veterinarian, and our practice’s economic resilience. It’s also income the non-surgically trained will continue to leave on the table throughout their careers. 2) Affordability Losing affordable surgical options means all our $1,500 surgeries turn into $5,000 procedures. This strains the specialists, too. They need to be handling cases requiring surgical expertise, not seeing cases GPs abandoned because they were not taught the skills to perform them. 3) Continuity Who evaluates the incision on Monday? Who decides whether that swelling is expected? Who talks to the client when recovery doesn’t go the way of the textbook? Fragmentation taxes care. Period. 4) Professional identity This might seem like more of an emotional argument, but I love being a derm, dentist, surgeon, internist, and grief counselor. We are amazing multitaskers. It’s part of our professional identity. 5) Insight When we don’t cut, we don’t get a chance to gather insight into anatomy and physiology in the same way. Part of our specialness as veterinarians is we get to see the whole picture like no other practitioners. Knowing what disease looks and feels like up close informs our other skills, too. 6) Credibility Clients expect us to perform relatively basic surgery. Full stop. Within our practices, something fundamental changes when one doctor becomes “the surgery person” and everyone else becomes a medical clinician. That’s not only confusing for clients but also damaging to our credibility and reputation as true generalists. What do we gain? Now, I’m not saying it’s all bad. There are benefits to carving out our own paths within our GP worlds. This way, clinicians can concentrate on what they’re excellent at. Patients might receive technically superior surgery from the GPs who love a good cut. Referring out can reduce our complication rates. Doctors aren’t forced into procedures they are not yet competent to perform, and specialization of labor can improve workflow efficiency if you have the capacity to do it right. The question, therefore, is not whether every veterinarian should perform surgery. Because it’s not. The question is more like, “What repertoire of surgical skills reasonably defines a competent small animal practitioner?” That’s a much harder question, but one I worry means fewer and fewer items will make it onto the list in years to come (particularly if non-surgical sterilization advances materialize). The key point here is this: We have quietly redefined surgery from a core competency of the general practitioner into an elective professional interest. Unfortunately, we haven’t really reckoned with what that means for general practice. It’s time we did. Patty Khuly, VMD, MBA, runs a small animal practice in Miami, Fla., and is available at drpattykhuly.com. Columnist’s opinions do not necessarily reflect those of Veterinary Practice News.
