Caught in a tough job market, Dr. Sara Craven may have to repay an $80,000 veterinary school loan if she does not begin working as required under a commitment she made to serve for four years in rural Kansas. She's considering taking an equine internship to defer the loan payment. Photo by Cathy Robert.
To a young woman who loves horses and could imagine a career in livestock medicine, the deal sounded great: Kansas State University would give her $80,000 to attend veterinary college if she promised to practice in rural Kansas for four years.
What no one anticipated was that she’d have trouble finding work in a sector that everyone said needed more veterinarians.
“Unfortunately, at the end of four years, I’m coming up short finding a job,” said Dr. Sara Craven, one of five students in the Veterinary Training Program for Rural Kansas who graduated this spring. Participants have six months to start working; otherwise, they are on the hook to repay, with interest, what technically is a loan.
Craven is not an anomaly. A second graduate from the same program also is unemployed. Their situation exemplifies a difficult truth about the much-publicized national shortage of large-animal and rural veterinarians: A lack of veterinary services in agricultural communities doesn’t necessarily mean good jobs are going begging.
In the eyes of Dr. Emily Buskey, a 2009 graduate who intended to go into large-animal practice but ultimately followed the job market into companion-animal medicine, “Any geographic location with a shortage of veterinarians does not have enough paying work to financially support more veterinarians.”
Dr. Chris Ross, associate dean for academic affairs at Oklahoma State University’s Center for Veterinary Health Sciences, where more than a quarter of this spring’s 82 graduates went into mixed- or large-animal practice, said Buskey’s is a common observation, and one he finds valid.
“The problem is mostly ... a lack of a business model that will support a veterinarian at a reasonable level,” Ross said.” We often hear a phrase repeated that ‘There are 1,500 counties that have no large-animal veterinarians at all!’ when in reality, probably most of the economies in those counties can’t or won’t support veterinary services for their food-animal populations.”
Vermont discovered the distinction between demand and need when it set out to identify which of its communities should be designated by the U.S. Department of Agriculture (USDA) as short on food-supply veterinarians
. Under a USDA program
launched last year, veterinarians who apply and are approved to practice in designated shortage areas for three years may have up to $75,000 of their educational debt paid by the government.
State Veterinarian Dr. Kristin Haas said Vermont tackled the shortage question in two ways. It looked at the ratio of veterinarians to animals per geographic area; and it surveyed veterinarians in the state to assess whether the areas that statistically came up short truly were.
The result: “On paper, we found that there were more areas in the state that looked like they technically had a shortage, and then when we got feedback from veterinarians in some of those areas, it was, ‘Are you kidding? We’re trying to keep ourselves afloat. Please don’t entice any others to the area!’ ” Haas said.
In the end, the state identified two “shortage situations” for 2011. Haas said she is confident those regions have enough food-supply-animal work to support at least 30 percent of a veterinarian’s time, the minimum required by the USDA program.
The difficult job climate leads some to conclude that the shortage — which seven years ago was cast virtually as a national emergency — is over.
Incentives may make difference
“There are still a number of people saying there’s a shortage of food-animal veterinarians or large-animal veterinarians right now, and I think that’s bogus,” said Dr. Armando Nieto, a large-animal veterinarian in California who is between jobs and having scant luck finding a position.
Nieto is a member of the American Association of Bovine Practitioners (AABP) Ad Hoc Committee on Rural Practice, which in May issued an opinion that “there is not currently a shortage of veterinarians for rural food supply veterinary private practice.”
was perhaps the first — and certainly the most prominent — by a professional veterinary organization to contradict conventional wisdom that some of the greatest opportunities for veterinarians lie in rural America.
The committee noted that some regions remain under-served for a variety of reasons. “In instances where rural jobs are still available, these jobs remain unfilled because the economics may be undesirable for an experienced practitioner and, in small clinics, there may be a lack of mentorship and support for graduating veterinary students,” it wrote.
The committee warned against veterinary schools using the perceived shortage as a reason to enlarge class sizes: “Continuing to increase the number of veterinarians interested in serving rural areas will not solve this problem. In fact, creating an ‘over supply’ of food-supply veterinarians will lead to widespread unemployment or underemployment of food-supply private practitioners and will have a significant detrimental effect on salaries for all veterinarians.”
“We just wanted to tell people, ‘Hey, stop. We’ve got enough students,” said Dr. Christine Navarre, president of the AABP.
The situation is far different from a decade ago, Navarre said, when bovine-practice employers reported having jobs they couldn’t fill. Young people by and large seemed disinterested in rural work. So the AABP, among others, reached out to students, talking up the virtues of practicing outside the urban core — the exhilaration of being outdoors, the lower cost of living, the warmth of small communities where clients might invite you in the house for pie.
“I think we turned it around as far as getting students interested,” Navarre said. “...What we haven’t fixed is the business end of those practices.”
