4
General Conclusions and Recommendations

The data and findings detailed in Chapters 2 and 3 indicate that there is currently a shortage of veterinarians with expertise in laboratory animal medicine and comparative pathology. Evidence also indicates that veterinarian principal investigators comprise an unsatisfactorily small percentage of all RO1-funded principal investigators, and that to fully realize the potential of translational and transgenic research, more veterinarians need to be engaged in leading research programs involving integrative whole-animal research.

After reviewing all of the evidence available and deliberating on the cause of this shortage, the committee feels that while there are many factors that contribute to the lack of veterinarians in biomedical research, a key reason for this shortage is a lack of commitment from veterinary schools to educate veterinary students and graduates for careers other than private clinical practice. Veterinary schools and institutions that offer postgraduate training must reaffirm their role in educating students for all types of careers, including careers in biomedical research. Veterinary schools and postgraduate training institutions then must take steps to reshape pertinent policies and actions in the areas of admissions, recruitment, and curriculum.

The committee recognizes that many of the recommendations aimed at veterinary schools and institutions that offer postgraduate training will take several years to institute and reflect a long-term strategy for increasing the number of veterinarians entering postgraduate training programs. Therefore, the committee also developed short-term recommendations meant to increase the number of comparative medicine veterinarians over the next



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National Need and Priorities for Veterinarians in Biomedical Research 4 General Conclusions and Recommendations The data and findings detailed in Chapters 2 and 3 indicate that there is currently a shortage of veterinarians with expertise in laboratory animal medicine and comparative pathology. Evidence also indicates that veterinarian principal investigators comprise an unsatisfactorily small percentage of all RO1-funded principal investigators, and that to fully realize the potential of translational and transgenic research, more veterinarians need to be engaged in leading research programs involving integrative whole-animal research. After reviewing all of the evidence available and deliberating on the cause of this shortage, the committee feels that while there are many factors that contribute to the lack of veterinarians in biomedical research, a key reason for this shortage is a lack of commitment from veterinary schools to educate veterinary students and graduates for careers other than private clinical practice. Veterinary schools and institutions that offer postgraduate training must reaffirm their role in educating students for all types of careers, including careers in biomedical research. Veterinary schools and postgraduate training institutions then must take steps to reshape pertinent policies and actions in the areas of admissions, recruitment, and curriculum. The committee recognizes that many of the recommendations aimed at veterinary schools and institutions that offer postgraduate training will take several years to institute and reflect a long-term strategy for increasing the number of veterinarians entering postgraduate training programs. Therefore, the committee also developed short-term recommendations meant to increase the number of comparative medicine veterinarians over the next

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National Need and Priorities for Veterinarians in Biomedical Research five years. These recommendations include retraining private clinical practice veterinarians for careers in biomedical research. RAISING AWARENESS The comparative medicine community must actively work to raise awareness of the role of veterinarians in biomedical research. Outreach programs should target the lay public, veterinary practitioners, and veterinary and pre-veterinary students. Educational campaigns can be very effective; however, it must be recognized that they are long-term solutions to an apparent shortage of comparative medicine veterinarians. Veterinary Community It is vital to raise awareness within the veterinary community of the importance of comparative medicine to both biomedical and veterinary medical research. Comparative medicine veterinarians need to influence decisions regarding curriculum within their veterinary schools. They should educate their fellow clinical faculty about the importance of research in general and encourage the use of examples of experimental research during didactic training. Professional societies could address this issue at a national level by encouraging the editorial staff of the Journal of the American Veterinary Medical Association to devote an issue to biomedical research. Current and Future Veterinary Students Comparative medicine veterinarians must be active in raising the awareness of middle- and high-school, college, and veterinary students about careers in comparative medicine. Veterinarians can be proactive by volunteering for outreach programs at middle and high schools, participating in undergraduate career forums, and supporting the establishment or expansion of veterinary student clubs. Faculty mentoring is perhaps the most effective tool for identifying students with an aptitude for and interest in comparative medicine. All comparative medicine faculty should make efforts to interact with first- and second-year veterinary students and to mentor those who show interest in comparative medicine. They should also ensure that their schools increase efforts to inform veterinary students of research training opportunities and should seek to establish research-training programs (summer externships and 1-year research fellowships for veterinary students) if they do not already exist at their institutions. Professional societies, such as ACLAM and ASLAP, can also be proactive in their efforts to attract veterinary students to careers in biomedical science. This can be done by establishing and/or supporting a biomedical

