The animal health industry, veterinary profession and pet owners largely acknowledge the acute, yearslong shortage of veterinarians. So how do we begin to reduce the shortfall? By finding ways to produce more professionals, which is what human health care has done for decades by graduating more MDs and DOs and adding physician assistants and nurse practitioners to the mix. Yet human medicine still doesn’t have enough of them. The lesson learned: Scarcities rarely are solved, but imagine what U.S. medical care would look like if partial remedies hadn’t been deployed.
This article is about arithmetic and limitations in the veterinary profession, specifically:
- What are we doing to add a significant number of new veterinary schools?
- How did we get here?
- Can we remove the limitations that make solutions harder or too slow?
We’ll start by diving into where we are and the complicated process to birth at least eight more programs.
Enter the Horse Doctor
The history of U.S. veterinary medicine and educating its practitioners is one of limitations — some self-imposed and others cultural. What do I mean by that? Veterinary schools initially were organized to address the needs of agriculture and the transportation of crops and goods by horses. The medical care of companion animals such as cats and dogs was a minor concern in the 1800s. Back then, the infrastructure requirements for doctoral large animal programs were massive, which mostly limited the sponsors to land-grant institutions supported by state legislatures willing to invest public monies.
When companion animal medicine and surgery arrived on the scene, higher education limited veterinary training to the offerings inside expensive, on-campus teaching hospitals. By “expensive,” I mean extremely pricey to build and operate.
Until recently (the past five years), organized veterinary medicine saw its mission as limited, not emboldened, by consumer demand. The profession’s leaders worried that we might have too many veterinarians. The concern about the need to limit the number of DVM graduates coincided with a 30-year stretch in which just one new veterinary school opened: Western University in Pomona, California. Over that period, the U.S. population doubled, and MD and DO programs grew by 45%. (I should note that only when litigation was threatened was Western University and its distributive clinical curriculum welcomed by the accreditation-granting AVMA Council on Education.)
Meanwhile, the COE accredited more foreign schools, three of which (Ross, St. George’s and UNAM in Mexico City) triggered intense debates in the AVMA House of Delegates and at American Veterinary Medical Association conventions. The popular fear that the industry was turning out too many veterinarians led to calls to stop accrediting new schools and reduce U.S. class sizes.
(Full disclosure: I represented Ross University in its accreditation campaign and fought to successfully overturn the COE’s initial rejection of UNAM.)
The overpopulation debate reached its crescendo and began to subside after the accreditation of two domestic nonprofit institutions: Lincoln Memorial University in Harrogate, Tennessee, and Midwestern University in Glendale, Arizona. LMU implemented a version of Western’s distributive model, while Midwestern effectively built a land-grant campus that includes a teaching hospital.
The New Dynamic
What became clear but not yet appreciated nearly a decade ago was that the United States faced a shortage of veterinarians as early as 2014, the year Lincoln Memorial and Midwestern opened. To be fair, no one foresaw that Americans’ view of pets would undergo a wholesale transformation in the 1990s and early 2000s, a sea change documented in my 2020 book, “Pet Nation.” What I chronicled was this:
- Dogs and cats went from accessories to center stage in U.S. households.
- Pet spending ballooned.
- Pet acquisitions (adoptions and sales) exploded.
- Dogs showed up seemingly everywhere in society.
- Millennial pet owners burst on the scene, demanding a scale and quality of pet health care matching their personal medical care. (Today, millennials and Generation Zers own half of America’s pets.)
All that is great unless you don’t have enough veterinarians and veterinary technicians to see more pets.
Today, Dr. Jim Lloyd, an economist and the University of Florida’s former veterinary college dean, forecasts a shortage of 15,000 U.S. veterinarians and 70 million pets going without veterinary care by 2030. We face the labor challenge even with the recent openings of three DVM programs: the University of Arizona (2020), Long Island University (2020) and Texas Tech University (2022). The first two are distributive and the latter a mix.
Next in Line
Here are the new programs in front of the Council on Education as of August 2023:
- A Lincoln Memorial University satellite campus near Jacksonville, Florida. (I am consulting.)
- Clemson University, a public land-grant institution in South Carolina. The proposal includes a teaching hospital developed by Dr. Tim Boosinger, a former Auburn University veterinary college dean.
- Rowan University, a public institution with financial support from New Jersey legislators and a major donor.
- Lyon College School of Veterinary Medicine at Heifer International, a private nonprofit institution in Little Rock, Arkansas. Dr. Eleanor M. Green, who once headed the veterinary program at Texas A&M University, is the founding dean. (I am consulting.)
- Arkansas State University, a public institution in Jonesboro, Arkansas.
- Three programs, including one hosted by an historically black college or university, in different regions of the United States. I am a consultant to all three, none of which were announced publicly at the time of this writing.
The Station Master
What paths must those eight institutions navigate before welcoming an inaugural class? All accreditation trains run through the COE station.
The Council on Education publishes exhaustive procedures and rules governing the accreditation process for new schools. That long list was updated in June 2022 with the addition of a requirement that all new programs participate in a consultative site visit (preceded by a self-study) before a comprehensive self-study and COE site visit can occur. The consultative process adds eight to 12 months to an already-slow process. The rules and procedures provide that when making accreditation decisions, the COE also must consider the needs of the veterinary profession and the public at large.
