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..."Overview
--Steven M. Davidoff, "The Economics of Law School."1
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 AVMA-IHS 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.
In this series of posts, we examine policy decisions made in the absence of sound data. The series consists of:
- Meet the Pink Elephant in the Room: Gender in Veterinary Medicine - 5/2/13; PDF
- Meeting Ourselves, Coming and Going: Maldistribution - 5/13/13; PDF
- Meet Big Veterinary: How the AAVMC Could Serve Students Better - 5/17/13; PDF
- Meet Big Veterinary: How the AVMA Could Serve Its Members Better - 5/22/13; PDF
- Meet Big Ed: Schooling Veterinarians is Big Business - 6/12/13; PDF
Meet Big Ed: Schooling Veterinarians is Big Business
Both the Association of American Veterinary Medical Colleges (AAVMC) and American Veterinary Medical Association (AVMA), two of the most influential organizations in the veterinary industry, derive their funds from similar mechanisms: the AAVMC from students who want to be veterinarians; the AVMA from members. Both of these organizations believe that, "if it benefits us, it must benefit the rest of the profession." While these organizations provide valuable services, we have shown in previous installments that their actions benefit the organization more than the membership. Similarly, the colleges sustain their revenue in an era of decreased state funding by charging higher costs to larger classes, even though these actions benefit neither the students nor the profession. Just like practice couldn't continue to rely on raising prices to compensate for changing market fundamentals, neither can the schools.
Private practice and colleges, once economically similar, are now quite different
In the 80's and 90's colleges and private practices operated on similar revenue models: as costs increased, each raised the prices and fees they charged to compensate. This revenue generation model is no longer economically feasible for the practice sector of the profession. Considering the debt burden of graduates and the critical evaluations being made of federal student aid programs in general,2 and professional fields specifically,3 it won't be feasible much longer for the educational sector either.
Slashed state appropriations to the US land grant colleges reflect the nonessential nature of training more companion animal vets.4 The veterinary academic community now pleads its continued relevance by emphasizing how the veterinary schools fulfill the research mission of land grant universities.5 The colleges seem impotent to adapt to increasingly rapid changes in their operating environment, as practices have been forced to do. State funding cuts have coincided with a decrease in charitable giving. Veterinary medical teaching hospitals (VMTH) may have as little room as private practices for revenue growth. In some cases they are already proudly self-supporting.6,7,8 This temptation to use the VMTH as a profit center is so strong the COE has a standard holding programs accountable for using their facilities to fulfill their instructional mission.9 One wonders if this is part of the impetus for off-site clinics. To expand teaching caseloads and revenue, schools that don't already have them are adding private clinics10,11,12 but these clinics simply compete for the same pool of client dollars available in a locale. With other revenue sources maximized yet still insufficient, the deans turn to tuition to fill the gap.
Currently, tuition revenue can still be manipulated at will. Thus, generating revenue by raising tuition and adding enrollment has become the path of least resistance for deans. Educational programs, like private practices, are under intense financial pressure in the face of falling revenue to maintain quality and above all avoid cutting staff. With no caps on easily accessible federal graduate loans, schools can and do write their own ticket with respect to the cost of an education.
The colleges are doing what they can to maintain current levels of operation. This is short-sighted and not in the best interests of the individual students and graduates on the micro level, nor is it in the best interests of the profession as a whole on the macro level. Students graduate with higher and higher debt loads in the face of stagnant salaries and ever scarcer jobs. Nor does this seem to be of any consequence to the colleges. Veterinary college deans, such as The Ohio State University's Dr. Lonnie King, have acknowledged that the current climate of student debt is not sustainable, yet no concrete efforts toward reform have been proposed.b We are no closer to a sustainable educational model than ever.
The search for solutions
The American veterinary education model is evolving; it must, as it is not currently capable of sustainably graduating veterinarians equipped to serve the needs of the public. The majority of veterinary graduates will not be able to live a lifestyle competitive with that afforded by other degrees- or no degree.14 Tuition, debt and starting salary data showing this is available at our fingertips; we authors were able to compile it despite neither training nor experience in research. If the existing colleges continue to expand classes, and universities without veterinary programs create new ones, and all of them insist on serially increasing tuition, the economic direction of our profession will not improve. How could it?
