Veterinarians question AVMA's role in international accreditation

Texas resolution calls for self-study

Published: July 13, 2010
By Jennifer Fiala

The American Veterinary Medical Association’s (AVMA) practice of extending U.S. accreditation to foreign veterinary medical programs is being heavily scrutinized, with the topic headlining last month’s Executive Board meeting and set for further debate during the House of Delegates session July 29-30 in Atlanta.

On the table is a resolution calling for the AVMA Executive Board to assign a task force to determine the impact, via risk-benefit analysis, that accrediting internationally might have on the U.S. profession. The request comes from the Texas Veterinary Medical Association (TVMA) and, if passed, will require a full report on the issue by the 2011 summer House session.

“We feel like there needs to be some discussion and possibly some changes in this process,” says Dr. John Morton, TVMA president elect.

Already, AVMA's top brass have weighed in, with the Executive Board recommending that the House defeat the resolution for several reasons, one being that another international body might start accrediting globally and not uphold the same high standards promoted by the U.S. system. 

Yet Morton and others want the AVMA and its Council on Education (COE), the association’s quasi-independent accreditation arm, to consider how treading in international waters, thereby easing foreign entry into America’s marketplace, might impact pet health and the professional lives of U.S. veterinarians — roughly 80 percent of whom the AVMA counts as members. At the controversy's center is a bid for accreditation from the National Autonomous University of Mexico (UNAM), the first veterinary program in Latin America that the COE has considered.

Many close to the AVMA’s accreditation process praise the COE's foreign accreditation system for distributing what’s been dubbed the “gold standard” of veterinary education internationally. Yet others fear that process is flawed, making the COE system vulnerable to external and internal pressures, political influence and excessive direction by the AVMA’s executive leadership.

Critics argue that the system for vetting foreign programs is burdensome to the COE. The group is charged by the U.S. Department of Education with ensuring quality veterinary education in America; its foray into foreign markets is self imposed. What’s more, two competing testing systems already are in place to gauge the educational competency of foreign-trained veterinarians seeking work in the United States: the Educational Commission for Foreign Veterinary Graduates (ECFVG) and the Program for the Assessment of Veterinary Education Equivalence (PAVE).

Graduates of COE-accredited programs can bypass these examinations and sit for the same national and state boards posed to graduates of U.S.-based programs. To date, the COE accredits nine foreign veterinary schools worldwide, including programs in Europe, Australia, New Zealand, Great Britain and Ireland. Most received the council’s nod during the past decade, as part of the AVMA’s self-imposed charge to become the “premier” global accrediting authority.

“We have the same concerns that everybody else has: the future of veterinary medicine, quality standards, opportunity and meeting the needs of the public,” explains Dr. Billy Martindale, Texas delegate to the House. “We want to get people talking and start the debate.”

While Martindale refers to AVMA’s leadership, members of the Veterinary Information Network (VIN), a former COE member, deans and others began debating the issues late last year when UNAM made a petition for U.S. accreditation — a decision that the COE has since narrowly defeated and is being appealed by the Mexican program.

According to AVMA Bylaws, a final ruling on the appeal will be handed down in October, at the latest. The reasons behind the COE’s decision have not been made public.

In the meantime, veterinarians contend that easing the way for Mexican veterinarians to practice in the United States could increase competition and drive down salaries for U.S.-trained DVMs. UNAM is the first Mexican veterinary program to seek U.S. accreditation. Some fear that opening the door will send a flood of its graduates migrating north, taking jobs from American graduates that are already saddled with low starting salaries and high educational debt. While veterinary education can cost upwards of $200,000 in America, tuition at UNAM, the country’s largest university, is heavily subsidized by the government and amounts to roughly $100 per semester. 

UNAM Dean Francisco Trigo hasn’t spoken publicly with the VIN News Service since being turned down for accreditation. In a 2008 interview, he characterized the COE’s prospective recognition of UNAM as historic — a distinction that could open doors for the 350-plus students who graduate from the veterinary medical program annually.

