California licensing bill polarizes veterinary community

Graduates of certain Mexican veterinary colleges could, under a highly contentious bill pending in the California Legislature, apply for a license to practice in California, essentially circumventing the AVMA's Educational Commission for Foreign Veterinary Graduates (ECFVG) certification process used by most state licensing boards to ensure that foreign-educated veterinarians are qualified to practice veterinary medicine in the United States.

Because of a perceived statewide practitioner shortage, graduates of the two colleges presently accredited by the Mexican National Veterinary Medical Council could be eligible to receive a temporary veterinary license upon completion of the National Board Examination, the California Board Examination, and the California Veterinary Law Examination.

Following a year of supervised practice with a California-licensed veterinarian, these foreign-educated practitioners would qualify for permanent license status.

The Oregon-based MMI-VetSmart Corporation, recently renamed "Banfield, The Pet Hospital Since 1955," is sponsoring the bill (AB 2842). Banfield claims there are not enough practitioners to staff its California clinics; the shortage is particularly severe in Los Angeles and San Francisco. As proof, the corporation notes, of the approximately 65 clinics the company owns in space leased in California PetSmart stores, about half are operational.

The assertion of a practitioner shortage, however, cannot be verified by the California Veterinary Medical Board, which, nonetheless, supports the bill. Sue Geranen, the board's executive officer, told JAVMA News there have been no consumer complaints of too few practitioners.

Banfield senior vice president for practice development, Dr. Hugh Lewis, said the legislation is less about the number of practitioners than the veterinary profession anticipating pet-owner needs and working to satisfy them. California is in need of bilingual practitioners, a need that will grow dramatically with the state's Hispanic population, explained the former Purdue School of Veterinary Medicine dean and one-time president of the Association of American Veterinary Medical Colleges.

That demographic increase is borne out by the US Census Bureau projection that Hispanics will surpass the white population in California by 2025.

Some critics of the bill suggest that Banfield's tampering with the certification process is really about the company's inability to recruit and retain veterinarians.

But Banfield's motivation is not as bad as some claim, Dr. Lewis said. "A lot of people want to parochialize our motive, that we can't hire enough people for our hospitals, and, therefore, we're looking at this from a self-interest standpoint. Obviously there's some of that, but the real issue is what's going to happen in California in the long term, because the population is increasing at a rapid pace."

Dr. Lewis believes that California's need is not being met by the University of California-Davis School of Veterinary Medicine, the state's only veterinary college, or by the ECFVG, an independent commission that advises the AVMA Council on Education regarding requirements for foreign-trained veterinarians. Those requirements are incorporated by all state licensing boards except those in New York and Ohio. Dr. Lewis said the ECFVG certification process has created unnecessary barriers for some qualified veterinarians to practice.

The bill has the support of the legislature's Latino Caucus, and race has become an inseparable part of the legislature's deliberations. State Assemblyman Thomas Calderon, who sponsored the bill on behalf of Banfield, has accused the AVMA Council on Education of being prejudiced and biased against foreign veterinarians, especially Mexicans, according to Dr. Richard Schumacher, executive director of the California VMA.

"When we point out that the AVMA COE has approved foreign veterinary schools and they're now working in New Zealand [and Scotland], and they've approved Glasgow [University School of Veterinary Medicine] and Royal Veterinary College, and Utrecht's been approved for years, basically, they say, 'Yes, all English-speaking schools. It just goes to show they are prejudiced against anything but English-speaking universities,'" Dr. Schumacher said, adding that those arguments are not faring as well in the state senate as they did in the assembly.

Calderon could not be reached for comment.

Some see the legislation as an alternative to the ECFVG program. The ECFVG is composed of seven veterinarians representing the AVMA Council on Education and Executive Board, Association of American Veterinary Medical Colleges, American Association of Veterinary State Boards, Government Service, National Board Examination Committee, and the Canadian VMA.

Some have criticized the ECFVG requirements as being costly and time consuming, resulting in a waiting list of otherwise qualified veterinarians, and a mitigating factor in California's practitioner shortage.

Still others fear the bill could spark a chain reaction of similar legislation across the country, each state exchanging a commonly accepted set of competence requirements for its own standards. Consequently, reciprocity would be unworkable.

Required for certification by the ECFVG is proof of graduation from an AVMA-listed college; passing a battery of English competence tests; passing scores on the North American Veterinary Licensing Examination (NAVLE) or, prior to November 2000, the National Board Examination, and the Clinical Competency Test; and passing scores on the Clinical Proficiency Examination (CPE), which is approved by the ECFVG, or completion of a year of evaluated clinical experience at an AVMA-accredited or approved college of veterinary medicine.

At this time, three US veterinary colleges are testing sites for the CPE. Most recently, UC-Davis also agreed to offer the examination, which will further reduce the waiting period. As of mid-July, 991 foreign graduates were enrolled in the ECFVG program; 181 have completed steps one through three and are eligible to take the CPE or the evaluated clinical experience. Of those, 32 are scheduled for the remaining test dates for 2000. Twenty-six are, so far, scheduled for 2001, and 62 spaces remain open.

