Federal panel finds in veterinary accrediting body's favor

Concerns linger as AVMA COE earns positive recommendation

July 5, 2016 (published)
By Jennifer Fiala

VIN News Service photo
Dr. Jim Wilson pleaded with a federal panel to consider Americans studying outside the United States as it mulled whether the American Veterinary Medical Association's accrediting body had met U.S. Department of Education requirements for re-recognition. Wilson spoke of staggering educational debt incurred by students, especially those studying abroad, and implored the panel to consider an AVMA report on the economy. "Seventy-six pages here, folks ... some valuable fiscal information," he said.

A federal oversight panel is satisfied that the Council on Education is in compliance with government regulations, voting June 24 at a hearing in Arlington, Virginia, to recommend continued recognition of the accrediting body until its next regularly scheduled review in 2017.

The National Advisory Committee on Institutional Quality and Integrity’s (NACIQI) findings are a step toward ending four years of heavy government scrutiny of the COE, a volunteer body charged by the U.S. Department of Education to act as the nation’s sole accreditor of veterinary education.

NACIQI is an 18-member panel that advises the U.S. Education Secretary on higher-education institutions. Following NACIQI’s recommendation, USDE has 90 days to determine whether the COE has met government directives to become more transparent, communicative and consistent in the application of accreditation standards.

Those orders stem from hearings before NACIQI in 2012 and 2014 that featured letters and testimony from hundreds of veterinarians who alleged that COE accreditation decisions reflected the influence and cronyism of its parent, the American Veterinary Medical Association.

As a result, the AVMA COE was ordered to create firewalls against conflicts of interest, streamline the review of standards and reach out to those critical of the accrediting body in order to demonstrate wide acceptance.

A steady stream of supporters including veterinarians local to Arlington offered testimony on June 24 that the COE has spent the past several years working to meet USDE requirements. They spoke of highly qualified graduates, increased communication from the COE, the accrediting body’s professionalism and a robust job market.

“I’m here to tell you that our current students are not deficient in any capacity with regard to education in their field,” testified Dr. William Tyrel, a board-certified veterinary cardiologist who said he’s observed hundreds of students as they’ve rotated through his practices in Virginia.

Not everyone is convinced. Ahead of the June 24 hearing, NACIQI reportedly received 200 or so letters from veterinarians dismayed by COE decisions and its close ties with the AVMA. Tyrel characterized those who believe the COE inappropriately accredits veterinary schools as unwilling to accept that education is evolving.

“Veterinary education is changing and will continue to change. We all felt we had to walk uphill to veterinary school, he said. 

Critics counter that concerns about the veterinary profession and accreditation’s role in its future health aren’t about resisting change. They’re about maintaining the quality of a proud but struggling profession that’s seeing a proliferation of new schools and an ever-increasing number of graduates, most who owe six-figure student loan debt that they’re expected to pay on salaries averaging $70,000 a year.

Those who believe COE decisions reflect an AVMA political agenda to spread U.S. accreditation overseas want USDE to force the two groups to separate. Federal regulations, however, do not require that level of autonomy for programmatic accreditors, meaning those that evaluate education but aren’t authorized to offer access to student loan programs.

USDE ordered the COE last year to mend its rift with veterinarians, resulting in a series of “listening sessions” to provide a forum for airing concerns in front of AVMA and COE leaders. Held during regional and national conventions, most of the sessions were poorly attended. Talks were one-sided, critics said, and featured little or no debate with AVMA and COE officials.

AVMA and COE officials spoke highly of the sessions during the hearing. When NACIQI member Bobbie Derlin asked how they fared, COE chairman Dr. John Pascoe responded, “Some of the issues that were raised were felt to be issues for the profession and not for the council.”

Those issues involved the profession’s economic health and workforce concerns, which NACIQI member Frank Wu inquired of Pascoe and his colleagues — Dr. John Scamahorn, the COE's incoming chairman, and Dr. Karen Brandt, AVMA director of education and research and a COE liaison.

“Does the parent organization … have any view at all on workforce issues?” Wu asked.

Several seconds of silence followed before Scamahorn, a former AVMA executive board member, responded: “I will say that veterinary medicine … is suffering from increased costs in tuition. There is substantial concern and there has been for some time.”

Market concerns, Wu said, aren't the purview of an accreditation body. Even so, NACIQI heard from several veterinarians citing a robust economy. 

Dr. Jeffrey Newman, a general practitioner in Arlington, testified that his eight-doctor practice group is thriving and the new graduates he sees are “equipped to handle challenges.” He spoke of struggling to “wrap his head around the concerns” some in the profession have about the AVMA and COE.

“We actually have what I believe is the greatest profession on Earth, and this profession certainly has challenges,” he said. “I believe economics are a big drive” of the criticisms.

Wu responded: “I think that really gets to the heart. I don’t think the COE should be the gatekeeper for (the profession’s) economics.”

Pascoe spoke several times about the fact that just 28 accredited veterinary schools exist in the United States before clarifying that two additional programs opened in 2014, and a third is in the pipeline. NACIQI member Hank Brown turned the conversation to the difficulties aspiring veterinarians face concerning admissions.

“For many years, I’ve talked to students who have extraordinary outstanding academic records who can’t get into veterinary school,” he said. “My impression is that you have far more applicants for veterinary schools throughout the nation than you have openings.”

Pascoe responded that the number of applicants has been static for some period of time. However, figures from the Association of American Veterinary Medical Colleges show that the applicant-to-seat ratio is trending downward, with 1.6 applicants for every seat. That's the lowest its been since 1980.

There was a clear dip during the financial crisis, Pascoe testified, and there were concerns, legitimate concerns I think at the time, of an oversupply of veterinarians. I think that’s changed dramatically.