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National Need and Priorities for Veterinarians in Biomedical Research science career day at veterinary schools. Career days provide an opportunity to offer information and guidance to veterinary student on the various career pathways available to them in biomedical research. It is important that veterinary students are made aware of the benefits of a career in comparative medicine. For example, the average salary of a laboratory animal medicine veterinarian in 2002 was $117,240 (Weigler and Huneke, 2003) compared with the average salary $83,979 of a veterinarian in private practice in 2001 (Anonymous, 2003). While higher salaries in comparative medicine careers will eventually draw more individuals into these careers, this type of market-based solution to the apparent shortage of veterinarians in the biomedical research workforce is a long-term solution, especially as it was not apparent to the committee that this information filters down to the student population. It is therefore important to also employ short-term strategies to address this shortage. These short-term strategies, such as retraining private practice veterinarians, are discussed later in this chapter. Public Awareness Veterinary societies must take a leadership role in educating the public through mass-media exposure to emphasize the importance of animals in biomedical research, the role of veterinarians in advancing biomedical research, and the role of veterinarians in refining and ensuring the humane care and use of laboratory animals. Veterinary societies should develop relationships with state biomedical research organizations—such as the Massachusetts Society for Medical Research, the North Carolina Association for Biomedical Research, and Connecticut United for Research Excellence—to establish outreach programs with local elementary and middle schools. ACQUAINTING STUDENTS WITH CAREER OPPORTUNITIES IN COMPARATIVE MEDICINE An effective method of maintaining student interest in comparative medicine throughout the veterinary-school experience is the use of summer research externships. Perhaps the best known of such programs is the Leadership Program for Veterinary Students, established in 1990 by Cornell University. Research training and experience are the foundation of the program, in which veterinary students pursue individual research projects under the guidance of Cornell faculty members. The aim of the program is to provide veterinary students with experiences that clarify and strengthen their commitment to careers in science. Students from 49 veterinary colleges worldwide have participated in the program. Participants are sup-

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National Need and Priorities for Veterinarians in Biomedical Research ported by NRSA: Professional Student Short-term Research Training (T35) awards, foundations, and industry. A recent survey of 280 of the 283 program graduates indicated that 44% have pursued research careers, 21% are engaged in postgraduate training or finishing veterinary school, and 34% went into private practice. Summer research externships provided through the program had favorable effects on the research interests of participants and their career trajectories. The committee recommends that veterinary schools take advantage of the T35 awards. The number of T35 awards that provide 2 to 3 months of research training to veterinary students has increased steadily, by 400% over the last decade (Table 4-1), and the average success rate of competing applications is 66%. NIH should ensure the continued success of the T35 program with adequate funding. In addition to summer fellowship programs, establishing 2- to 4-week externship blocks at academic institutions or in industry settings provides a good opportunity for veterinary students to be exposed to laboratory animal medicine. ACLAM has a funding mechanism that supports 10 externships per year. Industry has expanded the concept and contributes to the education of future comparative medicine veterinarians by offering opportunities for externships. Veterinary schools should aggressively educate students about the externships available. Having recognized the importance of increasing the numbers of veterinarians in biomedical research, NCRR has instituted a new funding mechanism, an NRSA: Training for Veterinary Students in Animal-oriented, Hypothesis-based Research: Institutional Training Award—the “new” T32. This mechanism enables institutions to award grants to veterinary students to support one year of training in hypothesis-based laboratory animal medicine, comparative medicine, pathology, or a related field of biomedical research. The first of these awards will be funded in 2003. VETERINARY-SCHOOL RECRUITMENT To increase the number of veterinary school applicants who have an interest in comparative medicine, recruiters can target colleges and universities that offer bachelor’s-degree programs in animal science or that TABLE 4-1 NRSA: Professional Student Short-Term Research Training Grant (T35) Awards Funded by NCRR, 1995-2002   1995 1996 1997 1998 1999 2000 2001 2002 Number of Grants Awarded 2 3 3 4 4 6 7 10   Source: NIH, CRISP database.

