"This is extraordinary. And I believe unsustainable."
That is how Malcolm Getz, an economist from Vanderbilt University, characterized fiscal inequities tied to earning a DVM degree in the United States. At the Association of American Veterinary Medical College's (AAVMC) meeting last Saturday in Alexandria, Va., he told an audience of academics that when it comes to financing higher education through the cost of tuition, limits are fast approaching.
"Veterinary schools are pushing tuition about as hard as they think they can get away with," he said.
The AAVMC geared this year's annual meeting to address economic challenges facing the profession and veterinary education — difficulties being fueled by declining patient visits
, heavy student debt loads, deep cuts in state support for higher education
and increased competition for jobs among veterinarians
During the meeting, AAVMC officials presented Getz with an award
in recognition of his work studying economic trends in the veterinary profession. Getz's presentation that preceded the accolade, however, was controversial. As the AAVMC continues to project a need for more veterinarians in the United States — a new veterinary program in Arizona
is being built based, in part, on AAVMC citing a need for 15,000 more DVMs by 2025 — Getz echoed many in the profession who believe there is a surplus or maldistribution of U.S. practitioners on the horizon.
The audience of veterinarians in academia, including some who fervently disagreed with much of Getz's analysis, was quiet as the economist laid out reasons why schools in veterinary education can't continue to increase class sizes and raise tuition and expect to stay in business.
Prospective students, he said, will stop seeing veterinary medicine as a good career investment due to the mismatch between the cost of earning a DVM degree and income generated in practice. Average indebtedness for new veterinary graduates was $142,613 in 2011
, up 6.5 percent from 2010. At the same time, salaries for new graduates are in decline. Last year, mean full-time starting salaries, not including intern salaries, totaled $66,469, down 1.3 percent from 2010, according to an article
in the Journal of the American Veterinary Medical Association.
What's more, some in the profession, especially small-animal practitioners in suburban and urban areas, are feeling the crunch of competition as greater numbers of new graduates enter the workforce.
The AAVMC projects that total enrollment for veterinary students in the United States, spread among 28 veterinary medical programs, soon will reach 11,766, an increase of 3.6 percent over current enrollment. Median tuition revenue per school is $9.8 million for the 2011-12 academic year, more than double that of the 2001-02 academic year, AAVMC data shows.
Mean annual tuition at U.S. veterinary schools during the 2010-11 academic year was $40,017 for out-of-state students and $22,348 for in-state students. It's not feasible for veterinary institutions to continue to lean on students, Getz said.
Malcolm Getz, an economist from Vanderbilt University, is known for comparing the earnings and education of veterinarians to that of other health professionals. These two charts were among a series he presented during the AAVMC meeting March 10 in Alexandria, Va.
To bolster his point, Getz showed average educational indebtedness for MDs at $157,944 and $167,000 for dentists who graduated in 2010. DVMs who graduated the same year averaged $133,873 in student loan debt, according to the American Veterinary Medical Association (AVMA).
Using the 2010 figures, Getz compared indebtedness by profession to median annual earnings and calculated a ratio of 0.85 for MDs, 1.17 for DDSs and 1.69 for DVMs. "That is to say, the debt burden relative to income is approximately double for DVMs compared to MDs, a daunting difference," he stated.
"I suspect that it means veterinary schools will start having difficulty attracting talent," he added.
So far, that's not a trend officials with AAVMC are seeing. Lisa Greenhill, AAVMC associate executive director for diversity, reports that the pool of applicants going through the AAVMC's Veterinary Medical College Application Service, or VMCAS, has grown 8.1 percent during the past five years.
"Enrollment is currently growing faster than the applicant pool (13 percent during the same time period), which makes the applicant pool appear to be stagnating," she said by email to the VIN News Service. "It is not appropriate to characterize the applicant pool as declining as that is simply not the case."
VMCAS is a clearinghouse for veterinary school applicants that fills 89.9 percent of all available seats in the United States. Each year, an estimated 10 percent of the applicant pool heads to U.S.-accredited international programs, Greenhill said.
VMCAS applicant figures do not include data from Caribbean-based programs, but applicant-to-seat ratios calculated by AAVMC, which do include Caribbean students, are said to hover around 2.1:1. That figure reflects all available first-year seats to U.S. students at accredited and non-accredited Caribbean programs as well as those offered by all VMCAS members, including 25 American and eight international programs. Greenhill explained by email that the ratio also reflects student-reported overlap with the three U.S. programs that are not VMCAS members.
