July 15, 2012


 Visions of the future

NRC study advances debate about veterinary medicine in the 21st century

Posted July 3, 2012 
More than two centuries later and veterinary medicine is still trying to live up to its potential.
A recent study of the U.S. veterinary workforce by the National Research Council for the National Academy of Sciences singled out veterinary medicine as “the only health discipline with expertise across multiple species and ecosystems” and noted that veterinarians play “a vital role in protecting and enhancing human and animal life.”
The report of the NRC committee, “Workforce Needs in Veterinary Medicine,” published May 30, also identified several challenges confronting the veterinary profession in the 21st century, among them, decreasing demand for food animal veterinary services and the skyrocketing cost of veterinary education that has reached “crisis” level.
There’s a shortage of veterinary expertise in industry and parts of academia, according to a study by the National Research Council.
 The study underscores the ongoing debate over the future of veterinary medicine. Some veterinary leaders envision a time when veterinarians are regarded as much for their contributions to human health as they are for protecting animal life. Others, skeptical that veterinary medicine can stray far from its core mission of healing animals, want to focus instead on producing an efficient, highly skilled companion animal sector capable of convincing pet owners about the value of their services.
Since veterinary medicine’s origins in the mid-1700s, its impacts on human health have never been widely appreciated by the public or within the medical community. Until early in the 20th century, butchers and policemen in the United States were more likely than veterinarians to be meat inspectors. Generations of veterinarians have attempted to showcase the range of veterinary expertise but with little success.
These efforts have undoubtedly been hampered by the fact that most veterinarians work in clinical practice. Such is the case today as companion animal medicine constitutes the largest and fastest-growing sector of the U.S. veterinary profession. Of the estimated 92,500 veterinarians employed in the United States in 2011, nearly 49,000 were in companion animal practices, according to AVMA employment figures. 
“I don’t want us to get away from our history as animal practitioners, but we need to start being looked at as the true scientists we are.”

AVMA President René A. Carlson
Historically, so few veterinarians have worked outside private practice that laboratory animal medicine, pathology, and research, for example, are considered “nontraditional” veterinary career fields. Last year, fewer than 16,000 veterinarians were employed in the public or corporate sectors, according to the AVMA.
Not surprisingly, the NRC analysis of the U.S. veterinary workforce sees a shortage of veterinarians with advanced training sought after by industry and academia. Dr. Alan M. Kelly, chair of the committee that wrote the study, warns that failing to address these shortages will have serious consequences.
“The profession will lose its ability to invent its future, and the quality of veterinary education will decline,” Dr. Kelly said. “Research is crucial for invigorating faculty to develop new concepts, to rigorously apply new knowledge to problems of disease, and to inspire students to be intellectually curious. How else can we address the problem of cancer in animals?”
“Instead of looking for ways of moving us in a direction that we don’t want to be moved, figure out how to make where we are work.”

