Commentary: compensating trainees as paid staff

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Every year, many young veterinarians match into internship and residency programs across the United States and Canada, entering postgraduate training programs to practice their skills or become highly specialized in a particular area. Along a career path that can sometimes seem like an endless series of low- and high-level decisions, the choice to pursue additional training is a major one, including a commitment to consistent long hours of hard work, a resolution to perform sometimes menial tasks, and the expectation of a meager salary.

The desire, or even ability, to take on those additional years of lost income plays an important role in the decision making of new veterinarians as they navigate growing debt loads, attempt to balance the stressors of professional life with enriched personal lives, and recognize the value of their time and education. As the industry struggles to address mental health, burnout, and suicide, the authors of a new study hope to challenge the profession to reframe the approach to postgraduate compensation from ‘what can we afford to pay’ to ‘what should we pay.’

Calculating a living wage

A new study recently published in the Journal of the American Veterinary Medical Association¹ took a quantitative and focused approach to demonstrating just how much financial strain postgraduate training may cause by considering regional cost of living. Financial strain and inadequate financial reward are noted in the study as documented risk factors for burnout and poor well-being. Considering the length of careers, these stressors during postgraduate training could accelerate the path to burnout and poor well-being. Although trainee compensation has been discussed for years, it is not clear that locations have determined compensation proportional to cost of living. That disparity affects peoples’ choices and, ultimately, their careers and lives.

To study the correlation between postgraduate compensation and cost of living, intern, and resident salaries were evaluated and controlled for cost of living by using the Massachusetts Institute of Technology’s Living Wage Calculator.¹ This tool calculates the local minimum subsistence income required for an individual to live without having to rely on state or federal assistance programs, such as food stamps. Therefore, a living wage only really accounts for the most basic of needs and doesn’t allow for things such as savings, loan repayment, caring for pets, eating out, or vacations.

By comparing specific program salaries with the local living wage, the authors determined that 15% of residency programs and 22% of internship programs had a negative income surplus, or rather, the annual living wage was higher than annual program salary before considering taxes.¹ Programs in academic institutions were compensated at a lower rate compared with those in private practice. Despite the urban location of many of these practices, the effect was not diminished even after controlling for regional cost of living. The hourly compensation rate, calculated using average working hours reported by the American Association of Veterinary Medical Colleges from a recent survey of resident and intern house officers,² was also strikingly low; 85% of all residency programs and 92% of all internships provided hourly compensation lower than hourly living wages, and 17% of internships and 14% of residency programs provided compensation lower than an hourly minimum wage.¹

Overall, there was minimal correlation between cost of living and how much salary a program offered, meaning employers may not consider what their trainees might need to live on when setting salaries.

The effect of income on opportunity

Poor salaries likely create barriers to opportunity for socioeconomic, racial, ethnic, and gender diversity.

“We’ve shown elsewhere that on the other side of a residency, depending on the type of residency, you may be rewarded financially but you also may not be.^3,4 We’ve also shown before that specialties do not represent women, married women with children, or people of color at rates equivalent to the rest of the profession or, certainly, the general population,”^3-7 said investigator and study author Samantha L. Morello, DVM, DACVS-LA.

Although the reasons for this are multifactorial, Morello argues that economic constraints pose challenges to families and create additional obstacles or difficulties for groups that may already lack available resources for career advancement.

The effect of student debt on mental health

The loss of friend and colleague Josh Smith, DVM, DACVECC, to suicide in March 2021 has sent ripples through the veterinary profession.

“The circumstances that contributed significant stressors in Josh’s life appear directly attributable to vast student debt [that has] accumulated over years of postgraduate training. As a specialist, I asked myself, ‘What more can we be doing as mentors, program directors, and employers to set up trainees for success outside [and inside] the clinic?’” said Kai-Biu Shiu, BVMS, DACVIM (Oncology), MRCVS, coauthor of the study.

The weight of low wages, income loss on future gain

This team of investigators was rounded out by Joe Thurston, BS, a third-year veterinary student at the University of Wisconsin-Madison, who has a passion for improving veterinary student financial literacy and well-being, mainly through his role as national vice president of the Veterinary Business Management Association. Thurston noted that the short-term effect of lost income during years of very low compensation can have major long-term effects, mainly through an inability for young veterinarians to establish investment savings and retirement accounts. “The most common piece of advice I’ve heard for young professionals is to start an emergency fund and begin some form of savings. Unfortunately, neither of these are easily achievable on the average intern or resident salary,” he said. The low income can also contribute to physical health stressors.

“Interns and residents rarely have time to cook, much less exercise, and low income can limit access to quality ingredients, leading to a reliance on low-cost, ready-made meals. This, coupled with a high-stress work environment, can quickly deteriorate one’s physical health,” Thurston said. Amid growing private equity and new multimillion-dollar hospitals and housing equipment for pets, it is increasingly distressing to understand how the profession consistently fails to provide a living wage to such a large and important subset of the workforce.

Additionally, interns and residents aren’t the only ones who experience inadequate compensation for their time and value. Technicians represent another huge group currently suffering from the same issue. Morello, who has spent her career in the equine industry, cites this as a problem that has plagued young, particularly female, equine associates for many years.

Morello has spent years researching professional sustainability and economic issues in veterinary medicine with a particular focus on gender and feminization. She now works collaboratively as a courtesy associate professor with Cornell University’s Center for Veterinary Business and Entrepreneurship to continue pursuing a goal of improving personal and professional lives through research that can help advance workplace structures and guide career decisions.

“We wanted to ignite a conversation here, with the best data and discussion around the most important and relevant issues we could provide. Veterinarians are scientists and leveraging evidence about veterinary life through research is a great pathway to guide meaningful change,” Morello said

References

1. Morello SL, Shiu KB, Thurston J. Comparison of resident and intern salaries with the current living wage as a quantitative estimate of financial strain among postgraduate veterinary trainees. J Am Vet Med Assoc. 2021;260(1):124-132: doi:10.2460/javma.21-07-0336
2. Peterson M. Clinician Wellbeing Initiative: Veterinary Intern and Resident Wellbeing Study. Presented at: 2021 American Association of Veterinary Medical Colleges Annual Meeting; March 4-6, 2021; Washington, DC.
3. Morello SL, Colopy SA, Bruckner K, Buhr KA. Demographics, measures of professional achievement, and gender differences for diplomates of the American College of Veterinary Surgeons in 2015. J Am Vet Med Assoc. 2019;255(11):1270-1282. doi:10.2460/ javma.255.11.1270
4. Morello SL, Colopy SA, Chun R, Buhr KA. Work, life, and the gender effect: perspectives of ACVIM diplomates in 2017. Part 1-specialty demographics and measures of professional achievement. J Vet Intern Med. 2020;34(5):1825-1836. doi:10.1111/jvim.15872
5. Colopy SA, Buhr KA, Bruckner K, Morello SL. The intersection of personal and professional lives for male and female diplomates of the American College of Veterinary Surgeons in 2015. J Am Vet Med Assoc. 2019;255(11):1283-1290. doi:10.2460/javma.255.11.1283
6. Morello SL, Colopy SA, Chun R, Buhr KA. Work, life, and the gender effect: perspectives of ACVIM diplomates in 2017. Part 2-the intersection of personal life and professional career. J Vet Intern Med. 2020;34(5):1837-1844. doi:10.1111/jvim.15873
7. Morello SL, Genovese J, Pankowski A, Sweet EA, Hetzel SJ. Occupational segregation by gender in veterinary specialties: who we are choosing or who is choosing us. Vet Surg. 2021;50(6)1191-1200. doi:10.1111/vsu.13676