Will veterinary education hit a tipping point?

Veterinary school applicant-to-seat ratio trending downward
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Getting into veterinary school is not easy. It takes a dedicated and bright student to excel at the undergraduate prerequisites, earn enough contact time with animals, put together an impressive application, and perform well in admissions interviews. Even then, veterinary schools and colleges don't accept every qualified applicant.

Illustration: Backpacks and classroom seats

Yet some leaders in academia, looking at trends in the national applicant pool and seats available at veterinary schools and colleges, are concerned about whether these institutions will continue to have plenty of capable students to choose from in coming years.

Students measure blood pressure in a Dachshund
Students at Kansas State University College of Veterinary Medicine measure blood pressure in a Dachshund. The veterinary college had 1,350 applicants for the class of 2014 and enrolled 119 of them.

Supply and demand

By now the argument to increase the number of veterinarians in certain areas of practice has been well-established.

Currently, about 1,300 U.S. counties have fewer than one food supply veterinarian per 25,000 farm animals, and there are 500 counties with at least 5,000 farm animals that have no food supply veterinarians to treat them, according to the AVMA.

The projected increased needs in public health indicate that in 20 years there will be a shortage of 15,000 veterinarians, according to the Association of American Veterinary Medical Colleges.

A 2009 Government Accounting Office report confirmed fears that the federal government's veterinarian workforce also isn't large enough to guarantee a safe food supply and effectively address zoonotic diseases (see JAVMA, April 1, 2009).

Lab worker
According to the annual AVMA recent graduate survey, U.S. veterinary schools and colleges handed out 2,564 diplomas in 2010. That was approximately a 2 percent increase from 2009 and an 11 percent increase since 2004, when 2,291 veterinary students graduated.

The GAO report was the focus of a February 2009 Senate subcommittee hearing. During testimony at the hearing, AVMA CEO Ron DeHaven called on Congress to go beyond the enactment of the Higher Education Opportunity Act of 2008, which included the School of Veterinary Medicine Competitive Grant Program. This was intended to increase the number of veterinarians in the workforce through grants designed to increase capacity at the 28 U.S. veterinary schools and colleges. The program language, however, stated only that the grants can be used for minor renovation projects for classroom space, libraries, or laboratories.

Dr. DeHaven requested a sizeable increase in appropriations to allow for more extensive construction projects at veterinary schools. Two years later, the grants have yet to come.

From state-supported to student-supported

In the late 1970s and early 1980s, the U.S. federal government partially funded a number of new veterinary schools and colleges. But, federal support since that time has been practically nonexistent, in stark contrast to what has been provided to schools of human medicine, dentistry, and nursing, according to the North American Veterinary Medical Education Consortium draft report.

State allocations for veterinary schools haven't been much better in recent years. Most state governments are in the second or third consecutive year of substantial budget cuts, with higher education consistently on the chopping block.

A recent survey by the AAVMC that focused on the impact of state funding for U.S. veterinary schools and colleges revealed that state funding for 27 of them had declined by $50 million in the past two years—equivalent to the total funding for two veterinary schools. Additional major budget reductions for the schools will come when stimulus funds authorized under the American Recovery and Reinvestment Act of 2009 are exhausted. As a result, some veterinary colleges could see a 20 percent budget reduction this year. The Louisiana State University School of Veterinary Medicine took a $510,708 budget cut this past fall after the university had already announced that state funding for the school would be reduced by $5.1 million. The University of Tennessee College of Veterinary Medicine has, in the past three years, lost $2.7 million in state funding.

Several U.S. veterinary colleges have met initial budget cuts in part by generating more revenue through higher tuition and increased enrollment.

However, these institutions are likely approaching a critical threshold on tuition costs, as evidenced by median educational debt of $130,000 reported for 2010 graduates, an increase of 4 percent over 2009. High student debt load is not surprising, given that mean annual tuition for students at U.S. veterinary schools during the 2010-2011 academic year is $40,017 for full-time, out-of-state students and $22,348 for in-state students.

According to the NAVMEC draft report: "It is clear that the growing cost of education to students and families, balanced against future potential earnings by graduates, is playing an important role in decision making of potential veterinary medical school applicants. Most in the profession see the economic challenges currently being confronted as unsustainable for a growing and thriving profession."

And even though most institutions have limited additional growth in the number of students in their veterinary degree programs, they have relied on the limited state appropriations that exist and other creative solutions to increase their capacity (see article).

Growth spurts

In the AAVMC's advocacy survey for 2010, the association asked schools whether they planned to increase seats between 2010 and 2015. Eleven veterinary schools said they were anticipating seat increases, but two of those said any increase was dependent on additional funding from their state legislature to help pay for physical accommodations.

Overall, it appears the aggregate first-year class size will grow between 5.7 and 8 percent through 2015, with much of that occurring within the next two to three years.

"That's roughly half of our original projection and represents the slowing of growth among colleges. What we're really seeing is just over one-third of schools are projecting seat increases, so it's not everyone. It's limited," said Lisa Greenhill, associate executive director for institutional research and diversity at the AAVMC.

To give some perspective, the total rate of growth in first-year seats at U.S. veterinary colleges over the past five years has been 10.3 percent.

"We saw 1, 2, and 3 percent (annual) increases at the 28 schools since 2005 in seats, and only a few schools are now doing more. There's been a lot of growth in five years, and it will be slower in the coming years," Greenhill said.

The number of veterinary school seats has increased annually 1.8 percent on average for the past 30 years, according to AAVMC data. For the next five years, the annual growth rate projected by the advocacy survey data will slow to 0.5 percent.

