Veterinary interns at Colorado State University next year will be paid 20% more than their counterparts this year, marking the first significant increase for such trainees at the school in five years. The move at CSU's College of Veterinary Medicine and Biomedical Sciences comes as some in the veterinary community push to improve the notoriously low wages paid to interns throughout the profession and give more regard to intern well-being.
Dr. Sue Lana, professor and assistant department head for resident and graduate education in the Department of Clinical Sciences, said the raise is part of an initiative to improve CSU's post-veterinary school training. "In our comprehensive program review, salaries were repeatedly seen as an area in need of improvement," she said.
Lana said CSU looked at the pay of interns and residents at peer institutions and private practices, evaluated pay across the institution and considered other expenses borne by trainees, including the rising cost of living and the increased cost of board certification. It raised starting salaries for first-year residents last year.
Next year, its intern salaries, now $28,000, will rise to $35,000, closer to the national average intern pay of $36,433. By comparison, the average annual pay of new graduates entering directly into private practice is about $92,000, according to 2020 figures from the American Veterinary Medical Association.
Veterinary school graduates need not complete internships unless they wish to specialize. Aspiring specialists typically must complete both internships (usually one year) and residencies (usually three years). Many new graduates who don't intend to specialize nevertheless pursue internships, for a variety of reasons, as described below.
Lana said the push at CSU to bolster intern pay was energized by recent research highlighting low trainee pay across the profession, especially in academic settings, which are some of the lowest-paid.
The paper, published in the Journal of the American Veterinary Medical Association in January, measures salaries paid to veterinary interns and residents against a minimum subsistence wage, referred to as a living wage. The authors suggest that for many veterinary trainees, wages were less than the minimum income needed to meet basic needs, such as food, housing, transportation and clothing. Factoring in actual hours worked, the study determined that hourly wages often fell below the local minimum wage.
The authors suggested that the financial hardship imposed by low salaries could contribute to poor well-being and depression. They also posit that the low pay might dissuade some students from diverse backgrounds from considering postgraduate training and therefore inadvertently contribute to a lack of diversity in specialty medicine.
The paper's lead author, Dr. Samantha Morello, an independent consultant and courtesy associate clinical professor at Cornell Center for Veterinary Business and Entrepreneurship, knew the study did not break ground in stating that salaries are often low for trainees. The goal, she said, was to illustrate just how low.
"It's not like it's a new idea that interns and residents don't make a lot of money. I wanted to find a way to measure the degree of financial strain that couldn't be ignored," Morello said. "I think it shows how difficult they've made the lives of the people that go through training programs, both in the short term and cumulatively in the longer term."
The study resonated with the CSU committee.
"When this article came out, it seemed pretty clear that we should push to advocate for [intern] raises as well," Lana said. "Sometimes things have been a certain way for a long period of time, and nobody questions it or looks at it for a variety of reasons. There are other priorities; it's not their responsibility … funding's tight, whatever it is. But it should be looked at periodically, and I do think that it is tied to well-being and success. And if our goal is for [trainees] to be successful, we need to support them in as many ways as we can. Salary is just one of those ways."
Why do veterinarians do internships?
Graduates of U.S. veterinary schools who pass the North American Veterinary Licensing Examination can go into general practice with no additional formal training or education.
This is in contrast to human medicine, for which at least one year, and more typically three or more years, of residency training is required for licensure. The term "internship" has mostly been phased out in human medicine, replaced with "first year residency" or "postgraduate year 1."
For the majority of U.S. graduate medical education programs (residencies and fellowships) and the institutions that sponsor them, education standards and maximum duty hours are established by the Accreditation Council for Graduate Medical Education. Training in an ACGME-accredited program is required for licensure.
In veterinary medicine, no organization oversees internships as a whole, and there are no universal enforceable standards to ensure that interns reliably receive the extra training and support they expect. Veterinary residencies have some oversight in that educational requirements are set by organizations that certify specialists. But in neither instance does any body set workplace rules, hours or minimum salaries.
Although internships aren't required of veterinarians, roughly 30% percent of recent graduates do them. The main reason is as a stepping stone to a residency. Among 2020 seniors, 61.5% of men and 46.2% of women cited a desire to qualify for a residency as the reason for pursuing an internship, according to an AVMA survey.
Additional mentoring and clinical experience are the second most common motivations. In that same survey, 28.8% of men and 42% of women said they saw internships as a means for practicing better medicine or enhancing their training.