We need less abstract, feel-good conversation and more viable interim solutions,15 such as admitting Chinese students into US veterinary programs. The American market for veterinary services is contracting but the market in China is on the verge of exploding. Further, the Chinese presently have no infrastructure, neither educational nor regulatory, to meet their demand in a timely manner. Still further, the Chinese view Western medical training in a prestigious light. From the perspective of the colleges and the Chinese, it is hard to see a downside. Politically unpalatable, yes. Not unlike the idea of outsourcing education, as presently occurs when US students choose to attend programs conferring an equal degree in other countries because they cost less.16 A recent trend of thinking outside the educational box has emerged, with consultants advising aspiring investors, academic boards and politicians to build facilities to house extensions of universities, establish accelerated programs, or expand the pool of private, nonprofit veterinary education providers based on largely unknown data.17 While the long term ability of these types of programs to provide relevant, quality veterinary education in an economically sustainable way is undetermined such innovation shouldn't be rejected just because it isn't the way we've always done it. The authors point out- the way we've always done it no longer works.
Most in the trenches of individual private practice endure without the benefit of a bankroll fat enough to deficit spend three years running, as, for instance, the Association of American Veterinary Medical Colleges did from 2010 through 2012.18,19,20 For practice owners and associates the recession has provided a brutal demonstration that care for companion animals is purchased with disposable income. At the same time disposable income has shriveled, preventive care has taken hold and the low-cost, non-profit sector has commoditized companion animal care. On the large animal side, agriculture consolidated, persistent widespread drought tanked livestock profit margins and recession cut the legs from under the equine industry. Even before their disposable income in each of these market sectors drooped, clients reported altered spending on veterinary care.21 The rate of private practice growth, both in terms of revenue and real client visits, has stalled in many areas of the country,22 and did so before the recession.
Unable to raise more revenue, private practitioners have had to cut costs, including their own compensation. Our clients, facing unemployment and underemployment at levels not seen in decades, have been forced cut costs to survive - and veterinary care is a cost that can be cut. When the care is for companion animals, that cost is a luxury - and many in the US cannot now afford luxuries. As society functions with us or without us, companion animal veterinarians are economically optional.
Veterinary academia is just as driven by money as the private sector. There is no significant difference in the behaviour of land grant, not-for-profit and for-profit programs- nor do we have evidence of any difference in the outcomes of their graduates. We're accustomed to acting as if those in academia act altruistically, solely or primarily to advance knowledge and the state of the profession. This is simply not so, as evidenced by the behavior and actions identified in our previous pieces. Profit motive is inherent to veterinary medicine and education both, and persistently setting policy without acknowledging this is one of the factors that has led us to this point. It is the authors' opinion that if the status quo in veterinary academia doesn't change, we will continue to observe increasing graduate debt, increasing numbers of veterinary graduates and a professional market where graduates will have difficulty finding employment that will enable them to repay their debt. A tipping point will come where applications fall or loans become unavailable- how then will we preserve our educational infrastructure?
(a) Myers, E. By accumulating publicly available tuition, enrollment, and loan interest data, and then performing some basic calculations, it became clear to these authors that schooling veterinarians is, in fact, big business.
(b) Gingrich, F. E-mail communication with Myers, E., and Gates, R. 28 February 2013. Dr. Gingrich attended a town hall meeting with Lonnie King, DVM, MS, MPA, Dipl. ACVPM, Professor & Dean, The Ohio State University College of Veterinary Medicine re: the state of the College of Veterinary Medicine, in Cleveland, OH, and shared his notes from the evening with the authors.
(1) Davidoff, SM. "The Economics of Law School." Deal Book, 24 September 2012. Web. Accessed: 11/13/2012. Available at: <http://dealbook.nytimes.com/2012/09/24/the-economics-of-law-school/>
(2) Dervarics, C. "New Data Show Many Students Struggling to Repay Loans." Diverse Issues In Higher Education. 1 October 12. Web. Accessed: 1/13/2013. Available at: <http://diverseeducation.com/article/48447/> Of particular note: "[President of the Association of Private Sector Colleges and Universities] Gunderson ... called on the Department of Education to give schools the authority to limit loans..."
(3) DeLisle, J; Holt, A. "Safety Net or Windfall? Examining Changes to Income Based Repayment for Federal Student Loans." New America Foundation, October 2012. Web. Accessed: 1/13/2013. Available at: <http://edmoney.newamerica.net/sites/newamerica.net/files/policydocs/NAF_Income_Based_Repayment.pdf>
(4) 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>
(5) Moore, RM DVM, PhD; Hubbell, JAE DVM, MS; King, LJ DVM, MS, MPA. "The role of the colleges of veterinary medicine in realizing the research mission of land-grant institutions to promote animal, human, and environmental health." J Am Vet Med Assoc 2012;241:869-874.
