A Profession in Decline, Revisited

I am honored to post this on behalf of my co-author, Dr. Ryan Gates.  Ryan, have at!

What follows is a re-posting of a piece that appeared on Veterinarians Behaving Badly in September of 2012. While it is nothing like the sarcastic humor that characterized VBB, my friends at the VBB hospital were kind enough to allow me to post it.


For a couple of reasons, I removed it from its original place of publication about 18 months after posting.  Given the state of our profession now that two more years have gone by, with expanding colleges, expanding class sizes, and questionable accreditation practices on the part of the AVMA's Council on Education since its appearance, there hasn't been a more appropriate time to revisit what at least a couple of us was observing a few years ago. 

I'll acknowledge at the top here that I made one error and one very arguable point in my observations back then. (Some may ask, "Really? Only one of each?")

The error: the idea that debt-strapped veterinarians would struggle to find a lender to help them purchase a veterinary clinic. I became aware during my interview with David McCormick for Good Intentions, Bad Data, Unintended Consequences: Part Two that lenders are quite happy to lend to aspiring practice owners, no matter their level of student debt. On that, I stand corrected.

The arguable point: the idea that more domestic students (in #1 below) equals more veterinarians on the market. Some argue that the surplus in domestic schools would have gone to island or other foreign schools, only to wind up on the same place by a different route. Let's agree to call this a point of ongoing debate.

Upon the rest, I wholeheartedly stand behind.  Nothing has been changed or edited, and it should be noted that the additional New York school has been abandoned.  Enjoy this blast from the past.

A Profession In Decline

author's note: Sarcasm will be set aside for this post as a critical topic is addressed. Looking for sarcasm? Find another post or stay tuned to VBB for the next post. Even without sarcasm, though, the veterinary power players will still say I'm a veterinarian behaving badly...

Historically, veterinarians have been thought of as intelligent people. The typical veterinarian finished college with a bachelor's degree and then went on to veterinary college for another four years. Some even have additional degrees: masters degrees, Ph.D.s, board certifications, you name it. Veterinarians are taught to think critically, to analyze situations after taking a step back, and to apply information gathered in one arena to another. How many times have you stopped to consider that your veterinarian has experience with dogs and goats, horses and llamas, birds and pigs? We may not be the smartest people in the room, but we've got a pretty good, broad knowledge base and we've got the ability to solve problems.

In light of the above, here are a couple of headlines that have recently surfaced:

* Items appeared within 48 hours of each other.

Let me summarize these news items: More veterinary colleges. Larger veterinary class sizes. Fewer opportunities for learning veterinarians. This begs some questions.
  1. What's the problem with the veterinary colleges? In a clear, shameless money grab, the college presidents and boards have expanded their class sizes to increase tuition dollars. Over the last couple of years Tennessee has expanded from ~70 to ~100, Auburn has gone from 92 to ~120, Ohio State has moved from 135 to >160, and Purdue has increased its class size by 15. And these are just the numbers that I could determine in a short period of time. More students will result in more graduates, which will result in more veterinarians out on the market. The presidents will have you believe that their decisions are a response to the current and future demand. Hold this thought.
  2. What's up with the professional organizations such as the American Veterinary Medical Association (AVMA), the American Animal Hospital Association(AAHA), the Association of American Veterinary Medical Colleges (AAVMC), and even the North American Veterinary Conference (NAVC) and other big conferences that like to think that they represent veterinarians beyond a continuing education level? These organizations are allegedly in place to represent and speak for veterinarians; to guard the profession. While these organizations do many, many good things, they are letting us down in key areas, most notably in facilitating an unsustainable trend of slowly increasing employment opportunities and rapidly increasing numbers of graduates. This translates over time to overarching economic and employment problems for the veterinary profession as the future becomes the present.

Let me get specific. The AVMA had told us for years that there was a shortage of veterinarians, and perhaps there was at one time. Perhaps we should define "shortage." For our non-veterinary professional readers here, ask your veterinarian if there is a shortage of veterinarians in America. You may hear that there is a shortage of large animal veterinarians in particular parts of the country. If there is a shortage of veterinary care in particular regions of the country, it is because the ranchers/pet owners/farmers are not willing to pay the veterinarian what he/she is worth. The root of any perceived shortage is economic in nature and not a lack of professionals with the tools to provide the desired medical/surgical care. Established veterinarians have moved to where they can be profitable and many students have decided that there is more money and less injury to be had by avoiding large animal practice. The time for believing in a veterinary shortage, as the AVMA has apparently defined it, has passed. Real solutions can be developed to shift more graduates toward large animal medicine (a discussion for another time/post). Rather than taking a leadership role and moving in the best interest of the profession, though, the AVMA has taken a dual role in the process as they sit idly while the veterinary colleges expand and they actively accredit more colleges.

