Meet Big Veterinary: How AVMA Could Serve Members Better

"...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

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 Veterinary: How the AVMA Could Serve Its Members Better
While the Association of American Veterinary Medical Colleges (AAVMC) generates the bulk of its' revenue from hopeful pre-vets applying multiple times to multiple schools, the American Veterinary Medical Examination (AVMA) relies on membership dues for the majority of their budget. Just as an increase in applicants and applications results in more revenue for the AAVMC, higher numbers of graduating veterinarians paying higher membership dues translates to more revenue for AVMA. And just as their revenue generation methodologies are similar, their spending patterns resemble as well, with each organization spending those monies more for the benefit of the organization than the members providing the revenue.

We believe the AVMA has, with all good intent, engaged in activity traps in lieu of judiciously spending resources to serve the profession. The AVMA has pursued actions that lead us to conclude the association acts in the best interest of the organizational leadership rather than the membership.

A clear example of this is the creation of an AVMA associate director for international and diversity initiatives.² This action was especially puzzling because there was already a director level volunteer position in place to oversee international activities as they are carried out by the Committee on International Veterinary Affairs.³ AVMA members voiced their concerns on the AVMA@Work blog that such efforts yielded little value for the membership. In response AVMA CEO and Executive Vice President Dr. Ron DeHaven said,

"From a purely economic point-of-view, these efforts represent less than 2.5% of the association's overall budget. At the same time, internationally focused activities contribute positively to AVMA's budget; international income in 2011 and 2012 represents nearly 2.0% of annual income anticipated each year."⁴

That vague percentages were used by the Executive Vice President to defend the decision in the face of criticism is a point that should not be lost on AVMA members. Using 2012 budget numbers,⁵ projected expenses for all international activities conducted by the AVMA during 2012 were $615,918, whereas projected income associated with international activities was $598,400. With an overall 2013 budget of more than $31 million,⁶ Dr. DeHaven is telling the AVMA membership that AVMA's seat at the global table will cost an estimated $775,000 of the members' dues. DeHaven went on to assert that increasing the AVMA's global stature is worth the cost.

"As they say, you either need to have a seat at the table or you may find yourself on the menu... Even at such a modest cost, we (AVMA) have a prominent seat at the table..."⁷

When the above concerns were raised in our recent Letter To The Editor in the Journal of the American Veterinary Medical Association, the official response from Director of Membership and Field Services, Kevin Dajka, DVM, included,

"As indicated, the AVMA's international activities are effectively cost neutral for AVMA members. Yet, those activities have a far-reaching impact. As travel and trade between countries increases, activities elsewhere are having a greater and greater impact here at home. Thus, it is vital that the AVMA remain engaged internationally."⁸

These figures, the expense and income numbers, are mostly independent of each other. The majority of the expense is consumed by the executive level salary, which did not have to be spent for the income to be realized. Further, the majority of the remaining expense funded organizational memberships in international associations and associated travel by AVMA officers. These activities are carried on whether or not there is a salaried, executive position. This decision represents a pure management cost; it was not, and never will be, an investment.

The net "modest cost" members pay for AVMA's seat at the global table is $157,587 based upon 2013 projections. Out of the same budget, only $65,500 is allotted for the entire Economics Division. To put this in perspective for those readers in private practice, those figures are very close to the debt load and starting salary of the average new grad going into private practice in 2012. Who, exactly, is on the menu at this table where AVMA had members buy them a seat?

Another example of an AVMA expenditure of resources that enhanced the organization but provided questionable benefit to members is the MyVeterinarian.com project. The membership was told, after it was underway, that the project would help pet owners identify veterinarians in their area by providing or enhancing a web presence for their practices. MyVeterinarian.com is a proprietary search engine for a redundant directory of cookie cutter practice listings. Not to put too fine a point on it but Google works great and is, Bing's ad campaign notwithstanding, clearly the public's choice for search. It initially suffered from an almost total lack of support and the interface remains clunky for both practices and clients.⁹ While acknowledging that "technological improvements are... needed to improve this resource," current AVMA leadership claims that roughly half of the veterinary clinics in America utilize the service and that member feedback "indicates that many members are pleased" by the site.¹⁰ This is favorable anecdotal evidence, the type that makes an intervention look good, but not the type that quantifies return on investment, justifies an expense or provides evidence to guide future resource allocation. It amazes us that a firm pitched this idea and that AVMA bought it. Literally, bought it- with members' money.