(6) "The [Purdue University]-VTH is self-supporting hospital." Web. Accessed: 11/29/12. Available at: <http://www.vet.purdue.edu/vth/your-visit.php>
(7) "The [Michigan State University] Veterinary Teaching Hospital is financially self-supporting." Web. Accessed: 11/29/2012. Available at: <http://cvm.msu.edu/hospital/information-for-clients/payment>
(8) "The [University of Tennessee] veterinary teaching hospital is self supporting." Web. Accessed: 11/29/12. Available at: <http://www.vet.utk.edu/clinical/lacs/fees.php>
(9) American Veterinary Medical Council On Education. April 2012. Web. Accessed: 1/13/2013. Available at: <https://www.avma.org/ProfessionalDevelopment/Education/Accreditation/Colleges/Pages/coe-pp-requirements-of-accredited-college.aspx> Specifically: 7.2.Standard 2, Finances: "...teaching hospitals must function as instructional resources. Instructional integrity of these resources must take priority over financial self-sufficiency..."
(10) Pyle, E. "OSU Veterinary Clinic to Open In Dublin" The Columbus Dispatch. 8 October 2012. Web. Accessed: 1/13/2013. Available at: <http://www.dispatch.com/content/stories/local/2012/08/10/OSU-to-open-veterinary-clinic-in-dublin.html>
(11) University of Florida. "New pet emergency clinic to open in Ocala." 30 May 2012. Web. Accessed: 1/13/2013. Available at: <http://www.vetmed.ufl.edu/2012/05/30/new-after-hours-pet-emergency-clinic-to-open-in-ocala/>
(12) Tufts operates a mixed practice [Tufts Ambulatory Service], a specialty/ER referral practice [Tufts VETS] and a low-cost practice [Tufts at Tech Community Veterinary Clinic]. Web. Accessed: 1/13/2013. Available at: <http://vet.tufts.edu/hospitals_and_services/>
(13) Federal Student Aid, An Office of the US Department of Education. PLUS Loans. Particularly, "PLUS loans are federal loans that graduate or professional degree students... The maximum loan amount is the student's cost of attendance (determined by the school) minus any other financial aid received." Web. Accessed: 1/13/2013. Available at: <http://studentaid.ed.gov/types/loans/plus>
(14) Akst, Daniel. "College and Its Discontents." Wall Street Journal, 3 June 2013. Web. Accessed: 6/3/2013. Available at: <http://online.wsj.com/article/SB10001424127887323855804578511571145523096.html> A book review of Waldon on Wheels, by Ken Ilgunas.
(15) Roark, Andrew DVM, MS. "Three Reasons Veterinarians Are Not Doomed." DVM360, 7 May 2013. Accessed: 6/6/2013. Available at: <http://veterinarynews.dvm360.com/dvm/Veterinary+news/Three-reasons-veterinarians-are-not-doomed/ArticleStandard/Article/detail/812564>
(16) Myers, E. "Costs to Obtain 2016 NA DVM." Available at: <https://docs.google.com/spreadsheet/ccc?key=0AuDAmocjP-XddEZFZ096NkxsMkdKVmJsUHZ3MmRqUFE#gid=1> The spreadsheet contains a compilation of publicly available information from the various colleges of veterinary medicine.
(17) Larkin, M. Veterinary education continues expanding. J Am Vet Med Assoc 2012;241:1135-1137. Particularly, "'Over 50 percent of America's pets receive no regular veterinary care, so there continues to be a need for veterinarians,' [Mark Chason, president of Chason Affinity,] said." 1136.
(18) AAVMC Annual Report 2010-2011 website. Web. Accessed: 1/13/2013. Available at: <http://www.aavmc.org/data/files/other%20publications/aavmc2011arfinal.pdf>
(19) AAVMC Annual Report 2009-2010 website. Accessed: 11/12/2012. Available at: <http://www.aavmc.org/data/files/other%20publications/annual%20report%202010%20-%20final.pdf>
(20) AAVMC Annual Report 2011-2012. Accessed: 12/3/2012. Available at: <http://www.aavmc.org/data/files/other%20publications/2012annreport.pdf>
(21) Bayer HealthCare LLC, Animal Health Division, Bayer Veterinary Care Usage Study. Web. Accessed: 1/13/2013. Available at: <http://www.bayer-ah.com/nr/45.pdf>
(22) Downing, J. VIN News Service. "Veterinary practices inch back to growth." 1 January 2012. Web. Accessed: 1/13/2013. Available at: <http://news.vin.com/vinnews.aspx?articleId=20994>