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NAVMEC addresses great challenges facing veterinary profession

Economist's call for change goes beyond NAVMEC recommendations


March 8, 2011
By: Jennifer Fiala
For The VIN News Service


Part 3 of 3: NAVMEC addresses great challenges facing veterinary profession

Editor’s Note: The VIN News Service is taking an in-depth look at the health of the veterinary profession. This is part of a series of articles exploring the economics of earning a DVM degree as well as plans for charting the profession’s future.

A plan is underway to streamline veterinary education, share resources among colleges, slow tuition increases and sniff out new sources of funding for the nation’s 28 veterinary medical programs.

The ideas are lofty; the overhaul could be monumental. But if dramatic changes aren’t made to the traditional means by which veterinary students in the United States are educated, some fear that the profession could become irrelevant within the next half century.

What is driving much of the talk can be summed up in two words: student debt.

"It is clear that the growing cost of education to students and families, balanced against future potential earnings by graduates, is playing an important role in decision making of potential veterinary medical school applicants. Most in the profession see the economic challenges currently being confronted as unsustainable for a growing and thriving profession."

That statement comes from the North American Veterinary Medical Education Consortium (NAVMEC), a group comprised of 400 or more stakeholders that’s been brainstorming since 2007 to chart a new course for the profession. In late October, the efforts thus far of leaders in academia, licensing, testing and accreditation culminated in the report “Roadmap for Veterinary Medical Education in the 21st Century: Responsive, Collaborative, Flexible.”

In contrast to the report's title, concrete directives have yet to be laid out on how to meet NAVMEC initiatives. At least one economist with a finger on the pulse of the profession believes a complete overhaul of the U.S. veterinary education system is key to its survival in the coming decades.

For now, the NAVMEC recommendations are more moderate than revolutionary. The Association of American Veterinary Medical Colleges (AAVMC) — the group that developed NAVMEC — opened the report for public comment last November and will receive comments through April 30. The report calls for the pursuit of five strategic goals:

•    Produce career-ready veterinary graduates who are educated and skilled in agreed areas of core competencies.
•    Ensure that competency drives admissions, curricula, accreditation, testing and licensure.
•    Aim for maximally cost-effective veterinary education.
•    Sustain an economically viable veterinary medical education system.
•    Generate a sense of urgency and focus on action throughout the profession.

The NAVMEC Board of Directors will vet all comments, consider a final report and recommend it to the AAVMC Board of Directors during the association's Summer Meeting in July in St. Louis.

From there, putting the report in action is the next stage, and the work to map such a plan is expected to require an influx of financial support that could reach half a million dollars. While the details are fuzzy, including the source for such funding, this much is known: Licensing tests will be asked to concentrate more on core competencies — the nuts and bolts of veterinary medicine — and focus less on tertiary care. The Council on Education, which accredits U.S. veterinary programs, also will be asked to hone in on the basics and rewrite its standards so they are more clearly understood. The importance of public health as well as racial and ethnic diversity will be driven home, and standardization is expected of pre-veterinary requirements to DVM programs.

Lastly, leaders of veterinary medical programs are being asked to ramp up efficiency by sharing educational resources — including faculty — with other universities.

“We want to give everyone a chance to put comments in because we’ve got to get this right,” stresses Dr. Michael Chaddock, AAVMC deputy director. “We need to change attitudes, change behaviors, and we as a profession have got to come together and be unified. When you start changing cultures, changing society, it’s a very heavy lift.”

For the plans to work, commitment from the entire profession is necessary, adds Dr. Jan Krehbiel, a NAVMEC board member and retired former dean of Michigan State University’s College of Veterinary Medicine.

“Executing our plans will be very challenging, but we really don’t have a choice,” he acknowledges. “The world is changing and certainly our profession is changing and these are critical issues that we need to be responsive to. We as a profession are great problem solvers. We don’t sit on our hands.”

To grasp the magnitude of the plight Krehbiel speaks to, consider this: Nowadays, most veterinarians graduate with educational debt in the six figures and starting salaries that rival those of well-paid electricians. Pockets of underserved and oversaturated markets in terms of veterinary care dot the United States. The trend toward small-animal practice and specialty medicine has left public health and food-animal sectors with a shortage of DVMs. And all the while, the nation’s 28 veterinary medical programs face dwindling state support, ever-rising expectations and an entrenched infrastructure that some liken to a hefty ball-and-chain.

