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AVMA attorney Isham Jones warned delegates during a meeting July 9 in Boston against enacting a temporary stop on COE activities while leaders mull revamping the accreditation system. “In my opinion, I do think that a moratorium of the COE could be viewed as being anti-competitive,” he said. “We would be possibly subject to legal action from schools that would want to be accredited and/or an investigation from the federal government.”
No word yet on the status of Dr. Mary Beth Leininger’s appeal to regain her seat on the Council on Education (COE). And as far as accreditation is concerned, AVMA leaders don’t want to entertain any more attempts to revamp how the system works.
That was the overwhelming message relayed during the AVMA House of Delegates meeting earlier this month in Boston, where a majority of the 160 or so delegates representing state and allied groups voted against three resolutions aimed at changing how accreditation operates.
Delegates also voted down a last-minute bid to create a task force to at least study the situation. Though Leininger, a former AVMA president, was in attendance, her appeal before the AVMA Board of Governors in Boston was not discussed on the House floor, despite the fact that the House met just two days after her hearing in the same hotel.
Leininger has not spoken publicly about her experience. She was quietly kicked off the COE in March 2014, after suggesting to delegates that the COE might be stretched thin between its responsibility to evaluate a growing number of domestic programs and mounting requests to assess schools overseas.
Some view Leininger's comments to conflict with her role on the accrediting body. Others consider her dismissal to be indicative of an organization that ostracizes and removes those with dissenting opinions.
The COE is a 20-member volunteer body that has operated under the AVMA 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.
Since then, 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.
Due to complaints from veterinarians, USDE has ordered the COE to make fixes to the program that include reaching out to critics, or risk losing its status as a programmatic accreditor.
Even as the government questions the COE’s continued status as a programmatic accreditor, USDE has tapped it for a bigger job, this time to ensure 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). Two other accrediting bodies based overseas — the Royal College of Veterinary Surgeons and Australasian Veterinary Boards Council — also received the USDE's nod to act as a Title IV gatekeeper.
Whether this means the COE’s troubles before the federal government have dissipated is unknown. The COE owes USDE a report by December that shows the accrediting body has complied with orders to become more transparent and less confusing and has weeded out conflicts of interest. USDE auditors will followup with the COE at a July 2016 hearing.
The AVMA and COE, meanwhile, say they “strengthened the firewall” between the two groups by allocating $10,000 to hire the COE its own legal counsel and no longer including AVMA board members out of accreditation activities, namely meetings and site visits. The COE selection committee also has been revamped, with positions once held by Board and House members replaced by at-large seats.
The changes have done little to silence critics who believe COE volunteers are guided by AVMA leaders with a political agenda to cement U.S. veterinary accreditation as the world’s “gold standard.” Even if the control isn't overt, they note that AVMA policies steer how the COE operates, pointing to the COE's self-imposed mission to accredit schools overseas as one example. Critics also point out that AVMA leaders ultimately appoint everyone sitting on the newly comprised selection committee. The COE won’t be truly independent, they say, until the body gets its own budget, office space and staff that works for the COE alone.
Moving on?
Either way, delegates in Boston appeared eager for the controversy to end after devoting many meetings over the years debating the topic of accreditation. Some expressed hopes that a grassroots push to alter how the COE functions might fizzle.
"We need to move on,” said Dr. Mark Helfat, a former New Jersey delegate and current vice chair of the AVMA Board of Directors. “The COE is healthy, vibrant and time-proven. I challenge you to show me any evidence that would indicate some new accreditation body would not come to the same decisions and standards which we now rely upon.”
Helfat’s impassioned talk on the House floor drew criticisms from a few delegates who took aim at his speech’s length and message. However, most delegates expressed desires to end the controversy surrounding accreditation, which have been ongoing for much of the decade.
Dr. Mary Ergen, Tennessee’s alternate delegate, isn’t one of them. “I’ve heard more from AVMA members about this issue than anything else,” she said, referring to a growing number of AVMA members who feel disenfranchised by the AVMA’s lack of transparency and governance structure.
For years, a growing faction of veterinarians has challenged how the COE operates, so much so that its status as a programmatic accreditor is in question.
Of an ultimately rejected resolution to study the COE’s role, she added: "This may be a baby step, and maybe it’s voted down. But the model we have today, I don’t think that it will be here in another five or six years. It will change.”
Dr. Eric Bregman, a past president of the New York Veterinary Medical Society who helped craft two of the failed resolutions on accreditation, hopes she’s right. Expressing disappointment after the House meeting, he predicted a "groundswell” of discontent is on the horizon: “If things continue the way they are, we will see that. There won’t be a way for veterinarians to work and pay back their debt and have a decent existence.
"I was really down and frustrated after the House meeting,” he added. "We had hoped at least for a task force. This one was a really heartbreaking outcome."
Bregman, noting the American Medical Association’s struggle for relevance among physicians, predicts that disenfranchised veterinarians might similarly defect from their national organization. "The AVMA will go the way of the AMA when young veterinarians see no value,” he said. "It’s already happening.”
Indeed, AVMA officials confirm the association’s market share is on the decline though overall membership numbers continue to rise. It’s unknown whether accreditation issues, general apathy or the fact that the AVMA’s medical insurance programs, once a major membership incentive, were killed in 2014 when federal health care reforms took effect.
