This is the second of two parts. Read part 1.

National Autonomous University of Mexico (UNAM)'s bid for U.S. accreditation remains uncertain as officials sit mum on their deliberations.

The American Veterinary Medical Association's Council on Education (AVMA-COE) — the accrediting authority for veterinary education in the United States and Canada — gathered more than a week ago to determine, among other things, whether Mexico's largest veterinary medical school meets the group's standards for accredited programs.

The unprecedented consideration of a Mexican program has led many practitioners in the United States to question the legitimacy of the U.S. accreditation system and its ultimate impact on the profession.

In an e-mail to the VIN News Service, Dean Francisco Trigo revealed that he does not yet know the COE's decision.

The COE, with a roster of 21 members including AVMA staffers, did not respond to a VIN News request for results of its deliberations on UNAM. The AVMA's Communications Division staff states that no official news on UNAM has been released since the COE's biannual gathering.

To veterinarians awaiting news of the outcome, the silence is deafening. Other decisions from the COE's Feb. 28 to March 2 meeting have been made public. For instance, news surfaced even before the meeting ended that the COE had granted three years of full accreditation to Western University of Health Science's veterinary college in Pomona, Calif.

The information void on UNAM is filled with speculation. Some wonder whether the COE denied UNAM's request, with the announcement of that decision hinging on whether UNAM officials appeal.

"There must have been a dust up at the meeting," presumes Dr. William Kay, a private practitioner in the Philadelphia area and former director of Manhattan's Animal Medical Center. As a COE member from 2003 until 2007, Kay explains that it's normal for COE decisions to go public immediately.  

"This is very unusual, even extraordinary," he says of the delay. "There must be a lot going on behind the scenes."

UNAM, which opened in the 1950s, is the first of an estimated 30 veterinary programs in Mexico to seek American accreditation. Due to a perception that UNAM's program is not on par with education in the 28 veterinary medical programs in the United States, a growing number of American practitioners are questioning whether the COE is unduly influenced by outside stakeholders, even the AVMA.

Five years ago, UNAM officials started pouring millions of dollars into the program to bring its facilities, curriculum and staff in line with COE's 11 accreditation standards. The improvements include a 15,000-square-foot teaching hospital paid for by Banfield, the Pet Hospital, America's largest chain of veterinary clinics, most of which are housed in PetSmarts. In a 2008 interview with VIN News, Trigo explained the significance to UNAM of gaining approval from an accrediting body that represents the "gold standard" in veterinary medicine.

"For our students, this could mean training and jobs in the United States," Trigo noted. "We could be the first non English-speaking program recognized by the AVMA."

Accreditation would allow the 350-plus veterinarians who graduate annually from the Mexican school to circumvent U.S. foreign graduate equivalency exams and sit for the same state and national boards posed to graduates of American veterinary medical programs.

If accredited, UNAM's would not be the first program outside the United States and Canada to be given the COE's stamp of approval. From England to New Zealand, the COE has extended full accreditation to nine foreign veterinary schools, most in the past decade. It plans to conduct a consultative site visit at the University of Queensland in Australia in late August. Three programs in the country already have been accredited by the COE.

According to the AVMA's Web site: "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."

At face value, that stance carries support. Veterinary Information Network (VIN) member and North Dakota practitioner Dr. Shelley Lenz volunteers in Central America where she describes veterinary care as "abysmal." She backs the use of accreditation as an incentive to raise the bar of veterinary education internationally.  

But others contend that the COE's charge to go global with accreditation might not be in the best interest of U.S. practitioners, the majority of whom are dues-paying AVMA members. Top worries include increased competition and the dilution of practitioners' salaries should large numbers of Mexican veterinarians, in particular, enter the U.S. system. In anticipation of the COE's vote on UNAM, grumblings of political agendas and allegations that the COE, made up of part-time volunteers, is governed too closely by its parent organization have grown louder. There are even concerns that Banfield might be influencing 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.

Officials with Banfield, a company owned by candy bar giant Mars, Inc., declined to comment for this story. With 730 practices in the United States and counting, it appears to some that the company might have a lot to gain from UNAM's accreditation. Earlier this decade, Banfield pushed a bill in California to extend temporary licensure to graduates of a handful of Mexican veterinary schools, including UNAM. The measure, defeated by organized veterinary medicine in the state, would have allowed them to bypass the educational equivalency examinations required of graduates of foreign programs.

The attempt by Banfield to circumvent the licensure system was widely criticized and has since fed practitioners' suspicions of the company's motives. Now with Banfield tied to UNAM, the union has fueled practitioners' doubts about the program.

While some peg such apprehension from veterinarians as anti-immigration, hundreds of comments in online discussions from members of VIN express concern about a variety of issues, including the quality and structure of the training. 

To those weighing the impact that globalization might have on U.S. practitioners, Lenz asks: "Are we Americans or are we veterinarians first? After all, nobody said anything when England and Australia got their programs accredited" so why the hubbub over UNAM?

Critics respond that Mexico, as a developing country, is different. For example, renowned oncologist Dr. Greg Ogilvie believes that high school graduates in Mexico, in general, are not offered the same quality of education as students in America — an inequity they carry into their education and career as veterinarians.

"When you look at students coming into Mexican veterinary schools, the desire is there, but they just don't have the depth of knowledge and background that American students might have," says Olgilvie, who practices in Southern California and lectures in Mexico. "If you question that, come to San Diego County where there are tons of (Mexican) veterinarians who work as techs. Their knowledge is so poor, we hire them as assistants."

He echoes the sentiments of a growing number of practitioners who, to varying degrees, question U.S. accreditation for Mexican programs and whether UNAM's animal husbandry focus is truly on par with veterinary medical standards set in America, where companion-animal practice dominates.