Put another way, a community may be short on veterinary care, but is it willing to spend enough on animal health to support a practice? That’s a critical part of the equation, said Charlie Powell, a spokesman for Washington State University College of Veterinary Medicine.
“When you ask the question, ‘Are you being served in a rural community by large-animal veterinary medicine?’ and people say, ‘No,’ you need to ask them, ‘How much money did you leave lying on the table for veterinary care had it been available?’ ” he said.
Powell suggested that too often, the veterinary shortage is cast in terms of the nation’s needs without recognizing practitioners’ needs. “Do we need more large-animal and mixed practice people in rural areas for the nation in terms of being sentinels?” he asked rhetorically, referring to the role of detecting disease outbreaks and other food-supply threats. “Of course we do. But veterinarians need to make a living, too.”
By Powell’s back-of-the-envelope calculation, $250,000 to $300,000 a year is required to sustain a large-animal veterinarian — enough for transportation and equipment, payments on educational debt and a $60,000-a-year living.
is a significant burden that didn’t exist a generation ago. A survey by the American Veterinary Medical Association (AVMA) of veterinary school graduates in 2010 found that students with educational debt owed nearly $134,000 each on average.
Recognizing that debt obligations made new veterinarians more likely to seek higher-paying urban jobs, a number of states
began in the past decade offering loan repayment and other financial incentives to practitioners willing to practice in rural communities and work with livestock. The USDA did the same on a national level through its Veterinary Medicine Loan Repayment Program
It was such a program that enticed Kansas State graduate Craven to pursue food-animal medicine.
Hailing from the Kansas City area, Craven was not a country girl but grew up around horses. As an undergraduate majoring in equine sciences at Colorado State University, Craven was introduced to the cattle industry through college friends. “I spent time at their ranches calving, branding and moving their cows to the mountains,” she recounted. She took animal science classes as electives and became involved with the school’s Agricultural Council and Animal Science Executive Committee.
Returning to Kansas for veterinary school, Craven applied for support through the Veterinary Training Program for Rural Kansas. “I basically told them that I was on the fence between doing all equine or entering into large-animal focus,” she said. “I told them if they didn’t give me the scholarship then I was going to pursue equine, but if they gave me the money, I would ... dedicate myself to rural Kansas. They apparently liked what I had to say and gave me the scholarship, which was great.”
Craven said she began the job search late last year. She inquired at 10 to 20 practices, landing three or four interviews. One promising position ended up going to a competitor from out of state.
The problem, Craven concluded, “wasn’t necessarily a lack of jobs in Kansas in total, but between the amount of people that were required to stay in Kansas and the people that wanted
to stay in Kansas — and add in out-of-state competition — it’s been tight for everybody.”
Of the three Rural Kansas program graduates who landed jobs, one is working with his parents, who are veterinarians. Another is working part-time on his family’s cattle operation doing embryo transfer, with the promise of a part-time position at a practice in his hometown come fall. The third had his pick between two job offers. His employment was secured by February.
Craven said she has begun applying for qualifying rural positions that have a predominantly small-animal focus — not what she planned for.
Another option she’s considering is to defer loan payment by continuing her studies. She has a line on an equine internship in Texas, but taking it, she fears, would cause both her small- and large-animal skills to rust, making it harder still to work in rural Kansas once the internship ends.
“I’ve definitely thought of saying, ‘Screw it’ and just paying (the loan) back monetarily,” Craven said. “But I’m not quite ready to give up that free money just yet, especially since I really like Kansas and could see myself working here.”
Dr. Ralph Richardson, dean of the Kansas State College of Veterinary Medicine, said he is aware that not all of this year’s graduates in the rural veterinary loan program are employed but stated, “There are definitely jobs available in Kansas.”
Craven said she knows of three openings in large-animal medicine that meet the program qualifications: One, at a cattle-feeding operation, requires five to 10 years of experience, which she lacks. The other two entail buying practices that are for sale, something Craven is unprepared to do at this point in her career.
Her dilemma highlights one of the challenges in matching new veterinarians with under-served regions. Existing practices in such areas may, for example, need substantial updates in equipment and facilities, work that someone freshly out of school feels is more than he or she can handle. Or there may be no veterinarian at all in an area of need, requiring someone to build a practice from scratch without the benefit of mentorship.
“I don’t know of any new grad that has the mojo to do that,” said Buskey, the 2009 graduate who faced similar challenges while seeking large-animal work in her home state of Vermont. Even as an older graduate who made a living as a dairy farmer before entering veterinary school, Buskey wasn’t comfortable starting a business as a solo practitioner with no guidance. She ended up taking a position in a small-animal clinic in upstate New York, which she said has proved rewarding.
Dr. Gary Sherman, national program leader for veterinary science at the USDA’s National Institute of Food and Agriculture, which administers the federal Veterinary Medicine Loan Repayment Program, acknowledged that veterinarians with some experience are likelier than brand-new graduates to be successful in some under-served areas.