The recent redesign of the Network of Animal Health (NOAH) is a third example of a spending decision that seems to reinvent the wheel for the comfort of a select few rather than provide a valuable benefit to the membership. AVMA leadership touts this service as part of an AVMA member's online community.¹¹ Even after the redesign, NOAH remains spare and sparsely populated. In contrast, Veterinary Information Network (VIN) has extensive discussion forums that are heavily used. The NOAH Forums directory shows 784 posts on 164 topics in 27 forums covering the six month period July 12, 2012, to Jan 31 2013.¹² The same time period on VIN shows 638,296 posts on 56,480 topics in 60 forums.a The difference in traffic between the two platforms shows an overwhelming and persistent preference for AVMA members to use VIN over NOAH to meet their online information needs. Thus the benefit to members of investing significantly in the recent redesign of NOAH is inapparent.

In February of this year the AVMA set aside $80,000 to design a new logo, and another $98,000 to implement it.¹³ Dr. Dajka responded to our criticism by saying,

"Our current logo design, text size, and style hinders our ability to make an effective impact, particularly in the online world. In addition, our involvement with the Partners for Healthy Pets initiative, which will include a substantial investment in public outreach, makes this an ideal time to move forward with a redesign. While the cost may seem high, a large part of that cost will be spent to ensure we have broad input from AVMA members."¹⁴

Clearly there are costs associated with such an undertaking, but this project amounts to the equivalent of dues from nearly 600 veterinarians. And many members have shared their unfavorable opinions on another part of the AVMA's online community, the AVMA@work blog.¹⁵ The benefits of spending those sums on the more pressing concerns of the membership seem clearer that the direction currently being pursued.

Dr. Dajka's quote reminds us of the wife who asks her husband, "Do these jeans make my butt look big?" The unspoken answer is, "No, it's the extra 20 pounds you're carrying because you eat too much and don't exercise enough." It isn't the logo design, text size and style that hinders AVMA's ability to make an impact. It's the organization's design, the size of its leaders' egos and the operational style that hinder AVMA's ability to effectively prioritize its spending. This leads directly to less-than-effective impact.

In each of these examples, the association spent membership dues creating redundant services of inferior quality rather than leveraging participation in existing, high quality commercial solutions. How might the resources consumed in these examples have been used in a way that benefited the members more than the organization? Perhaps by...

• subsidizing memberships in other global veterinary associations
• allocating additional funding to the CIVA so members can travel to participate in those other organizations.
• reaching out with technical support specifically to those members without practice websites.
• reaching out to those members who do have practice websites to provide search engine optimization counseling, not unlike what was addressed in a recent AVMA@WORK blog post.¹⁶
• partnering with VIN to provide reduced VIN dues for AVMA members.
• partnering with VIN to provide a members only section, as it has for other organizations; that area could then fulfill NOAH's stated mission of being "the best place to interact with your AVMA leaders on the issues that are important to you."¹⁷
• choosing a more opportune time to spend the dues of nearly 1% of the membership on logo cosmesis.

We believe these are activity traps that sustain the pattern of feel-good behavior that put the Association in the position of having to scramble for alternatives when the Patient Protection and Affordable Care Act began to be implemented and the AVMA's GHLIT underwriter, New York Life Insurance, announced that they would be canceling health insurance plans at the end of 2013.¹⁸ The Association claims to have worked with the Health and Human Services Department during 2012 to find ways to keep the current health insurance plans in place, but there was no degree of transparency. Many members received no communication regarding the association's efforts or the issue's potential outcomes until letters informing members of the cancellation date of their health insurance were sent.¹⁹

In the hyper-political climate we all endured last year, as well as the years during which Obamacare was debated and voted upon, the AVMA chose to avoid wading into political waters with their membership. At no point did they poll their membership for opinions on the matter, and at no point did they inform their membership of potential consequences based upon legislative acts and electoral results.

We are aware of the progress with GHLIT partnering with Cigna and Humana, and it is important for those members who were facing the loss of coverage to obtain good coverage. But things should never have come to a head as they did. Inactivity, a reluctance to appear politically incorrect before one group of people or another, and distracting busy work created a scenario within our profession's largest representative association that prevented them from efficiently and optimally serving their members.

While the AVMA performs many functions well, members are questioning the value they receive for their dues. Conventionally, organizations serve themselves before their membership. AVMA has kept itself occupied with the above accomplishments- but they are accomplishments that do more to provide organizational job security than enable members to prosper. Our profession cannot afford this model anymore; our economic climate demands tangible return on investment. The AVMA will have a difficult time sustaining the vital functions we need it to perform well if even a significant minority of members must leave for lack of value.

Some veterinarians have already assessed the Association, decided that it provides little benefit, and joined the ranks of former members.²⁰ They have learned that life goes on, and that there is little consequence to them of no longer being a member. However we risk "eating an elephant one bite at a time." By weakening our collective representation we risk losing our ability to have a unified voice, and devolving into a noisy hubbub. Rather than telling individual veterinarians to keep giving money and start giving more time, we challenge the AVMA staff and leadership to give better service that justifies the level of commitment its members are already demonstrating. Meeting this challenge demands the AVMA listen first to practicing veterinarians rather than dismissing them as being unable to appreciate the professional climate.