Concerns linger
What’s clear is that dissatisfaction among some AVMA members remains.
“It’s a small number, but I don’t think we should ignore it,” Dr. Rick Baum, alternate delegate for Vermont, argued in a House committee meeting. “It bothers me that member perception is that something smells bad in the room, and we haven’t dealt with this for two or three years.”
Baum was referring to a faction of the veterinary profession that for years has pushed the AVMA to cease foreign accreditation, ease its grip on the COE and re-evaluate the accreditation body’s criteria for distributed learning, a teaching model that allows programs to outsource clinical education to private practices rather than clinically train students in a traditional veterinary teaching hospital.
Teaching hospitals, which cost tens of millions of dollars to build, inadvertently acted as a hurdle to the development of new programs for decades. Having students rotating through an on-campus hospital, proponents argue, gives faculty oversight and control over a program's clinical education component.
Western University of Health Sciences’ veterinary college challenged what some considered the sacred cow of veterinary education by emerging in the late 1990s as the nation’s first veterinary program to employ distributed learning, forgoing a traditional teaching hospital by rotating students through private practices.
The COE initially balked, denying accreditation. In 2000, Western sued and the AVMA countered. The lawsuits were dropped the following year when it became clear that the COE would work with the program, which was fully accredited a decade later.
Since then, a veterinary college without a full teaching hospitals has emerged at Lincoln Memorial University in Harrogate, Tennessee. The University of Arizona’s new veterinary school also is in the pipeline, with the COE is expected to conduct a comprehensive site visit next January. That’s not soon enough for the program's administrators, who expressed frustration on the university’s website.
“We were disappointed …,” officials wrote. "The AVMA’s decision means we must delay our targeted program start to August 2016.”
Midwestern University, an independent nonprofit institution in Glendale, Arizona, welcomed its inaugural class last August and received the COE's provisional accreditation soon after. The university has committed $180 million to build facilities for the college, opening a 111,800-square-foot companion animal teaching hospital last month. A bovine and equine center also is in the works, officials said. Rotations are expected to begin in spring 2017.
Driving discontent
The influx of new programs and veterinarians entering the marketplace has come while the profession struggles with a rocky economy, greater competition from colleagues as well as pet pharmacies, record-high student loan debt and comparatively low starting salaries. As a result, veterinarians have questioned whether the AVMA’s mission to serve members conflicts with its role in accreditation.
AVMA officials long ago squashed any notion that the COE could steer the market without facing the Federal Trade Commission’s wrath. In 2011, AVMA attorney Isham Jones held a closed meeting with delegates, warning them that any talk of stopping accreditation could be construed as anti-competitive behavior. The same, he said, would happen if the COE denied accreditation to programs and it appeared that accreditors were trying to curb the number of DVMs entering the market.
But there are many critics for whom the market bears less concern. Rather, some believe that rotating students through private practices fails to provide the same quality education offered in campus teaching hospitals, resulting in dumbing down the profession.
The message from those calling for change has shifted from workforce concerns to issues with the COE’s lack of true autonomy and unevenly applied standards. They point out that the AVMA’s intent to spread accreditation abroad originated without the USDE's mandate or oversight. All the while, AVMA officials insist that any moratorium on accreditation, foreign or domestic, would come with legal or regulatory punishments.
While arguing in favor of the accreditation resolutions in Boston, New York Delegate Dr. Walt McCarthy said severing AVMA-COE ties would eliminate those risks.
“When I started here 12 years ago, we used to elect COE members the same way we elect other council members ... we traded votes and put people there who weren’t qualified,” he recalled. “Over the years, we’ve gotten better. But I think it’s time to make the decision to separate (AVMA) completely from the COE. We believe that (accreditation) should be done differently and independently.
"Every time I come to these meetings, I hear legal questions come up,” he added. "Everyone is afraid of being sued. (Removing the COE from under the AVMA’s umbrella) would put us away from that; we would no longer be responsible.”
Fed up with fighting
That argument didn't go far with delegates such as Jessica Carie, president of the Student American Veterinary Medical Association (SAVMA).
“If we spent nearly as much time and energy and dollars (on other issues), who knows what we could be doing?” she said on the House floor. “But the amount of time and energy spent arguing about the Council on Education … who arguably accredits the best veterinary schools, is flabbergasting to me. I’d like to see us work on other issues.”
Newly installed AVMA President-elect Dr. Joe Kinnarney made an emotional speech before the House, calling on delegates to forgo the accreditation battle in favor of unity and success.
“It is not an accident that the rest of the world has labeled us as the ‘gold standard’ for veterinary education worldwide. The Council on Education has been directly responsible for our successes. There are those that wish to do it harm — people I believe love the profession but now seek to destroy the COE. I call upon these folks, if your intent is pure, to help us make the COE even greater to serve the changing needs of our profession and society and to not destroy it.”
Anything less, he said, could have heavy repercussions on the AVMA’s status as the nation’s largest and most powerful membership organization representing veterinarians. Negativity, he said, has taken its toll on the AVMA’s membership.
“During the past six years, we’ve had 10 percent membership decline,” Kinnarney said. “Instead of focusing on critical issues, we’ve been arguing over governance issues. Unfortunately, this heated debate has impacted our members. … This is distracted us from things that really matter. Our members do not understand why we are not focused on current needs, like economics, student debt-to-income, wellness and communication."