NACIQI member Dr. Arthur Keiser quipped about the high costs of providing medical care for his dogs, to which the audience laughed.

“Consequently, I would like to see more competition. It costs a lot more to take care of my dogs than it does for me,” he said.

Foreign programs 

Lingering points of contention between the AVMA and its critics include the COE’s acceptance of distributed learning, which permits colleges to forgo the expense of building a teaching hospital in favor of sending students through private practices for clinical education.

Another issue has been the COE’s involvement in foreign-school accreditation, which critics say distracts from the agency’s domestic responsibilities while benefiting foreign schools that use U.S. accreditation to attract higher paying American students. Until recently, the COE’s efforts to take U.S. accreditation global was part of an AVMA political directive with no oversight from USDE.

That changed last summer, when USDE authorized the COE to evaluate foreign veterinary schools to satisfy new federal regulations that make it an institutional accreditor of foreign programs, acting as a gatekeeper to federal student loans.

In other words, COE accreditation now ensures that a foreign school is qualified to access USDE's Direct Loan Program for its American students. 

The same isn't true for the COE's domestic duties. "The COE is a programmatic accreditor, and as such is not required to be separate and independent, but as you’ve noted from some third-party commenters, some think it should be," Pascoe testified. 

Federal regulations mandate a higher level of autonomy for institutional accreditors, however those regulations do not cover the COE's new charge. That's covered by a different set of regulations for which an autonomy requirement isn't included. "AVMA COE’s status as an accreditor for foreign veterinary schools is separate and apart from its responsibilities as a recognized accrediting agency," NACIQI Executive Director Jennifer Hong explained by email.

The COE's new role hasn't subdued critics, particularly those who assert that the COE spends roughly 40 percent of its time focused on the evaluation of programs outside the United States. Consultative site visits are scheduled this fall at the Univeristy of Bristol and University of Cambridge, both in England. Fourteen foreign schools in Europe, New Zealand, Australia and the Caribbean already are U.S. accredited, along with another five programs in Canada. 

Dr. Mary Beth Leininger, a COE member and former AVMA president, is among those who've voiced concern that the COE is stretched thin between its responsibility to evaluate a growing number of domestic programs and mounting requests to assess schools overseas.

Leininger said as much during a public meeting in January 2014. Two months later, she was kicked off the COE for alleged confidentiality violations.

Leininger’s removal caught the attention of NACIQI when she testified before the panel later that year. Soon after, she appealed. AVMA officials reinstated her position in July 2016, on the condition that she not participate in accreditation decisions involving foreign veterinary programs.

NACIQI members inquired about Leininger’s status though she was not present during the hearing. Brandt, the AVMA staff liaison to the COE, stumbled in her response to NACIQI, recounting that “concerns of bias” had emerged after Leininger expressed thoughts on the COE’s foreign responsibilities.

Pascoe spoke of her reinstatement: “(Dr. Leininger) recused herself of accreditation and votes on international veterinary schools.” When asked why, he said, “It would create perception at the very least, of … a known or perceived bias.”

That’s misleading given that Leininger’s comments in 2014 referenced the COE’s workload, not the merits of foreign programs, critics say. Dr. Paul Pion, co-founder of the Veterinary Information Network, parent of the VIN News Service, characterized her reinstatement to the COE as a "skillful political maneuver." 

"Indeed, it is the very nature of AVMA’s control over COE that gave them the ability to decide if Dr. Leininger should be allowed back on the COE and under what restrictive terms," Pion stated. "By reinstating Dr. Leininger with limited scope, AVMA provides the appearance of fairness while limiting Dr. Leininger’s role as a council member, as well as neutralizing and silencing what was likely to be the most potent voice of dissent at these hearings."

Pion reflected on Leininger’s appeal hearing before the AVMA Board of Governors, which he attended.

“I saw the COE leadership display utter disdain toward Dr. Leininger,” he told NACIQI, adding that the condition that she recuse herself from foreign accreditation matters sets a “dangerous precedent.”

Pion applauded recent modifications to COE standards for research and outcomes assessments — changes ordered by USDE in 2014. The new versions are designed to be more meaningful and evenly applied among accredited institutions, though Pion said it's too early to tell if the modifications will be "enforced and have the intended impact upon the institutions COE accredited under the laxer prior standards." 

Per a USDE edict to erect greater firewalls against conflicts of interest, AVMA officials no longer attend accreditation site visits or play a role in creating COE policies and procedures. The COE now has its own attorney, and AVMA officials no longer appoint COE members. That's the job of a newly created COE selection committee.

Even so, the AVMA's authority over the COE hasn't diminished, critics assert. Pion pointed out that the AVMA Board of Directors still approves the COE's budget and appoints members of the COE selection committee. "AVMA still has significant control over the selection and budget of COE and fiscally limits the COE's access to independent legal counsel," he testified. 

To illustrate the point, Pion referenced a conversation he’d had with an AVMA official regarding calls to grant COE independence from AVMA governance and budgetary contraints. “One of the leaders asked, ‘Why would we continue to financially support the COE if we have no control over it?’ ” Pion stated. 

Dr. Jim Wilson, an attorney and veterinarian who teaches career development and personal finance at veterinary colleges across the country, was sharing his perspective on how the accreditation system harms the profession when he reached NACIQI’s three-minute limit on testimony. 

NACIQI chairwoman Susan Phillips turned off Wilson’s microphone, but Wilson continued, holding up an AVMA economic report that he said contains “valuable fiscal information” regarding the profession’s health. As Wilson stood to exit, he waved several professional trade magazines that featured articles about the mental health of veterinarians.

“Our profession has the highest rates of suicide, and part of it is because of this process,” he stated.

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