The numbers game

Historically, applications to veterinary schools have been outpacing the growth in first-year seats. Applicants through AAVMC's Veterinary Medical College Application Service have increased by about 29 percent from 2004-2010—from 4,447 to 6,265.

A number of veterinary schools, in turn, boast healthy applicant-to-seat ratios, anywhere from 7-to-1 to 12-to-1. But for every school with a high ratio, there are others with a 2-to-1 or 3-to-1 ratio, said Dr. Marguerite Pappaioanou, AAVMC executive director.

Notably, approximately 60 percent of VMCAS users, who represent 88 to 90 percent of U.S. applicants and first-year seats, apply to more than one veterinary school. The mean is 3.9 applications per applicant.

"Schools talk about the number of applicants going up, but they don't know that those same applicants applying to them are applying to three to four other schools. Even though some schools see applicants go up, others might see them go down," Dr. Pappaioanou said.

Because of the large number of students who apply to more than one veterinary school, the national applicant-to-seat ratio is a more reliable number to look at, according to Greenhill.

2010 was the first year the AAVMC made public projections on the applicant pool as it relates to future class sizes, and then used those projections to calculate the ratio of the national number of applicants to the number of seats available at U.S. veterinary schools and colleges.

The association projects that in five years the applicant-to-seat ratio will be 2-to-1. That would be a slight decrease from 2010, when the ratio was 2.1 applicants for every first-year seat available. The decrease has been gradual over the years. In 1980, the ratio was 3.29-to-1.

Pushing the limit

There is concern now, she said, that the greater number of seats available, thanks to the increases in the past few years coupled with the stagnant application figures, will mean veterinary schools and colleges will start to have some difficulty in filling seats.

"Where is the break point? I'm not sure, and no one wants to find out this way. I can say it appears there is a correlation when the ratio dips to 1.7-to-1 that GRE scores and GPA start to slide," Greenhill said. "That doesn't mean they're bad students, but we do see those quantitative arbiters start to take a dip."

She continued, "I do think there will be a cadre of students who would normally not apply or be admitted. They would still be under the bell curve but closer to the wings. There's a population that will do just fine, but where's the line?"

The attrition rate, one indicator of a weak applicant pool, currently remains negligible for practically all U.S. veterinary schools. That said, more veterinary schools report having to go deeper into the applicant pool than in the past when filling seats.

"Right now they're burning through wait lists, but some of that may be mitigated with an influx of more students. The blowback on that is it actively reemphasizes the mythology that there isn't an applicant problem. It's a hard myth to break within external and internal populations," Greenhill said. "I don't want to be Chicken Little, but I am a little bit concerned about that."

Dr. Ronnie G. Elmore, associate dean for academic affairs and admissions at the Kansas State University College of Veterinary Medicine, agrees.

"I see an increase in class sizes at an increasing number of schools, and the applicant pool is not going up much, and students graduate with larger debt. That points to a potential crisis in the applicant pool if it isn't already here," he said. "At K-State, we're still getting really good students, but I can say even with a 2 percent increase (in the number of applications) this year, 20 to 30 percent of the applicants I look at probably won't be successful academically. So even though the national number may say 2-to-1, if you really look at the qualifications of those people, that's just applications, not qualified applications. When you take 20 to 30 percent out of that number, it makes this an even bigger crisis."

A call to all veterinarians

Challenges to attracting more students to veterinary schools and colleges are plenty. Among them are lower starting salaries relative to other health professions, the high cost of a veterinary education, a lack of familiarity with the profession, and the dearth of information on effective methods for recruitment.

"There's little peer-reviewed research on this. Ask for studies in the medical field on recruitment, diversity, or workforce, and you'll come up with hundreds of articles. We might have five," Dr. Pappaioanou said. "There's a huge gap because there's not a lot of money for this type of research. … There's lots of hypotheses out there and this recruiting report that came out three years ago. It starts with recruitment and how we sell ourselves."

She is referring to the 2007 National Recruitment Promotion Plan by the AAVMC, which has helped the association develop and launch the National Recruitment Strategy Steering Committee's Building the Applicant Pool Project.

Strikingly, but perhaps not surprisingly, the AAVMC report found that veterinarians are the best and worst recruiters.

Dr. Elmore advocates for practitioners to take a "we're-all-in-this-together" approach to shaping the future of veterinary medicine.

"I think we in the profession really need to be honest with ourselves and say we need to recruit. We can't wait and hope students will come to us," Dr. Elmore said. "The veterinary profession is still a great profession, and there are so many opportunities. We just need to do a better job of selling our profession and making obtaining a veterinary education economically feasible."

Over the years Dr. Elmore has conducted a survey in which he asks students to identify the individual who was most influential in helping them decide to become a veterinarian. Almost always, 41 percent say it was their local veterinarian who took the time to actively recruit them and allowed them to shadow, he said. Another 41 percent say their parents were most influential; the remainder cite others, such as college advisers and high school teachers.

"The best recruiters are positive professionals who like what they're doing. If every veterinarian in the U.S. influenced one student every 10 years to become a veterinarian, we would have a much larger pool of applicants each year," Dr. Elmore said.

Despite the urgency he feels for the situation, this student of history also takes some solace in knowing that the profession has weathered crises before.

"Between 1910 and 1920, veterinarians at AVMA national meetings were in despair about what would happen when the horse disappeared from use. The public didn't need horsepower anymore. That was a major crisis back then because almost all veterinarians were equine veterinarians. They didn't know how they'd survive," Dr. Elmore said. "Things tend to recycle. Every generation has its crisis, and our profession has been good about being relevant and serving society. While many things will change for our profession, we will continue to have new opportunities to serve society."