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National Need and Priorities for Veterinarians in Biomedical Research emphasize mentoring of undergraduates in biomedical research. By developing strong ties to those institutions, veterinary schools can ensure a steady flow of applicants interested in comparative medicine. It is necessary for admission committees to recognize the need for and value of comparative medicine veterinarians. Veterinary schools should encourage their admission committees to select students with different backgrounds and career objectives to match the breadth of the veterinary profession’s responsibility to society. Admission offices should make applicants aware that the selection committee values an interest in comparative medicine or previous research experience. Acceptance into veterinary schools is highly competitive, and applicants might not express an interest in a non-traditional career path, fearing that it will affect their chances of acceptance. CHANGES IN VETERINARY-SCHOOL CURRICULUM One way to increase the exposure of veterinary students to comparative medicine is through coursework in laboratory animal medicine. In a recent AAVMC survey of the top 27 NIH-funded veterinary schools, only six of 22 respondents required one or two courses in laboratory animal medicine (none required more), 13 offered electives (from one to six electives), and three offered no courses in laboratory animal medicine. Given those results and the clear need for veterinarians to enter comparative medicine, the committee recommends that all veterinary schools offer at least elective courses in laboratory animal medicine and that more veterinary schools require coursework in laboratory animal medicine. The coursework should emphasize facets of veterinary medicine involved in the research use of animals that is often absent in “pocket pet” coursework (pocket pet refers to rodents, rabbits, or other small animals kept as companion animals). Consideration should also be given to actively recruiting laboratory animal medicine specialists who are conducting peer-reviewed research for faculty positions at veterinary schools. Veterinary students can be further exposed to careers in biomedical research by the liberal use of examples involving laboratory animals in other coursework to promote understanding of biologic and disease processes. Many students are unaware of how advances in prevention, diagnosis, and treatment of diseases were attained. By exploring the research that led to breakthroughs, the students not only are exposed to the indispensable role of laboratory animals in research but also gain an appreciation for the importance of the research endeavor to advances in veterinary and human medicine. The committee acknowledges that although individual veterinary schools may recognize the importance of training laboratory animal medicine specialists, curricular content at many schools is influenced by state

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National Need and Priorities for Veterinarians in Biomedical Research legislatures and national board content, which can lead to reduced emphasis on didactic training in comparative medicine. The committee recommends that AVMA’s National Examination Board re-evaluate its emphasis on comparative and laboratory animal medicine in light of current societal needs. Veterinary schools must educate state government officials about the contributions of comparative medicine veterinarians to biomedical research and ultimately to the economy. MENTORING Although the Leadership Program for Veterinary Students has favorably influenced the career choices of its graduates toward research, a small group (2%) of its participants elected to pursue careers in private practice after 6 years or more of postgraduate training. Those few cited a lack of mentoring as contributing to their disillusionment with faculty appointments and to the challenges they faced in establishing independent research programs (D. McGregor, personal communication; McGregor and Fraser, 2002). That feedback highlights the importance of mentoring for veterinary students, residents, and postdoctoral fellows. Because the absolute number of veterinarians in comparative medicine is small compared with that in clinical practice, there is a constant need for individual veterinarians in comparative medicine to actively seek out and mentor students with an aptitude for and interest in comparative medicine. Veterinary schools focus on education for clinical domestic-animal practice, and most of their instructors are clinical practitioners. With such constant exposure to careers in clinical practice, the importance of every veterinarian involved in com parative medicine to be a mentor cannot be overstated. FINANCIAL ISSUES As highlighted by the ACVP survey, financial constraints are a source of serious concern to new veterinary graduates who are deciding whether to pursue postgraduate training. Debt burden and the comparatively low stipends available during postgraduate training are both factors. The AVMA annually surveys the graduates of veterinary medical colleges on employment, starting salaries, and education indebtedness. In 2001, the AVMA survey revealed that 85.4% of graduates of veterinary medical school incurred educational debt, and that 72% of indebted graduates had debt of $40,000 or more. The average debt was $67,819 (Wise and Gonzalez, 2002). This level of debt is comparable with the educational debt incurred by graduates of medical school. In 2001, 82.8% of medical school graduates had incurred educational debt and 83% of indebted graduates had debt

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National Need and Priorities for Veterinarians in Biomedical Research greater than $50,000. The average educational debt of medical school graduates in 2001 was $99,089 (AAMC, 2001). In contrast, in 2001, only 49.5% of graduates of research doctorate programs (PhD, DSc, and EdD) in the life sciences had incurred educational debt. Of indebted graduates, only 29.7% had debt greater than $30,000 (data on average educational debt are unavailable) (Hoffer et al., 2002). These individuals are usually supported by training grants and/or RO1 awards to the faculty mentor. It is evident that the educational debt incurred by veterinary medical graduates is significantly greater than that incurred by research doctoral graduates and is comparable with that incurred by graduates of medical schools. This difference is mostly due to the fact that the majority of research doctoral students receive support through teaching or research assistantships or fellowships. As evidenced by the 2001 Survey of Doctorate Recipients (Hoffer et al., 2002), only 15.1% of research doctorate graduates in life sciences used their own resources as the primary source of financial support. This is in contrast to veterinary medical graduates, who in 2001 indicated that on average, 91.2% of their educational debt was incurred while in veterinary medical school (Wise and Gonzalez, 2002). The high debt burden incurred by the average veterinary graduate has been identified as a significant barrier to pursuing postgraduate training (ACVP, 2002). In 2001, the average starting salary of veterinary graduates entering private practice was $44,547, and the average starting salary of veterinary graduates pursuing postgraduate study was $21,966 (Wise and Gonzalez, 2002). The prospect of an additional 1 to 3 years for residency training or 4 to 6 years to obtain a PhD while earning stipend-level salaries is a major deterrent to pursuing postgraduate training. To address concerns about the large debt burden that graduates of veterinary college face, a debt-repayment initiative similar to the NIH Clinical Research Loan Repayment Program should be initiated. In 2000, based on the assumption that large debt burden was a major impediment to medical school graduates pursuing postgraduate research training, the Federation of American Societies for Experimental Biology (FASEB) recommended that a national program for medical school debt forgiveness be established (Zemlo et al., 2000). In response, NIH established the Clinical Research Loan Repayment Program, authorized by the Clinical Research Enhancement Act (H.R. 2498). This program permits qualified health professionals who agree to conduct clinical research for 50% of their time for a 2-year period to receive education loan repayment equal to 50% of their debt up to $70,000. The Clinical Research Enhancement Act of 2000 indicated that one of the reasons for establishing the loan repayment program was the “average debt of $85,619” incurred by medical school graduates. The comparable debt incurred by the average veterinary school graduate is

