Veterinary medicine in Bulgaria is developing, but there is still a serious distance between a university diploma and a doctor's real readiness to take on a complex patient on their own. This raises questions about both the practical training of young veterinarians and the standards, specializations and quality control of medical activities. Are there sufficiently clear requirements for clinics and doctors who perform specialized activities? Why are there still few world-class specialists in our country and what is missing to change the overall picture? Dr. Vladislav Zlatinov, chairman of the Bulgarian Association of Veterinary Orthopedics and Traumatology, works at Orthoclinic, spoke to FACTI.
– Dr. Zlatinov, when a student graduates from veterinary medicine in Bulgaria and receives his diploma, how ready is he to take on a patient independently - what can he do and what can he not do yet?
– With a few exceptions, newly graduated doctors in Bulgaria cannot do much. Of course, they can administer a vaccine or perform some other preventive activities. But taking on a patient with pathology requires a much richer set of knowledge and an established routine in obtaining and analyzing important information.
A separate set are the purely technical skills, which can only be built with longer practice. If students have not interned in private clinics during their studies, after graduation, colleagues are just beginning to master the art of clinical activity.
– You said that when you were studying, the training was quite slow and conservative. How has veterinary education in our country changed in recent years and is the university managing to keep up with the pace at which modern veterinary medicine is developing?
– There has probably been a change in the pace and innovation of the curriculum since I graduated. However, the end result is unchanged. After graduation, students have training in the basic disciplines - anatomy, physiology, etc., but they are just beginning their real training in clinical disciplines.
– Is there a difference with newly graduated students from abroad?
– I have some impressions that students who studied in Western Europe have also not encountered enough real patients and cannot really take on their treatment independently. However, they have a richer set of general clinical knowledge and a clearer structure for the role of history, examination and diagnostic methods.
For example, a student in Vienna may not be proficient in laparoscopic techniques, but he has trained on models. This gives him a clear idea of the role of this specialized surgical technique and how it is used.
– In your opinion, is there a difference between having a veterinary degree and being a trained clinician?
– Absolutely yes. But I think this is normal in every profession and discipline. The university gives you the direction and the foundation on which you can practice as a veterinarian, but only clinical practice can build you up as a trained clinician.
– Where is this boundary and how long does it really take for a young doctor to start working confidently?
– Everyone progresses at a different speed, but let's say that one year is the absolute minimum for acquiring some practical knowledge and skills. It is no coincidence that internship programs in the West last a minimum of one year. Of course, specializations in a given field last between three and five years.
– Now almost every veterinarian can reach the point where they open their own clinic. Do you think there should be clearer standards for what equipment, what qualifications, and what practical experience a clinic should have before starting to perform certain medical activities?
– Yes, this is an important question. It is not at all difficult for any veterinarian, prepared or not, to start their own practice. There are standards for registering medical institutions in terms of equipment, but the requirements are low.
Before, there was also a requirement for internship - three years of work before you could open an office or clinic, but this was dropped. There is also almost no talk of real qualification through postgraduate training.
So the standards and requirements are minimal and, with the help of modern advertising, any veterinarian can present themselves to their clients as more qualified than they actually are.
But this is a global trend - a blurring of advertising and reality. Our society is flooded with false information.
– Your own professional path includes numerous specialized trainings, internships abroad and work in specialized clinics in Finland. Is it possible for a veterinarian to stay with only their university education and still be at a sufficiently high professional level?
– Certainly, but not in clinical disciplines. In these areas there is a sea of information, continuous innovations and skills that need to be mastered.
I have not met a good doctor in practice who relies solely on his university education.
– What is the role of further training? Do Bulgarian veterinarians have an affinity for specializing?
– Yes. Many colleagues are aware of the limitations of basic training at the university. About five years ago, a trend began for mass practical courses in Bulgaria on various topics. The attendance was very high.
They are most attracted by the practical benefit - the opportunity to acquire skills that will be useful for expanding the portfolio of services in a given clinic.
However, I suspect that the latest generations of graduates - especially Generation Z - are less interested. They are clearly a more self-sufficient generation.
- Where is Bulgaria compared to the leading European countries in terms of veterinary medicine?
- We are still in the developing category. To be fair, many things have evolved, but there are still a huge number of conceptual problems to solve.
One of them is the consistency in the quality of services. In the same clinic, it is possible to get very good treatment and treatment, but also disappointing ones. This confuses customers a lot.
There is no clear division between general practitioners, clinics offering a certain specialized expertise, and those with clearly expressed specialized activities.
Another problem is the control over the activities of doctors. Unfortunately, ethics committees do not work effectively enough and cannot help objectively and professionally in resolving cases of claims by owners.
– Do we already have specialists and clinics that work at a world-class level, or are these still separate islands of very high competence?
– More precisely, we have world-class veterinarians, but they are few. The overall picture is far from the best in the world.
– Do you see a problem in the fact that good veterinary medicine is gradually becoming more specialized – orthopedics, neurosurgery, imaging diagnostics, anesthesiology, oncology – while a general practitioner should know a little bit of everything? How and should the work model change at all?
– This may be a problem in human medicine. Veterinary medicine will always offer a more holistic approach. That is simply the nature of our work.
For the moment, the opposite is rather lacking - a sufficient number of real specialists working in a given field and capable of taking on the most complex cases.
Otherwise, on paper, many colleagues are specialists in both dermatology and surgery, which is illogical and probably untrue.
– Who should actually be responsible for the quality of the veterinary profession - the universities, the Bulgarian Veterinary Union, the state, the doctors themselves or the market, which ultimately leaves animal owners to choose whom to trust?
– All of the above, but especially the doctors themselves. Being as prepared as possible in the medical profession is an ethical act and an important responsibility.
This is especially evident among colleagues who recognize their profession as a calling. The more this worldview develops, the better the level of veterinary medicine in Bulgaria will be.