Veterinarians voicing opinions on accreditation are not 'elitists'

Cushing's blog posts driven by undisclosed conflicts of interest

November 12, 2014 (published)
By Paul Pion

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Dr. Paul Pion

In a flurry of blog posts on DVM360 (post1post2post3), Mr. Mark Cushing derides as elitist “a handful of veterinarians, originally 13 or so, (who) have taken it upon themselves to urge the Department of Education to abandon the COE (Council on Education) ... and support a new federally approved agency to oversee veterinary education in the United States."

It is not entirely clear to whom Mr. Cushing refers as his handful of veterinary elitists, but I surmise that he is speaking of the 14 colleagues whose letters to the National Advisory Committee on Institutional Quality and Integrity (NACIQI) were posted online as examples of colleagues’ letters.  

Oxford Dictionaries defines elitism as "the advocacy or existence of an elite as a dominating element in a system or society.” Elite means “a group or class of people seen as having the greatest power and influence within a society, especially because of their wealth or privilege.”

The colleagues to whom I believe Mr. Cushing refers are, in my opinion, hardly elitist by definition. They are a diverse group of veterinarians. Some are outspoken, others are reserved. Some have recognized names in the profession; others are familiar only to their clients and friends. Some have been involved in veterinary medical organizations, while others have not. Their career paths range from private practice and industry to academia. Two are former COE members.

Of the 14 colleagues I've mentioned, none is in a position to wield significant power or influence over the process of accreditation. Yet all care about the profession enough to speak out, their voices coming from diverse corners in veterinary medicine that together sound nothing like the "odd coalition of elite Ivy League school progeny" that Mr. Cushing blogged about.

Some might say that I, as co-founder and president of Veterinary Information Network (VIN), the largest online community of veterinarians, have the resources and forum to exert power and influence. Being cognizant of that, I consciously resist exercising that potential power. And when I do feel a need to reach out, such as with this letter, it is only when I feel strongly that it is the right thing to do for the common good and not for personal gain. Consistent with that philosophy, we have a long-standing policy at VIN to not accept sponsorships or advertising in order to insulate the organization and community from commercial influence and remain independent.

What I know about the colleagues to whom I believe Mr. Cushing refers is that they have nothing personal to gain from the outcome of this debate. With one or two exceptions, all have reached a point in their careers where they could easily ignore this issue were it not for their desire to pass on to the next generation a profession that is as rewarding and fulfilling as the one they inherited.

Mr. Cushing is not a veterinarian. He is a lawyer and lobbyist who makes money by representing his clients in this debate. One could argue that it's Mr. Cushing who represents the "elitists," given that his clients include some of the largest and most powerful corporations in veterinary medicine.

I can only conclude that Mr. Cushing has misunderstood the terminology he's used to denigrate veterinarians who've done their civic duty by responding to the U.S. Department of Education's call for public comments regarding the job performed by the COE. Either he doesn't know what "elitist" means, or he's deliberately trying to smear the credibility of those who'd like to see the COE become a more independent and stringent evaluating body.

All the while, Mr. Cushing has failed to reveal his own professional conflicts of interest.

I’m also puzzled by Mr. Cushing's assertion that restructuring the COE is in itself elitist. The proposals to restructure seek to redistribute authority for veterinary school accreditation from an insular (dare I say "elitist") group with significant professional influence and controlled by the AVMA, to an independent body with diverse viewpoints whose selection is outside of the AVMA's control.

Cronyism and trading of power and influence within the AVMA and the COE have been recognized by many. The problem recently was outlined in a letter by Dr. Mary Beth Leininger, who was removed from the COE after she voiced concerns with the COE's direction and accreditation process. 

Mr. Cushing compounds his error by then asking, “Are (we) are to trust these elitists to shape a new federally sanctioned accrediting agency, funded by sources yet to be identified and empowered to decide which schools may go forward and which must close their doors?”

The letters to which Mr. Cushing refers, as well as dozens of others from similarly concerned colleagues, do not, in the vast majority, propose creating a new accrediting body. Rather, they call for changes to transform the COE into an accrediting body that operates independent of political and financial influence and cronyism.

Mr. Cushing appears concerned that efforts to create a COE free of AVMA politics will “reduce the quantity of veterinary care available for a pet-owning public that already finds fewer than one out of two pet owners seeking veterinary healthcare for their pets.” I would submit that his own sentence undermines his point.

By Mr. Cushing’s own admission, fewer than 50 percent of pet owners seek veterinary care. Yet he bemoans efforts to maintain standards that protect high-quality education rather than facilitate an increasing quantity of graduates.

