Added Interest

Good Intentions, Bad Data, Unintended Consequences
Eden Myers, DVM, MS
Ryan G. Gates, DVM

"...it could be worse. Consider the plight of veterinarians. The average tuition and expenses for a veterinary degree at a private school has doubled in the last 10 years...yet their pay remains moribund..."
--Steven M. Davidoff, "The Economics of Law School."1

Overview
The veterinary profession is currently suffering the effects of decades of decisions based on unexamined beliefs and subjective surveys rather than objective, statistically valid evidence. With respect to workforce needs and career opportunities, we are operating in the dark. There are signs of potential improvement, most notably the 2013 US Veterinary Workforce Study. We must improve qualitatively, though, if we are to better the economic condition of our profession- which we must do to maintain the quality of service we provide to society.

Over a series of posts, we will show some effects of policy decisions made in the absence of sound data. We will identify areas where we can improve our profession's prospects by compiling and analyzing high quality data across the entire profession. The series consists of:

Meet the Pink Elephant in the Room
Although the practitioner population in the US has swelled hugely over the past two decades, we have service gaps in public health, food security, animal welfare and wildlife health. Meanwhile, companion animal private practice is saturated beyond economic sustainability. If we had and understood comprehensive, current data about how individual veterinarians respond to socioeconomic changes, we could better predict the response of the veterinary workforce to those changes. Without this understanding, we will continue to risk such gaps and bulges.

With the growth in the practitioner population came a dramatic gender shift.2,3

The National Board of Veterinary Medical Examiners (NBVME) administers the North American Veterinary Licensing Examination (NAVLE). According to NAVLE Technical Reports,4 40,184 people have passed the NAVLE since 2001. While NBVME tests administered from 1993 to 2000 were not computerized and thus can't be examined with the same degree of precision, applying similar rates of passage as achieved on the NAVLE yields an approximate period total of 60,349 people entering practice between 1993 and 2012.a

Figure 1: Gender of US DVM Recipients 1987-2011b
Gender

The proportion of female DVM recipients documented in the Integrated Postsecondary Education Data System (IPEDS) has been over 50% for more than 20 years, and now stands at almost 90%. If the same gender percentage applies to those passing the NBVME exam, then the profession gained approximately 43,028 female practitioners in the past twenty years.

We have precious little data documenting the behavior of these members of the veterinary workforce.5,6 Conventional wisdom holds that women work part time or intermittently to accommodate family. Such workers can contribute elasticity to a labor force by being able to work more if demand goes up. If true, the large percentage of recent graduates that are female could dampen upward compensation trends for decades.

We need objective, current data on the workforce participation patterns of male and female DVMs. We need to know the number and distribution of hours worked by each, as well as the perception each has of the hours they work. Are female DVMs more likely to work fewer hours? Does this depend on having children? Are the hours worked by female DVMs more likely to occur at different times, such as evening and weekend hours, or overnight shifts, or in concentrated blocks indicating relief work? How do the genders differ in the number and distribution of hours worked as careers and families progress?

Figure 2:
Mean debt of US CVM grads, self reported at graduation, 2012$

Why are so many recent applicants and therefore graduates female? We don't know. (We don't even know how many graduates there have been.) The above figures contain numbers that had to be inferred or approximated. Neither the programs conferring the degree, the entity responsible for program quality (Council on Education, COE) nor the professional organization representing such programs (Association of American Veterinary Medical Colleges, AAVMC), make comprehensive applicant or graduate numbers readily available. We have effectively no system for tracking how many total graduates there are, what schools they attended or what their education cost- much less where they live and work, how they spend their professional time and how much they get paid.