The pandemic may have added a new reason, at least temporarily. Ashley Miller, a senior at Western University College of Veterinary Medicine in Southern California, applied for small animal rotating internships to make up for training time lost to the pandemic. At Western, students receive clinical experience in community practices rather than at a teaching hospital, and those experiences were limited due to state COVID-19 restrictions imposed exactly when Miller would have been digging in.
"Missing all that was frustrating," she said. She hopes to recapture some of that lost experience through an internship. She'll find out if she landed a position on Monday, which is Match Day — the day the Veterinary Internship and Residency Matching Program posts the results of internship and residency acceptances. Administered by the American Association of Veterinary Clinicians, VIRMP facilitates the majority of trainee placements.
Miller added that her response might not be typical: Some of her peers have been spurred by COVID-19 in the opposite direction. "The pandemic has worn them out," she said. "They do not want only a year-long opportunity with the possibility of having to relocate again after. They want to get out, settle down and start life."
Questioning the value of internships
Practitioners, professors and students have for years debated the value of internships for new veterinarians headed to general practice. Over time internships have evolved from a largely academic enterprise to one in which the majority are offered by private practices. In 2021, there were 422 academic internship positions and 1,217 in private practice offered through VIRMP.
With the expansion of internships came complaints from interns about being overworked and under-mentored, according to a 2011 report by an AVMA task force. The AVMA developed internship guidelines to improve the chances that interns get the education and experience they are promised and are not exploited as cheap labor. The American Animal Hospital Association launched an internship accreditation program for member hospitals in 2014.
Now, pay is getting attention. Added to efforts like the living wage study and CSU's decision to raise salaries is a 2020 study on intern and resident well-being conducted by the American Association of Veterinary Medical Colleges.
"We know that there are many factors that impact well-being, and certainly being able to pay your bills and feel a sense of financial security is one of those factors," said Makenzie Peterson, the study author and AAVMC's director of well-being. She said the study found that "only 55% of respondents felt that their training experience was worth the financial constraints."
Lisa Greenhill, senior director for institutional research and diversity at AAVMC, said, "Since 2020, we have turned our attention to more intentionally discussing the impacts low compensation has on trainees." She said evidence supports an effort to reform salaries, adding that finding the necessary funding to raise pay in academia is more complicated than in the private sector.
Photo by JMV Digital
A resident at Colorado State University's veterinary teaching hospital works with two students. Residents got a significant pay boost last year, and interns will see a salary bump next year, as part of the school's comprehensive effort to improve the graduate training program.
Miller, the fourth-year student at Western, has applied to four internship programs — two private and two academic. During the application process, one of the private practices on her list announced it was raising the salary from $37,000 to $50,000, putting it well above the average.
Bumping up a salary by $13,000 on short notice is presumably much easier at a private business than a veterinary school. As Greenhill alluded to, universities with their often complicated funding streams, missions and varied employee and student classifications face a complex process for raising wages. For example, Lana at CSU explained that when CSU set out to raise the salaries of all interns and residents — known collectively as "house officers" — they had to figure out how to make it happen across positions funded by diverse sources, including graduate program funds, hospital revenue, corporate sponsorships, the U.S. military, philanthropy and gift funds. (The term house officer comes from human medicine, where trainees used to live "in-house" at teaching hospitals.)
Six current and former directors at veterinary schools talked with the VIN News Service about how house officer salaries are set and the constraints on pay. They described programs bound by the status quo and taking cues from peer institutions. To a person, they said pay is not what it should be. They all wanted to see improvements — although they varied in their optimism over how much things can or will change.
Dr. Tim Hackett, chair of the clinical sciences department at Cornell University College of Veterinary Medicine, said things are stuck.
"It's always been this way," Hackett said. "Therefore, it doesn't change." He speculates one reason inertia rules is that with annual turnover, interns don't push for better pay, and budgets get updated using figures from the previous year.
He also emphasizes that internships are first and foremost about education. "It's not about hospital throughput," he said. "Done right, it's years of mentored experience compressed into one year, possibly worth a year of ramen and Kraft mac and cheese."
Consistently high interest in academic internships seems to prove his point. The demand for internships at teaching hospitals, despite lagging pay, is unabated. These internships have cachet and are seen as the preferred gateway to a residency.
While Hackett sympathizes with the push for better pay for house officers, he points out that competitive pay is an issue across all positions at teaching hospitals, from faculty to veterinary technicians and support staff.
He lamented: "It's not the way to have highly motivated, highly-competent employees — devaluing them by paying them less than they are worth."