Trigo also has outlined the millions of dollars the university has poured into the program with the goal to meet the COE’s 11 accreditation standards. In 2004, Banfield built UNAM a 15,000-square-foot small animal veterinary teaching hospital, giving the program a leg up in terms of coming into COE compliance.

Yet despite the upgrades in facilities, UNAM continues to be plagued by criticism that its brand of veterinary education is substandard compared with programs in the United States. Opened in the 1950s, UNAM admits students out of high school without an entrance exam. At any one time, there might be more than 2,000 students studying to be veterinarians at UNAM, yet only 65 percent graduate.

Though the Texas resolution does not address it, some suspect that Banfield is pushing the merits of UNAM on AVMA officials and its COE, with the goal to dip into UNAM’s graduate pool to fill its ever-growing chain of veterinary practices. Earlier this decade, the company petitioned the California Legislature to extend temporary licensure to graduates of a handful of Mexican veterinary schools, including UNAM. The measure was defeated by organized veterinary medicine in the state. 

While Banfield officials have yet to characterize the company's interest in UNAM for the VIN News Service, CEO John Payne recently spoke to the Journal of the American Veterinary Medical Association (JAVMA). In a May 15 article, he countered notions that the company wants to use UNAM graduates to fuel its 730-plus practices by stating plans to expand operations in Mexico. The article also touted Banfield’s “dedication to cultural and ethnic diversity” as well as a lack of Spanish-speaking veterinarians to serve the Hispanic pet-owning population in the United States.

Despite the supportive press, trepidation concerning the current system for accrediting foreign programs extends beyond veterinarians in the Lone Star State.

In recent months, AVMA members across the country and in VIN discussions have questioned the national association’s mission to spread its standards for veterinary education worldwide.

According to COE rules, the accreditation process is private to ensure that all matters are dealt with objectively; the COE meets in closed sessions. But some veterinarians believe that a lack of transparency has allowed the COE to be overly directed by the AVMA and become vulnerable to outside influences.

In a VIN discussion featuring more than 500 comments, Dr. Ena Valikov, of Bellflower, Calif., echoed those concerns with: “Secrecy by its very nature gives birth to speculation.”

VIN member Dr. Steve McDonald, of Henrietta, Texas, added that one important question is missing from the international accreditation process:

"Is it in the AVMA members’ best interest to do this?"

According to AVMA spokeswoman Sharon Granskog, the association is responding to members’ concerns by making accreditation a focus of the House Information Meeting, held just before the regular session kicks off on July 29 in Atlanta. There, Dr. David Granstrom, AVMA liaison to the COE and director of education and research, will be joined by Dr. Jim Brace, chair-elect to the COE and a dean at the University of Tennessee, for a question-and-answer session with delegates.

Brace and his 20 COE colleagues — volunteers bound by strict confidentiality agreements — are not known for publicly addressing council issues or policies. To date, none have openly tackled the recent controversies concerning the accreditation system. Each COE member serves a six-year term, and most are elected by the House of Delegates to represent various professional disciplines. The council’s meetings near AVMA headquarters in Schaumburg, Ill., usually are met with little fanfare.

The AVMA Executive Board, which approves the COE’s budgets, staff, site visits and even policy changes, gave some attention to these concerns during its June 10-12 meeting, and elected to reaffirm a continued commitment to the COE’s process of evaluating foreign programs.

Concerning the substance of the Texas resolution and merits of the COE’s international business, JAVMA reports that board member Dr. John Brooks had this to say:

"Because of what we’ve achieved through accreditation and how we’ve educated veterinarians and the value we’ve placed on veterinary medicine, we’ve been recognized as having standards that other countries want to achieve. ... I believe we take this and move forward and provide other countries with an opportunity  (to become accredited). If they’re accredited, they (meet the standards).”

Another objection to the resolution is more technical in nature and hinges on its second sentence: "Said analysis shall be prepared by a task force assigned by the AVMA Executive Board and shall be ready for presentation at the 2011 Regular Annual Session of the AVMA."

According to officials, the AVMA Bylaws permit the House to recommend — not mandate — that the Executive Board do anything, including create a task force. Insiders with the TVMA insist that it's likely the resolution will be amended on the House floor to replace the word "shall" with something more appropriate. 

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