The COE may conduct site visits any way it deems appropriate under the rules and procedures. The COVID pandemic provided an opportunity for the COE to experiment with videoconferencing, which could accelerate the review of the eight programs.
Unfortunately, the COE faces staffing issues (paid and volunteer) in attempting to evaluate eight schools at once. For their part, colleges and universities devote substantial resources to developing new programs, so any delays due to COE resource limitations are frustrating.
Videoconferences might hold the key to moving things along at a businesslike pace while veterinarian shortages persist. I recommend that the two organizations that appoint COE members — the AVMA and the American Association of Veterinary Medical Colleges — work on streamlining the processes. I also urge the animal health industry and veterinary profession to augment the COE’s financial resources, no strings attached.
If the COE approves eight new programs, we can expect to see at least 800 new DVM graduates each year. However, if we do the arithmetic, that number is but a dent in the dynamics of shortages when we subtract the retirements of baby boomers and some Generation X professionals. In other words, launching eight more programs is not a panacea.
Off Campus vs. On Campus
Another subject to explore is the performance and opportunities offered to graduates of distributive programs versus those trained at campus-based teaching hospitals. At least five, and possibly six, of the proposed schools would provide a distributive education. Such a model isn’t chosen solely because it’s less expensive than building and operating a teaching hospital but because the distributive experience helps prepare students for the job market.
Human medical schools provide an interesting comparison. I have a front-row seat because my wife is a leader at Mayo Clinic’s School of Medicine in Scottsdale, Arizona.
Medical schools such as Mayo devote two years of the four-year curricula to clinical rotations, and increasingly a portion of Year Two. The final year of four-week rotations effectively serves as audition time for residencies. It works both ways: Residency programs get first-hand experience with candidates, and the students evaluate residency landing spots.
That describes what veterinary students experience with distributive rotations in their final year of school. Practices get an upclose view of a soon-to-be DVM, and the opportunity often leads to a competitive job offer for the candidate. Corporate and small veterinary practices have discovered the model’s mutual benefits, which explains why many hospitals and animal health companies support some of the new schools offering distributive education.
At least five of the proposed programs in which I’m involved want to copy the University of Arizona and offer a nine-semester curriculum over three calendar years (no summer break). Those students can become practicing veterinarians one year earlier than their peers.
The Teaching Work Force
The pandemic and veterinarian shortage opened the door for innovations in the deployment of faculty members at emerging programs. Unfortunately, veterinary specialists employed in academia are recruited heavily by practices nationwide and at compensation levels outstripping the reach of their institutions. It’s the law of supply and demand, so schools should open themselves to virtual and adjunct faculty in delivering their curricula.
Meanwhile, COVID’s social-distancing norms played a crucial role in stimulating the delivery of didactic courses, often the basic sciences, through virtual technologies. Students understood and adapted to the new pedagogy, and costs fell. Such an approach might not be a long-term solution, but it does open the door for “star” faculty members to deliver content to more than one program effectively and be compensated competitively, bridging the private-sector pay gap.
Another idea is for animal health industry partners to nominate academic talent within their ranks to deliver part of the DVM curriculum. Those conversations are underway and would tap into practitioners and industry experts who want to remain involved with veterinary education.
Let’s close with a topic that’s less about economics and arithmetic. Each year, at least 2,000 academically qualified college students are denied admission to veterinary school due to
class-size constraints. Many of those students dreamed of becoming veterinarians since childhood. Eight new schools, if approved, would open the door for many of those students to pursue their aspirations. That’s a good thing. If the profession and animal health industry are serious about addressing access-to-care issues, then having more doctors of veterinary medicine surely will help.
This is an exciting time in U.S. veterinary medicine, and higher education is a powerful agent. Keep your seat belts buckled!
A CALL TO ACTION
Just over a year ago, the American Association of Veterinary Medical Colleges issued a powerful statement regarding the veterinary workforce. The summary reads: “The current shortage of veterinarians in the U.S. is having a significant impact on access to health care for animals and the well-being of the veterinary health care team. AAVMC stands ready to work with partners from academia, veterinary medical associations, industry and other stakeholders to ensure that veterinary medical colleges, and higher education more generally, effectively respond to the current shortages.”
Visit bit.ly/3Co3l4G to read the entire statement.
WHAT IS THE COE?
The U.S. Department of Education approves and oversees a single accreditation body for each academic program enrolling students receiving Title IV loans. In the case of DVM programs, the Council on Education is in charge.
With privilege comes rules and responsibilities, including a federal mandate that no institution or organization shall attempt to sway COE decisions. For example, the American Veterinary Medical Association staffs and houses the COE but is not permitted to control or influence COE decisions.
The AVMA and the American Association of Veterinary Medical Colleges each appoint 10 of the COE’s 20 members. All appointees are volunteers whose three-year terms may be renewed once.
While volunteers outside of the COE handle institutional site visits, the Council on Education sends its members to act as nonvoting participants.