Dr. Luis Travares, dean of a veterinary medical school in Portugal, does not believe a global gold standard exists when it comes to accrediting veterinary education.

To that end, he challenges a notion that the American Veterinary Medical Association Council on Education (AVMA COE) needs to spread its brand of accreditation overseas to elevate veterinary education internationally.

“I believe that the expression ‘the world looks to the United States and to the AVMA for leadership in veterinary education’ is certainly blown out of proportion,” he said by email, reflecting on the assertion recently made by AVMA officials. “AVMA should not think that it can just export their evaluation/accreditation methods to other countries.”

One country’s animal health needs often differs from the next, making unwarranted a one-size-fits-all approach to evaluating veterinary education, reasons Travares, who earned his DVM from Cornell University and works at the Universidade Técnica de Lisboa.

Travares' perspective stems from practical considerations but carries a political subtext in the United States where a faction of the AVMA's 84,000-plus members are calling on the nation’s largest trade group for veterinarians to stop accrediting veterinary schools overseas. His views are shared by many of his international colleagues who don't have ties to U.S. accreditation.

Stateside, critics believe AVMA’s involvement in international accreditation conflicts with its mission to advocate for American veterinarians, many of whom face stifling educational debt, a tightening job market, declining starting salaries and what some fear is an oversupply of practitioners, especially those who treat companion animals.

AVMA accreditation eases the way for foreign-trained veterinarians to practice in the United States, allowing them to bypass equivalency examinations and sit for the same licensure tests as graduates of U.S.-based programs. What’s more, exporting U.S. accreditation overseas provides U.S. students with more options for earning a veterinary degree, thereby potentially contributing to a steady uptick of American veterinary graduates seeking jobs in the U.S. marketplace.

Responding to those who believe the AVMA contributes to an oversupply of U.S. veterinarians, association officials insist there’s no surge of foreign veterinarians seeking work in America. The association cannot stop international accreditation — or the proliferation of U.S. schools — because the Federal Trade Commission might view it as protectionism, officials add.

Legal experts outside of AVMA offices, however, say it's unlikely that the association would face such a challenge. According to legal opinion solicited by the Veterinary Information Network, parent of the VIN News Service, "non-import commerce" that does not have a direct, substantial and reasonably foreseeable anti-competitive effect in the United States was excluded in 1982 from the Sherman Antitrust Act's jurisdiction. That amendment "may afford protection to the AVMA in connection with its foreign accreditation activities," attorneys familiar with U.S. antitrust laws say.

Antitrust issues aside, AVMA officials insist that U.S. accreditation is needed outside the United States to raise the bar of veterinary education internationally. Executive Board chair Dr. Janvier Krehbiel stated as much in a recent online letter supporting the AVMA’s decision to continue accrediting foreign schools despite calls to end the program.

“… There has been no question among our members that COE accreditation is the global gold standard for quality assurance of veterinary education,” Krehbiel wrote. “Allowing international schools to seek accreditation and recognition according to established COE standards improves the quality of global veterinary education.”

Krehbiel’s statement is consistent with what AVMA officials have said since late 1990s, when the AVMA COE first started ramping up efforts to take U.S. accreditation global.

The U.S. Department of Education (USDE) recognizes the COE — a 20-member volunteer body established in 1946 under the AVMA umbrella — as the accrediting agency for colleges and schools of veterinary medicine in the United States. However, there’s no USDE oversight of the AVMA’s international accreditation efforts, which were initiated and driven internally by the association’s leadership.

The COE's foreign accreditation activity has attracted attention from AVMA members due to a surge of overseas approvals. Since the 1970s, 13 veterinary medical programs outside of North America have been recognized by the COE. Seven of those schools earned the distinction during the past decade.

Now it seems VetAgro Sup in Lyon, France, might soon join the list. The AVMA COE is scheduled Sept. 22 to evaluate the college’s preparedness to meet U.S. accreditation standards. The University of Surrey School of Veterinary Medicine in England, set to open in 2014, also has expressed an interest in U.S. accreditation. So has the University of Nottingham School of Veterinary Medicine and Science, which opened in 2006 in the English Midlands.

Representatives from Surrey and Nottingham could not be reached. Dr. Peter Eyre, dean emeritus of the Virginia-Maryland Regional College of Veterinary Medicine, surmises that in seeking AVMA accreditation, overseas schools are following the lead of their neighbors.

