Universities, private practices struggle to find certain specialists, blame lack of residency training programs
September 26, 2018
In August, the American College of Veterinary Radiology had 70 job listings.
Dr. Tod Drost, the college's executive director, said 10 were for jobs at universities and 60 for private practice.
Last year, there were 43 new diplomates of the ACVR. "So, 70 jobs, 43 new people coming in—the math, you can see, doesn't work out that well," he said.
The shortfall is similar, if less severe, in other specialties.
Dr. Calvin Johnson is president of the Association of American Veterinary Medical Colleges, dean of the Auburn University College of Veterinary Medicine, and a board-certified anatomic pathologist. Veterinary specialists are vital to universities for classroom teaching; conducting research that advances the veterinary profession; and training students, interns, and residents.
"Every specialist is in demand," he said. "Most colleges of veterinary medicine have very active searches going on almost constantly—multiple searches."
Dr. N. Bari Olivier, chair of the Department of Small Animal Clinical Sciences at Michigan State University College of Veterinary Medicine, said the need for "-ology" faculty—specialists in cardiology or neurology, for example—is acute. All four of Michigan State's radiology positions have been empty for more than a year.
"When people go under their desired number of faculty in that position, they're having a really hard time replacing them," he said.
In the mid-1980s, when Dr. Olivier finished his cardiology residency, universities were the main employers for specialists. Today, private practices and industry hire most veterinarians finishing residencies.
Diagnostic imaging, in particular, went through a major change as hospitals and clinics became able to send digital images to consultants.
"It's literally true that a radiologist can be kept completely busy, earning very high levels of compensation, working in front of a computer anywhere in the world, with hours that they dictate," Dr. Olivier said.
Dr. Cathy Carlson, chair of the Department of Veterinary Clinical Sciences at the University of Minnesota College of Veterinary Medicine, said pathologists, especially those with research experience, also have become difficult to recruit. Most work for diagnostic laboratories outside academia and they, like radiologists, can examine images from home.
"It's just they don't have the collegiality, camaraderie, ability to get second opinions in person with other people, which I would see as a huge drawback," she said.
As for radiologists, Dr. Carlson also is trying to find more.
"We're trying to make some of the teaching digital, save some time there. But radiologists also need to interpret CT, MRI—they need to do some of the procedures that require hands on."
Dr. Jimmy Barr, chief medical officer for BluePearl Veterinary Partners, said the company employs about 400 full-time specialists at 70 specialty hospitals—numbers rising to meet pet owners' expectations that their pets will receive advanced care.
Even in private practice, the demand for specialists has outstripped supply, and Dr. Barr expects the gap will keep growing.
Internal medicine, surgery, and emergency and critical care specialists are in the highest demand, by volume, because they are core elements of multispecialty practices, Dr. Barr said. But specialists certified by the smaller colleges can be especially tough to find.
"Ophthalmology, dermatology, dentistry—they have relatively few programs that are putting out residents," he said. "And, so, the practice that wants to add or grow those particular specialties, that can be pretty hard."
Drs. Olivier and Barr both said doctors in their organizations refer clients when needed, and that no patients have suffered for lack of specialists.
Changes in supply, demand
The U.S. is adding specialists at a faster rate than veterinarians overall, up 47 percent from 2007-17, a period during which the overall veterinarian population grew by almost a third, according to AVMA data.
Specialists remain a fraction of the profession: 13,000 of the estimated 111,000 U.S. veterinarians. But data available from the biggest residency matching program indicate hundreds who want to become specialists are turned away because of a lack of openings.
This year, about 1,100 veterinarians applied for residency matching through the Veterinary Internship and Residency Matching Program, operated by the American Association of Veterinary Clinicians, and 340 (31 percent) were matched, according to program data. About 160 of them took internships, and 600 were unmatched.
Of those applicants, 94 sought placement in the 16 available diagnostic imaging and radiology residencies. It was the third-most wanted category behind small animal surgery, for which 222 applied for 45 positions, and small animal medicine, for which 109 applied for 46 positions.
Dr. Drost said the ACVR has between 550 and 600 diplomates, most of whom work in private practice, whether in a hospital or doing remote consulting.
"We don't have the capacity at the present moment to train enough radiologists to meet that demand," he said. "So, it's a good time to be a radiologist, but we also feel the pinch that we don't have enough people in all of those jobs."
Dr. Drost also is a professor at The Ohio State University College of Veterinary Medicine, which, in August, had three radiologists and openings for two more. He said several veterinary colleges in North America had none and, so, no programs to train more.
Dr. Olivier said specialists may go into private practice to focus on patient care rather than dividing that time with teaching and research, and for the higher salaries. Private practices don't always pay more, he said, but enough do to create headwinds against universities.
