Internships under scrutiny as supply, demand continue to increase despite pay, hours
At the beginning of veterinary school, Dr. Tiffany Sheldon had herself convinced. “There was no way I was going to do an internship. I said, ‘I want to be done with school and start making money.’” Nevertheless, on June 13, the recent veterinary graduate from Louisiana State University started her internship at Hollywood Animal Hospital, just outside Miami.
Percentage of residencies in a private practice setting in 2012
Source: Veterinary Internship and Residency Matching Program
Encouragement by friends and faculty to do an internship led her to look further into the matter. But, in the end, it came down to what she wanted.
“I don’t think anyone feels fully prepared to graduate and move on to the big, bad world,” Dr. Sheldon said. “I feel like I have good surgical skills with spay and neuter but would like more surgical experience in other aspects like soft tissue surgery and hernia repair and other basics, at a private practice.”
Dr. Sheldon this summer will join hundreds of other freshly minted veterinarians starting internships, be they in private practice or an academic setting. For some, the goal is to pursue board certification. For others, such as Dr. Sheldon, it’s to get further hands-on experience and hone their skills.
More and more veterinarians have been selecting this option, and, it appears, more for the latter reason than the former, as applicants for residencies and the number of residency positions—often the next step taken toward receiving board certification—have not grown at the same rate as applicants for internships and the number of internship positions.
||Source: American Association of Veterinary Clinicians
With this proliferation of internships has come greater scrutiny.
Concerns have been raised about consistency and quality control for internships, as currently no processes are in place to accredit these programs. Authors of a letter to the editor this past year suggested a veterinary counterpart to the Accreditation Council for Graduate Medical Education, which oversees postgraduate medical training programs (J Am Vet Med Assoc 2012;240:939-942).
In addition, the Student AVMA House of Delegates in spring 2011 approved duty hours guidelines. Delegates focused on fourth-year rotations because SAVMA’s purview doesn’t extend to internship or residency programs; however, according to the guidelines’ background information: “SAVMA is looking to the academic leaders of the profession to take up the charge in protecting interns and residents. Veterinary interns and residents at academic institutions are no longer students, but continue to work through long hours and challenging schedules within veterinary teaching hospitals. These guidelines could easily be adapted for interns and residents; all that is lacking is a coordinated effort among the national organizations.”
National mean veterinary intern salary in 2012
National mean starting salary for all veterinary employment types in 2012—excluding advanced education
Source: Association of American Veterinary Medical Colleges and AVMA
The AVMA Executive Board created the Task Force on Veterinary Internships in May 2009 to assess the status of veterinary internships, identify areas that need improvement, and develop a plan to address identified needs.
To do this, though, task force members needed to fill information gaps to fully define potential problem areas. So, they requested the addition of internship-related questions on the AVMA Senior Survey and Biennial Economic Survey, both starting with the 2010 editions.
The task force’s work culminated in a final report in spring 2011. The report included a revised internship definition indicating that internships should provide mentorship, direct supervision, and didactic experiences, including rounds, seminars, and formal presentations; internship disclosure guidelines, which comprise questions applicants should ask to obtain more detailed information from potential employers and mentors; and accompanying model AVMA Internship Guidelines. All have been adopted as official AVMA policy (see JAVMA
, June 15, 2012
The American Association of Veterinary Clinicians, which runs the Veterinary Internship and Residency Matching Program—a computer program that is the primary vehicle for placing veterinarians in internships and residencies in the United States—also has adopted the guidelines. However, the American Association of Equine Practitioners, which coordinates most equine internships through its Avenues Program, has not done so.
The Task Force on Veterinary Internships went one step further and had a survey conducted in 2012 to examine internship quality and intern satisfaction.
The survey was designed to help determine the need for a more formal quality assurance program for veterinary internships (see JAVMA
, Aug. 1, 2011
). Release of the survey results is anticipated later this month, and given those results, the approach the task force has recommended is to improve quality where needed and not yet pursue a full-blown accreditation program for internships.
Dr. David E. Granstrom, director of the AVMA Education and Research Division, estimates the cost at around $2 million to establish an independent accrediting agency similar to the AVMA Council on Education or Accreditation Council for Graduate Medical Education. This figure is based on accrediting and reaccrediting approximately 800 sites on a five-year cycle.
It would cost the AVMA about 40 percent less to do that because of economy of scale, i.e., if the Association were not to charge overhead for the existing resources it would use, he added.
Dr. Roger B. Fingland, director of the Veterinary Internship and Residency Matching Program and executive associate dean and director of the Veterinary Health Center at the Kansas State University College of Veterinary Medicine, said it is important to note that, despite longer hours for less pay, 85 percent of the survey respondents were satisfied with their internships.
“There are internships that are very different than those that existed 20 years ago. That does not mean the system is broken. It means there are more and different opportunities. If some are less than ideal training programs, we need to identify them and help them improve,” he said.
With the task force now sunset, the AVMA Early Career Development Committee has taken on the responsibility for executing the task force’s plan, which has also been endorsed by the AVMA Executive Board.
The plan includes the following action items:
- Use the AVMA Internship Guidelines and survey results to develop a model assessment tool to promote the development of quality internships by providers and enhance the selection process for new graduates.
- Repeat the survey every two to three years to track progress, assess the need for a more formal internship quality assurance program over time, and assess whether veterinarians are aware of and using the guidelines.
- Launch an awareness campaign that would promote the AVMA Internship Guidelines, including presentations at national meetings, and ask the Association of American Veterinary Medical Colleges to update the Dr. Bradford P. Smith article on effective internship selection (J Vet Med Educ 2006;33:121-124), as needed, for republication and availability to a wider audience—targeting veterinary schools, to promote a more informed internship selection process by graduating students.
Whether giving students even more information on internships will change how many pursue that route is up for debate. When Dr. Fingland talks to veterinary students at Kansas State about internships, he makes certain to mention that they could make $65,000 in starting salary as an associate, compared with $25,000 as an intern.
“What we’re talking about is a young professional who hopefully has made a decision with the full knowledge of consequences to seek additional training rather than become an associate. Some may say that’s not a smart thing to do. Everyone can voice their opinion, but hundreds of people make this decision and are very comfortable with it,” Dr. Fingland said.
Dr. Tiffany Sheldon has amassed about $200,000 in student loan debt from veterinary school and will earn about $45,000 at her internship. She said selecting the highest-paying internship she found was a big factor in her decision.
Even though she may not go on to do a residency, she said, “I’m guaranteed a high caseload and will have mentorship that people going straight into practice aren’t necessarily going to get. It’s worth the cut in pay. Plus, it’ll sharpen my skills after graduation, and, hopefully, I can be worth more after the internship.”
Dr. Sheldon added, “Everyone who comes into the profession is not in it to make money. We have this much debt and ... we take it for what it is and deal with it when the time comes.”
The AVMA Early Career Development Committee has developed an internship landing page
that includes an array of resources for providers and applicants.
Also available is the Task Force on Veterinary Internships report.