The AAVMC clearly has a vested interest in promoting strong colleges, but should they also not consider the students they will graduate, the debt with which these students will graduate, and the job market in which these graduates will find themselves? Is there no responsibility to be taken by the educational institutions?

It is at this point where the cynical among us will wisely point out that with more veterinary colleges, more veterinarians will be needed in academia, and therefore more graduates will be needed. This Theory of Perpetual Academia qualifies for "bass-ackwards" and is foolishness on its face.

Friends, we are witnessing the death of veterinary medicine as we once knew it. Big Veterinary has assumed its place alongside Big Oil, Big Food and Big Pharma. A healthy, long-term vision for the veterinary profession has been cast aside in an effort to maximize tuition dollars at the state schools and dividends at the for-profit schools in the present. All the while, the veterinary representative organizations take a pass on their callings and become complicit observers.

The victims in all of this are three parties:

  • Most graduates - The vast majority of veterinary students will finish with crippling, long-term debt. Some of them will not find work. Debt-laden graduates, forced into positions of paying off their loans, will be unable to assume leadership positions within the profession.
  • Current veterinary practice owners - The ones that graduated in the 70's, who worked 60-80 hrs/week to build their businesses (the home-town hospitals where you know the technicians by name, where you've loosely followed your veterinarian's kids from elementary school to high school to college, where your veterinarian asks about your family, and where you've taken 30 to 40 years worth of pets) will either sell to a corporate practice, with all of the WalMartization that comes with it, or they'll have to board up their doors when their retirement years come. What choice will they have? Veterinary graduates, the pool of potential buyers that they were counting on to be available prior to their retirement, will be not be in any position to purchase because of their burdensome debt.
  • Caring animal owners - Let's face it, the colleges are not expanding their enrollment by producing more top-tier veterinary graduates. Instead, the colleges are now accepting students that would have missed the cut in years past. Further, the current culture at veterinary colleges is pushing more and more of the top graduates into specialty fields. What will that leave for the critically important role of general practitioners? Many of these lower-tier (to be most kind) graduates will be providing medical care for the nation's animals. Perhaps an argument can be made that there have been more qualified applicants than seats all along. Having spent four years in veterinary college alongside scores of veterinary students/graduates, I can assure you that for a long time there have been too many seats available.
The winners in this rush to create more schools and expand class sizes?
  • Academia - With the student loan situation as it is, what is stopping the current schools from raising tuition and new schools from forming? It's free money for the administrations, professors and investors.
  • Debt-free graduates - If a graduate can make it through veterinary college without debt, they will be able to experience the quality of life about which all aspiring veterinarians dream. They'll be attractive to prospective, hiring practice owners as candidates for succession. From the graduate's perspective, it will be a buyer's market when it comes to purchasing an established practice. And because they will not be a slave to a lender, they will be in a better position to seek roles of professional leadership, should they desire to do so, which can positively impact the profession.

The practice owners with whom I keep in contact, some of whom sit at this prestigious VBB roundtable, are unanimous in their desire to be long gone by the time any more schools show up on the radar. While I share their sentiment, at the current rate, this is wishful thinking.

Bold leadership is needed on this front. Big Veterinary, however, has shown no interest in listening to us little DVM/VMDs, the ones with some ideas that could actually work. The deck is stacked against the front line veterinarians... if we wanted to influence the organizations listed above, and affect positive, industry-wide change, how would we do so? In fact, I have made attempts, and my conversations with the big-shots have gone nowhere. At what point does hoping for Big Veterinary to "get it" meet the criteria of insanity?

Historically, veterinarians have been thought to be intelligent people. The problem-solving skills that we each were taught to utilize on the medical side have simply not been applied to the academic, financial, and diplomatic side of veterinary medicine by the people charged with the responsibility for doing so. As a result, and until this changes, we are certainly a profession in decline.

After this post was published, Dr. VBB gave each of our nation's veterinary college deans an opportunity to respond. There was nothing. Zero response.

It cannot be said that nothing has come from this post.  Unfortunately, it seems that only a shifting of the goal posts has occurred, such as shunning "veterinary shortage" like a politically-incorrect plague in favor of high-brow economic terms such as "overcapacity."

As far as real, meaningful action? Eden and I had high hopes when Michael Dicks joined the fold over at AVMA, with all of his intellect and promise. He even reached out to us through a series of blog comments and private e-mails. Since that time, though, and I don't want to minimize his efforts, we just don't see the type of vision, goals and improvement our profession so desperately needs.

There is, though, opportunity for us to bypass Big Veterinary and voice our opinions to the NACIQI in the very near future. What is this acronym and what's the opportunity? Inform yourself here.

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@JustavetFromSDN tweeted this page. 2014-08-08 09:27:07 -0400
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