6 Ways to Reverse the Specialist Shortage
How we train residents isn’t sustainable. Online learning and greater collaboration between universities and private practice are among the solutions.
I followed a relatively typical path to becoming a veterinary ophthalmologist. I graduated from an accredited veterinary school, matched and completed a one-year rotating internship at an academic institution, and then did a two-year private practice ophthalmology residency alongside dedicated board-certified mentors. I attended MD program lectures and rounds, spent a month here and there on pathology training, and built relationships with horse farms and zoos for large animal and exotics experience.
(Author: By Jennifer Welser, DVM, DACVO)
Everything worked out well, but that was in the ’90s. Today, the path to high-quality specialty training and board certification is expensive, unrealistic and unreliable. As the global chief medical officer at Mars Veterinary Health, I see the pain points in specialty education from a broad perspective.
Frankly, the current system worries me. How can we adapt the way we train residents and provide a more effective educational experience that serves all?
A 2018 JAVMA News article — read it at bit.ly/2MGwgdZ — attributed the short supply of veterinary specialists to a lack of residency programs. While the number of internship programs seems to be increasing, residencies are flat. Because we don’t have enough residency programs to accommodate the number of applicants, we must make changes to better meet the need.
The specialist shortage hurts:
- Primary practice veterinarians who need the support.
- Specialty practices providing services.
- Most importantly, the pets that need specialized care.
Imagine this: A veterinary school graduate wants to pursue a specialty. Let’s say veterinary ophthalmology. She could take a path similar to mine — my student debt was manageable and paid off in five years, unlike her expected debt load — but I question whether that pathway remains the best or only means to educate these doctors. The landscape of the profession has changed drastically over the past 30 years, yet our system to support and educate aspiring specialists has stood still.
Ask yourself this:
- What if we could accommodate more residents and improve training by evolving the requirements to more closely match current needs?
- How can we train more efficiently, balancing hands-on experience with didactics and structured learning?
- How can we better utilize private practitioners in busy referral practices to balance the university programs, which provide rigorous academics but frequently a tertiary referral caseload that doesn’t always mirror daily practice?
We need the best of all worlds. Done right, I believe, we could accommodate a larger number of aspiring specialists and increase the breadth and quality of education.
The six concepts below have been around, but now is the time to seriously look at upgrading and innovating the requirements to keep our profession sustainable and meet the demand for the full spectrum of services.
1. Greater Mobility
What if residency programs permitted training at more than one location? Given the challenges of taking on residents, adjusting the requirements could expose doctors to several hospitals, practitioners and situations, resulting in more diverse learning opportunities and more flexible doctors. Allowing residents to be trained at more than one place should improve the efficiency of student and doctor time while strengthening the quality of training. And no, that doesn’t mean residents floundering on their own in a remote satellite clinic.
2. Private Practice and University Collaborations
My colleagues at Antech Imaging Services have forged partnerships with 18 universities in the United States, Europe and Asia. The arrangements differ based on the needs of the university and might include elements like faculty support, equipment, didactic teaching support, research collaborations, a virtual case conference and a journal club to help alleviate pressure on the faculty. Shared models could allow universities to increase the number of residents and enable them to spend time both at the university and in private practice, resulting in the majority of residents who end up in private practice being practice-ready. Caseloads seen in private practice also will benefit universities by enhancing the quality of clinical science being delivered and allow residents to receive training and achieve their goal of publication with a large dataset, resulting in better science. A win for everyone.
3. Increase Online Options
Current rules limit the percentage of rounds that residents can do virtually in a clinic and require in-person training on topics they could do online, such as histopath and virtual pathology, virtual journal club and virtual didactic rounds. This outdated approach decreases the work-life balance and limits access to experts interested in teaching. Additionally, work is being done to improve simulation training — think cataract training, surgeries, SynDaver models and virtual reality.
Taking a fresh look at what is possible through online learning and adjusting the requirements to reflect technological advancements will make it easier for experts in their fields to deliver high-quality training to a larger number of residents — the true experts in their fields. One should learn about fungal disease from someone who has treated it in practice. In the COVID and post-COVID world, it just makes sense.
The concept isn’t new, but it’s worth mentioning. Allowing residents to choose a small or large animal focus would make training more efficient and allow residents to concentrate on relevant content and build their expertise more quickly.
5. Adaptive Learning
The New England Journal of Medicine Group rolled out NEJM Knowledge+, a learning program for human health residents that uses adaptive training to improve both efficiency and board outcomes. Researchers found that residents were 6% more likely to pass their boards if they learned through this method.
I love adaptive learning because it identifies what the student doesn’t know and allows correction in a shorter period. Rather than spending time relearning what they already know, the technique redirects to what they don’t know, improving efficiencies and narrowing the focus to knowledge gaps.
What if we used blockchain technology to track the training and credentials of professionals safely, quickly and accurately? We could dramatically increase mobility, which not only opens opportunities for individuals but also could serve us well in times of natural disaster or, perhaps, pandemic. We could dramatically increase capacity by allowing individuals to practice at the top of their training and experience level throughout the learning journey. And, of course, education could be paid for via bitcoin, but that’s a bit off-topic.
The bottom line is we need the help of untapped specialists to get more specialists in the pipeline. The only way to fuel the pipeline is to create an environment that allows both qualified experts to train and aspiring students to learn. It’s a classic chicken-or-egg situation and one we need to address soon to keep specialty veterinary medicine robust as well as accessible and affordable for pet owners.
Innovation Station guest columnist Dr. Jennifer Welser is a Veterinary Innovation Council board member and the global chief medical officer at Mars Veterinary Health. She is a former private practice owner and former chief medical officer at BluePearl Veterinary Partners. An inventor, she is passionate about advancing the industry in a manner that serves people, pets and the planet.
The annual salary offered to qualified internists by a suburban Cleveland veterinary practice. The help-wanted ad on the American College of Veterinary Internal Medicine job board also promised “a generous signing bonus.”