“Many of these areas are shortage situations for a reason,” Sherman said. “It should be no surprise to anyone that some of these areas are socio-economically depressed. ... We’re trying to do something that’s very, very difficult to do: fill gaps in areas in which others have chosen not to serve.”
Sherman has stated in the past and reiterated that the program is not an employment service. “The applicant is the one responsible for finding employment, whether as an associate or a sole practitioner,” he said. “If you want to self-employ, there is a job. It’s up to you.”
He acknowledged: “It could be a monumental task. ... There are probably places in the country where no amount of loan repayment can make it financially viable in the long run. The market analysis is the responsibility of the applicant.”
Of 62 veterinarians who last fall became the first to be offered awards through the USDA program, nine did not accept for various reasons that Sherman said he could not disclose due to confidentiality rules. From among the remaining 53, he said, “We’ve had only one or two calls where they’re saying, ‘I’m a little concerned.’ The rest have been excited about the opportunities.”
Bottom line: “This isn’t a needs program for individuals," he said. "This is a program to address national agro-security, public-health, animal-health and food-safety infrastructure issues.”
As for the scope of the food-animal and rural veterinary shortage today, opinions are mixed. “There’s absolutely, positively a shortage in certain areas,” declared Dr. John U. Thomson, dean emeritus and a professor in veterinary diagnostics and production animal medicine at Iowa State University College of Veterinary Medicine. “There’s no doubt about it. We have a distribution issue.”
Thomson, who was involved in a large marketing study
released in 2004 that examined the shortage in food-supply veterinary medicine, said future job-market demands can turn on a dime. For example, he said, government requirements for animal-disease traceability
and/or increased supervision by veterinarians of all antibiotic distribution
could heighten demand for large-animal veterinarians. New eradication efforts against diseases such as brucellosis, tuberculosis and foot and mouth disease would do the same.
A National Academy of Sciences study underway on veterinary workforce needs
could settle open questions about overall demand for veterinarians. Unfortunately, the study’s release is years overdue
kept by the AVMA tracking the number and type of positions in the profession present a hazy picture. While the number of positions occupied by mixed-animal and food-animal-predominant practitioners has declined over the past five years, the number of positions filled by veterinarians devoted exclusively to food animals has grown — from 993 in 2006 to 1,109 in 2010.
That jibes with an observation by Dr. Fred Muller, a cattleman and bovine veterinarian in Washington state. He maintains that the mixed-practice sector is hurting the most. Muller, who graduated in 1997, said he found the demand for intensive dairy, swine and beef cattle work strong, with salaries to match.
“The real problem we’re facing is not in strict food-animal people like myself,” Muller said. “The real problem that still exists is this rural mixed-practice scenario. It’s basically the fact that we’re kicking out students with higher and higher debt load and these rural communities and ranchers and agricultural businesses, their margins are tighter with higher input costs so they don’t want their veterinary services to just keep escalating (in price). ...
“What we’re really looking at now is, how do we change this business model to make rural mixed practices more profitable?” Muller said. “That is the crux of the deal.”
Ross, associate dean for academic affairs at Oklahoma State’s veterinary school, agreed. He believes that the traditional country animal doctor, whom he described as “solo practitioner, low fees, low salary, long hours, many miles traveled, extremely low cost to clients but low standard of service in many cases” likely will go extinct.
“My guess is that the Lone Rangers are going to be replaced by better equipped multi-doctor practices in larger population centers, supported by much better trained and paid technical staff,” Ross said. “There will be clientele at the margins that are going to have to either go without or be less passive about seeking out veterinary services.”
The bovine practitioners association committee that opined that the rural shortage is past is now tackling the business-model question. Association president Navarre said one subcommittee is examining sustainable practice models and seeking “out of the box” approaches.
“Do we need to partner with other medical professions?” she said, by way of example. “Share a building with pharmacy and radiology, with physicians and dentists? We’re not the only profession this is happening to. Physicians and dentists (too) are having trouble staying in business in rural areas.”
Another subcommittee is looking at the role of technicians and paraprofessionals, she said. A third group is developing tools to hone practitioners’ business skills.
Separately, the USDA has put $500,000 toward establishing a National Food Animal Veterinary Institute aimed at helping veterinarians and veterinary technicians serve food-animal-production needs through private and public practice, according to Iowa State’s Thomson, who is involved with the initiative. The institute aims to identify the skills and business savvy practitioners need be successful in rural practice, then coordinate or offer education toward that end, Thomson said.
Thomson said the various incentive programs designed to attract practitioners to rural communities would benefit, as well, from greater coordination, which he is advocating that the institute help provide. Otherwise, “it’s like throwing a dart at a wall, and just seeing where it lands,” he said. “We need to see the outcomes: Are they successful or not successful? We need to stop, look together and unify our efforts.”
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 firstname.lastname@example.org.