Combine that with the greater expense of programs more focused than ever on tertiary care and churning out research and specialists and the result is a system that’s overburdened and underfed. A recent survey by the AAVMC reveals that U.S. veterinary medical programs lost $45 million to $50 million in public support in recent years. What’s behind the pullbacks? The economic downturn combined with the fact that veterinary education has evolved to primarily produce graduates going into companion-animal practice. With 25 of the nation’s 28 veterinary medical colleges based at land grant institutions, lawmakers in cash-strapped states are stripping veterinary programs of tax-based support — funds originally intended to assure a state’s agricultural health.

Without major change, the profession’s relevance and survival appears uncertain for future generations, experts say. The solution requires no less than a major overhaul of the entrenched system that is veterinary medical education, reports Malcolm Getz, an associate professor of economics at Vanderbilt University.

Getz, who has no direct ties to any veterinary medical programs, first identified shortcomings in the model for educating veterinarians in his 1997 book “Veterinary Medicine in Economic Transition.” He encountered the topic while looking for a case study of how higher education expenditures affect a profession downstream.

“The health of veterinary medicine has a pretty tight relationship with what goes on in the schools. The more I looked, the more fascinated I became,” he recalls.

Getz’s findings revealed that research revenue streams coveted by ivory tower academics paid off only for a few veterinary programs and were more of a drain on others; employment opportunities were shrinking for those planning on a career practicing in food animal medicine; and the growing numbers of students flocking to a profession with high educational costs and poor starting salaries was leading to underemployed DVMs.

Nearly 15 years later, the problems continue, and Getz considers it ironic that no research exists on the consequences of educational indebtedness of veterinary medical students. With average student debt at $133,873, some new graduates are responsible for $1,700 or more in monthly loan repayments while earning salaries in the mid-$60,000 range. Students who study at U.S. accredited veterinary medical programs overseas can come back to America a half-million dollars in debt.

“We need to look at how students are managing their debt, and my guess is they’re making huge mistakes,” Getz says. “Let’s suppose half of the graduates can do reasonably well and manage their debt, there’s another half that have extraordinary burdens that can last for 30 years.”

Getz now works with the National Academies of Sciences (NAS) on a highly anticipated report assessing future workforce needs in veterinary medicine. The goal of the NAS study: to take an unprecedented look at the supply and demand of veterinarians in America.

Getz stresses that his views are independent and should not reflect on the NAS, though few argue with the economist’s belief that veterinary medicine faces crises. That wasn’t the case in the late 1990s, when Getz says his research was shunned by organized veterinary medicine, including the American Veterinary Medical Association (AVMA). Following Getz’s book, the AVMA co-commissioned the now-famous KPMG Mega Study, which showed pitfalls in the system that educates veterinarians but focused more on veterinary practice management. The KPMG identified the profession’s lack of business prowess at the same time it correctly projected that female students would become a majority in veterinary schools. It also revealed that the incomes of DVMs greatly lagging behind the earnings of physicians and dentists despite the fact that educational costs were comparable in those professions.

The significance of that report set the stage for a decade’s worth of fee increases and a focus on business acumen for private practice owners, though the NAVMEC report does not reference it. “The AVMA spent a huge amount of money on the KPMG, trying to prove me wrong,” Getz says.

What makes medical education on the human side function more economically than their veterinary counterparts, Getz says, has to do with income. Medical colleges operate major clinical programs that usually are profitable, while veterinary teaching hospitals can be a resource drain. Research enterprises in human medical education generate more income than those in veterinary medicine. Then there are funds from Medicare, which also support human medical education.

Veterinary medicine programs have tried to make up in the difference through tuition increases often in the double digits. Last year, the University of Missouri-Columbia imposed a 30-percent tuition hike for out-of-state residents attending its veterinary medical program. Veterinary students at the University of California-Davis pay more than $30,000 in annual tuition.

By contrast, schooling costs just $10,000 a year for in-state veterinary students at Tuskeegee University — one of the country's least expensive programs. But despite Tuskeegee's comparatively low prices, tuition alone isn't a real indicator of the expenses incurred by students. For example, the total program budget for first-year veterinary students at Tufts University is nearly $60,000 a year. That includes rent, food, books, household expenses, health insurance and utilities. Tuition alone runs almost $40,000 annually.

