Accreditation under fire in veterinary medicine

February 26, 2010
By: Jennifer Fiala
For The VIN News Service

Part 1 of a 2-part series (Part 2)

Next: An in-depth look at AVMA’s charge to accredit internationally

Twenty-one council members with the power to extend U.S. accreditation to veterinary education programs around the globe will meet next week to make decisions that some believe could have far-reaching effects on veterinary medicine — consequences that could include, among other things, increased competition and eroding educational competence.

In response, a number of practitioners are calling on the agency to stall its deliberations to mull the impact that their actions might have on the profession.

On Sunday, the American Veterinary Medical Association Council on Education (AVMA-COE) will gather for a three-day meeting in Schaumburg, Ill. On the table are accreditation requests by the veterinary medical programs of Western University of Health Sciences (Western U), in Pomona, Calif., and the National Autonomous University of Mexico (UNAM) in Mexico City. Also up for a vote is a move to alter COE policies, including a change that could assist Western U’s bid for full accreditation and encourage the development of other programs like it.

The Western U and UNAM programs both have a rich history with the COE, the only recognized accrediting agency for veterinary medical colleges in the United States and Canada. Western U sits at a final stage, awaiting full accreditation, as does UNAM, where officials expect to receive the COE’s nod for established programs.

There are major differences between UNAM and Western U, America's newest veterinary medical program. While UNAM accepts students out of high school into an educational system that's largely based on animal husbandry, Western U boasts a heavy focus on problem-based learning and a new model for teaching students that does not rely on clinical rotations at a conventional teaching hospital. Both programs are unique compared to more traditional U.S. veterinary medical colleges.

That has prompted concerns about whether either program is qualified to earn COE's stamp of approval, which some believe to be a mere formality. As a consequence, the COE has been exposed to rebuke, giving rise to allegations that politics are steering COE actions and calls for the volunteer-based accrediting body to remove itself from AVMA auspices and operate more like an autonomous agency. What’s driving the scrutiny? At its root is a lack of COE transparency leading up to decisions that some claim could be detrimental to veterinary medicine’s future. Such criticism comes from former veterinary school deans, private practitioners, a former COE member and attorneys. To varying degrees, they believe that corporations like Banfield, the Pet Hospital, internal pressures from high-ranking AVMA officials and a lack of independent legal advice work to overly influence COE decisions.

For two months, the VIN News Service (VNS) gathered reports from dozens of sources, many speaking on condition of anonymity or only on background, fearing political repercussions from those within the nation's largest trade organization for veterinarians. Many asserted that the AVMA officials who guide the COE, which is largely made up of unpaid volunteers, are manipulating its accrediting agency. One example: The COE’s self-imposed charge to act as an international accrediting body now has leaders committed to extending accreditation to foreign programs without considering the domestic impact, says Dr. Paul Pion, founder and president of the Veterinary Information Network (VIN), the parent company of the VIN News Service (VNS).

Pion points specifically to UNAM, a program that many believe isn’t on par with U.S. veterinary education but has Banfield in its corner. Owned by candy bar giant Mars, Inc., Banfield petitioned California lawmakers and regulators in 2000 to 2001 to allow UNAM graduates to circumvent the AVMA’s foreign graduate equivalency examination to more immediately staff its ever-growing chain of U.S. practices. When that failed, the company built UNAM a 15,000-square-foot teaching hospital in 2004. Then last September, Dr. Don Simmons, a top AVMA staff member who was involved with the COE for more than a decade, flew out to Mexico City to consult with UNAM on accreditation prior to the COE’s final site visit in November — an unprecedented move that hints at unscrupulous behavior and tarnishes the accreditation program’s reputation, critics say.

UNAM Dean Dr. Francisco Trigo maintains that $8 million has been poured into the program since 2005, with the goal to meet the COE's 11 accreditation standards. Despite clear differences between UNAM and its U.S. counterparts, "We certainly are ready for accreditation," Trigo promises.

Banfield officials declined to comment for this article and Simmons, who retired as director of the AVMA Education and Research Division in 2007, could not be reached at his North Carolina residence.

A COE vote in favor of UNAM’s accreditation would allow its graduates to bypass foreign graduate qualifying exams and sit for the same national and state board examinations posed to U.S. veterinary graduates, offering easier access to a job market that’s ripe for bilingual veterinarians.

There’s the rub. Caught in a vortex of rising educational costs, new U.S. veterinarians can rack up more than $150,000 in student debt. How are they supposed to compete with their Mexican counterparts who spend as little as $1,000 to earn a degree and whose salary demands might be a lot less," Pion questions.

“I wish (the COE) would stop and think, and just delay this vote for now,” he says. “Let’s get the mess straightened out. Right now it’s an abscess. It needs to be lanced and opened up and aired out.”

