Politics & Policy columnist Mark Cushing is a political strategist, lawyer, founding partner of the Animal Policy Group and founding member of the Veterinary Virtual Care Association. Since 2004, he has specialized in animal health, animal welfare, and veterinary educational issues and accreditation. He is the author of “Pet Nation: The Inside Story of How Companion Animals Are Transforming Our Homes, Culture and Economy.”Read Articles Written by Mark Cushing
The economic surge in pet health care and services has exceeded 14 months. There’s no end in sight. The fundamentals appear to be in place: rising pet ownership, growing demand for pet services, the millennial and Gen Z appetites for human-quality pet health care, the acceptance of online delivery models, access to capital, etc. The trajectory seems sustainable, right? Or is the foundation cracked? I’m not referring to the usual skepticism that all good things for veterinarians must come to an end. I’m talking about the four challenges we must address to keep a great thing going. That’s what we will consider here, one challenge at a time, and what the veterinary industry can do to keep up with the American pet economy’s sizzling pace.
1. Veterinarian Shortage
The veterinary establishment acknowledges the new reality. Ask any practice owner or associate veterinarian about their most significant problems, and the answers mirror each other: “Burnout and I cannot find a veterinarian.” That is true in the nonprofit sector, too, as shelters scramble to hire veterinarians but lack the resources to match the new levels of starting salaries.
When Silicon Valley executives need more software engineers, they do something about it: They push the schools to produce more engineers and raise salaries to fuel the growth. Why doesn’t the pet health care industry follow that lead? I’m not referring to higher compensation because that’s happening in every corner of the country.
Veterinary practices and the animal health industry are unwilling or don’t know how to prod schools to produce more veterinarians despite a 19% growth in applications from qualified students. There is no organized mechanism for the accrediting body, the Council on Education, to hear from its consumers (employers) about the shortage’s severity. Accreditors continue to restrain growth and micromanage the excellent collection of 32 U.S. veterinary colleges.
The two bodies that appoint COE members — the American Veterinary Medical Association and the American Association of Veterinary Medical Colleges — face restraints in raising the issue. Despite an expectation from the Association of Specialized and Professional Accreditors that accrediting bodies such as the COE will actively reach out to employers and stakeholders, there is no organized engagement between the COE and veterinary practices and all other DVM employers. It’s as if no one is looking outside the window to notice that we are in an epic drought.
Veterinary schools that want to grow and have a plan for it should be encouraged, not told to wait or slow down. Fears that growth in the veterinary student population inevitably will damage quality are just that: fears without data or evidence. If the issue is a lack of funding to expand teaching hospitals, every veterinary school can diversify clinical training through proven distributive rotation models. But nothing will change if we don’t talk about the issue openly and create a mechanism for the COE to understand the dramatically changing realities of veterinary practice (and demand) in America.
2. CVT Turnover
The challenge here is equally acute but doesn’t require an accrediting body to fix it. Nearly half of our credentialed veterinary technicians (CVT, RVT, LVT and LVMT) leave the profession after five years. It’s a crisis that few people even try to dispute. Two factors drive the turnover, and veterinary practice owners control both: undercompensation and underutilization by most clinics of the trained (and national board-certified) skills of credentialed veterinary technicians.
The best data suggests that most veterinarians utilize half or less of the skills technicians are trained and certified to deploy. That is like telling a right-handed baseball pitcher to throw left-handed every other game. This chronic mistake and the turnover of qualified veterinary technicians lead to a perennial shortage. When it’s combined with the lack of veterinarians, are we surprised to see professional burnout nationwide? One might hope that we could address the problem in an era of unprecedented growth in practice revenue.
3. No Midlevel Professionals
Human health care has addressed chronic shortages for decades, in large part through the creation of a ladder of professionals from two-year community college registered nurses through post-residency doctor fellowships. They have two- and four-year nurses, master’s and doctoral nurse practitioners, physician assistants, DOs and MDs, plus layers within these certified professionals.
Veterinary medicine has DVMs and, with few exceptions, two-year credentialed veterinary technicians. With demand for pet health care surging and an acute shortage of veterinarians and credentialed technicians, does it make sense not to explore the creation of a midlevel professional? Is veterinary medicine somehow immune from all the efficiencies we experience with human medical practice and its battery of professionals?
The Veterinary Innovation Council devoted two years of study, outreach and debate to address those questions and is encouraging veterinary colleges to develop pilots for master-level extender programs. The Lincoln Memorial University College of Veterinary Medicine is planning such a pilot through an online model that would allow a practicing veterinary technician to remain in her community and job while earning the degree and additional expertise. Let’s hope that veterinary professionals welcome this development without the old worry that a midlevel provider somehow threatens veterinarians’ livelihood. If human health care is an example, we will witness the growth of compensation and services at all stages of the spectrum.
4. Little Freedom of Movement
This topic garners very little attention. Licensed veterinarians and credentialed veterinary technicians face extreme difficulty practicing in more than one jurisdiction. Again, veterinary medicine lags behind other professions.
The rationale or underpinning for this lack of reciprocity is an outdated fear that veterinarians and veterinary technicians will lose their jobs if we let other professionals move into their states. Shortages and burnout should extinguish that fear, yet 34 states still make moving there unfairly difficult for a licensed veterinarian from an accredited veterinary college who has passed national board exams and possesses a sparkling professional record. Why? Because those states require a licensed veterinary professional to retake the national board exam (NAVLE for veterinarians, VTNE for credentialed technicians) to become licensed in their state unless the person has practiced continuously in a prior state for anywhere from one to 10 years.
Profession after profession in the United States has stepped up to fix the inequity. The American Association of Veterinary State Boards is addressing half of the problem quite effectively, namely the development of a database of professional credentials or records covering all 50 states and the District of Columbia. Let’s salute the AAVSB. As these solutions are implemented, now is the time for the 34 states (particularly those requiring two or more years of continuous service in a prior state) to address the other half of the problem and not require retaking a previously passed national board exam.
Ignoring DVM and technician shortages only prolongs the suffering and increases the scale. Now is the time for the pet health care industry to address the fundamental causes of shortages and the barriers to solutions. Now is not the time to oppose telemedicine when veterinary practices and pet owners need every available tool or resource to meet demand. Now is not the time for veterinarians to fear change when it’s precisely what’s needed to tackle burnout and maintain prosperity and opportunity. The solutions are in plain sight.
THE NEXT GENERATION
Total enrollment at U.S. colleges of veterinary medicine was 13,548 in 2020. According to the American Association of Veterinary Medical Colleges, the number of first-year seats grew by an average of 2.4% annually from 2009 to 2019.