Dr. Doug Aspros
Aug. 7, 2012
San Diego, Calif.
Wow. 150 years of AVMA coming up this year, a century and a half of modern veterinary medicine in America. I’m excited to be leading our association in these times of turmoil and promise.
Charles Dickens is one of my favorite authors; “Bleak House” one of my favorite books. If Dickens had been a veterinarian, too, he might have written a Tale of Two Professions instead of that book about the French Revolution. He wrote:
“It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness.”
It pretty neatly sums up where we find ourselves today.
The best of times? It’s not what I’ve heard from many of our colleagues lately.
Students see a wall of debt facing them after graduation, and dimming employment opportunities as they compete with a larger cohort for jobs in private and public sectors.
Colleges face declining state support – support that is already at an all-time low. Many teaching hospitals are at the end of their service life, but the cost of building a contemporary facility strains capital budgets. It’s increasingly difficult to attract graduates to pursue advanced degrees and make an academic career for themselves. The sustainability of our current model of education is in doubt.
Practitioners face a stagnant economy and a rapidly evolving world of service delivery.
If you treat companion animals, you know that the past 10 years has changed both the way we practice and the pricing model for our services. There are three revenue drivers for us – the three P’s - professional expertise, procedures and pharmaceuticals. All are under great pressure in the marketplace.
Routine expertise isn’t worth what it used to be worth. We laughed about Dr. Google in the past but I don’t joke anymore because, these days, he’s no slouch. From avma.org to WebMD to myriad individual practice websites, what clients get is reliable information for free, enough to allow them to make good choices about the need to consult a veterinarian.
The iconic procedures for dogs and cats are spays and neuters, but these days most rescue pets come pre-spayed. They come immunized, too, and afterwards they won’t need vaccinations as often as in the past. Given the range of services offered at low-cost or donor-supported facilities, even more complex procedures find downward pressure on pricing.
On the pharmaceutical side there’s HR 1406 – the Unfairness to Veterinarians Act – Internet drug sales, grey-market products, diversion and chain drug stores. The writing may be on the wall, but, for companion animal practice, pharmacy still represents a substantial revenue stream. When it goes, it’s unclear what, if anything, will take its place.
Everything isn’t happy in equine practice, either. As noted in the recently released NRC study, investment in the racing industry, horse ownership, and demand for veterinary services have all been declining. New graduates entering equine practice face the lowest starting salaries among all private-sector practitioners.
Animal agriculture has been changing as rapidly as any other sector of society. Consolidations of producers and increased efficiency have led to a declining need for veterinary services and have changed the roles of veterinarians in the livestock industry. We’re challenged to provide veterinary services to rural America because, in many communities, it’s hard to find opportunity for one expensively educated professional in a family, much less two.
Public practice is problematic in its own way. There are not enough jobs, or we don’t compete well for the jobs that exist or we don’t have enough advanced degrees to qualify for the jobs that go vacant.
So, back to Dr. Dickens. Is this the worst of times?
Not by a long shot.
Veterinary education is more sophisticated and research-driven than ever before. We are, these days, truly veterinary scientists. A contemporary graduate is just as well founding in the molecular and genetic basis of disease as in the differential diagnoses of sneezing cats.
Educators look more critically at the skills, knowledge and aptitudes needed for successful clinical practice, and students receive more didactic and practical training in critical communication skills.
Clinical practitioners make more decisions based on evidence-based studies, as the art of practice yields slowly to science of practice.
Veterinarians have accepted the responsibility of looking out for animals for more than their utility, more than just their health and productivity. Veterinarians have been willing to champion the animals in our trust, at times to the discomfort of our clients and colleagues, sometimes even ourselves. Welfare isn’t a four-letter word.
Pain management is an ethical obligation we’ve not just accepted, but embraced as a profession.
Specialization, while not an unmitigated blessing, has helped raise standards of practice, to the benefit of our patients and our clients. We can do so much more to treat disease, relieve suffering and extend life than we could a generation ago. We’re far and away better doctors.
On the food animal front, veterinarians are more likely to be highly valued consultants to ever-larger farms, as the fire engine practice of the past gives way to our role in modern production systems. Food safety and security in the US advance each year. Greater efficiency in animal agriculture means fewer animals feed more people at lower cost.
Veterinarians hold key positions in a wide range of public health and policy agencies, not enough, for sure, but from the Department of Homeland Security to state health departments, from USDA to CDC, the recognition of the need for veterinary expertise is growing.