Stationing veterinarians on every street corner won’t bring that untended half of pets to clinics for care. Until pet owners who don't currently seek veterinary care come to value veterinary care, and until our economy provides a higher discretionary income for the average American, visits to veterinarians are unlikely to increase. In fact, we risk exactly the opposite. Churning out veterinarians without regard for market demand risks forcing the veterinary profession to focus on economic survival rather than putting more of its energies into providing high-quality veterinary care.

Indeed, Mr. Cushing’s own profession has recently experienced such a crisis of market forces, resulting in a reduction in student intake by several law schools to curtail the excess of lawyers who are unable to sustain a living. Similarly, numbers of applicants to law schools are dropping because prospective students are recognizing the financial problems of embarking on that career. We would not wish this fate to befall the veterinary profession.

In one of his posts, Mr. Cushing compares the number of veterinary schools accredited by the COE to medical schools and veterinary technical schools, thus comparing apples to salmon.

Some facts regarding the history of veterinary school accreditation: 

  • In 1973 there were 18 accredited veterinary schools when the first foreign veterinary school was recognized (Utrecht).
  • In the ensuing years, 10 more domestic schools were accredited. with no foreign accreditation activities.
  • In 1998, by the direction of the AVMA Executive Board, a focus on accrediting foreign schools was initiated.
  • Since 1998, 12 foreign and two domestic veterinary schools have been accredited. That brings the total of U.S. veterinary medical programs to 30, and I believe another new domestic school is close behind. These figures contrast with Mr. Cushing's assertions that the COE has accredited just three programs in 33 years. True, the COE has accredited three new domestic schools since 1981, but he has overlooked the recent surge in the COE's accreditation of foreign programs.
  • The Association of American Veterinary Medical Colleges reports that the number of veterinary students annually graduating from COE-accredited schools has increased from fewer than 2,500 in 1980 to 4,460 enrolled and projected to graduate in 2017. The uptick in veterinary student numbers is reflective of the newly accredited schools and growing class sizes at long-established domestic programs. Of the 4,460 enrollees, 25 percent will graduate from foreign programs accredited since 1997, and all are expected to enter the U.S. workforce after graduation.

It is worth noting that AVMA economist Michael Dicks, Ph.D., and the AVMA Economics Committee recently reported a 12.5 percent excess capacity within the profession. This excess capacity occurs during a period when student debt has risen at a near constant 7 percent per year, salaries have risen at about 3 percent per year and stagnated during the past several years, and the number of U.S. citizen applicants seeking to enroll at domestic and foreign accredited schools has not kept pace with the number of available positions. Although the data is imperfect, I calculate that the approximate ratio of applicants per seat has hit an all-time low of less than 1.6 applicants per seat. When this number was reported to be 2.1 in 2011, a Journal of the American Veterinary Medical Association news article asked, “Will veterinary education hit a tipping point?"

Mr. Cushing further belittles legitimate concern regarding the recent accreditation of veterinary schools. Some of these schools would not have met the 1990s accreditation standards written by the very COE he defends. By weakening its own standards in order to accredit these schools, the COE has opened the door for profiteers to operate veterinary schools at low cost without significant research programs and/or teaching hospitals.

I am sure these schools can adequately train practitioners. But can they provide an atmosphere that nurtures thought leaders and generates the ideas and advancements we need to move forward as a profession? Relaxing accreditation standards to facilitate the opening of more schools and graduate more veterinarians may bring certain groups short-term gains that are not sustainable nor will benefit society.

Name calling, relying on poor data and misinterpreting or misrepresenting what little data exist in a flurry of blog posts will not silence the voices of rank-and-file veterinarians who want to keep our profession vibrant and healthy for decades to come. Nor will it help our profession find the way forward. 

The true elitists are those who have manipulated and plumbed loopholes in the accreditation standards so as to turn our veterinary education marketplace into College Inc. By doing so, they protect and enhance their privilege and power at the expense of today's and tomorrow's veterinarians and the clients, patients and society they serve.

About the author: Dr. Paul D. Pion is a board-certified veterinary cardiologist and co-founder of the Veterinary Information Network, an online professional community and parent of the VIN News Service. He earned his DVM from Cornell University in 1983 and completed a residency in cardiology at the University of California, Davis, School of Veterinary Medicine in 1987. Among his many accomplishments, he is credited with discovering the cause, cure and prevention of feline dilated cardiomyopathy secondary to taurine deficiency. Dr. Pion resides in Davis, California, with his wife, children and a plethora of pets.

Dr. Christy Corp-Minamiji contributed to this article.

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