Dicks commentary bug
Any contemporary discussion about veterinary education inevitably turns to its high cost. No doubt about it, the cost of becoming a veterinarian is accelerating faster than inflation and increasingly is borne by the student.
More than 50% of veterinary graduates have student debt that is more than twice their starting annual salary. This far exceeds the rule of thumb that students should borrow no more than their first year's expected salary upon graduation. Having such a great imbalance in debt to income will make it difficult to achieve the lifestyle they likely imagined as aspiring veterinarians. Add to that little or no training in personal finance, and the debt burden can seem insurmountable.
California Veterinary Medical Association surveys in 2015 and 2017 found that 40 percent of new veterinarians strongly (15%) or somewhat (25%) agreed that if they had known what their student debt would be relative to their salary, they wouldn't have become veterinarians. The 2018 Merck Animal Health Veterinary Wellbeing Study confirmed that student debt impacts well-being, and found only 41% of veterinarians recommend a career in veterinary medicine.
Blame for the high cost of veterinary education often is laid at the feet of colleges and their deans, but such blame is misplaced. Neither has much control over accreditation standards or state funding, two factors that heavily influence the price of education and who gets the bill.
Michael R. Dicks 230
Photo by Scott Nolan
Michael R. Dicks directed the American Veterinary Medical Association Veterinary Economics Division from 2013 to 2018.
Accreditation standards are set by the American Veterinary Medical Association Council on Education, a volunteer group comprised of academicians and private practitioners. The International Council of Veterinary Assessment (formerly the National Board of Veterinary Medical Examiners), which develops and administers a national professional licensing exam, also influences curriculum. In addition, state veterinary licensing boards manage the requirements for initial and continued licensing to practice in their respective jurisdictions.
Colleges must do what's necessary to meet COE and ICVA expectations, which can require spending more on advanced tools, facilities and staff. They must do this with declining or no state funds, leaving student tuition to fill the gap.
Herein lies a conundrum: Should an institution increase the amount of money charged per student or should it accept more students to share the burden?
Raising tuition places more burden on students. Further, increasing tuition to cover an escalating price of providing an education is unsustainable. If fewer than half of veterinarians recommend the profession, and as word spreads about financial hardships associated with the livelihood, it's only a matter of time before students seek a career elsewhere. We already have heard from some that they chose not to apply to veterinary school for this very reason.
The second option for institutions, adding more students, requires more resources (faculty, facilities and equipment) to meet accreditation requirements. And adding greater numbers of graduates to the workforce might drive down starting salaries, especially in crowded suburban job markets or during economic downturns.
Neither option is appealing, yet many institutions do both.
Dr. Melissa Maddux
Dr. Melissa Maddux, an AVMA Economics Fellow in 2016-2017, contributed to research and helped communicate economics concepts to a veterinary audience.
Coming up with better solutions requires colleges, the COE, ICVA and state boards to work together to identify strategies that will produce quality veterinarians at lower costs.
There have been tentative steps in this direction. Three years ago, leaders in the profession met at Michigan State University under the banner of Fix the Debt to discuss the problem and work as a team toward solutions. People from academia, private practice, veterinary associations, state licensing boards, industry, government and the student body came together to discuss how to reduce the average debt-to-income ratio to a more manageable 1.4 to 1.
After productive discussions, the retreat closed with an outline of solutions and a call to action for each segment of the profession. Ideas ranged from greatly reducing the time needed to earn a veterinary degree to teaching entrepreneurship to finding ways to minimize the cost of borrowing money for education. Yet very little has been done to significantly reduce the cost of education for the majority of veterinary students, and even less has been done to aid recent graduates struggling to manage their high debt. The current debt-to-income ratio is 2.1 to 1.
Who is the veterinarian of the future?
Before we can reimagine the veterinary education system, we must clearly understand what's expected of veterinarians now and in the future. The educational system of the last six or seven decades may have been the best for producing an ideal veterinarian in the past, but does that veterinarian possess qualities that society values today? Figuring this out requires answers to a lot more questions, such as:
- What market segments — private practice, public practice, industry, government, research, One Health or academia — will demand the services of veterinarians and at what level?
