With the American Veterinary Medical Association’s annual gathering of policymakers on the horizon, opposing stakeholders are posturing ahead of next week’s House of Delegates meeting in Boston.

Accreditation and what role, if any, the AVMA should have in that process are topics of several resolutions on the House's agenda, even as the U.S. Department of Education (USDE) grants the AVMA new authority to accredit foreign programs — a duty separate from agency's recognition process for accrediting domestic veterinary education.  

The AVMA's accreditation arm, the Council on Education (COE), is a 20-member volunteer body that has operated under the association's umbrella since the 1950s, when USDE named it the nation’s sole programmatic accreditor of domestic veterinary education. Programmatic accreditors provide schools, including foreign programs that cater to U.S. citizens, the ability to offer students access to professional loans under Title VII of the U.S. Public Health Act.

For years, a growing faction of veterinarians have challenged how the COE operates, so much so that its status as a programmatic accreditor is in question.

In a twist, however, USDE tapped the COE for a bigger role — ensuring that foreign veterinary schools are qualified to participate in Title IV federal student aid, which includes programs such as Pell Grants, Direct Loans and Perkins Loans. The COE's new authority began July 1, per federal regulations that ordered USDE to find an accrediting body to do the job previously held by the National Committee on Foreign Medical Education and Accreditation (NCFMEA)

The irony: Turmoil still surrounds how the COE operates domestically and its self-imposed mission to accredit foreign programs, a role the USDE now has mandated. How delegates, particularly those calling for change, will respond is unknown. 

For nearly half a century, the COE attracted little controversy. That's no longer the case.

As the AVMA's primary policymaking body, the House comprises delegates from every state and 18 allied groups who are elected or assigned to represent constituent association members. Up for consideration are two resolutions to reform the COE, either by enacting a yearlong moratorium on accreditation or creating an independent review board to restructure the evaluating body. A third resolution, submitted by six veterinary medical associations, moves to cut AVMA ties by establishing a new accrediting body with its own bylaws, budget and staff.

Voting will take place July 10 in Boston as the AVMA kicks off its annual convention. Already, there's been lobbying to sway delegates, including a grassroots initiative to foster member-delegate communication and a letter by AVMA top brass, both owing to the topic's contentious nature.

During the past few years, not a single House meeting has concluded without debate about accreditation. The battle between veterinarians seeking to change the COE and AVMA officials fighting to maintain the status quo has resulted in the creation of a task force, reports, letters, videos, meetings and two highly publicized reprimands from a USDE oversight panel regarding COE shortcomings that include lacking consistency, conflicts of interest and a strained relationship with the profession.

Critics have expressed concerns that the evaluating body has bowed to an AVMA mission to accredit foreign schools, stripping U.S. veterinary programs of needed attention. Proponents for change contend that the AVMA maintains too much influence over the COE, which is supposed to operate autonomously, spurring allegations of cronyism and political jockeying.

To alleviate scrutiny and comply with USDE demands, AVMA and COE officials recently made several changes to better ensure that a firewall exists between the two groups. Advocates for spreading U.S. accreditation overseas believe it's needed to elevate veterinary medicine internationally and suggest other accrediting bodies will do the job if America doesn't step in. The hubbub over how the AVMA and COE operate is rooted in a lack of knowledge about accreditation processes, they contend. 

Dr. Chip Price, chair of the AVMA Board of Directors, echoed as much in a June 25 letter to delegates asking on behalf of board that they vote against all three resolutions to alter COE operations. Accompanying the letter was an eight-page chart comparing the accreditation practices of several other health professions.

There’s no “substantive evidence” to justify the call for change, he said. 

“Simply put, it is not clear to the board what problem the resolutions are attempting to resolve,” Price concluded. “Further, the reasoning behind the resolutions reveals a fundamental lack of understanding of programmatic accreditation and the role of the (USDE) in the process.” 

Multiple narratives 

How, what and where veterinary programs are evaluated provide overview and context for the accreditation saga, yet the smaller moving parts — the fight for and against accrediting foreign and nontraditional schools, a lack of transparency regarding accreditation processes and fears that agenda-driven leaders pull strings for their own benefit —  have captivated many in the profession. 

The firing of Dr. Mary Beth Leininger and her fight to regain a seat on the COE is one such event. 

Leininger, a former AVMA president, was kicked off the COE last spring after publicly suggesting that the body might be stretched thin between its responsibility to evaluate a growing number of domestic programs and mounting requests to assess schools overseas.

