Dr. Rena Carlson serves as president of the American Veterinary Medical Association, the nation’s leading advocate for the veterinary profession with more than 100,000 members.Read Articles Written by Rena Carlson
Each day more than 80,000 companion animal veterinarians work to provide the best possible care for millions of pets in the United States. Additional veterinarians in mixed animal, food animal, equine, laboratory animal, exotic and zoo/wildlife practice, specialty practice and public health provide services that keep patients, their owners and the public safe. And, in academia, veterinarians of all types make certain the next generation of veterinarians is well prepared. The American Veterinary Medical Association works every day to help ensure our colleagues continue to provide high-quality services so important to the health and welfare of animals and the public.
The AVMA recognizes how difficult the past few years have been. While challenges existed within the profession before COVID, the pandemic exacerbated them. The weight of these challenges has placed significant pressure and stress on practitioners and practices, which is why we are so committed to finding the right solutions to help veterinary teams now and into the future.
These challenges include a shortage of trained veterinarians in rural areas of the United States and in certain segments of our profession, including food animal, equine, academia, shelters, emergency practices, specialties and public health. However, some circulating estimates on the number of companion animal veterinarians needed by 2030 substantially overestimate demand while underestimating supply. These estimates are based on faulty math, positioning COVID-19 pandemic data as a baseline instead of an outlier when anticipating future needs, and neglecting to account for future capacity growth.
These inaccurate projections have led to claims of crisis-level shortages of companion animal veterinarians, causing lawmakers to consider proposals for long-term changes that would threaten animal health and safety. They also have led to dramatic, knee-jerk proposals to change how the profession is regulated — even to the point of contemplating removing the requirement for a license to practice veterinary medicine.
A New Wave of Veterinarians
What has been less broadly shared is that there is soon to be an influx of veterinarians that should ensure an ample supply well into the future. For example, the number of companion animal veterinarians is projected to grow by more than 20%, from 80,000 in 2022 to approximately 98,000 by 2030. Contributors to this growth include the continuation of historical increases in class sizes and the addition of three new schools graduating their first classes in 2023, 2024 and 2025. On top of that 20% growth are at least 10 new veterinary schools in various stages of development. At the same time, nationwide data show a decline in the number of clinic visits, new patients and new clients.
As we continue to navigate a volatile environment, we can take steps in the short term to help alleviate the pressures our teams are feeling. However, it is critically important that any long-term proposals put the health and welfare of animals and public health first and that they position the profession for continuing to meet these needs. Unfortunately, some longer-term solutions being proposed present risks.
No Middle Ground
For instance, there have been calls for the introduction of a midlevel position. While the potential to lower the cost of labor might be attractive to some, the most important factor for AVMA is how this is likely to impact our patients’ health and welfare. There is no agreed-upon standard curriculum, no programmatic accreditation and no national test to deliver and assess knowledge and skills. Developing such infrastructure would take decades and is required to ensure that animals and the public are protected.
Furthermore, restrictions under federal law mean these individuals could not deliver the services some have suggested they could provide. All members of the veterinary health care team should have clearly defined roles and responsibilities supported by the education they received, the skills they acquired and a regulatory structure that ensures their competence protects the health and safety of animals and people.
Since existing data do not support the need for a midlevel position, it is confounding that the profession would commit to an enormous expenditure of time and resources to create one when we aren’t fully leveraging the team members that are part of our practices now. We believe efforts are much better spent on programs and tools that fully engage veterinary technicians, veterinary technologists and veterinary technician specialists as part of a veterinarian-led team and that would allow them to practice to the top of their degrees and training.
Reflecting the AVMA’s longstanding commitment to veterinary technicians, veterinary technologists and veterinary technician specialists, we recently created the Committee on Advancing Veterinary Technicians and Technologists. The committee is charged with identifying resources to maximize the opportunity for these valuable members of the veterinary health care team to fully utilize their education and skills in all aspects of veterinary practice and to support and advance the veterinary technology profession generally.
The AVMA consistently reminds its members about the value that veterinary technicians, veterinary technologists and veterinary technician specialists contribute to the health care team and provides suggestions for what they can do to better engage these professionals’ talents to improve the quality and efficiency of patient care.
In-Person VCPR Is Best
Claims of a crisis-level cross-profession shortage also are driving proposals to allow a virtual veterinarian-client-patient relationship (VCPR). At the state level, these efforts are largely supported by direct-to-consumer telemedicine companies that have grown exponentially in human and veterinary medicine since the pandemic. Some of these companies appear to be sales-oriented rather than care-oriented, meaning their focus is on delivering their preferred set of drugs and medical products instead of comprehensively evaluating patients and delivering best-suited care (which may or may not involve a prescription). These types of companies have business models that are sustainable and profitable only in an operating environment that allows a VCPR to be established electronically. We should learn from — and avoid — what’s happened in human health care, where allowing provider-patient relationships to be established virtually has led to pill mills, increasing liability risk, fraud and government intervention.
Others claim allowing a VCPR to be established virtually will increase access to care. Let’s be realistic. Often, when people talk about access to care, their thoughts go to basic care. The basic care most animals need is preventive care tailored to an animal’s specific circumstances. That requires an in-person visit.
Unfortunately, animals that don’t regularly see a veterinarian are highly likely to need care that requires a complete physical examination to diagnose and treat. A wrong diagnosis or inappropriate treatment plan do not improve access to care. Instead, delays in diagnosis and effective treatment result in prolonged illness and suffering, and they cost the animal’s owner more.
In the past year, the AVMA has vigorously opposed multiple legislative efforts at the state level to remove or relax the VCPR requirement, because we believe a VCPR established in person is fundamental to quality patient care. It gives the veterinarian information that can’t be discovered in any other way. The in-person visit provides a 360-degree view of the patient and its situation, including a physical examination and the opportunity to obtain appropriate diagnostic specimens, both of which support an accurate and timely diagnosis. It also provides necessary familiarity with the client, including the owner’s relationship with the animal and ability to comply with a recommended treatment plan.
Beware Quick Fixes
As the profession works to overcome our workforce challenges, it is critically important that we fully evaluate the advantages and disadvantages of any proposals that will have long-term impacts on the delivery of veterinary medicine. Let’s not misdiagnose a short-term problem and then treat it inappropriately. Let’s identify the right long-term solutions — solutions that will not jeopardize quality medical care for animals or undermine public health.
The AVMA understands the impact of our current workforce challenges because our members tell us what they are experiencing every day. And we have first-hand knowledge, too. For instance, not only did I work as a relief veterinarian through the pandemic, but I also currently work as a mentor, helping new graduates start their careers as they navigate these challenging times.
We empathize with practitioners and their teams and are committed to addressing the challenges head-on. We look forward to working with our colleagues across the veterinary community in the months and years ahead to support veterinary professionals while protecting animals, their owners and the public.