In the time that it has taken to sit down and compose this series of essays, both the AAVMC and AVMA have released subjective datasets documenting employment of recent graduates and gaging the workforce as a whole. We flatter ourselves that we have distributed the thinking and the resulting information compiled here to many of the WAG, the executive Board, AVMA staff and other organizational leaders and influencers in the profession at strategic points in time over the past two years. We applaud those two associations for conducting their respective surveys, and to the extent the data they accumulated is objective and useful for real world ground level decision making, they should be encouraged to continue to take similar steps moving forward.

We are going to need more. A LOT more. These datasets, while timely, barely begin to address our data needs. They in fact may even be worse than nothing, as we fool ourselves into thinking that what we have is what we need since we spent a lot of time, effort and money to get it.

We do know many women report graduating with more debt than men, yet receiving lower pay.

Figure 3:
Self reported starting DVM salary at graduation, all jobs, 2012$
This discrepancy in compensation appears to persist regardless of ownership status or time since graduation. As long as the largely female veterinary labor pool continues to experience gender disparity in debt and compensation as shown above and elsewhere,7 gender disparities in ownershipc will likely persist as well.

Much of the data needed is generated annually by individual organizations such as the AAVMC, COE and state licensure boards. However, those organizations do not coordinate or share their data. The much anticipated 2012 National Academies of Science workforce study was delayed because of this:

The report has been long in the making, in part because of the inconsistent ways in which organized veterinary medicine compiles data, rendering it difficult to analyze long-term trends in the profession.8

The AAVMC compiles the annual Comparative Data Report and the Veterinary Medical College Application Service (VMCAS) database.9 The COE holds accreditation reports while the American Association of Veterinary State Boards (AAVSB) has access to the numbers and geographic distribution of licensees in every state.

Licensee information is a matter of public record. The individual state boards already collect, maintain and disseminate this information. The AAVSB could facilitate construction of a common platform for housing, analyzing and sharing the aggregated information. This would let us know where our gaps were, geographically and demographically. Thus in addition to serving their own mandate to their individual states, the boards could contribute to fulfilling the profession's mandate to serve society as a whole.

Figure 4:
Debt to Income Ratio

Another rich source of data about veterinary applicants, students and graduates is accreditation reports. Accreditation, the voluntary process of quality assurance in what is taught at a school, is coming under pressure in all of US higher education to be more transparent. Some veterinary schools already make their COE accreditation self studies available, either within the college community by placing copies in the library or more widely by placing the studies on the internet. The largest accreditor in the country, the Western Association of Schools and Colleges, announced last year that it would make accreditation reports public, and accreditors in other fields are expected to follow suit. From the April 2012 Report to the Secretary of Education:

...data collected for accreditation by accrediting agencies should be available to the public by both the institution and the accrediting agency...to afford students and the general public the opportunity to make accurate comparisons based on facts. ...Make accreditation reports about institutions available to the public.10

The increased national emphasis on transparency declared above was expressed by the requirements COE received December 2012 in their review before the National Advisory Committee on Institutional Quality and Integrity (NACIQI). The COE anticipates easily fulfilling those requirements by the next anticipated review date.d

The National Board of Veterinary Medical Examiners (NBVME) publishes an annual comprehensive report on the North American Veterinary Licensing Exam, releasing far more of the objective information that it produces than any other organization listed here. It is this wealth of information which allows the projection of supply and demand of veterinarians found in the final installment of this series.

Notwithstanding the availability of various statistically inadequate data, we don't know what we need to know to make data driven decisions about our own profession. The lack of basic, objective demographic and economic data about the individual members of our profession - who does what, when and where, for how much - means we can't understand and predict veterinary workforce behavior. A major contributing factor to this is the inability or unwillingness of veterinary medicine's professional organizations to coordinate and share their information.

Let there be no misunderstanding. The economic problems that our profession faces are not caused by a female-dominated workforce, any more than they are caused by the accreditation of new schools. It seems that whenever the topic of gender is raised, a perception of blame follows.11 There is no blame to be assigned, just understanding to be sought. Despite repeated costly attempts that leadship believe show otherwise, no one is yet in a position to accurately capture and analyze this trend, or emerging trends. This lack of analytical ability handicaps the profession's response ability.