U.S. accreditation, he says, is popular. However, it’s no better than British or European accreditation systems, said Eyre, who was born in England and spent the early years of his educational career at the University of Edinburgh in Scotland. “I don’t think it’s quite fair to say that the AVMA accreditation body has all the answers any more than the Royal College of Veterinary Surgeons does.”

Evaluators are aplenty

Worldwide, veterinary institutions seek accreditation from an array of evaluating agencies, including the Royal College of Veterinary Surgeons (RCVS), European Association of Establishments for Veterinary Education (EAEVE) and the Australasian Veterinary Board Council (AVBC).

A representative with the EAEVE said that the agency welcomes collaboration with the AVMA COE. However, no accrediting body should be considered the world’s “gold standard,” said Professor László Fodor, EAEVE president and dean of veterinary education at Szent Istvan University in Budapest.

“The standard of veterinary training in the U.S. is among the highest, but it does not exclude that several schools around the world reach the same standard,” Fodor said by email. Szent Istvan University, he added, is not seeking U.S. accreditation.

Officials with RCVS and the ABVC did not respond to VIN News Service queries.

Last year, an AVMA task force studying the impact of foreign accreditation polled accredited foreign programs about what drives them to seek U.S. accreditation.

The result: Foreign schools view U.S. accreditation as “the international benchmark of quality,” and being held to such a high standard improves the quality of their programs.

There's another reason U.S. accreditation might appeal to foreign schools: It's perceived to attract American students and their tuition dollars. This possibility was raised by an AVMA accreditation task force member who spoke on condition of anonymity because working with the group required him to pledge confidentiality. “Those schools knew full well who was asking them questions and why,” he said. “In no way would they ever say they were in it for the tuition dollars. Their answers must be taken with a grain of salt. It’s all bologna.”

AVMA officials rejected a VIN News Service request for a copy of the survey questions and results. Communications official Sharon Granskog explained by email that the association considers such data to be "highly confidential and adheres to the standard principle of not broadly releasing raw data."

She added: "As far as an AVMA member seeing the results, the Task Force on Foreign Veterinary School Accreditation, which requested the survey, is comprised of AVMA members. Therefore AVMA members, though not all 84,000, have seen the results."

A synopsis of the survey is featured in the task force's final report. Reasons for seeking COE accreditation, Granskog said, "included: recognition of quality, international bench marks and meeting highest standards."

If some foreign veterinary institutions use U.S. accreditation to elevate the quality of their programs, others are less enthusiastic about the AVMA’s efforts. Dr. Antti Skura, dean of the University of Helsinki’s veterinary college in Finland, called the notion that AVMA leads global educational quality assurance “provocative.” She said by email that the university’s courses are not taught in English, eliminating any need for review by U.S. evaluators.

The same goes for Universidade Técnica de Lisboa in Portugal.

“Our Faculty of Veterinary Medicine in Lisbon is proud and certainly encourages all contacts and partnerships with U.S. veterinary schools, but having been evaluated and approved by EAEVE at several occasions, we are not seeking AVMA evaluation,” said Travares, dean of the program. 

Incentives to earn U.S. accreditation

Many veterinary schools overseas have multiple accreditations. The Royal Veterinary College at the University of London, for example, is accredited by the RCVS, EAEVE and ABVC, in addition to the AVMA COE.

For foreign schools, advantages of being U.S. accredited go beyond the ability of its graduates to practice in the United States without first taking costly and cumbersome equivalency examinations.

U.S. accreditation attracts American students, many of whom seek veterinary education abroad after being rejected by U.S.-based programs. Others simply want an international learning experience. And all have access to U.S. government-backed student loans.

"Accreditation absolutely is a draw" for American students, said Dr. William Kay, a former COE member who's now an outspoken critic of the AVMA's role in foreign accreditation. "With 13 AVMA-accredited schools, no one in their right mind would go to an unaccredited one."

Exactly how much American veterinary students bring to overseas programs in tuition dollars is tough to say given that no organization tracks such data, not even the nation’s biggest issuer of student loans, the U.S. Department of Education. Another hurdle to calculating the value of U.S. veterinary students to foreign programs is that tuition among universities varies, costing upwards of $50,000 a year at some of the highest-priced private institutions and roughly $20,000 on the lower end.