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National Need and Priorities for Veterinarians in Biomedical Research the basis for the committee’s recommendation that NIH establish a Veterinary Research Loan Repayment Program that permits veterinarians who agree to conduct biomedical research to qualify for loan repayment. Modest residency salaries present an additional hurdle to pursuing postgraduate residency training. In the ACVP study, 57.1% of pathology training programs identified low salaries as a barrier to recruiting qualified applicants (ACVP, 2002). Veterinarians participating in postgraduate research training programs are generally paid according to the NRSA postdoctoral salary scale. In 2002, the NRSA postdoctoral salary was $31,092 to $48,852 and was based on years of relevant research training. The minimum NRSA postdoctoral salary is targeted to increase to $45,000 within the next few years. In contrast, veterinary residency training salaries in laboratory animal medicine were as low as $25,000 and averaged only $31,883 (Colby, 2002). To address the financial barriers to postgraduate residency training, the committee recommends increasing veterinary residency training salaries to eliminate inequities between resident salaries and research training salaries. The ability of academic institutions that sponsor residency programs to increase resident salaries is questionable because of the current economic difficulties faced by most universities and colleges. This academic constraint provides private industry with an opportunity to fund fellowships for training comparative medicine veterinarians. The growth of the pharmaceutical and biotechnology industries during the 1990s has contributed to the increase in demand for comparative medicine veterinarians. By contributing directly to residency training, private industry can actively participate in increasing the number of comparative medicine veterinarians. POSTGRADUATE TRAINING There are two avenues of postgraduate training for individuals interested in comparative medicine: clinical training (usually called residency training) and research training (often called postdoctoral fellowship training). While all comparative medicine veterinarians should receive research and clinical training to some extent, the main focus of a fellowship should be research training for the comparative medicine veterinarian interested in developing a career in research; the focus for a comparative medicine veterinarian developing a career in supporting biomedical research should be clinical training through a residency. Training Comparative Medicine Principal Investigators The committee has identified a need for more veterinarians to participate in biomedical research as principal investigators, and the first step

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National Need and Priorities for Veterinarians in Biomedical Research toward this goal would be to increase the number of people in research training programs. The NIH granting mechanism for postgraduate research training is the NRSA Institutional Research Training Award (T32), funded by NCRR’s Division of Comparative Medicine. The program provides up to three years of research funding for four or six postgraduate fellows per institution. Before an applicant is eligible for support through a T32 grant, the institution must support the first year of clinical training if the applicant has not previously had at least 1 year of clinical experience. This places a burden on the applicant who wishes to enter the training program immediately after graduation as well as on the institution, which must find alternative funding to support these individuals during the year of clinical training. As seen in Table 3-3, since 1994, the number of T32 awards has been relatively stable; there has been no increase in the number of awards commensurate with the initiative started in 1998 to double the NIH budget. However, as noted in Chapter 3, the T32 program is currently underutilized, and many institutions do not utilize the award to train the full complement of trainees (four or six) funded through the award. The committee recommends that each awardee institution fully utilize its T32 award and train the maximum number of trainees for which funding has been awarded. Congress established the NRSA in 1974 to consolidate the various research-training activities of NIH and the Alcohol, Drug Abuse, and Mental Health Administration. NRSA awards are to be made only in fields in which “there is a need for personnel” and should be responsive to research needs through periodic evaluations. In addition to developing young investigators with an interest in comparative medicine research, this program also provides a mechanism for quickly retraining private practice veterinarians in research methodologies to allow them to enter the comparative medicine workforce. However, in the committee’s experience, T32 programs are seldom utilized for this purpose. The committee therefore recommends that if the current T32 program becomes fully utilized, NIH should consider increasing the funding to this program to accommodate additional awardee institutions. Lack of federal funding for residency programs in laboratory animal medicine has been a topic of considerable debate since NIH re-evaluated the use of T32 awards to exclude the funding of clinical training (both MD and DVM residency training) in the 1990s (Jacoby and Fox, 1999). However, the T32 award still requires trainees to complete at least one year of clinical residency before they are eligible for support through the T32 award. The T32 training programs were forced to find alternative means to fund this clinical training, often coming up short (Jacoby and Fox, 1999). Trainees who focus on integrative whole animal research would be exposed to the clinical aspects of research, in much the same way that physicians receive clinical training pertaining directly to patient-oriented

