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Texas veterinarians mull reviving bid to examine AVMA’s role in global accreditation

Those calling for audit face accusations of racism; issue clouded by politics, some contend


August 19, 2010
By: Jennifer Fiala
For The VIN News Service


Texas veterinarians will gather during next month’s Southwest Veterinary Symposium in response to a failed resolution to audit the American Veterinary Medical Association’s (AVMA) growing stake in the accreditation of foreign veterinary medical programs.

On the table: revisions to the Texas Veterinary Medical Association’s (TVMA) resolution for possible submission during the AVMA House of Delegates’ Winter Session in January, as well as a recap of the heated objections raised last month to assessing the impact that extending U.S. accreditation to foreign schools might have on the profession in America.

Sixty-one percent of the AVMA House of Delegates voted to defeat the TVMA-sponsored measure during the group’s regular session July 29-30 in Atlanta. The resolution called for a risk-benefit analysis of efforts by the Council on Education (COE), the AVMA’s quasi-independent accreditation body, to become the world’s “premier” global accreditation authority.

The House of Delegates is the AVMA’s principle body responsible for setting association policy. It’s comprised of delegates from each state, the District of Columbia and more than a dozen allied organizations. In June, the association’s top brass — the AVMA Executive Board — formally opposed Texas’ push for a self study, advising the House to not open the COE to unneeded scrutiny.

Backlash to the resolution climaxed during last month’s House meeting, when veterinarians took the debate in a divisive direction that included accusations of bigotry and bias. While the initiative’s backers consider the requested audit of the COE’s international dealings to be innocuous — a mere internal examination — others contend that racial discrimination and protectionism are driving the measure. Supporters of the COE’s efforts to spread its brand of accreditation internationally argue that if the AVMA fails to take the lead on the global scene, countries such as China will assume the responsibility.

In a recent interview with the VIN News Service, Texas delegate Dr. Mark Cox, a practitioner from El Paso, expressed dismay concerning how the resolution has been received.

“It seemed to have gotten awfully muddied, and maybe that’s politics,” Cox says, reflecting on last month’s House session. “This was a member-driven issue, and yet we got beat up pretty badly when it became something that it wasn’t intended to be.”

According to the TVMA, practitioners in Texas want to know how treading in international waters, thereby easing foreign entry into America’s marketplace, might affect pet health and the professional lives of U.S. veterinarians — roughly 90 percent of whom the AVMA counts as members. Though it’s not specified in the resolution, a bid for accreditation from the National Autonomous University of Mexico (UNAM), the first veterinary program in Latin America that the COE has considered, sits at the controversy’s center.

Charged by the U.S. Department of Education with ensuring quality veterinary education in America, the COE’s foray into foreign markets is self-imposed. To date, the volunteer-based council has extended accreditation to nine foreign programs in Europe, Australia, Great Britain, Ireland and New Zealand. Most received the COE’s nod during the past decade.

A blurb on the AVMA’s Web site reads: “The COE believes that accrediting foreign veterinary colleges supports and encourages the achievement of high standards of veterinary medical education world wide thus improving animal and human health."

Based on reaction during the House meeting, it's clear that many veterinarians among the AVMA's leadership agree.

“We now have leadership and some control,” stated Dr. Daniel Lafontaine, House delegate from the American Association of Food Hygiene Veterinarians, in opposition to the Texas resolution. “Let’s not do anything to diminish what we’ve already accomplished and can accomplish in the future (to raise global standards for veterinary education).”

The COE’s status as the world’s accreditation authority is not what the resolution addresses, counters Cox, the House delegate from Texas. The measure calls for an audit to explore the impact that the COE’s international role might have on U.S. practitioners; it does not demand that the COE throttle back on its charge to accredit foreign programs.

Yet critics of the AVMA’s business in international accreditation tout a long list of reasons to keep the COE domestically focused. After all, an avenue for foreign-trained veterinarians to work in the United States already exists with two competing testing systems designed to gauge their educational competency: the Educational Commission for Foreign Veterinary Graduates (ECFVG) and the Program for the Assessment of Veterinary Education Equivalence (PAVE).

COE accreditation allows graduates of foreign programs to bypass these examinations and sit for the same national and state boards posed to graduates of the 28 veterinary medical schools based in the United States. What’s more, an English language proficiency test is not required of graduates of COE-accredited foreign programs in states with practice acts — most modeled after the AVMA’s version — that do not call for such an examination.

“It’s a quality control issue to us,” explains Cox, who represents a state where roughly 6,500 veterinarians are licensed to practice. “We thought this was a fairly straightforward resolution asking the AVMA to establish a body to review the (international accreditation) process to make sure that students from foreign schools are comparable to our graduates.”

Standing before fellow delegates during last month’s meeting, Cox added: “We have lots of folks in Texas that are very disturbed by foreign school accreditation. We shouldn’t blow them off. I don’t want to have to go back to Texas and say, ‘Folks, the AVMA knows all the answers.’”

