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
America’s veterinary industry acknowledged in 2021 that we face an acute, chronic and growing shortage of veterinarians. We’re not alone. A 2020 study conducted by the Association of American Medical Colleges — read it at bit.ly/3sUafuY — projected a shortfall of up to 139,000 physicians by 2023, compounded by shortages of physician assistants and nurse practitioners. As states wrestle with strategies to address this human health care crisis, won’t failure inevitably lead to rising prices and medical deserts? A similar question confronts pet health care leaders not accustomed to steering their industry in new directions.
Only seven years ago, many veterinarians convinced themselves that we faced a surplus of practitioners, and we heard calls for opening no more veterinary schools and reducing class sizes. This came on the heels of a debate triggered by the accreditation of the Lincoln Memorial University and Midwestern University veterinary schools. Mind you, over the 35 years from 1979 to 2014, only one U.S. veterinary program opened: Western University of Health Sciences in California. Western’s commitment to distributive clinical rotations rocked the establishment.
Now that we recognize that the shortages aren’t going away, can we shift the conversation to an industry-wide engagement about solutions? I’ll explore the options here for persuading a majority of veterinarians and industry professionals to take practical steps to solve the problem. Will everyone get on board? Of course not, and certain interests might never be convinced. But war stories from practices across America and growing frustration among pet owners unable to access veterinary care cannot be ignored. Unless you believe that millennials and Gen Z–ers will cool their love affair with pets, don’t we have a responsibility to get things right?
In brief, here are seven measures we could implement separately or together:
- Convince accreditors of the need to expand veterinary school class sizes.
- Open additional veterinary schools at a fraction of the cost of older programs by deploying proven innovations in curricula.
- Emulate human health care’s 60 years of success with midlevel practitioners.
- Amend practice acts and state regulations to expand the scope of practice of credentialed veterinary technicians and veterinary assistants.
- Educate veterinarians about the efficient use of telemedicine.
- Encourage and fund technological advances to reduce labor pressures and provide valuable patient care.
- Expand from 16 the number of states that recognize reciprocity in allowing licensed veterinarians to move to a new state.
1. Expand Class Sizes
Some causes of shortages require years to fix, but that doesn’t mean we can’t start now. Such is the case with the size of entering classes, which range in the United States from 60 to 164. Every U.S. veterinary college does an excellent job of teaching, whether measured by the performance of graduates in practices or the absence of serious accreditation problems. So, why not trust high-performing schools to add students? Why is the Council on Education’s default position to restrain growth? If schools have a growth plan anchored by adequate financial resources, then let them expand at a pace each deems feasible. Over 2,000 qualified applicants are not admitted to U.S. veterinary colleges each year, so we know that the demand for seats is strong, as former University of Florida veterinary dean Dr. Jim Lloyd’s pioneering study discovered.
Now that COE members no longer serve as site visitors (only as observers in groups of one or two), which means they have limited hands-on familiarity with individual school facilities and resources, shouldn’t the COE’s default position support the schools’ expansion plans? The industry and profession should demand meaningful dialogue with the COE on the needs of the marketplace and modern pet owners. Accrediting bodies are supposed to listen to their consumers (employers), per the guiding principles of the Association of Specialty and Professional Accreditors, of which the COE is a member. Meaningful dialogue should be arranged without difficulty.
2. Open New Schools
The COE has approved five new programs since 2014: Lincoln Memorial, Midwestern, the University of Arizona, Long Island University and Texas Tech. That’s progress. Now, the opportunity is to leverage new economies of scale to open additional programs at substantially lower costs, tapping student demand and possibly lowering tuition. The value of distributive clinical rotations no longer is questioned — four of the five new schools deploy such programs. The virtual delivery of basic science didactic courses lowers costs, and COVID-19 requirements demonstrated that these methods work. Veterinary practices, industry and schools are open to new partnerships. The COE should be encouraged to support such initiatives.
