Veterinary education enrollment worries

NATIONAL REPORT — An influx of new DVMs to satisfy a perceived workforce shortage could pose serious long-term economic problems, veterinary officials say.

Enrollments are increasing at veterinary schools and three new veterinary programs are in development. Simultaneously, 51 percent of veterinarians are reporting a net drop in patient visits according to newly released data from the Bayer Veterinary Care Usage Study by the National Commission on Veterinary Economic Issues (NCVEI) and Brakke Consulting. Factor in accreditation of foreign veterinary schools, and some say it foreshadows a kind of economic train wreck.

"We don't need any more companion-animal veterinarians. I'm firmly convinced of that," says Karen Felsted, CPA, MS, DVM, CVPM, and executive director of NCVEI.

A recent committee statement from the American Association of Bovine Practitioners echoes the same concerns.

Other sectors of the profession may be different, but those sectors have smaller needs and may not need as much room to absorb the increasing number of students being enrolled at domestic and off-shore veterinary colleges, she says.

"If you look at some of the other fields, without a doubt, there are areas that needa veterinarian," says Felsted. "But I don't think it's that simple. You really have to look at the underlying reasons why there isn't a veterinarian there."

The profession needs to more closely examine why some areas are underserved by veterinarians, Felsted says. Some rural areas may not provide enough work to support a practice, clients may not want to pay reasonable fees for veterinary care, or veterinarians may not want to live there.

"Until we figure out those issues, just graduating more veterinarians isn't going to be the solution," she says.

On the companion-animal side, Felsted says the recession has been tough on practices. More new veterinarians in that market could lead to greater price competition, spreading clients over more practices so that DVMs won't be able to earn enough to pay back their student debt.

But more new graduates are coming and because of enrollment increases the number of new graduates will increase by roughly 300 over the next few years at U.S. veterinary colleges alone.

One side of the argument for increased enrollment is that some groups, like the Bureau of Labor Statistics, predict a need for more veterinarians in the future. Leaders in veterinary education say they're answering that call, preparing for a future need. But some have argued that the colleges are increasing enrollment to make up for revenue shortfalls and flooding an already saturated veterinary job market.

"Pre-recession, the schools weren't as short of money," Felsted says. "The recession has really killed the schools, and it's hurt veterinary practices, so now these issues are more critical."

Schools are expected to deliver a high-quality education for less. Add to that the growing difficulty new graduates have in finding jobs, and Felsted says she doesn't envy the challenges facing veterinary colleges.

Dr. Bennie Osburn, dean of the University of California-Davis School of Veterinary Medicine, understands both sides of the debate. "I know new graduates are not able to find jobs where they want to go. We will not need as many jobs as we needed in certain areas of the United States," Osburn says. "On the other hand, schools cannot turn the spigot on and off like that." Osburn is in his final days as one of the longest-serving deans in the nation and has played a role in several recent studies trying to get to the root of the veterinary workforce issue and how education must adapt to the future.

Dr. Sheila Allen, dean of the University of Georgia (UGA) College of Veterinary Medicine, says the problem is regional. "In our area, our students might not have multiple job offers, or the exact job they want and where they want, (but) our graduates have been able to find jobs," Allen says. "I recognize that in some places graduates are having a more difficult time."

Changing financial structure

Part of the problem for veterinary schools, Osburn says, is that society no longer wants to bear the burden of higher education costs.

"We're having to figure out how to put on the quality programs we've done in the past without (state support). Much of this is being transferred to the backs of students," Osburn says.

Client revenue should start paying for training in teaching hospitals, Osburn says, and faculty salaries will be more dependent on research grants and service contracts.

"What was a state-supported program is now becoming a business model, and the real problem is it's taking place so quickly for us, it's causing problems," he says.

Veterinary college deans are being asked to take on more nonresident students, who pay more in tuition, Osburn says. This is at a time when schoools are reducing support staff and faculty.