One Medicine has given way to One Health; and it no longer seems like us talking to ourselves, as the vision spreads the word beyond our profession.
Last year saw the first Zoobiquity Conference, co-sponsored by U.C. Davis and the Geffen School of Medicine, one that finally brought together veterinarians and physicians to better understand health and disease. Last month, Dr. Barbara Natterson-Horowitz, along with Kathryn Bowers, published a book focused on the need for a common understanding of comparative medicine – the One Health message.
So I've got Great Expectations.
Veterinary medicine survived its first great dislocation in the last century when the horse stopped being society’s main source of transport and many city veterinary colleges closed. With the surviving colleges in the land grant system, we turned to large animals and food production as our primary charge. Today, we look to biomedical research and public health to re-cast our mission for the future. These are important endeavors for which we are uniquely qualified, and society would benefit from our increased participation in these spheres.
But please, offer no apologies for treating companion animals – given the importance of pets, this is not a trivial reason for us to exist as a profession. With a growing world population, where people are rapidly losing physical communities and replacing them with virtual ones, supporting the human-animal bond is both a vital and noble undertaking. Don’t sell companion animal veterinary medicine short, or our role in the emotional, psychological and physical health of people.
Finally, of course, to AVMA.
I’m proud of how far we’ve come in such a short period of time, from the slow-moving, deeply conservative, resistant-to-change organization that I encountered when I was first sat on the Executive Board, to the far more dynamic and engaged AVMA of today. Regardless of the challenges, I believe that AVMA of today can face our times – the best and the worst – in a strategic, focused, even visionary way.
I’ve said before that AVMA is one of veterinary medicine’s best tools, and we can’t afford to start looking like a Leatherman tool – doing everything, just not very well. The Task Force on Governance is this generation’s opportunity to remold the association into a better tool for our times and for the members of tomorrow’s association.
AVMA needs to remain broadly focused on the needs of all of our constituencies, yet ready to lead even when leadership is painful for us. AVMA’s support for the UEP-HSUS legislation on poultry housing sent shock waves through the profession and right on up to Capitol Hill. With all due respect to those who opposed our stance, it was the right position for AVMA and the veterinary profession.
This kind of wrenching disagreement will happen again – we’re not a monolithic profession, after all – and, when it does, we need to remember that real friends don’t tell you you’re right when you’re not, they tell you the truth. And, in the end, they’re your best friends.
I’m pleased that AVMA finally has a senior staff member whose job description includes diversity. It’s been a long time coming, and it’s a fair start. We need to open up. We’re a not-very-diverse profession serving an increasingly diverse society, and that gets in our way. We can’t serve those whose needs we misinterpret, whose cultures we misunderstand or whose languages we don’t speak. It’s about service and professionalism, and it’s also good business.
And business is one aspect of the profession that AVMA is no longer afraid to embrace. This past year saw the advent of the Veterinary Economics Strategy Committee, and the start of a new AVMA Economics Division. The first act of the committee was to choose a vendor for a workforce study to focus on demand for veterinary services, and develop a model for future needs. By next spring, we should have high-quality data to forecast, more accurately than ever, the demand for veterinarians and veterinary services in the next decade.
In the absence of good data and in the face of the Recession, we’ve struggled to rationalize a larger cohort of new graduates who face life with staggering educational debt. This year, the AVMA Executive Board initiated a dialogue with the deans of the accredited schools to work collaboratively towards solutions to the problems the profession faces. Treading lightly, we established some trust and found some common ground. We’re analyzing the recent NRC study together, and Eleanor Green, dean at Texas A&M, has been named to the committee to oversee our own workforce study.
In the end, of course, we can’t ignore our different positions, and no perspective serves everybody’s interest. Our role at AVMA is to build consensus on what’s best for the profession and then help us get there. That isn’t always possible; as I said earlier, leadership is sometimes about speaking painful truths to people who don’t want, or can’t afford, to hear them.
So finally, at the end of my year as President-elect, my thoughts turn once again to Charles Dickens. I am deeply honored to serve the profession and the AVMA. I am thrilled for the opportunities that you’ve presented to me, and respectful of the work ahead.
In Paris, at the end of “A Tale of Two Cities,” Sydney Carton said this:
“It’s a far, far better thing I do than I have ever done.”
I hope that’s true for me this year, and that I can make it true for you all, too.
But I hope to keep my head.