Footnotes

(a) Boyce, J. Personal email communication with Myers, E. 22 June 2011. Boyce is the Executive Director of the National Board of Veterinary Medical Examiners.

(b) Integrated Postsecondary Education Data System, Institute of Education Sciences. "Degrees conferred by degree-granting institutions in selected professional fields, by gender of student, control of institution, and field of study: Selected years, 1985-86 through 2009-10." Custom query by Myers, E. Available at:

(c) McCormick, DF. Telephone interview with Gates, RG. 7 Nov 2012. McCormick is a Charter Member of Association of Veterinary Practice Management Consultants and Advisors (AVPMCA) and is currently the Immediate Past President.

(d) Granstrom, Dave. Personal communication with Myers, E. at AVMA Veterinary Leadership Conference. 4 Jan 2013.


References

(1) Davidoff, SM. "The Economics of Law School." Deal B%k, 24 September 2012. Web. Accessed: 11/13/2012. Available at: <http://dealbook.nytimes.com/2012/09/24/the-economics-of-law-school/>

(2) Shepherd, AJ. (2010). "Distribution of actively employed US veterinarians by state and gender, 2003-2008." J Am Vet Med Assoc, 2010; 236:420-422.

(3) Wise, JK; Shepherd AJ. "Employment and age of male and female AVMA members, 2003." J Am Vet Med Assoc, 2004; 225:876-877.

(4) National Board of Veterinary Medical Examiners. NAVLE® Technical Reports. Updated 28 August 2012. Accessed: 12/1/2012. Available at: <http://www.nbvme.org/?id=82&page=NAVLE+Reports>

(5) Smith, C. "The Gender Shift in Vet Med: Cause and Effect." Veterinary Clinics of North America - Small Animal Practice. Saunders, 2006 March;36:329-339.

(6) Smith, C. "Gender and work: what veterinarians can learn from research about women, men, and work." J Am Vet Med Assoc, 2002;220:1304-1311.

(7) Felsted, Karen E., DVM, CPA, MS, CVPM; Volk, John. "Why Do Women Earn Less?" Veterinary Economics, 2000; 41:33-38.

(8) Committee to Assess the Current and Future Workforce Needs in Veterinary Medicine; Board on Agriculture and Natural Resources; Board on Higher Education and Workforce; Division on Earth and Life Studies; Policy and Global Affairs. "Workforce Needs In Veterinary Medicine." National Academies Press, Summer 2012. Web. Accessed: 1/13/2013. Available at: <http://www.nap.edu/catalog.php?record_id=13413>

(9) AAVMC Annual Data Report. 2011-2012. Web. Accessed: 1/13/2013. Available at: <http://www.aavmc.org/Public-Data/Annual-Data-Report.aspx>

(10) U.S. Department of Education National Advisory Committee on Institutional Quality and Integrity. "Higher Education Act Reauthorization, Accreditation Policy Recommendations." Web. April 2012. Accessed 3/1/13. Available at: <http://www.msche.org/documents/naciqi-final-report.pdf>

(11) Lee, J.A. DVM, DACVECC, DABT. "Are We Abandoning Our New Graduates?" Web. Accessed: 4/26/2013. Available at: <http://veterinaryteambrief.com/article/are-we-abandoning-our-new-graduates-3> In particular, Dr. Lee's statement, "Here is where I feel some of the problems lie: ... An all-female field. I'm all for women's equality, but a woman-dominated veterinary field will have repercussions."

Words Fail Me

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An article came out in the Sunday New York Times yesterday, in the Education section.  It was written by Phyllis Korkki, and it's about the financial state of the veterinary profession.  

 

According to the article we have a 1:1 debt to income ration, make an average of $121,000 a year, yes tuitions are going up but hospitals are expensive to run and we need more vets in food animal medicine.  Besides, we do it for the 'personal fulfillment...which is worth more than a paycheck."

