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
COVID carried on a curious relationship with the veterinary industry throughout 2020 and early 2021. Much has been written about the industry’s financial strength and gains during this period, hopefully putting to rest chronic fears that pet health care is a fragile sector and susceptible to sudden downturns. The toll on human lives is a different story.
What I’m interested in today are the shortages and excesses in the animal health industry and our willingness to take action with or without a pandemic in our midst. This will be a primer, not a deep dive.
What are the shortages? Veterinarians, veterinary technicians/nurses and dogs top the list. What are the excesses? I’ll focus on student debt. Each affects American pet owners, practitioners and access to veterinary care. Solutions are available, though none would have an instant impact. Is the industry serious about finding and implementing, or even discussing, solutions? That remains to be seen.
Let’s examine the status of each one and consider the initial steps for tackling the challenge.
A Shortage of Veterinarians and Technicians
Studies by economist and former University of Florida veterinary college dean Dr. Jim Lloyd point to a growing shortage of veterinarians in the range of 3,000 to 5,000. U.S. Bureau of Labor Statistics reports confirm the numbers and predict the problem will get worse as we move forward.
Anecdotal evidence from large and small practices throughout the United States is consistent and alarming. It seems that every small animal clinic needs help. As baby-boomer veterinarians retire (approaching a 2,000-a-year pace), the shortage grows. The same condition persists for veterinary technicians, although the precise number is harder to pin down.
The direct and collateral damage from a shortage of veterinarians and technicians is profound: staff burnout, service delays, the potential effect on the quality of care, and limitations on access to care. Human health care has experienced acute shortages for as long as we can remember, and the same problems or effects persist. What options do we have?
First, you cannot produce more veterinarians if you do not increase class sizes at our veterinary colleges. Since 1978, the United States has added five schools, and one more (Texas Tech University) is on the way. Compared to the growth in our human and pet populations (dramatically more with the latter), the expansion from 27 schools to 32 or 33 doesn’t keep pace. This disparity is heightened when compared to the expansion of human medical, osteopathic, nurse practitioner and physician assistant programs. The expansion of veterinary class sizes lags even further.
Two constraints keep veterinary class sizes relatively stagnant: finances and the accreditation bureaucracy. Twenty-eight of the first 30 U.S. veterinary schools primarily conduct their clinical fourth year at on-campus teaching hospitals. Twenty-five of those 28 schools rely heavily on state funding. With the exception of Purdue and Texas A&M universities, state legislatures have refused to commit significant resources to upgrades or expansions of teaching hospitals. And in the case of Purdue and Texas A&M, upgrades and new facilities did not lead to greater capacity.
The building, maintaining and remodeling of veterinary tertiary hospitals is not cheap, and the welcome rise of private specialty/emergency hospitals as viable options for pet owners compounds the challenge.
No surprise that three of the four newest programs — Texas Tech will make it four of five — adopted the distributive model for clinical year training. Despite the evidence of student success at Western and Lincoln Memorial universities, traditional veterinary schools have been reluctant to utilize distributive options to expand classes. (Schools at the University of Arizona and Long Island University opened only last fall, so no clinical rotations yet.)
The accreditation bureaucracy is an even heavier constraint on producing more veterinarians. The American Veterinary Medical Association’s Council on Education (COE) seemingly has appointed itself as guardian of the current supply of veterinarians and consistently restrains the expansion of class sizes. Recent COE rule changes make this slow-growth policy official, and requests to expand class sizes meet resistance. The rationale relied upon by the COE is the fear of harm to the quality of education, but unfortunately, no data or evidence has been provided to support the position. The decision is arbitrary.
The challenges facing our veterinary technician/nurse population have been documented by many groups, led by the National Association of Veterinary Technicians in America, the Veterinary Innovation Council and others. Technicians are leaving the profession in alarming numbers. They face tall hurdles in improving compensation, career paths and recognition of their training and certified skills.
We have yet to see a midlevel extender or new professional to bridge the gap (as human medicine has done) between technicians and doctors. Imagine the scale of human health professional shortages if we didn’t have nurse practitioners and physician assistants. Put aside the issue of what to name a new professional. There is a growing consensus that veterinary medicine needs a new professional who has a host of skills and knowledge not available currently. One or more veterinary colleges are preparing to launch such programs.
A Shortage of Dogs
I have written before about chronic canine shortages, which intensified during COVID-19. (Read more at bit.ly/3oH76ZW and bit.ly/3a2EdDs.) In August 2019, the Centers for Disease Control and Prevention and the U.S. Department of Agriculture agreed that U.S. supply needs attract in excess of 1 million dogs annually from foreign sources. About 3% of these dogs arrive without health, vaccination or veterinary records. This still leaves an annual shortage of 1 million or more and begs the question of whether the United States wants its annual pet needs to be met by questionable foreign sources.
The issue is politically charged, and veterinary groups have avoided direct engagement. The alternative to foreign sources is to increase breeding in the United States, which invites debate about breeding standards and commercial dog breeders.
My discussion here is brief for the reason that the solution is not as difficult as you might imagine. The left and the right, or animal welfare groups and commercial breeders, do not differ fundamentally on what constitutes humane breeding standards. Issues of transparency in breeder practices might be solved.
What stops progress is the lack of trust between animal welfare organizations and breeders. America has a rich and successful record of pulling opposing factions into rooms to negotiate settlements in almost every field of endeavor, including wars. The veterinary profession has the opportunity to step (bravely) into the arena, bring the factions into a room and hammer out a deal on humane breeding standards that would assure pet owners of quality sources. Our 76 land-grant universities should be able to contribute expertise.
Excessive Student Debt
The average educational debt of a 2019 veterinary school graduate was $149,877, according to an AVMA report. Two solutions are within reach:
- Hold a lid on tuition growth, even lowering the cost of veterinary college.
- Increase starting salaries by focusing even more on teaching clinical skills that would be of value to veterinary practices (employers) on Day One.
Tuition prices are a function of the cost of operating veterinary programs and are driven heavily by labor and bricks and mortar. COVID is teaching every professional school (not just veterinary) that didactic learning might be handled through virtual technologies, which opens the door to a multitude of efficiencies to reduce labor costs and share talent across veterinary programs. Distributive clinical rotations are significantly less expensive to operate than full-service teaching hospitals, and schools could shift at least some of their fourth-year curriculum from on-campus teaching hospitals, many of which compete with local practitioners, to distributive sites. This has the ancillary benefit of increasing the clinical readiness of fourth-year students and enhancing their economic value upon graduation.
Simple to implement? No, but manageable. Shortages and excesses might always be with us, but our profession can take responsibility and manage its way to better outcomes and concrete results.
DID YOU KNOW?
The average starting salary for newly graduated veterinarians rose by 6% in 2019 to $70,045, the American Veterinary Medical Association reported. The highest earners were found in private companion animal exclusive practices, at $90,893. Mixed-animal veterinarians started at an average of $75,391 and the typical new equine practitioner took home $53,804. AVMA members can download the 2020 Economic State of the Veterinary Profession study for free at bit.ly/32ZG8EA.