Footnotes
(a) Pion, Paul. Email communication with E. Myers. 5 February 2013.

References
(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) AVMA@Work Editor. "New Staff Position to Coordinate International, Diversity Activities." AVMA @ Work Blog. Web. 25 September 2012. Accessed: 10/2/2012. Available at: <http://atwork.avma.org/2012/09/25/new-staff-position-to-coordinate-international-diversity-activities/>

(3) Committee on International Veterinary Affairs - Entity Description. Web. Accessed: 1/30/13. Available at: <https://www.avma.org/About/Governance/Councils/Pages/Committee-on-International-Veterinary-Affairs-Entity-Description.aspx>

(4) DeHaven, R. Web Comment. "New Staff Position to Coordinate International, Diversity Activities." 25 September 2012 at 4:37 pm. Accessed: 10/2/2012. Available at: <http://atwork.avma.org/2012/09/25/new-staff-position-to-coordinate-international-diversity-activities/#comment-5421>

(5) AVMA Office of the Executive Vice President. "AVMA's Current Role in Global Veterinary Activities." Accessed March 25, 2013. Available at: <https://www.avma.org/KB/Resources/Reports/Documents/Resolution-9_Report_FINAL.pdf>

(6) AVMA 2013 Final Budget, in the 2012 HOD Proceedings. Web. Accessed: 1/13/2013. Available at: <http://www.justvetdata.com/avma_budget>

(7) DeHaven, R. Web comment. "New Staff Position to Coordinate International, Diversity Activities." 29 September 2012 at 11:01 am. Accessed: 10/2/2012. Available at: <http://atwork.avma.org/2012/09/25/new-staff-position-to-coordinate-international-diversity-activities/#comment-5445>

(8) Myers, E., DVM, MS; Gates, RG., DVM. "Benefit versus cost of recent AVMA moves." J Am Vet Med Assoc, 2013;242:1340-1342.

(9) AVMA@Work Editor. "MyVeterinarian.com Pulls into Town." Web. Accessed 2/28/2013. Available at: <http://atwork.avma.org/2011/12/20/myveterinarian-com-pulls-into-town/#comments>

(10) Myers, E., DVM, MS; Gates, RG., DVM. "Benefit versus cost of recent AVMA moves." J Am Vet Med Assoc, 2013;242:1340-1342.

(11) Ibid.

(12) AVMA NOAH Discussion Forum. Web. Accessed 2/18/2013. Available to AVMA members at: <https://www.avma.org/Members/Community/Discussions/Pages/AVMA-NOAH-Discussion-Boards.aspx#ctl00_breadcrumb_SkipLink>

(13) AVMA to replace its logo. Web. Accessed 2/26/2013. Available at: <https://www.avma.org/News/JAVMANews/Pages/130301g.aspx>

(14) Myers, E., DVM, MS; Gates, RG., DVM. "Benefit versus cost of recent AVMA moves." J Am Vet Med Assoc, 2013;242:1340-1342.

(15) AVMA@Work Editor. "A New AVMA Logo? Here's why" Web. Accessed 1/31/2013. Available at: <http://atwork.avma.org/2013/02/26/a-new-avma-logo-heres-why/>

(16) AVMA@Work Editor. "Doctor, Have You Checked Your Website's Pulse Lately?" Web. Accessed 1/31/2013. Available at: <http://atwork.avma.org/2013/01/30/doctor-have-you-checked-your-websites-pulse-lately/>

(17) NOAH Discussion Groups for AVMA Members. Web. Accessed 2/5/2013. Available at: <https://www.avma.org/members/community/discussions/pages/default.aspx?PF=1>

(18) Aspros, D., DVM. "A Message to AVMA Members about GHLIT Medical Coverate" Web. Accessed 5/17/2013. Available at: <https://www.avma.org/PracticeManagement/Insurance/Pages/MessagetoAVMAMembersGHLIT.aspx>

(19) AVMA@Work Editor. "Important News about AVMA Medical Insurance" Web. Accessed 5/17/2013. Available at: <http://atwork.avma.org/2012/12/19/important-news-about-avma-medical-insurance/>

(20) The authors of this piece each resigned their membership for different reasons. Dr. Gates resigned over a series of policy disagreements which he decided were not worth his financial support, some of which have been listed here. Dr. Myers resigned because she was not being paid enough for her professional activities to cover the cost of membership. Neither have regretted their decision, although both regret that they felt they had to make it. Both would like to see their profession's largest representative association better represent practicing veterinarians on a broad basis.