She noted that quantitative measures of quality begin to change when the ratio falls below 1.7:1, "which we are not close to yet."
"The student profile has not changed dramatically at this point," Greenhill said during a presentation at the AAVMC meeting. She added that while the overall GPA of seated students has gone up during the past decade to average 3.59, GRE scores are slightly down from last year.
To ensure that veterinary medical programs continue to attract bright students, Getz suggested creating more balance between starting salaries and the costs of education. One way to do that, he said, might be to create a new model for educating veterinarians that would strip at least two years off the current educational system to lessen costs for students and lower overhead costs for veterinary medical programs. He proposed creating a Doctor of Veterinary Medical Practice, a paraprofessional degree that would take six years of higher education to complete, rather than the eight years that it takes most veterinarians to earn a DVM.
"The DVM would remain the classic education, based in a research setting and responsible for fueling the intellectual core of the profession," Getz said.
The idea was shot down by a handful of audience members, who noted that not all veterinary medical programs require a bachelor's degree, though the vast majority of veterinary students complete one.
Dr. Peter Eyre, former dean of the Virginia-Maryland Regional College of Veterinary Medicine, is involved in opening a new veterinary school at Lincoln Memorial University, north of Knoxville, Tenn. He's not comfortable with Getz's plan to create a paraprofessional degree, stating before the AAVMC audience: "That troubles me a great deal." He did not elaborate, but then outlined his own plans for altering the way veterinarians are educated in the United States.
Eyre is involved with creating a program at Lincoln Memorial that will require six years of education. It differs from Getz's proposal in that students would earn both a DVM and bachelor's degree during their time on campus. He noted that he's encountered criticism from his colleagues and those entrenched in the accrediting process for challenging the status quo with a new system.
"When are we going to start pissing people off and actually doing something?" Eyre implored of audience members. "If the deans continue increasing their tuition and class sizes, who is going to make it less expensive to earn a DVM degree?"
Getz used dentists as an example of a profession with a history of controlling its supply and demand, making it so that earnings remain high enough that educational costs aren't as burdensome to new graduates.
Jeff Johnson, OD, CFA, the senior research analyst covering medical technology with Robert W. Baird, Inc., corroborated Getz’s assertion that a large number of dental schools closed during the 1980s, forcing dentists to become more efficient. Between 1984 and 1994, six private dental schools closed, according to information published by The National Academies Press. Many closures were due to cuts in state aid combined with falling enrollment.
Georgetown University, which formerly housed the nation's largest private dental school, was one of the casualties. At the time, the New York Times reported that many of the 57 other U.S. dental schools had cut back on class sizes because they were unable to attract enough qualified applicants.
“According to the American Association of Dental Schools, applications have dropped by almost two-thirds since 1975. The academic quality of the applicants has declined, too,” the article reported.
High tuition and educational indebtedness among new graduates were cited as reasons for the decline in applicants. Another culprit was the public's perception that dental care was not a necessity, causing reduced demand for it.
“Tuition that tops $15,000 a year at some private dental schools discourages many applicants, as does the fact that the average private dental school graduate has educational debts of $51,000,” the article, published in 1987, stated. “But the main cause for the declining interest in dental school is a widespread perception that advances in dental care have diminished the public's need for dentistry.”
The dramatic decline in programs led to fewer dentists. The upshot: greater investments in technological advancements and increased salaries for the profession, Johnson said in an interview with the VIN News Service.
That trend now is reversing, he added. The American Dental Association supports opening new programs or increasing the number of dentists working in the United States. In 2003, there were 4,443 U.S. dental school graduates — about the same number of graduates as in the early 1970s.
Today, there are 62 accredited dental programs in the United States and 10 in Canada. At least two new dental schools are slated to open by 2013, and five others have been accredited since 2008. U.S. dental school enrollment for the 2009-10 academic year totaled 20,052.
“More dentists are delaying retirement, and there are more schools opening,” Johnson said, adding that like veterinarians, “if you start having an oversupply of dentists, they’ll have a lot more free time on their hands.”
VIN News Service commentaries are opinion pieces presenting insights, personal experiences and/or perspectives on topical issues by members of the veterinary community. To submit a commentary for consideration, email email@example.com.