Pion is referring to a sense that the COE exerts the will of powerful leaders in the AVMA, operating in closed meetings. Although ties exist between private companies and association officials, the AVMA Executive Board continues to approve COE budgets, staff, site visits and even policy changes.

“I’ve come to understand AVMA and why they have issues,” Pion says. “They are stuck between a semi-regulatory agency, by their own choosing, and being an advocate for the profession.

“I fear that (the accreditation of UNAM) will be the event that wakes up veterinarians, and they’ll turn on AVMA,” he adds. “I am aghast at how our profession is operated.”

The backlash that Pion foresees appears to be building. In January, AVMA’s attorneys threatened legal action against this news agency to block the release of COE documents dubbed “proprietary assets.” While association officials defended the move as necessary to safeguard the objectivity of the accreditation process, news of the cease and desist letter attracted more than 300 comments from veterinarians in a VIN online discussion.

One VIN member writes: “Sure sounds like AVMA suspects something got out that they don’t want anyone else to know about. ... The AVMA’s language certainly reminds me of some power-drunk politicians in Washington who have developed big egos and the opinion that what they believe in and do is above suspicion.”

While the AVMA initially responded to a set of questions concerning the legality of various COE actions in accordance with the group’s federal overseer, U.S. Department of Education (USDE), follow-up queries were not answered. In an e-mail to the VNS, AVMA spokeswoman Sharon Granskog writes: “We believe that further dialog on this issue would be unproductive and not the best use of member resources. It appears futile to us to continue the dialogue when it only produces additional questions that appear to be based on rumor and innuendo.”

In light of that statement, individual COE members who are elected by the AVMA House of Delegates to serve six-year terms and sign confidentiality agreements could not be reached because AVMA policy mandates that all media inquiries be routed through the central agency.

The COE has quietly accredited colleges since the late1940s. Recent criticisms address the process by which AVMA influences its accrediting body, not the individual COE members, contends Dale Atkinson, who is legal counsel for the American Association of Veterinary State Boards (AAVSB) but speaks on his own behalf. Atkinson’s firm also represents the Joint Review Committee on Education and Radiologic Technology as well as the Accreditation Council for Pharmacy Education. He says that most accreditation bodies do not operate under the umbrella of one professional association.

The Liaison Committee for Medical Education, for example, is the nationally recognized accrediting authority for MD programs in the United States and Canada. The American Medical Association co-sponsors the body alongside the Association of American Medical Colleges.

“I think that when professional promotion entities like the AVMA are involved in accreditation and make intimate determinations that cross over into the licensure and public protection side, there is cause for issues, both legal and practical to come up,” Atkinson says.

“Is it legally sound? Sure. The USDE has recognized them. But is it the right thing to do? I don’t think so. The 64,000-dollar question is, can or does the AVMA influence the COE?” he adds.

The short answer is “yes,” states Dr. Michael Groves, dean emeritus of Louisiana State University’s veterinary medical program.

In 2006, Groves raised a series of concerns about the relationship between the AVMA and the COE when he and former AAVSB official Dr. Thomas Whitely each authored letters to the USDE, requesting that the agency investigate the council’s actions.

The letters didn’t receive much public attention. AVMA officials reportedly did not share them with COE members.

In his five-page complaint, Groves airs concerns that have been whispered for more than a decade. He described a disconnect between AVMA’s primary mission — to advocate for its members — and an apparent drive to monopolize all things veterinary medicine through its accreditation program, foreign graduate equivalency examination and its one-time control of the national licensing test for veterinarians.

(In 1994, the National Board of Veterinary Medical Examiners spun off from being an AVMA council and began administering the North American Veterinary Licensing Examination as an autonomous agency in 2000.)

Groves claims that the means by which COE volunteers are selected operates like a popularity contest rather than one based on qualifications, and that leaves room for the AVMA to assert "undue influence” on the accreditation process.

“I believe it is a potential conflict of interest for an organization whose primary mission is to represent and lobby for veterinary practitioners to serve in this capacity, and it has the potential for abuse,” Groves writes. “... I believe that the U.S. Department of Education should recommend the establishment of an independent professional accrediting body for schools and colleges of veterinary medicine ...”

While the USDE has investigated, officials have not pushed changes to the accreditation program. The USDE does not have the authority to intervene in any part of the COE's accreditation process for an institution. It can, however, take action if there is evidence that the COE acted in a manner inconsistent with its own policies and procedures or in violation of the Education Secretary's criteria for the recognition of accrediting agencies.

A former COE member who served from 2003 to 2007 wants the USDE to take a fresh look at how the council functions.