The last AVMA Report on Veterinary Compensation, published in 2013, indicated private practice veterinarians who had board certification earned a mean of $180,000, whereas those without earned a mean of $113,000. The same report indicated specialists at universities earned a mean of $151,000, and other veterinarians in academia earned a mean of $90,000.
Dr. Barbara Lightner, director of medical recruiting for MedVet Medical and Cancer Centers for Pets, said more specialists are needed in private practice because pet owners are learning what specialty care is available for their pets, and they want to give them care comparable to what human family members would receive. MedVet employs about 300 veterinarians at 22 hospitals, with practitioners in 17 specialties.
Since Dr. Lightner exited her surgery residency in 1997, the market has shifted from an excess of applicants to an excess of jobs. MedVet now needs more internists, Dr. Lightner said, but demand shifts each year.
She noted that becoming a specialist is no small feat: five years of training after earning a veterinary degree—two in internships and three in a residency. Increasing the number of training programs is the obvious but difficult solution, which involves providing mentors and committing practice resources.
Dr. Marc Hirshenson is chair of the American College of Veterinary Surgeons Public Outreach Committee and a surgeon at Triangle Veterinary Referral Hospitals in Durham and Holly Springs, North Carolina. He said decades of growth in specialty medicine has brought the specialty colleges to a crossroads.
"You want to advance the level of care and make specialty care very available to every pet owner," he said. "But, at the same time, obviously, we also need to make sure that we're training residents and training individuals to uphold what we consider a high level of care."
He also said specialty colleges need to consider how many diplomates they can produce before saturating the market and how much pet owners can or will pay for care. The private hospitals where Dr. Hirshenson has worked have been growing, a trend he expects will continue."I don't know of any scenarios where there are people finishing their residencies and not being able to find a job," particularly among surgeons, he said.
Fixing the imbalance
While hospitals could improve efficiency to make better use of specialists, Dr. Barr said that alone would not be enough.
"The limiting factor, at this point, is the number of residencies," he said.
He thinks some of the specialty colleges could reduce barriers to training by allowing more use of video conferencing and other technologies to deliver didactic teaching about, say, physiology and the nature of diseases. If a surgeon adept at total hip replacements can deliver lectures to people in remote locations, they could help their profession grow to meet public demand.
Dr. Barr estimated BluePearl has about 50 residents each year, and he called that training some of the company's best work.
Dr. Calvin Johnson said he and fellow deans are trying to entice specialists with benefits other than salary: the satisfaction of training the next generation of veterinarians, the ability to choose research subjects, and time for their personal lives. But university teaching hospitals are under a competing pressure to provide enough clinical services to offset costs, in addition to having enough cases for clinical education.
Dr. Olivier said the competition for specialists has a silver lining: Universities are giving more mentoring and support to young faculty.
At the University of Minnesota, Dr. Cathy Carlson said her department had eight faculty openings when she became chair in February. Finding a new cardiologist was a coup. She has made a job offer, with fingers crossed, to an ophthalmologist and another to a neurologist who was found after extensive recruiting.
"Once they're on board, I plan to keep them here," she said.
As for imaging at the university, clinicians are sending some images to outside consultants and asking university-based radiologists only for second reads, Dr. Carlson said.
Recruiting new doctors may require paying residents who will stay afterward. "For the longer term, we need to be training more people with an interest in academic veterinary medicine," she said.
Dr. Olivier said the shift in radiology toward consulting has been so sudden that he worries too few residents are training to replace those in practice, a danger that could lead to the specialty's demise. Dr. Drost agreed that the ACVR is facing such a crisis, a product of high educational debt and relatively low academic salaries.
Dr. Olivier said some institutions are paying others to train residents who will return under contracts to work as faculty. Michigan State is considering such agreements.
The Ohio State has trained radiology residents sponsored by Oklahoma State University, the University of Florida, the U.S. Army, and private practices, Dr. Drost said. Auburn officials announced in July that Tuskegee University officials would fund training for a veterinarian who would be a radiology resident at Auburn and return to Tuskegee as a board-certified specialist and faculty member.
Dr. Drost said improving recruitment is not as simple as raising pay. Prospective faculty also have to want to work in university towns and enjoy teaching, he said.
An institution with at least two radiologists can start, continue, or resurrect a residency program, Dr. Drost said. Training any specialist takes time and effort.
Meanwhile, veterinary colleges struggle to fill absences, and department chairs like Dr. Carlson worry what happens if they don't.
"After this year, if we don't find somebody, we're in danger of the program collapsing because two people doing the work of four can only go on for so long," she said.