Allen agrees that some colleges are resorting to enrollment increases—especially of out-of-state students—to make up for revenue shortfalls, but she cautions against such practices.

"The main reason our veterinary schools were established was to meet the needs of the state, and if you're running your school on out-of-state tuition, it's not sustainable," she says.

As for those schools instituting major enrollment increases, Allen adds, "I would wager most of those additional spots are for out-of-state students, so what impact that will ultimately have on the local job market remains to be seen."

Allen suspects schools in states with low population growth, low tax rates and budget cuts are probably the ones increasing enrollment for out-of-state students in order to "keep the college up and running for constituents."

Creative thinking

There are other ways to keep veterinary education fiscally sound, the deans say.

Education will have to be provided in new ways, Osburn explains, with more resource-sharing among veterinary colleges. One college may house a swine program while another offers a poultry program, rather than each school offering the same thing, he says. Distance learning opportunities would help facilitate this kind of resource sharing across regions.

But enrollment decisions based on making ends meet rather than meeting the market's need may be a mistake, she says.

"I don't think that is a prudent way to manage your operating budget but it's easy for me to say that because we're in a much better situation than some veterinary schools," Allen says.

Georgia has seen double-digit population growth in recent years and cuts to the veterinary school, while not easy, have not been as severe as at other veterinary colleges, she adds.

But there's also an argument for increasing enrollment, Allen says, explaining that the desire of many students to become veterinarians will send them off-shore if they can't reach their goals here.

"Whether we meet it or they go outside the United States, those students are going to become veterinarians," she says. Those students will go abroad if they can't get into a U.S. veterinary school and come back with double the debt of the students educated here. "(Veterinary) positions are going to be fought for by U.S. citizens who are getting educations elsewhere, also."

Allen wonders why veterinary schools would want to chance giving up that enrollment to foreign colleges.

The problem of job market saturation occurs when students from out-of-state attend veterinary school and then want to work in an area that is facing slow population growth and can't support more veterinarians. New veterinarians, or those that can't find jobs where they want, need to be flexible, she says.

"It's not something where we can cast a wand over the country and solve the problem," she says.

Understanding workforce trends

Leaders in the profession have been looking at the veterinary job market for some time, and Osburn and Allen both played a role in the compilation of a report that has been more than four years in the making. The National Research Council began work on a $600,000 study, which was originally slated for completion in just 18 months, in 2007 to examine the present and future veterinary workforce needs. The study is now slated for release this fall.

Part of the problem in understanding the needs of the veterinary workforce has been gathering the initial data, Osburn says. With such a diverse profession, it's difficult to see what's out there and figure out what will be needed in the future.

"We anticipate the future probably not really as well as we need to," he says.

Consider that 17 percent of veterinarians are over the age of 60, he says, and, in large-animal practice, 40 percent to 50 percent are over 50 years of age. Those people will have to be replaced eventually, he says.

"If you cut back on anything right now, what's going to be out there to replace them in eight to 10 years?" he asks. "We cannot necessarily shut down the pipeline at this point.

"If we stop all of these things, we won't be able to come back very fast, if at all. I'm not saying we try to encourage a lot individuals at the moment to go into large-animal practice, but need to work with stakeholders and regulators and better determine what we should be looking for five to 15 years from now."

As for advice for new associates in the job search, Osburn says cross-training and an open mind are key.

"At the moment, I would say, you need to be coming in with an understanding of comparative medicine as you graduate. So you need to be knowledgeable in more than one species of animal and keep your options open as you're moving through training."

Veterinary schools will need to train new DVMs differently, too, he says, in a way that gives students the skills practices need in doctors.

"We're going to have to change our offerings in the schools and colleges.

Veterinary education's future

The North American Veterinary Medical Education Consortium (NAVMEC) has been working on creating a "roadmap" for the future of veterinary education, and was approved at the American Veterinary Medical Association meeting in July. Osburn, who served on the NAVMEC committee, says the report will offer suggestions about some of these changes so that veterinary colleges can incorporate them into the curriculum. Changes are being made already, but those changes will take four years to have an impact on new graduates, he says.