How to mitigate rising costs tied to educating veterinary students isn’t something the NAVMEC group has spelled out, apart from suggesting that schools share some resources and indicating that more public relations is needed to showcase the importance of supporting veterinary medicine to the public, especially lawmakers. Rather, the NAVMEC report focuses on the training needed for graduates to leave school and hit the ground running in terms of their production, which can lead to greater earnings. The term they've coined is “day-one competencies.”

“It’s not just a matter of cutting the cost of education, or making veterinary students go into food animal medicine. It’s much broader than that,” says Dr. Mary Beth Leininger, NAVMEC project manager and a well-known figure in organized veterinary medicine and industry.

She speaks to the emphasis that NAVMEC places on effective teaching models and curricular changes that improve confidence and competence, usually by integrating knowledge, skills and attitudes. In the last decade, veterinary education has been criticized for traveling on a path toward academic elitism, focusing more on tertiary care and less on basic applications of veterinary medicine.

The influence of that, coupled with a need for new graduates to increase their earnings to pay their student loans, can be seen in the influx of veterinarians seeking advanced training in specialty programs. Numbers of active diplomates of veterinary specialty groups jumped 15 percent between 2006 and 2009, with totals reaching 10,210 as of last December. More than 40 percent of all new graduates pursued post-graduate training last year. In 1995, that proportion was 15 percent, according to the AVMA.

The prospect of higher earnings from specialty practice can allay the cost of advanced education; wages in some specialized fields are double a general practitioner’s starting salary. But that solution is drying up, too, as more specialists enter the workforce and the economic downturn dampens demand for tertiary care. Simply put, owners are less likely to pursue dialysis or advanced chemotherapy for their pets when they’re jobless and can’t make their mortgage payments. At the same time, increased competition among specialty referral practices threatens the health of even iconic tertiary care operations such as Manhattan’s Animal Medical Center.

“The rate of increase in the number of DVMs entering the pipeline to post-DVM training has grown rapidly because being in general practice pays so poorly,” Getz says. “I wonder if that isn’t creating a bubble, considering the hard economic times will certainly decrease a consumer’s willingness to pay. After all, these are discretionary funds we’re talking about.”

Given the cost of education, he adds: “No matter how much you love animals, it doesn’t make sense to be a veterinarian today if you’re not wealthy.”

Getz considers the economic circumstances for the profession to be so dire, he doubts that the tide can truly turn without altering what it currently means to be educated as a veterinarian: a four-year baccalaureate followed by a four-year professional degree that encompasses medical training on all species.

Getz takes the overhaul efforts of NAVMEC further by predicting significant and, in his terms, unavoidable changes in how veterinary colleges do business within the next two decades. Among them: Less expensive training, with the length of some veterinary graduate programs shrinking to mirror those training pharmacists or physician’s assistants.

“It wouldn’t be the full eight years of post secondary education, but perhaps six years total rather than eight,” he says. “The budget limitations for the veterinary schools are genuine and real, and the people who are struggling with them know they have to change. That’s where the rubber meets the road.

“The current system — it’s not survivable,” he adds. “The sense that every veterinary practitioner should be a master of all species could very well fall away.”

The NAVMEC recommendations do not touch on the limited training and licensure of veterinary students, though talk of those ideas surfaced at brainstorming sessions. According to NAVMEC’s Leininger, the concept was not widely favored.

“We as veterinarians have so much to offer society, education and the health of this world, and a veterinarian’s breadth of knowledge and training is key to that,” Leininger says. Speaking to the need for collective thinking, she adds: “The problems that this profession faces can’t be solved by one person, but if we keep taking steps together, we’ll get this eventually.”

That optimism is lost on Getz. Without fundamental change, he believes that some veterinary colleges will succumb to the financial hardships they face within the next two decades. Once students max out on their ability to pay ever-rising tuition rates, tuition increases won’t yield enough revenue to sustain the programs. That will result in downsizing the estimated 90,000 or so veterinarians practicing in the United States, leaving non-veterinarians to perform routine medical procedures.
 
“The veterinarians who are graduates of full DVM programs that are left will practice the highest level of medicine and be highly compensated for it,” Getz predicts. “And technicians, technologists and veterinary masters (a level of veterinary education that currently does not exist) will be doing more of the health maintenance.” 






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