The COE has accredited 14 programs outside the United States and Canada, eight of which were recognized during the past decade. Thirty veterinary colleges have been evaluated on U.S. soil and five are based in Canada. 

Leininger was accused of expressing opinions that conflicted with her role as a COE member, an accusation she rejects. The AVMA Board of Governors will hear her appeal on July 7 in Boston, two days before the House is scheduled to convene. It's unclear when a decision might be rendered; the meeting is closed to the public despite Leininger's request to keep it open, at least to AVMA members. 

Transparency is a theme that goes beyond Leininger's push for an open hearing. Apart from accreditation, other resolutions before the House include a call for pharmacists to receive more education in veterinary pharmacology and an edited policy on how dogs and cats are used in research, testing and education. There’s also a new draft on veterinary ethics and several proposed bylaws changes involving term limits for volunteers in governance.

Lastly, an attempt to make House voting records transparent — an idea delegates have shunned in the past due to fears that disclosing voting records would invite public scrutiny — could incite debate. 

Submitted by veterinary medical associations in New Hampshire and Vermont, the resolution postulates that “trust is a necessary part of any successful organization and the (House) needs to trust its members and to be trusted to help lead the AVMA.” 

Veterinarians such as Dr. Bonnie Bragdon, an AVMA member who does not belong to a state association, say they feel disenfranchised by the AVMA's governance structure. A lack of transparency, she stated, compounds the problem.

“Are we the Freemasons?” she quipped about the secrecy surrounding voting records. Given that she's not a member of a state group that selects delegates, she added, “I feel like I have no access to my national association.”

In an effort to be heard, Bragdon and others launched "Under the microscope," a website that opines on the state of veterinary accreditation and other controversies in the profession. Last month, a means for AVMA members to identify and email their delegate representatives was added to the site. Users plug in their state of residence or allied association and names of their House representatives appear, prompting them to email a form letter or erase the text to create a unique message.

"The AVMA’s House of Delegates will review a number of resolutions this summer at the annual conference in July. Here are three resolutions we think you should know about," the website stated, listing those involving accreditation. 

Some 130 veterinarians have participated. Another 1,000 are members of the website's closed group on Facebook. Bragdon, an industry consultant and the site's moderator, is hoping those numbers will climb. She struggles to get people's attention but doesn't want to be inflammatory, something the site's been accused of in the past. 

"I really do want to be a positive constructive person who changes the world, but unfortunately, I feel like people aren't listening," Bragdon said. "I don't know whether it's apathy or the AVMA. The AVMA does seem to shut out dissenters."

She later observed, "It seems to me that sometimes, if we don't put pressure on, they don't take us seriously." 

Federal expectations 

If AVMA officials aren't feeling pressure, the federal government could change that. 

Last December, the National Advisory Committee on Institutional Quality and Integrity (NACIQI), an 18-member oversight committee within USDE, ordered the AVMA and COE to make several fixes such as reaching out to critics and demonstrating wide acceptance among practitioners. If that doesn't happen within a year, the COE could lose its status as a programmatic accreditor.

Critics surmise that student-loan access — not the prestige associated with U.S. accreditation — is driving overseas institutions to seek the COE's approval. U.S. accreditation helps foreign programs attract American students who pay a premium for tuition due to their international status.

Now that the COE is a gatekeeper for Title VII and Title IV eligibility, U.S. veterinary accreditation is even more attractive. Two other accrediting bodies also received USDE's approval to be a Title IV evaluator, including the Royal College for Veterinary Surgeons and the Australasian Veterinary Boards Council. 

In a letter dated June 30, USDE officials notified the AVMA-COE Director Dr. Karen Brandt that the COE was selected. According to AVMA officials, this foreign accreditation duty runs separately from recognition process for domestic accrediting agencies. 

"I am writing to inform you of my decision ...," wrote Gail McLarnon, senior director of USDE's Policy Coordination Group. "Department staff reviewed the processes and accreditation standards the AVMA-COE uses to accredit veterinary schools and has determined that the AVMA-COE has an acceptable quality assurance system for evaluating the educational quality of veterinary schools ...

"I concur ..." McLarnon continued. "Please convey my appreciation to the members of the AVMA-COE. Your organization's willingness to participate in this process is greatly appreciated and will give U.S. students access to U.S. federal student aid while attending veterinary schools accredited by the AVMA-COE." 

Editor's note: This article was amended to include news that in addition to the COE, the Royal College of Veterinary Surgeons and Australasian Veterinary Boards Council also received the USDE's nod to act as a Title IV gatekeeper.