3. Create Midlevel Professionals
I covered this innovation in previous articles. The idea is simple: Follow human medicine’s lead and create a professional position between a credentialed veterinary technician and a DVM. The Veterinary Innovation Council endorsed such a reform in 2020 and encouraged veterinary colleges to launch pilot programs. Lincoln Memorial is the first, stepping up with a master’s in veterinary clinical care starting in August 2022. The three-semester degree will be online, allowing talented veterinary technicians to continue their clinical training at their current practice while pursuing a professional track, such as small animal general practice, specialty/emergency, industry or large animal. These students will take core veterinary courses and become qualified to manage care delivery in large practices and work up cases for veterinarians in smaller practices, much like physician assistants and nurse practitioners in human medicine. No title change or legislation is required at this stage.
4. Expand a CVT’s Scope of Practice
Each veterinary medical board should be encouraged, with the support of the American Association of Veterinary State Boards, to review their states’ practice acts and board regulations with the goal of upgrading and modernizing the privileges granted to credentialed veterinary technicians. Veterinarians spend too much time performing tasks better handled by veterinary technicians. Bring the AAVSB to the table with practices, the National Association of Veterinary Technicians in America and the Committee on Veterinary Technician Education and Activities. Together, they can push the envelope on new opportunities for credentialed veterinary technicians, learning from human medicine and the nursing profession. Efforts to expand practice acts have been too timid. We need big, bold steps.
5. Do More With Telemedicine
My articles have considered telemedicine in-depth, so I won’t conduct a deep dive now. However, shortage conditions cry out for the profession and industry to focus on understanding how virtual tools relieve staffing pressures and provide frustrated pet owners with resources that overburdened practices cannot offer under present conditions. An estimated 14,000 female DVMs are at home and able to provide telemedicine services to clients. This resource alone, if tapped, could have a measurable impact on the shortages in clinics by taking care of pet issues that do not require an in-person visit.
Teletriage addresses a key pressure point for pet owners: “Do I need to take my pet to the emergency hospital?” Teletriage gives pet owners what they need and relieves pressure on short-staffed clinics. With shortages challenging practices nationwide, why impede telemedicine for veterinarians willing to try it? Must we handcuff teletriage services and place more demands on clinic staff? After a long battle, telemedicine converted human health care skeptics. Will veterinary medicine require decades to reach the same outcome?
6. Adopt Technology and AI
Modern commerce has demonstrated that chronic labor shortages place a premium on meeting demand through technological advances. Artificial intelligence is the best example. Veterinary medicine deploys AI, but sustained investments in AI tools are not yet in force. This must change, and we could learn from the commitment that Great Britain and Leeds University made in sponsoring veterinary AI with a commercial partner, Vet-AI. I’m not calling for government funding — we shouldn’t turn it down if offered — but instead for companies and investors now flooding the pet sector to accelerate the pace of AI research in the U.S. veterinary economy. Pet owners consume a plethora of services and products reflecting AI advances, so we shouldn’t fear how clients will react.
7. Reject Anti-Competitive Restraints
Sixteen states allow licensed veterinarians in good standing to move there and begin practicing, and six more require only one year of practice before a move. Twenty-eight other states make things difficult, with many requiring five or even 10 years of practice in the original state before the veterinarian can move without retaking the North American Veterinary Licensing Examination. (The veterinarian already passed it.) The only rationale for such a regressive policy is to protect the economic interests of veterinarians in those 28 states.
In an era of chronic shortages and increasingly limited access to veterinary care, such an anti-competitive rationale might no longer be justified. States have made tremendous advances in reciprocity for professions such as medicine, law, nursing and architecture, yet veterinary medicine lags. Reciprocity doesn’t solve shortages, but it does provide an avenue for veterinarians to meet demand in other states and honors their freedom to practice where they want. Since every state allows graduates of accredited veterinary colleges who pass the NAVLE to start practicing right away, how can anyone argue that experienced veterinarians who passed the NAVLE and earned an accredited DVM degree must wait longer?
The American Veterinary Medical Association’s Council on Education in 2021 put out a call for veterinarians to serve as volunteer site visitors.
“Site visitors conduct veterinary medical college accreditation site visits on behalf of the AVMA COE, with free training provided by the COE,” the organization stated in its request for applications.
“Site visitors carefully review a college’s self-study, verify the information during a comprehensive site visit of the institution, and submit a report to the AVMA COE for its consideration. As a site visitor, you will make recommendations to the COE but will not attend council meetings, discuss findings or otherwise participate in accreditation decisions.”