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National Need and Priorities for Veterinarians in Biomedical Research research through a Mentored Patient-oriented Research Career Development Award (K23). This would also provide the trainees with clinical exposure to various animal models, eliminating the need for the one year residency requirement that has become a financial stumbling block for many T32 programs. In addition to the T32 awards funded by NCRR, there are also the National Research Service Awards for Individual Postdoctoral Fellows (F32). The F32 award is to support “promising applicants with the potential to become productive, independent investigators.” NCRR’s Division of Comparative Medicine specifically funds F32 awards to veterinarians to receive research training in comparative medicine. However, these awards are underutilized (Table 4-2), as few individuals apply for the F32 fellowship (F. Greider, personal communication). A groundswell of commentary on the need for physician-scientists during the middle 1990s (Shine, 1998) led to several changes, including re-evaluation of the composition of integrated review groups and of the level of support of MD-PhD programs through the Medical Scientist Training Program (MSTP), which is administered by the National Institute of General Medical Sciences. Acknowledgment by the research community, and NIH in particular, of the need for physician-scientists led to the increase in participation of physician-scientists in biomedical research. The committee recommends that veterinary schools with dual-degree programs seek support through the MSTP mechanism. Only one DVM-PhD program—at the University of Pennsylvania—is supported by the MSTP, and there have been no applications from veterinary schools in recent years. The University of Pennsylvania’s MSTP program has been successfully training veterinarian-scientists since its inception in the late 1970s; 85% of its graduates hold research positions in academic, government, or industrial organizations or are pursuing postdoctoral training (A. Kelly, personal communication). Several studies have recommended that there be no increase in the number of PhDs trained in the biomedical sciences (NRC, 1998b; NRC, 2000), but encouraging the pursuit of dual degrees for veterinarians would help to meet specific demands for integrative biologists and whole-animal scientists and would not contribute to the general overproduction of PhDs TABLE 4-2 NRSA: Individual Research Training Grant (F32) Awards Funded by NCRR, 1995-2002   1995 1996 1997 1998 1999 2000 2001 2002 Number of Grants Awarded 0 2 2 1 1 2 2 1   Source: NIH, CRISP database.

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National Need and Priorities for Veterinarians in Biomedical Research in the basic biomedical sciences. Veterinarians who receive dual degrees have unique clinical experience to contribute to the research enterprise, and they are in little danger of stagnating in postdoctoral or other temporary positions, as are many PhDs trained in the basic biomedical sciences (NRC, 2000). Veterinary schools should also aggressively encourage their faculty to apply for NIH grants. Enriching the quality of comparative medicine research through competitive applications provides a greater opportunity for postgraduate training of veterinarians and the availability of faculty that can teach comparative medicine courses. However, from 1999 to 2002, NIH awards to veterinary schools have accounted for an average of 0.8% of all the funds awarded through NIH grants (Figure 4-1). These data imply FIGURE 4-1 Total NIH grant awards versus NIH grant awards to veterinary schools. During the same time frame of the doubling of the NIH budget (1999-2002), the increase in the total NIH grant awards and NIH grant awards to veterinary schools were similar (48.3% and 48.1%, respectively). However, NIH grant awards to veterinary schools comprised less than 1% of the total amount of NIH grant awards. Grant awards include research grants, training grants, fellowships, and R&D contracts. Data on NIH grants to veterinary schools were unavailable for the year 2001. Source: National Institutes of Health, Office of Extramural Research.