To encourage more schools to serve as CPE testing sites, the AVMA Executive Board recently approved a recommendation to raise the examination fee from $2,500 to $6,000. Of that, $5,000 goes to the college offering the examination, while the remainder is used to improve the examination and ensure its standardization among testing sites.

Over the past five years, there has been discussion by the National Board Examination Committee and the American Association of Veterinary State Boards to oversee the CPE and ECFVG, respectively. But because this is an issue of education quality, the AVMA chose to retain management of the ECFVG. The AVMA Executive Board has, however, approved a recommendation to explore outsourcing oversight of the CPE.

The AVMA acknowledges that the certification requirements are not inexpensive but are a necessary mechanism to ensure that foreign-trained veterinarians have the skills to practice veterinary medicine in the United States.

Needless to say, the attempt at recognizing an approval body for foreign veterinary colleges other than the AVMA has had a polarizing effect inside and outside the state.

Others backing the California bill include the Milk Producers Council and some veterinarians. In addition to the AVMA, the New Jersey Board of Veterinary Medical Examiners, the Association of Veterinarians for Animal Rights, Western States Livestock Health Association, and at least one Canadian veterinary college have gone on record against the bill. UC-Davis School of Veterinary Medicine has no official position about the legislation.

The AVMA has no interest in state licensing issues, per se, but is concerned for the integrity of the process by which veterinary colleges are accredited, as well as the standards used to determine the competence of foreign-trained veterinarians seeking to practice in the United States. Since 1952, the US Department of Education has recognized the AVMA Council on Education as being the accrediting agency of domestic veterinary colleges.

The bill has further exacerbated the already strained relations between the California Veterinary Medical Board and the California VMA. The two were recently on opposing sides of a state bill requiring mandatory CE for state veterinarians. The association viewed the CE law as necessary to maintain practice standards in the state, whereas the board believed that such a mandate would be difficult to enforce.

Geranen, the board's executive officer, explained that public boards and professional associations often have conflicting mandates. In the case of the licensing bill, she said, the board lacks the "political clout" to influence it either way; rather, the board had proposed, and received, amendments guaranteeing funding for accreditation site visits by board members to the Mexican National Veterinary Medical Council.

But the Californian VMA perceives the board as maneuvering to broaden its authority at the expense of animal well-being and the accreditation of veterinary education programs.

Banfield and the California VMA have spent thousands of dollars on lobbyists pressing their cases in the legislature. After the licensing bill passed the state assembly in early May, it looked like it would not survive a vote by the Senate Committee on Business and Professions, but was withdrawn at the last minute for additional amendments, according to Dr. Joan M. Samuels, who represents District X on the AVMA Executive Board, which includes California.

Shortly afterwards, the legislature adjourned for summer recess. The senate committee is expected to resume deliberations when the legislature reconvenes this month.

At its heart, the tug-of-war is over who has the authority to determine whether a foreign-trained veterinarian is competent to practice in the United States. The bill requires the California board to decide for itself whether the accrediting standards used by the Mexican National Veterinary Medical Council are equivalent to the "11 Standards" used by the AVMA Council on Education when it evaluates veterinary colleges.

Even if the bill is passed, the Mexican council is not ensured automatic approval by the California board. Should the board review team determine the council has failed to adequately incorporate the AVMA accreditation standards, the board is under no obligation to approve the Mexican council, Geranen said.

That the California board is qualified to make such a determination is, to some, troubling. "They have no expertise to do this," Dr. Samuels said.

The board is made up of four veterinarians, who are appointed by the governor, and three public members. There are presently two veterinarian vacancies.

Dr. Lewis said an aim of the bill is to remove extraneous licensing barriers to foreign-trained veterinarians who are US citizens or residing in the United States. Limited enrollment opportunities at US veterinary colleges, such as at UC-Davis, he noted, often compel students to seek admission at foreign colleges.

In Mexico there are approximately 31 veterinary colleges, each emphasizing various aspects of animal science. The Mexican council acknowledges there is a "huge difference" between Mexican veterinary colleges and those in the United States. Dr. Lewis anticipates that only a handful of colleges would receive California accreditation.

"I'm not at all concerned about hordes of Mexicans invading the country," Dr. Lewis said. "People don't leave home easily, but if they have a veterinary degree from [the Mexican National University] and they are officially allowed into the country so that they become residents of this country, then we should treat them just like citizens. If they have a veterinary degree and they've passed the national and state boards, I'm wondering why they can't practice."

Yet Dr. Lewis acknowledges that he knows "very little" about how thoroughly the Mexican National Veterinary Medical Council has applied the 11 Standards.

"I've read through their [standards] booklet, of course. We had it translated. I have met and come to know the president of that association and group, and understand, rather than know, that they've based their criteria very much on the AVMA's criteria, expanded it in terms of detail, because the 11 [Standards] are fairly nondetailed, and are busy applying it. They're actually providing more detail than the AVMA, or insisting upon more detail than the AVMA does. The criteria are essentially the same," Dr. Lewis said.

If the bill passes, that will be a decision for the California Veterinary Medical Board to make.

"I think even if we kill [the bill], this issue is not going away," Dr. Schumacher said. "My inclination is that VetSmart [Banfield] will be back again with a new bill, either here or in Texas or somewhere else. They seem to be determined to change the accreditation process for veterinary graduates in the United States, and the world, for that matter."