Members of the Veterinary Information Network (VIN) — an online community for the profession and the parent of the VIN News Service — as well as a former COE member, deans and others began debating the issue last year when UNAM made its formal petition for the COE's consideration. Of hundreds of comments on the topic littering VIN’s discussion boards, many echo a statement made by North Carolina practitioner Dr. Scott Helms: “The AVMA needs to be more transparent regarding the COE and the changes that have been made to the accreditation process. Should this process be re-evaluated? Likely so.”

Helms believes that the AVMA, like other political organizations, often makes decisions without knowing the will of its general membership, most likely because there isn't an effective way to poll them.

That concern resonates within widening political divides in the profession and among pockets of the national association, where some report that AVMA leaders are disconnected from many of the 80,000-plus veterinarians who are members. During a House breakout discussion on the resolution, Executive Board member Dr. Larry Dee, of Florida, expressed disinterest in allocating AVMA funds to quell the concerns of Texas veterinarians by creating a task force to study the issue.

“Protecting the economic viability of our veterinarians, protecting our wagons? I’d hope that we are beyond that,” he stated. "Tell the Council on Education not to accredit foreign schools? Do we have $40,000 bucks to spend on that?"

By contrast, Ohio delegate Dr. Walter Threlfall expressed support for passing the resolution: “It shows interest. Can you buy good will? Maybe not, maybe so. I’m not saying it’s a wise expenditure of money, but maybe it’s a necessary expenditure of our money.”

Though the TVMA resolution does not mention UNAM by name, concerns from practitioners have mounted with the program’s storied quest to earn the COE’s recognition.

Last April, the COE denied accreditation for the UNAM’s veterinary college in what reportedly was a narrow defeat. The reasons behind the COE’s decision have not been made public and Mexico's largest university is appealing the ruling.  

Apart from concerns that UNAM’s veterinary education fails to match that of the 28 veterinary colleges in America, some believe that pressure on COE makes the eventual accreditation of the Mexican program inevitable. That would give the 350-plus veterinarians who graduate from UNAM annually greater access to the U.S. marketplace and could put American-trained veterinarians at an economic disadvantage should a large number of Mexican-trained veterinarians emigrate to the United States. While U.S. veterinary college graduates can amass upwards of $200,000 in educational debt, UNAM is heavily subsidized by the Mexican government, which makes the cost of education nearly free for its students. Competition from Mexican-trained veterinarians on American soil could drive down salaries, some contend, and along with it, the nation’s high standards for veterinary care.

There are also concerns that Banfield, The Pet Hospital, could influence the council’s actions considering the company is poised to recruit UNAM graduates to cater to Hispanic pet-owning populations and supply its ever-growing number of U.S. practices. Five years ago, Banfield built UNAM a 15,000-square-foot small animal teaching hospital, giving the program a leg up in terms of coming into compliance with COE’s 11 accreditation standards. In 2004, the corporate chain owned by Mars Inc., petitioned California lawmakers to ease licensure requirements in order to fill its practices with Mexican veterinarians.

“You may not share our concerns,” stated Dr. Billy Martindale, Texas’ alternate delegate to the House in his appeal to colleagues on July 30 in Atlanta. “However, we believe that the vast majority of AVMA members do not know or understand why the AVMA assumes this responsibility and how it works. Why is the AVMA in the business of accrediting foreign schools of veterinary medicine? Questions are being asked of our members.”

Still, many vocal members of the House stated concerns that the Texas resolution brings with it an air of intolerance and racial discrimination.

“While I empathize with Texas being a border state, I strongly believe that it’s not what’s written but implied. That frightens me,” stated Dr. Mary Bryant, a House delegate representing Pennsylvania, in a breakout discussion on the topic.

Dr. Jacqueline Neilson, alternate delegate from Oregon, added: “We’re making it easy for them to come in and get jobs. I feel for the membership, but it’s a global world. We need Spanish-speaking veterinarians."

But Dr. Gregg Culter, a representative of the American Association of Avian Pathologists, gave perhaps the most animated speech disparaging the resolution. Before the entire House, he ardently countered proponents of the Texas measure:

“I recognize prejudice and discrimination when I see it. It’s not what’s written in this (resolution), but what’s not written in this. We need to make it clear that the AVMA will not tolerate that kind of thinking.

“If something like this were to pass and the New York Times or the Washington Post got a hold of it, I’m sure they would rip us a new orifice,” he added.

Public image also appears to be a concern of the AVMA executive staff, which spent $5,000 to create a 20-minute promotional piece on the COE accreditation system, laden with praise from college deans, council members and other stakeholders.

The video, rumored to have truly cost $25,000 when factoring in the time and talents of in-house staff, devoted little time to the topic of foreign accreditation. It was played for the House of Delegates as a forerunner to debate on the TVMA resolution. Featured in the video, COE Chairman Dr. Jim Brace alluded to some of the criticisms being lodged against the council's actions:

“The AVMA’s accrediting program has been in a state of constant improvement. … Just because the COE goes about its work quietly and outside the view of the media does not mean it’s a closed process.”




VIN News Service commentaries are opinion pieces presenting insights, personal experiences and/or perspectives on topical issues by members of the veterinary community. To submit a commentary for consideration, email news@vin.com.




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