Estimating numbers of overseas students

No single agency or association tracks how many U.S. veterinary students earn their degrees abroad, including the COE. One way to estimate that figure rests with the National Board of Veterinary Medical Examiners (NBVME), which develops and administers the North American Veterinary Licensing Examination, or NAVLE.

The NAVLE is a requisite to practicing veterinary medicine in the United States, and it’s widely assumed that the vast majority of foreign-trained NAVLE test takers are American citizens. According to NBVME data, 562 foreign-trained veterinarians and students sat for the NAVLE in 2012, and more than half graduated from programs based in the Caribbean. (The figure excludes test takers who studied at veterinary schools in Canada and Americans educated abroad who did not return to the United States to practice.)

“There are three drivers I’m aware of that send foreign schools seeking AVMA accreditation,” said Dr. James Wilson, a veterinarian and lawyer in Pennsylvania who’s been studying the COE’s foray into international accreditation for years. “Sure, it might be a ‘gold standard’ that schools want to brag about having. But a secondary factor is the tuition dollars it brings by attracting American students. A third factor: It eases the pathway to U.S. licensure.”

The push for foreign schools to seek U.S. accreditation is expected to ramp up in anticipation of July 1, 2015, when the U.S. government will start requiring foreign programs to be accredited before they can offer American students access to federal student loans. To date, no organization has been authorized by the government to serve as the accreditor of foreign programs. It's unclear whether the COE will be selected.

Dr. Duane Moore, a veterinarian in Palisade, Colo., hopes the COE won't be tapped for the position. “Veterinary professional education has turned into a business with no concern for its graduates,” he stated.

In July, Moore became one of nearly 400 veterinarians who signed a change.org petition calling on the AVMA to “relinquish its role as a foreign veterinary school accreditor” and publicly acknowledge that there are too many veterinarians practicing in the United States. “The AVMA has been instrumental in creating the problem and continues to foster the creation of more and more schools in the face of continued economic decline,” Moore said on the website. “It's time for a reality check!”

Role tuition plays

Much like the disparity between in-state and out-of-state tuition costs in the United States, some overseas veterinary schools charge higher tuition rates to international students. What’s more, generating international tuition dollars can alleviate a school’s reliance on tuition subsidies from their own governments — a situation evident in the United Kingdom, where the economic recession ushered in austerity measures that pose major challenges for higher education.

The Royal Veterinary College, for example, annually admits 25 to 40 international veterinary students, the vast majority of whom are Americans. U.S. students pay roughly £20,810 ($32,500) a year to attend Royal, compared with UK students who pay £9,000 ($14,000) a year — a price that does not account for UK government subsidies, according to Nina Davies with the program’s admissions office.

“Our international students pay a very small premium on what it costs us to run our courses; we don’t set ourselves up to make a big profit from international students," Davies said. She added that when subsidies are factored in the overall cost of education, the gap between domestic and foreign tuition narrows.

Expanding a school’s sources of income to include more international students is a way to ensure dependable revenue streams, she said. The Royal Veterinary College is set to increase its international student body 5 percent by 2019.

“We all have quite different goals and needs,” Davies said of UK veterinary institutions. “Of course, some of the other schools have used international students to raise capital for building projects.”

Davies pointed to the University of Edinburgh in Scotland, a five-hour train ride north of The Royal Veterinary College, where a $70-million building opened in 2011 to house Edinburgh’s veterinary education. “There was quite a push to raise that money,” Davies recollected.
 
Dr. Brendan Corcoran, professor of veterinary cardiopulmonary medicine and director of the school’s international affairs in Edinburgh's Royal (Dick) School of Veterinary Studies, explained by email that the building's construction was funded via a bond from the university's endowment program. "A proportion of that is being paid back from increased tuition income over many years," he said.

Corcoran did not specify what role tuition from international students will play in the repayment plan. There’s no question the university draws heavily from a pool of foreign candidates. Edinburgh's online international office — seemingly more sophisticated than that of other nearby institutions — is devoted to guiding prospective students through immigration paperwork and financial aid options.

Corcoran said the program is popular among international students. "Originally we thought we would get USA students as an overspill from the USA system, but what surprised me was the increasing numbers who specifically elect to study abroad, turning down offers from vet schools back home," he said. "We have the Facebook nation who are not scared to travel the world, and that has to be good for vet med in the USA and UK."