Dr. Paul Lunn, former dean of North Carolina State College of Veterinary Medicine, is blunt. "We would love to solve the problem, but we can't afford to," he said. "There is an enormous fiscal cost to substantially addressing this. The schools are in a hole that they have slowly dug." At schools with large intern and residency programs, he said, a significant course correction could cost hundreds of thousands or even millions of dollars.
Now dean at the University of Liverpool School of Veterinary Science in the United Kingdom, Lunn said the living wage study makes a meaningful contribution to understanding the impact of low salaries on house officer well-being. He also highlighted the study's suggestion that low pay may negatively impact diversity in internship and residency programs and, down the line, representation among veterinary school faculty, which he believes deserves urgent further study.
Joseph Thurston, a third-year student at the University of Wisconsin School of Veterinary Medicine, plans to go straight into practice after graduating. He'd like to see students become more educated on the wide range of factors involved in choosing between an internship and practice, and consider following his example, getting experience on the job — at full salary — rather than training for one more year.
Thurston was a co-author on the living wage study, collating internship salary data for the project. He said he was "shocked" by the low compensation. He worries about the cumulative consequences of lost income early in one's veterinary career, saying that's a topic of interest to many of his peers.
But Thurston is battling an entrenched culture in veterinary school. "Everyone you know ... all the residents, all the faculty — they've done internships, so it feels like the internship is the route to go," he said.
Thurston is using his platform as the 2022 national vice president of the Veterinary Business Management Association, a student-run organization focusing on increasing graduates' business knowledge, to raise awareness of alternatives to internships, with presentations focusing on other forms of training and mentorship.
Dr. Daniel Burba has a similar message. Head of the Department of Veterinary Clinical Sciences at Oklahoma State College of Veterinary Medicine, Burba said he generally dissuades students from pursuing internships unless they plan to complete a residency.
"If you are doing it to gain confidence, don't do it," Burba said. "The data is showing you are going to lag behind."
Dr. Lance Roasa, a practice owner and attorney in Nebraska, agrees. Roasa is a co-founder of drip.vet, an online veterinary education company that was acquired by the Veterinary Information Network last year. VIN is the parent of VIN News.
In lectures to veterinary students about how to decide what to do after graduation, Roasa said, "I do my very best to focus on the right reasons to do an internship and the wrong reasons to do an internship. It's simply not true that interns do better."
He cites a study of 2009 salaries published in JAVMA that found completing an internship had no effect on subsequent pay.
And like Thurston, he believes new veterinarians can get the training they need in private practice. As he sees it, after agreeing to a six-figure salary plus a signing bonus, an employer has an incentive to help a new associate be productive and loyal. "They have to make that investment return," he said. "The more they mentor, the more productive you are going to be."
For those seeking a middle ground between an internship and what they worry will be a job that provides little training, Roasa advocates for mentorships, which are burgeoning across the profession.
"Corporate practices realize if they push mentorship, they are more likely to get those hires," he said.
Like internships, mentorships are not regulated, and it may be harder to suss out if a mentorship delivers on its promise since there is no clearinghouse for information like that on VIRMP. Roasa urges interested students to do their due diligence, including talking to former mentees when possible. He also discourages veterinarians from signing long-term employment contracts as part of a deal to obtain mentorship. He reviews these topics in a free monthly webinar for students called Modern Mentorship.
An example of a fast-growing mentorship program in the private sector is one offered by Veterinary Emergency Group, which has 28 emergency hospitals across the country. VEG started a six-month mentorship program, called Early Entry Track, in 2018 with one participant. This year, it expects to graduate around 130 veterinarians, according to Dr. Morgan Callahan, who co-directs the program.
Describing how the program originated, Callahan said, "We worked together as a team to think of all the things that were broken" in post-veterinary school training.
The program includes 18 days of hands-on training in taking care of exotic animals, point-of-care ultrasound, endoscopy, surgery, and critical care and emergency skills at CSU's Translational Medicine Institute (paid for by VEG); one day a week of didactic training; and three to four 12-hour mentored hospital shifts per week.
Participants are promised a minimum salary of $100,000 in their first year if they stay on for six months after completing the Early Entry Track, Callahan said. However, there is no obligation to remain after the training program, and there is no requirement of those who leave to promise not to take a job at a competing practice. "We realize that ER isn't for everyone, and that's OK," Callahan said. "So if it's not for you, we're going to ... wish you the best and help you along on your way."
Veterinarians who finish the program and want to stick around are guaranteed a position, according to Callahan, who said the program has a 97% retention rate.
In addition to practice-based mentorships, several online companies and organizations offer virtual support and training for early-career veterinarians. They include, for a fee, MentorVet, Vet Mentor Solutions and VIN's Veterinary Mentorship Academy.