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National Need and Priorities for Veterinarians in Biomedical Research that there is an opportunity for veterinary schools to increase their research funding through NIH, especially in light of the increasing emphasis on translational research and the extensive use of animal models during the last 5 years. To move veterinarians aggressively into roles as independent principal investigators, the K award system is administered by NCRR’s Division of Comparative Medicine. The Special Emphasis Research Career Award (SERCA), also called a K01 award, is awarded by NCRR to help prepare veterinary researchers for faculty appointments (Table 4-3). It is the only K award targeted specifically for veterinarians. In addition, there are a number of other K awards that are available to veterinarians, though it was not apparent to the authoring committee that young veterinarian researchers are being encouraged to apply for these awards. Nevertheless, some veterinarians have successfully competed for the Mentored Clinical-Scientist Development Award, K08, which is not funded by NCRR or specifically targeted to veterinarians. This award provides 3 to 5 years of support for mentored research experience and will support didactic training integrated into the research experience. In addition, there is a K23 award (Mentored Patient-oriented Research Career Development award) which is similar to the K08, except that it supports the career development of investigators with a commitment to focus their research endeavors on patient-oriented research. Training Comparative Medicine Veterinarians to Support Biomedical Research Efforts There is a great need for veterinarians to play an integral role in the biomedical research effort as clinical laboratory animal medicine veterinarians, pathologists, technical advisors, and animal resource program directors. The shift toward translational research has created a substantial need for veterinarians who have exposure to and experience with animal models in biomedical research to provide guidance to principal investigators. Not only has the reliance on animal models increased, but large numbers of investigators involved in molecular and cellular biology are also capitalizing TABLE 4-3 Special Emphasis Research Career Award (K01). SERCA Awards Funded by NCRR, 1995-2002   1995 1996 1997 1998 1999 2000 2001 2002 Number of Grants Awarded 19 22 19 18 20 18 20 24   Source: NIH, CRISP database.

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National Need and Priorities for Veterinarians in Biomedical Research on the recent advances in genomics with in vivo experimentation. Veterinarians who support biomedical research require exposure to research training but, most importantly, to clinical training in laboratory animal medicine or comparative pathology. As discussed in Chapter 2, a two-fold problem appears to be resulting in a decline in the number of individuals entering and completing laboratory animal medicine residencies—a lack of qualified applicants and a lack of funding for residency programs. Unfortunately, it is not clear from the data whether one problem has a greater effect than the other on the supply of laboratory animal medicine veterinarians. It is apparent, however, that residency programs in veterinary pathology are also struggling to attract adequate numbers of qualified applicants. In the ACVP survey (ACVP, 2002), 78% of veterinary pathology programs described having a somewhat or very difficult time in recruiting qualified applicants. While changes in veterinary-school curricula and the attitudes of veterinary-school faculty will eventually affect the applicant pool favorably, it may take many years to effect this change. Meanwhile, there are two courses of action that will positively affect the number of applicants: establishing a residency matching program and aggressively recruiting applicants. The current veterinary residency-matching program is administered by the American Association of Veterinary Clinicians. This program, designated Veterinary Internship and Residency Matching Program (VIRMP), is patterned after the Physicians National Intern and Resident Matching Program. The applicant supplies the VIRMP with a ranked list of residency programs of his or her choosing. The residency program then supplies the VIRMP with a ranked list of applicants who applied to that program. The VIRMP then matches the applicant with the program based on mutual levels of interest. Currently, 26 veterinary specialties participate in this program, but neither laboratory animal medicine nor pathology programs participate. This committee recommends that ACLAM and ACVP facilitate the registration of their associated residency programs with the VIRMP; alternatively, ACLAM and ACVP could establish their own matching programs. Concurrently, residency programs should recruit aggressively to increase the number of applicants immediately. There are indications that aggressive recruitment is effective. In 2002, one laboratory animal residency program recruited potential applicants aggressively and increased the number of applicants from approximately one to four per position (Colby, 2002). Addressing the issue of scarcity of funding for residency programs is more problematic. It is apparent that this issue stems from the fact that there is no clear funding mechanism for residency training in areas of