Corcoran explained that four- and five-year veterinary programs are offered, and American students take advantage of both. The latter program, attended mostly by UK students who are fresh out of high school, does not charge tuition to Scottish students. Residents elsewhere in the UK pay £9,000 ($14,000) a year. In both cases, Scottish and UK governments heavily subsidize tuition for domestic students but not for those who pay full tuition.

If a student enters the veterinary school’s graduate program — a four-year program much like what’s traditionally offered in the United States — tuition costs roughly £27,000 (roughly $42,000) per annum. That’s true regardless of a student’s international or domestic status. The tuition fee is the same if an international student enters the five-year program.  

Of 120 seats offered in the five-year program for 2013-1014, 13 are filled by Americans and 12 by Canadians. This year's four-year program contains 48 international students, of which 22 are American and six are from Canada. The remaining international students within both programs represent 13 other countries.

“There is no set number of seats for USA and Canadian students, although they will be our main international group,” Corcoran said. “Like any vet school, student fee income is crucially important to our operation, and all our full-fee students contribute equally to that, irrespective of where they come from.”

While Edinburgh's status as an AVMA-accredited school is a major draw for American students, an increasing number of would-be veterinarians from the United States are lured by the university's venerable reputation, Corcoran said. “(The University of Edinburgh) is the top destination for USA students studying for any degree program in a UK university."

Overseas draw

Dr. Andrew Hagner, an American-born veterinarian practicing in upstate New York, graduated from Royal Veterinary College in 2010. He says it wasn’t the school’s reputation but its application deadline that attracted him to the program.

Hagner suddenly was jobless in spring 2005, when the University of Pennsylvania research program he worked with lost its grant. At the time, the deadline to apply to U.S.-based veterinary schools had passed.

He refers to his decision to attend Royal as “fate.” Not only did Royal have a spring deadline, university officials helped facilitate Hagner's loans and welcomed him to the program. Satisfied with his education, he doesn’t mind the $33,660 a year — not including living or travel expenses — it cost to earn his degree.

He does, however, warn that employment prospects in the UK are tightening for veterinarians — a situation acknowledged by the British Veterinary Association (BVA), which stated in June that there’s a trend toward extending temporary contracts to new graduates rather than permanent jobs. What's more, it's reportedly taking new graduates longer to find employment.

The recent opening of the Nottingham Veterinary School and another at the University of Surrey has veterinarians in the UK concerned about a potential oversupply. More schools mean greater numbers of veterinarians will enter the workforce annually.

A survey conducted by the RCVS reveals that the new veterinary program at Nottingham hasn't had much impact on job prospects. However, "... the ease with which our graduates are getting jobs is changing,” BVA President Peter Jones said in a news release. “We will therefore be considering in some depth the impact that two, three or more new veterinary schools could have in the future."

Critics question whether some overseas veterinary schools mine the United States for students so they can generate tuition but avoid overfeeding their own workforce, owing to a notion that Americans typically head stateside post graduation.

"I think Americans are a cash cow, at least for foreign schools that need the money," said Dr. Carl Darby, a 1991 graduate of the University of Cambridge's veterinary school and organizer of the online petition that objects to the AVMA's foreign accreditation efforts. "The arrogance and hubris of Americans is a fairly common theme in Europe, and to think that somehow the AVMA's accreditation system is the best in the world is mind-blowingly arrogant."

Darby, born in Manchester, England, has practiced in Seneca Falls, N.Y., since marrying an American. Given that graduating from a U.S.-accredited program makes acquiring a license to practice in America easier, Darby once inquired of Cambridge faculty why the veterinary school remained one of few in the UK to not seek the COE's seal of approval. "The faculty's answer to me at that time was they didn't see any value in U.S. accreditation," he recalled. "It wasn't important."

Darby surmises U.S. accreditation "is only important if you want the money that U.S. students bring." Cambridge is the UK's wealthiest institution; in 2013, its endowment fund reportedly was valued at £4.9 billion.

Cambridge Veterinary School Dean Michael Herrtage did not respond to interview requests. Darby believes the COE would be traveling to underdeveloped countries to offer accreditation expertise if elevating veterinary education was a genuine objective.

"I challenge any dean in Europe to say they need the Americans to help them improve their programs," he said. "That's really laughable."