Oh, yeah, and we pay $18,000 a year tuition and can get our debt forgiven- if we don't get it paid for by the government through the VMLRP, that is.  The VMLRP is the Veterinary Medicine Loan Repayment Program which provides up to $25,000 a year towards your loans if you take a job in a state designated shortage area.

Last year it funded 80 people. Year before, 62.  Over those two years we know AT LEAST 39193879 = 7798 people became eligible to join the North American practitioner population.

And according to JAVMA, in 2012 those 3879 were carrying an average $151,672 debt load; $148,614 in 2011.

Grand total debt load, adjusted for inflation....$1,013,179,641  

Personal fulfillment...priceless.

 

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Good on ya, Queensland!

Congrats, UQ!Screen_Shot_2012-11-04_at_5.29.13_PM.png

The University of Queensland School of Veterinary Science has earned accreditation from the AVMA Council on Education.  The decision was announced after the October meeting of the COE along with the reaccreditation of Sydney, Auburn, Michigan and Calgary.

Ah, Auburn, my alma mater, proud proponent of the technical approach. And good ol' MSU, which to the best of my knowledge still sends students to see practice with the star of the not so "Incredible Dr Pol" show.  And let's not overlook Calgary, first vet school in North America to implement a distributive model. No, Western didn't invent it. Yes, it's been evaluated and yes, it works quite well. 

So, hmmm, another overseas vet school has been accredited.  You know what, let's not have another "accreditation is evil" battle.  Here's the bullet:

Do we need more schools?  No.  Do we need different schools?  Damn skippy.

If the ones we have can't change fast enough, then new ones will join the market. This does not mean the newly accredited schools or the newly founded ones are profiteering pawns in some sinister political plot to ruin our profession.  Accreditation just means a school delivers high quality education.  That's all.   

So RELAX.  Take a pill, have a drink, go for a run, hug your wife, eat a sandwich, whatever.

 Queenslanders, have two drinks and go for a swim*, you've earned it!

 Queensland_CVM.jpeg

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 *Not in that order, and please adhere to all applicable local regulations regarding the consumption of alcohol. You look like good kids.  Keep your heads on, eh? 

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A Halloween Scare

CA 07 Health Sciences Workforce Study

This is a scary scary document.  It is the veterinary section of the 2005 California Health Sciences Workforce Study.  

Highlights, you ask?  

-calls for increasing enrollment from 122 to 160 a year at UCDavis, even though Western is producing 85 grads a year

-infers a need for more grads, over half of which are female, from the prediction that many female vets work fewer hours to accomodate family demands

-bemoans the undersupply of veterinarians in the state, as judged by the fact that California is one of almost half of all states that are below the national average vet to population ratio and in fact, horror of horrors! half of all California counties are at or below the average for the state.  

Think about that for a minute.  Just let it sink in.  OK, got it?  Moving on....

 Here's the scary part.  Remember this study was published in 2007- almost a decade ago.  

The study calls for more vets while stating clients won't pay what vets will need to charge:

"Veterinary health care for the most part is financed by animal owners. Limited pet insurance is available, but
it has not been embraced widely by animal owners due to its relatively high costs. As clients pay for services
“out-of-pocket,” veterinarians must adjust their prices to fit what the market will bear in their communities.
In most instances, veterinarians work with owners to review estimated costs of veterinary care at the time
services are delivered and may work out a payment plan if necessary. They must also consider when clients
cannot pay the cost of saving their animal, even though the health issue may be treatable and would restore
the animal back to a normal, healthy condition. As medical services become more sophisticated, the demand
for more sophisticated services at low prices is increasing. Given the high cost of providing such services,
meeting this demand to lower prices is unrealistic for most veterinarians."

From the land of the unfunded mandate, where perception is reality.  We're all perceiving that reality now, eh?

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