- Will private practices predominantly be large corporate practices, staffed with boarded specialists, or will they mostly be locally owned, independent practices?
- Is there a difference between the training that veterinarians need to thrive in a large corporate practice versus an independent practice?
- Should veterinary education focus on medical skills or meeting the animal health-care needs of diverse communities or some hybrid of the two?
- How important will innovation and entrepreneurship be?
- Are veterinarians likely to serve one market segment for their entire careers or will they weave through many?
- Does the current licensing system — e.g., each state issuing separate licenses that authorize practitioners to treat all veterinary species — best meet the needs of the veterinarian or the markets they serve?
- What role will technology play in animal health care?
We need to know the kind of veterinarian we want to produce before we can do it efficiently. The problem isn't unique to veterinary education; all of education has this problem. A plethora of diverse expectations exists for all kinds of graduates, while the programs from which they graduate strive to standardize their education processes.
These varied expectations and a single standardized process are at loggerheads. Meeting a variety of expectations requires a variety of approaches. As one example, perhaps each college could focus on meeting one or two expectations instead of trying to meet them all.
How to begin?
Building a new system requires, for starters, removing the restrictions, rules and established norms of the old one. Then, focus on the clearly defined primary objective: creating a veterinarian who is qualified to take on the responsibilities valued by society. Consider the skillsets needed to empower that veterinarian to thrive in his or her new role.
Two factors are important in developing guidelines for veterinary patient care: household income and the strength of the human-animal bond. A veterinarian in a community with lower incomes or that is less bonded to its animals may need to deliver a spectrum of care that reflects the range of available resources, or lack of resources. More specialized — and higher cost — veterinary services might be expected in a community with higher incomes or a high bond with animals.
Most veterinary schools today attempt to teach skills suitable for working with a wide range of species, from companion animals to food animals. But how likely is it that new veterinarians will transition from one field to the other within the first few years of graduation? If the answer is "not very likely," teaching and licensing a broad spectrum of skills might not be the best use of limited educational resources.
Now let's ruminate on all of the possible ways to deliver an ideal educational experience. Technology could play a vital role. Webinars could put the best experts on any screen across the country (or world). Voice-activated digital assistants along the lines of Alexa, Google Home or Siri could serve as a simulated client or provide an instant medical reference. All a student would need is high-speed internet and a laptop, tablet or smartphone to access the very best knowledge.
For experiential learning, time spent in traditional teaching hospitals could be shifted to time in community clinics or at a public research institution such as the U.S. Centers for Disease Control and Prevention. How about finding opportunities for technicians and veterinarians to learn side-by-side, shaping their long-term professional relationship from the beginning?
How much should this new educational experience cost? Imagine if the profession constrained itself to some multiple of the average veterinary salary (e.g., 1½ times the average annual salary) or based the cost of education on the resources required to deliver it. That cost might not be the same for every field of veterinary medicine. Training for a career in industry might cost more or less than training for a career in private practice, for instance.
Guided by the clear, single objective of creating a veterinarian who is qualified to take on the responsibilities valued by society, it is possible to develop an efficient educational process. Without that, the cost of a veterinary education will continue to be greater than it needs to be. Our first step then, is to understand the role of the veterinarian today and imagine the likely transformations to that role in the future.
Next: Why private equity investors pay so much for clinics
About the authors:
Michael Dicks, PhD, established the veterinary economics division of the American Veterinary Medical Association in 2013 and was its director until 2018. Dicks earned a BS in biochemistry and animal science from California Polytechnic State University, taught chemistry as a Peace Corps volunteer in Kenya, then completed a master's and doctorate in agricultural economics at the University of Missouri.
He was employed by the U.S. Department of Agriculture Economic Research Service for five years before joining the faculty at Oklahoma State University, where he spent nearly 24 years prior to his stint at the AVMA. Dicks now works as a consultant in several capacities, including as data chief at Erupt LLC, which provides data analytics and educational outreach to clients in the veterinary realm.
Melissa Maddux, DVM, is a 2016 graduate of the University of Tennessee College of Veterinary Medicine, a former AVMA Economics Fellow and CEO of Erupt. She also practices equine and small animal medicine in Knoxville.
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.