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National Need and Priorities for Veterinarians in Biomedical Research comparative medicine. While T32 programs were utilizing award money to fund trainees in clinical laboratory animal medicine or comparative pathology until the 1990s, residency programs have never had a formal funding mechanism through the federal government. Medical schools and hospitals have a well-established funding mechanism for supporting residency training. Physician residency programs are funded by the federal government, mostly by Medicare through Direct Medical Education Funds that are paid per resident and Indirect Medical Funds that supplement payment for patient care (AMSA, 2003); however, there is no equivalent funding mechanism for residency programs in laboratory animal medicine (Jacoby and Fox, 1999) or comparative pathology. Some have urged that individual institutions should support their residency programs by paying residents’ salaries from funds generated by per diem charges for research animals being used at the institution or through other institutional funding mechanisms. Others have countered that these approaches would severely limit the training of comparative medicine specialists, and they defend the benefits of a more formal funding mechanism for laboratory animal medicine and comparative pathology residency training. Per diem charges are already severely impacting the budgets of investigators utilizing animals and it is the committee’s opinion that principal investigator opposition to such an increase in per diem charges may be substantial and that few institutions would be able to successfully increase per diem charges to support their residency program. Additionally, academic institutions are facing other economic challenges that limit funding for professional salaries not covered by grant monies. There is no easy answer to this problem. Unlike medical residency programs, laboratory animal medicine residency programs have no formal mechanism established for funding. Although PHS requires the involvement of trained veterinarians in the execution of animal-based biomedical research, NIH has a firmly established policy that precludes PHS support of any type of professional residency training. Another option for funding residency programs at institutions that use laboratory animals is through funds generated by per diem charges; however, this places the burden for training on the investigative community, which makes this approach untenable in most instances, given their operational fiscal constraints. In addition, although veterinary schools support residency training for many specialties, such as cardiology and surgery, the majority of laboratory animal medicine residency programs are found at medical schools versus veterinary schools. To date, most veterinary schools have not expanded their residency training opportunities into the field of laboratory animal medicine. Based on the committee’s understanding of present funding options, the committee concludes that there is no mechanism currently available for procuring adequate and stable funding of laboratory animal residency programs. However, the

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National Need and Priorities for Veterinarians in Biomedical Research committee strongly supports the concept that granting agencies, current residency programs, and veterinary medical schools be charged with developing new avenues to fund laboratory animal medicine residencies. As discussed above, some residency programs have found alternative sources of funding from corporate entities (mostly pharmaceutical companies), who have acknowledged difficulties in recruiting qualified veterinary applicants for laboratory animal medicine and research positions. This problem has grown for corporate entities because they generate approximately 28% of the open positions for veterinarians (Table 4-4) and are the employers of an increasing number of ACLAM diplomates (Table 4-5). Several corporate employers have recognized that they can positively influence the pool of qualified applicants through support of postgraduate training (Bennett, 1994). These corporate employers support training through three mechanisms: (1) in-house residency programs, (2) cooperative programs with academic residency programs, and (3) by providing monetary support directly to residency programs. Organizations that have established in-house training and cooperative programs can benefit not only in the long-term, through an increased pool of qualified veterinarians, but also in the short term, through the skilled labor these veterinarians provide during their training. For other organizations that are too small or not interested in establishing residency programs, providing monetary support directly to academic programs is a way for them to contribute to efforts to increase the pool of qualified veterinarians. These innovative corporate employers have established several models through which other corporate entities can directly and indirectly help increase the pool of comparative medicine veterinarians. TABLE 4-4 Mean Number of Employment Advertisements per Year (+ SEM), by Sector, from COMPMED List-serv in 1999-2002a   Average Annual Number of Job Advertisements ± SEM Academic 68.5 + 8.1 Industry 28.3 + 5.0 Government 7.5 + 2.4 aCOMPMED is an e-mail forum for professionals working in biomedical research to discuss issues related to comparative medicine and laboratory animal medicine. Positions in organizations in the United States that required a DVM or VMD were tallied; duplicate postings were removed. Each position was categorized as academic (university or college), industrial (pharmaceutical, biotech, or laboratory animal breeding company), or government (NIH or USDA).

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National Need and Priorities for Veterinarians in Biomedical Research TABLE 4-5 Employers of Active ACLAM Diplomates by Sectora Employer 1981 1991 2001 Academic Organization       University or College 36 93 171 School of Medicine 54 64 67 School of Veterinary Medicine 20 24 13 Government Organization       Military 40 30 33 Other (e.g., USDA, FDA, NIH) 35 39 48 Corporate Organization (e.g., pharmaceutical, biotech, lab animal breeder or supplier) 45 78 162 Hospital 7 12 25 Primate Center 2 4 9 Other (e.g., nonprofit research center) 27 23 46 None listed 7 25 69 Total 273 392 643 aUnpublished tally of employers of active ACLAM diplomates listed in the ACLAM membership directories from 1981, 1991, and 2001. Some individuals at academic institutions did not identify their school and departmental affiliation; therefore, the tally of veterinarians at schools of medicine and veterinary medicine may be artificially low while the tally of veterinarians at a university or college may be artificially high. Alternatively, DVMs in these categories my be providing professional support university-wide, as well as for specific schools and departments. ATTRACTING VETERINARIANS INTO ROLES THAT SUPPORT BIOMEDICAL RESEARCH To attract more veterinarians into roles that support biomedical research, academic institutions should provide faculty appointments to comparative medicine veterinarians. It is the committee’s experience that many academic institutions do not provide faculty appointments to attending veterinarians, laboratory animal medicine clinicians, and other veterinary staff. Without an academic identity, comparative medicine veterinarians are often marginalized as “service staff,” and their time is used to address the clinical and compliance issues inherent in management of an animal resource program. This allows little or no time to interact with principal investigators and research staff. That conundrum severely underutilizes their training and creates an environment in which comparative medicine veterinarians, who have many years of postgraduate training, are not active and productive participants in the research enterprise (NRC, 1998a). The pharmaceutical and biotechnology industries provide an excellent example of the integration of veterinarians into biomedical research programs. Many veterinarians in industrial positions do provide clinical