Dr. William Kay, a private practitioner in Pennsylvania and former head of Manhattan’s Animal Medical Center, talked extensively with the VNS about his “deep concern” that the council operates outside its own policies and procedures, which violates federal laws. He asserts that the AVMA Executive Board’s control over the COE’s budget, staff liaisons and final word on policy changes speaks to its power over the council. The AVMA keeps COE members in the dark, Kay says.

For instance, Kay says that during his term, the council had no involvement with a mandatory five-year report to the federal government designed to maintain its power as an approved education accrediting body. Rather, AVMA staff authored the document and did not inform council members of its existence, he says. The motive, Kay believes, was to keep COE members unaware of federal regulations that he alleges the AVMA-COE relationship violates.

In an e-mail to the VNS, Dr. David Granstrom, who replaced Simmons as head of AVMA's Education and Research Division, refutes the notion that reports to the federal government were not made available to COE members. He explains AVMA's involvement with the COE this way:

"Council members are volunteers. They have little time or interest learning the intricacies associated with the (government) recognition processes. Professional staff is paid to facilitate the accreditation process for the volunteers, which includes knowing, understanding and
managing compliance issues on behalf of the council."

Kay claims he was kicked off the council for asking too many questions. One example: He repeatedly raised objections to the COE's ability to properly assess the merits of Western U's distributive model considering the program has no teaching hospital. Instead, it partners
with more than 300 private practices where third- and fourth-year students are expected to learn their clinical competencies. While COE site teams normally are required to tour a teaching hospital as a group to assure that it meets a checklist of standards, that method is virtually impossible at Western U, where site teams must split up to visit a handful of core clinical practices. Most are never examined.

“It’s illegitimate,” says Kay of the council's means for reviewing Western U. He is emphatic that the COE has violated its own policies and adds, "I fear for the profession's future."

Western U Dean Phillip Nelson did not respond to VNS requests to talk about the pending COE vote or the program’s distributive model of veterinary clinical education.

In his 2006 letter to the USDE, Groves addresses the COE’s inability to adequately examine such a large number of remote sites, drawing on his own experience with LSU site visits, where a COE site team once spent 50 percent of its time examining the teaching hospital, even noting cracks in its concrete floor.

“More importantly what will be the quality control of the education students receive at these remote sites? The COE has bent or ignored their very own standards to grant possible accreditation to this school,” Grove writes.

He and others surmise that the COE has relaxed its standards for Western U based on fears that the university will sue. In 2000, Western U made federal antitrust claims against AVMA for rebuffing its initial attempts to gain accreditation. The action was eventually dropped when AVMA agreed to work with the program.

Now the COE is looking at changing its standards, alterations that could prove a better fit for Western U by mapping out a system for evaluating its unique program. Meanwhile, Western U promotes its veterinary college as “AVMA accredited” on its Web site, even though COE officials have not yet deliberated on its final status.

Where some see Western U's program as a corruption of standards, others view it as a model for the future. Dr. Michael Blackwell, former dean of the University of Tennessee’s veterinary medical program, is among those who think Western U provides a reasonable alternative to the ever-growing expenses tied to maintaining traditional teaching hospitals. With the growth of specialty referral centers, these costly and cumbersome facilities are seeing a decline in cases and funding, he states.

Blackwell characterizes it as “an evolutionary thing.” At the same time, he acknowledges that if COE members have doubts about Western U’s program, they might find it hard to voice them.

“It’s politically incorrect to question the sacred cow that is the AVMA,” Blackwell says. “But there really does need to be a process in place to ensure good training (of Western U students).”

Oncologist Dr. Greg Ogilvie seconds that. He accepts Western U veterinary students for rotations in his California specialty referral practice and, based on his intimate knowledge of the program and its educational processes, deduces that the COE’s consideration of Western U must have involved “a lot of politics and some backroom dealing.”

“That’s a serious concern, frankly,” says Ogilvie, a periodic Western U lecturer. He says that real problems should be addressed at Western U before its veterinary medical program is fully accredited. As an example, he points to a lack of uniformity among the 300-plus private sites where Western U students go to develop their clinical acumen.

"A student randomly selects among a smorgasbord of 'approved' programs to fill their clinical schedule. But there is little guidance in that. There is little oversight or quality control of the clinical teaching at these practices," he contends.

That's not to say methods for teaching students at "standard" veterinary colleges don't have their own set of problems, like a lack of qualified teachers, Ogilvie adds. What's important, he says, is uniformity in accrediting veterinary medical programs: "In my opinion, we should have one evaluation process and every institution should be held to that same level of excellence."

VIN’s Pion believes transparency and inclusiveness at the AVMA and its COE could go far to assure veterinarians like Ogilvie that such matters are adequately being considered. He wants to know that the concerns of dues-paying AVMA members carry weight at the council's table.

“I guess I’ve come to think that everything’s better out in the open,” he says. “There really are few secrets in the world. For the most part, these are public institutions. We have a right to know everything about them.”

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