"If UNAM is accredited, they're going to come into the U.S. and dilute our numbers significantly," he says. "I'll bet they'll work for nothing and that will drive down salaries." 

Dr. Ben Leavens, a VIN member and practitioner in Missouri concurs. In an online discussion, he writes: "While I have no wish to offend my Mexican colleagues, I have experienced Mexican human and veterinary medicine culture first hand. It is simply impossible to produce a veterinarian capable of practicing to modern USA standards of medicine in that culture."

Leavens refers to a culture that places less emphasis on treating pets and focuses more on the health of animals used for food and production. Dr. Lisa Fromer, an American-born practitioner in New Mexico who graduated from UNAM's veterinary school in the 1980s, does not share the same views as Leavens but further characterizes the cultural differences between Mexico and the United States this way: 

"At the time I attended, there was a focus to make sure that populations of people could grow up with adequate sources of animal protein. That was a real goal," she says. "The pet population was somewhat secondary. You didn't become a veterinarian to be a small-animal clinician. You became a vet to help people through animals. That's the real difference." 

After graduation, Fromer took the educational equivalency test to practice in the United States. Thirty years later, she remembers that the difficulties in acclimating she experienced stemmed mostly from interactions with her American colleagues and not from a lack of instruction in veterinary medicine.

"I integrated probably about the same as U.S. grads," she recalls. "I never got a course in ophthalmology, for example, but it was a good education and it was particularly relevant to the country of origin. Sure, I had to learn American drug names. But it was the elitist attitudes of American-trained veterinarians that got to me. They made it fairly miserable to practice.  

"If you tell American veterinarians that you went to a foreign school they automatically believe that your education is inferior and it will hold true until you die. ‘Where did you go to school?' is a loaded question."

Should the COE extend accreditation to UNAM, Trigo doubts that would prompt his students to emigrate to the United States en masse. Mexicans, he says, are tied to their families and country, and UNAM graduates enter a healthy job market.  

"Language would be one barrier," Trigo adds, referring to the English-based national and state examinations that are required to license any veterinarian practicing in the United States.

Even among developed countries, there exists sharp variations in veterinary education. One example: Many foreign veterinary medical programs, UNAM's included, admit high school graduates, whereas veterinary school applicants in the United States must first complete a bachelor's degree.

That disparity alone has some questioning AVMA's self-imposed charge to accredit internationally. The U.S. Department of Education, the council's federal overseer, does not direct the COE to accredit foreign programs, spurring questions as to why international activities have become an AVMA agenda item.

By contrast, the Liaison Committee for Medical Education, the national accrediting authority for MD programs in the United States and Canada, does not accredit internationally. Instead, all medical graduates of foreign programs seeking to practice in the United States must pass a certification test designed to ascertain whether their knowledge and skills are adequate.

On the veterinary side, the United States has two programs to address the needs of foreign-trained veterinarians seeking to practice here: The AVMA's Educational Commission for Foreign Veterinary Graduates and the Program for the Assessment of Veterinary Education Equivalence, run by the American Association of Veterinary State Boards.

Concerns about UNAM and other recent activities of the COE have led critics to ask why a membership-based organization such as the AVMA is in charge at all of the nation's single accrediting body. AVMA officials insist that the COE operates as an autonomous entity, directed by volunteer veterinarians who serve six-year terms and travel the globe conducting accreditation site visits. Yet AVMA Executive Board members approve everything from the council's budget and travel to its policy changes. The association retains the COE's legal counsel. The group's meetings are not open to the public.

As a result, a growing number of veterinarians are expressing concerns about the apparent lack of transparency as well as the potential for personal and corporate agendas to affect council decisions — actions that some believe have the potential to dilute veterinary medicine in the United States or expose the AVMA to legal action. Such talks have, in recent weeks, spurred intense discussions by members of VIN's online community. Is the the parent of VIN News. One discussion thread, to date, includes more than 400 responses from VIN's veterinary membership. 

Dr. Paul Pion, president and co-founder of VIN, believes that the council, before approving any international program, should weigh how the decision will impact the U.S. profession along with the program's merits.

AVMA officials have rejected that notion, citing internal legal guidance that states refusing to accredit a program based on such a notion could expose the association to antitrust violations if its actions were viewed as anticompetitive. In response, VIN attorney Raphael Moore consulted legal experts concentrating in the field to get an opinion on whether federal antitrust laws extend to foreign soil.

As it turns out, a federal law known as the Foreign Trade Antitrust Improvements Act has amended U.S. antitrust laws so that they're not applicable to accreditation, Moore says.

"In essence, if the party who claims to be injured is not involved in ‘import trade or import commerce,' there is no effect on United States commerce, and they can't sue under U.S. antitrust laws unless it was so obvious that an anticompetitive effect would result," he explains.  

Pion says he just wants to know that the actions of the AVMA and the COE are not harmful to the veterinarians who subsidize its programs.

"The AVMA has a duty to consider how the decisions they make will affect their members," Pion says.

Dr. David Granstrom, director of the AVMA Education and Research Division and staff liaison to the COE, explains that the association's role in international affairs came about after a number of councils and committees determined that the nation's largest veterinary membership body was needed to weigh in on "evolving international matters" that include the accreditation of veterinary education.

"The AVMA has an important role to play in veterinary medicine," Granstrom writes in an e-mail to VIN News. Officials declined to directly address criticisms being lodged against the COE, making the determination that further dialogue on the topic would be "unproductive and not the best use of member resources." 

Part 1: Accreditation under fire in veterinary medicine