Rural vet crisis: USDA fends off critics

WASHINGTON — Proponents of an overdue national program to beef up veterinary medicine's presence in underserved, largely rural areas are pressuring its administrator — USDA.

In the coming weeks, Agriculture Secretary Mike Johanns is expected to address Congress concerning the United States Department of Agriculture's (USDA) budget and departmental duties, including status of the National Veterinary Medical Services Act (NVMSA). The program, originally scheduled for implementation last October, now has no public release date, and department employees blame the lag time largely on bureaucratic red tape.

USDA's Dr. Gary B. Sherman, national program leader within the Cooperative State Research, Education and Extension Service, says he hopes "something significant will happen (to implement NVMSA) in the next few days."

"The wheels are turning, but we cannot go public with virtually anything about this. There are an awful lot of people working very hard," he insists.

That statement might not quell what appears a growing sentiment that USDA fails to take NVMSA seriously. At presstime, at least two congressional letters asking USDA to prioritize and accelerate the program emerged. Insiders like Dr. Robert Nichols, a Washington lobbyist for the American Veterinary Medical Association, predict more are likely to surface. Congress might even draw up a mandatory timeline for instituting NVMSA in the 2008 agriculture appropriations bill, he says.

"The issue is that USDA's not writing the rules for the program, which they have to establish before it's going to work," Nichols says. "We're doing a number of things to apply pressure, yet USDA won't even give an estimate as to when the rules will be done. It appears they are not acting in good faith."

Urgency swells

Sherman disagrees with that assessment, yet he acknowledges the veterinary profession's patience wears thin.

Critics want to know why NVMSA sits idle despite authorization of nearly $1 million in congressional funds since 2005. Enacted by President Bush in 2003, the program sanctions the agriculture secretary to contract with recent veterinary graduates who agree to provide veterinary services in shortage situations. Their incentive: a government payoff of qualifying veterinary educational loans.

The pressure to jumpstart NVMSA stems from the profession's migration toward small animal practice, which leaves large animal sectors scarce of DVMs and public health and food safety segments not far behind. NVMSA is an attempt to allay a crisis that, in extreme cases, forces owners to treat and euthanize their own animals in DVM-deficient rural areas and hinders bioterrorism safety when veterinarians' disease expertise acts as a first-line defense, officials say.

From the ground up

The loan-repayment deal sounds good on paper, but to make it work, USDA must first spell out a system for dispensing thousands of dollars in educational reimbursements.

Sherman admits authoring such a structure hasn't been easy. The process is expensive, time-consuming and under-funded. At USDA, $1 million creates "such a small program that it's extremely difficult to develop it," he says.

Another major challenge: There's no current program from which to model NVMSA. When the act was appropriated in 2006, little sufficient, objective data supporting the claim of shortages existed. Officials had no idea how to rank needy areas, especially when NVMSA refers to urban, rural shortages as well as those in the federal government. It also names deficient areas related to the advanced training of veterinarians, especially those pursuing post-DVM training food safety, epidemiology and public health.

With language that broad, determining the nation's most disadvantaged sectors presents an enormous challenge. Results cannot be anecdotal, Sherman says.

"That's especially important when you're giving away money," he says. "I know there is a fairly large contingent that points to the neediest sector being that of the rural practicing veterinarian, but Congress votes on the act in its final form. There's nothing in it that gives ranking of importance, and we have no authority to determine that unless studies say truly, this is an area of shortage."

Sherman now credits two National Academies of Sciences reports released in 2005 for giving USDA guidance as well as a number of recent peer-reviewed articles on the topic.

But those articles still provide only a fraction of the required evidence to make sweeping determinations, he says.

Self-improvement plan?

That lack of hard evidence leaves critics fearing rumors that USDA will earmark much of NVMSA's allocation to attracting veterinarians into needy areas within the department's Food Safety and Inspection Service (FSIS), which is responsible for ensuring safety of the nation's meat, poultry and egg supply.

"All federal employees are already eligible for loan repayment," Nichols says. "Now USDA has this pile of money from NVMSA, so using it to get veterinarians to agree to work in chronically short areas within FSIS seems feasible, but it goes against the spirit of this bill. The intent was to get vets out into rural, underserved areas."

Tightlipped about that possibility, Sherman reiterates that the act's language goes far beyond rural sectors.

"There's an awful lot of misinformation out there; that's not to say there aren't elements of truth," he says. "I'm a veterinarian, and I support this program, but until certain people at the secretary office's level give us the go-ahead, I cannot speak on details, including any level of involvement by FSIS."