AAHA President Mark Russak
“To build its future, the veterinary profession must remain current with advances in biomedical research and the application of new knowledge to disease control,” he added.
Another of the NRC’s conclusions is that consolidation within the nation’s increasingly cost-sensitive livestock industry has resulted in declining demand for food animal veterinary services. “The veterinary profession is losing its presence in food-animal production and care,” the study stated.
The NRC study challenged the AVMA and Association of American Veterinary Medical Colleges to rectify these problems by working collaboratively with stakeholders to rectify veterinary manpower shortages and formulate new ways of delivering cost-effective food animal veterinary services to rural America.
Additionally, veterinary leaders were advised to increase the profession’s visibility, standing, and potential to address global food security. “Global food security is one of the most pressing challenges of the 21st century,” the study stated. “The food and water security and safety concerns confronting the world today are far more daunting than anything veterinary medicine has previously had to confront. Because these challenges are enormously complex, they will require the veterinary profession to engage in interdisciplinary and interprofessional One Health solutions.”
The veterinary profession was warned of impending difficulties as far back as 1988, when the Pew Commission concluded veterinary education was out of step with the needs of the profession and the various constituencies veterinary medicine serves. The recent “roadmap” developed by the North American Veterinary Medical Education Consortium means to get veterinary colleges back on track in terms of creating a profession better equipped to meet society’s needs.
When Dr. René A. Carlson assumed the AVMA presidency last year, she expressed her desire to see veterinarians recognized as champions of animal health as well as protectors of human and ecosystem health. Dr. Carlson acknowledges that for this to happen, there must first be greater parity between the numbers of private-practice veterinarians and those in public practice, such as government, industry, and corporate veterinary medicine.
“I don’t want us to get away from our history as animal practitioners, but we need to start being looked at as the true scientists we are. We need to raise the value of a DVM degree in a number of other fields,” she explained.
Dr. Carlson worries too many veterinarians are falling short of their potential by not incorporating the one-health concept into their practices. “Veterinarians will see a cat that has diarrhea or a dog with a chronic, nonhealing wound, and they don’t consider how it might affect the family. We need to make those explanations an automatic part of what we do with each visit, including when we see healthy pets,” Dr. Carlson said.
The importance of veterinary medicine to public health is recognized when society faces the immediate threat of a pathogen transmissible from animals to humans, such as during the West Nile virus infection outbreak and the discovery of bovine spongiform encephalopathy. Unfortunately, the epiphany is short-lived.
“Diseases come and go, and the public soon forgets,” observed Dr. Kelly, adding that since veterinary medicine has removed the threat of bovine tuberculosis and most other zoonotic diseases in the United States and as society has become increasingly urbanized, the public has become less and less aware of the importance of veterinary medicine to the nation’s well-being.
Redirecting the focus of an entire profession is no small feat and certainly won’t happen overnight. Dr. Carlson expects it will take at least a generation before veterinary medicine has a meaningful presence in fields other than private clinical practice. This transformation requires a change toward a much broader and diverse applicant pool, an expanded group of potential employers, and new educational models to further prepare graduates for these other positions, Dr. Carlson said.
Change also requires the veterinary profession to think differently about itself. “It requires a huge paradigm shift in how we look at ourselves if we’re going to change the way the rest of the world sees us,” she said.
“I really think veterinary medicine is at a turning point and that this is indeed the time to change,” Dr. Carlson continued. “There’s a sense of urgency to make sure veterinary medicine is well-prepared to respond to environmental challenges and ready to help us meet the global demand for food and water security. This is our chance. If we don’t do it now, we risk a loss of significance in the 21st century.”
AAHA President Mark Russak agrees that substantial growth in industrial and public practice depends on a major paradigm shift within the profession. But he doesn’t see that happening organically and believes such a change will require veterinary colleges to favor applicants inclined toward research and similar areas over those interested in companion animal medicine.
“I don’t think that’s fair, and I don’t think it’s appropriate, but I don’t know how the profession will voluntarily shift in this direction, and I don’t think it can be shifted,” Dr. Russak said.
The National Research Council workforce study notes that, with a mean annual salary of well over $100,000, private industry offers the highest-paying jobs in veterinary medicine—an area experiencing a lack of qualified veterinarians. That so many underpaid and debt-burdened veterinarians would rather work with animals than for an agrochemical company gets at an attitude typical of veterinarians, according to Dr. Russak.
“This is a profession of the heart,” he said. “It has nothing to do with mindset or the economy; it’s the heart that rules everything.” Dr. Russak believes society and the veterinary profession would be better-served by focusing on improving efficiencies in the companion animal sector. “Instead of looking for ways of moving us in a direction that we don’t want to be moved, figure out how to make where we are work,” he said.
The remedy for two of the profession’s most pressing problems—increasing education costs and student loan debt—is teaching veterinarians to be more profitable, Dr. Russak says. “We know that pet spending is consistently increasing. We know the veterinary piece of that is going down all the time. That makes no sense to me. People are putting fur coats on their animals but not bringing them in for vaccinations and complete wellness care? Let’s reverse that trend, and let’s get the pet-owning public back in,” he said.
This requires a more-focused veterinary education curriculum that produces a new generation of veterinarians able to build lasting relationships with their clients who, in turn, bring their pets in regularly. “There’s been a knowledge explosion in veterinary medicine,” Dr. Russak said. “Maybe we need to stop trying to teach every student everything about every species in veterinary medicine, and every biological fact and every piece of virology. We cannot continue to teach this way. We need to start looking at what’s most important to be successful.”