"The graduates now are caught in this trough where the changes are not complete yet," he says. "And the economy is such that the salaries are not up to where its going to be easy to pay off their debts right away. It's really a tough time all the way around. I don't know a time in veterinary history, at least in this country, where everything came together like this."

Allen says she strongly endorses most of the recommendations in the NAVMEC report, adding that many of those ideas are already being put into practice in veterinary colleges. At the University of Georgia, communications skills are emphasized to a great degree, she says, as well as personal and practice financial management.

"What we try to emphasize is you can't be a very good veterinarian unless you run a financially sound business," Allen says. "That's what we are trying to get the students to have an appreciation for before they graduate."

Going forward, it won't work for new DVMs to take 18 to 24 months to bring in their salary, Osburn says. They need to be able to "at least be a contributor within six months."

Not all of this can be accomplished within the walls of veterinary school, though. New graduates must be willing to take a risk, he says.

"I know that it's hard, because the way you build up the relationships in a community takes some time. It's easier to go into a practice that's going to pay you something rather than stepping out on your own," Osburn says.

Loan-repayment programs to attract new graduates into underserved areas of the profession have benefits, even if students question how they will be able to make a living in rural areas that previously have not supported a veterinary practice, Allen adds.

"If you have help paying off your loan, that makes up for less salary and they also have lower cost of living," she says. "They will be able to invest in purchasing a practice much earlier than a student who has that debt burden to worry about ... it's a balancing act."

While food-animal medicine is a primary area of concern when it comes to workforce shortages, Allen says the way veterinarians care for large populations of animals has changed. Veterinarians help producers care for their stock now, rather than focusing on individual animals. What once took many veterinarians will require fewer in the future. But overall, more veterinarians will be needed to care for animals of all kinds in the coming years, Allen says.

"In general, as the population grows, the need for veterinary services will grow. It just depends on what part of the country and what part of veterinary medicine you are employed in," she says. "There's sectors of our profession that will have needs in the future that must be met."

At UGA, more students have been pursuing mixed-animal medicine rather than strictly large- or production-animal tracks.

"They want to make sure they are prepared for any part of the job market," Allen says.

Still, despite the best efforts of veterinary colleges in trying to guide students into underserved areas, Felsted says it's a tough sell.

"You can expose people all the time to different opportunities," she says. "But if fundamentally what they want to be is a companion-animal veterinarian, that is what they are going to be."

On the practice side, Osburn wonders what veterinarians are doing to strengthen the profession for the next generation and how academia can help them with that monumental task. What are companion-animal veterinarians doing to improve wellness care and establish value for themselves? Companion-animal practitioners are facing what large-animal veterinarians did 25 years ago, he says—losing revenue as more medicines are sold over the counter.

"They've taken that market away from the companion-animal practitioners. What do they do next? We need to be working on this in the schools and looking at better practice models than in the past."

But academia can only do so much.

"In my mind, and I think many others, there are only 26 states that have veterinary schools and colleges, and we're here to provide mainly a workforce that feeds the whole country, that protects it from many emerging diseases ... and there's essentially no federal funding for anything other than research," Osburn says. NAVMEC and the workforce study won't solve all the profession's problems, but they will offer suggestions for a direction for the future, he says.

"We have to add value to what our veterinarians are doing," he says. "We're all facing a more business-directed model than we've ever done, and we have to step up to these things."

Moving forward, students should focus less on starting salaries and more on being flexible, Allen says. There are shortages in some areas of the veterinary workforce and saturation in others, Allen says, but overall, the situation isn't as dire as some say.

"I don't think we can paint the picture with one brush stroke," Allen says. "There are many of us who are frustrated by all the sky-is-falling rhetoric. Much of it is anecdotal and does not necessarily reflect the whole profession."

"I think it's very scary to be a new veterinarian right now," concludes Felsted. "It's just so unclear if, and when, the good times are going to come back."