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National Need and Priorities for Veterinarians in Biomedical Research services, but a portion of their time is protected to interact with research staff and contribute to the research mission. Academic institutions can emulate that approach by appointing veterinarians to nontenure track faculty positions as clinician-scientists. Reinvigorating comparative medicine departments or integrating comparative medicine veterinarians into existing departments with appropriate faculty appointments will ensure that veterinarians have the opportunity to participate fully in research in a manner that matches their research training and experience. Institutions must also evaluate the burden of regulatory and compliance issues on laboratory animal medicine veterinarians. The administrative role of the veterinarian changed dramatically during the 1990s. In 1996, the National Research Council’s Guide for the Care and Use of Laboratory Animal, the reference mandated by PHS Policy, was revised. The revision detailed more clearly the responsibilities of the IACUC, such as endorsing biannual inspections, and the associated administrative duties that most often fall to the attending veterinarian. Accreditation of animal facilities by AAALAC International has grown in importance, also increasing the documentation and reporting responsibilities of the attending veterinarian. It is a common requirement for research institutions to comply with the AWA, the PHS Policy, and AAALAC International policies, each with its own oversight, documentation, and reporting mandates. It can be advantageous for institutions to hire additional support staff to alleviate the regulatory tasks (such as annual reports and laboratory inspections) now given to veterinarians. One approach to increasing the support staff is to increase the size of residency programs; additional resident veterinarians could be assigned a limited role in the regulatory program, thereby relieving attending veterinarians of some of these responsibilities. Reassignment of these tasks would allow veterinarians to use their training more appropriately to provide advice to principal investigators and to participate actively in research design and implementation. Recapturing Private-Practice Veterinarians In 1999, the results of a study of the veterinary market predicted an excess supply of private practice veterinarians through 2008 (Brown and Silverman, 1999). Coupled with the stagnant income of private practice veterinarians (Brown and Silverman, 1999), these data suggest the existence of a pool of clinical practitioners who, because of economic pressures and disillusionment with private practice, may be interested in retraining for another kind of career. Professional societies related to comparative medicine should expose clinical-practice veterinarians to the opportunities and benefits of a career in comparative medicine. For example, in 2002 the average salary of a laboratory animal medicine veterinarian was $117,240

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National Need and Priorities for Veterinarians in Biomedical Research (Weigler and Huneke, 2003), a highly competitive salary when compared with the average salary of $83,979 for a private practice veterinarian in 2001 (Anonymous, 2003). This exposure could occur through advertising and articles in journals and trade publications, on professional web sites (such as AVMA’s), and in exhibits at annual conferences. Residency and research training programs should be aware of this potential pool of applicants and actively recruit veterinarians with clinical-practice experience who desire a career change. Both types of programs (residency and research training) could provide retraining of a private practice DVM in one to three years. RECOMMENDATIONS The AVMA should utilize its current methodology for surveying its membership and recent graduates of veterinary medical schools and extend that methodology to (1) gather demographic information on the veterinary graduates of postgraduate training programs (both research and clinical), and (2) to include questions pertaining to curriculum and career choices in the survey instruments completed by graduates of veterinary medical and postgraduate training programs. To increase the number of applicants to veterinary schools and postgraduate training programs who have a sincere interest in comparative medicine, the comparative medicine veterinary community (as individuals and professional societies) must actively work to educate college and veterinary school students about the role of veterinarians in biomedical research, the training necessary to achieve these careers, and the benefits associated with careers in comparative medicine. Veterinary schools should aggressively seek out applicants with an interest in comparative medicine, and admissions committees should be encouraged to select applicants with interests outside private clinical practice. To encourage more student interest in careers in biomedical research, veterinary schools are encouraged to establish summer externship programs and also year-long research programs that can be supported through T35 and the “new” T32 (NRSA: Training for Veterinary Students in Animal-oriented, Hypothesis-based Research: Institutional Training Award) award mechanisms, as well as through institutional funding and partnerships with corporate sponsors. Veterinary schools should aggressively seek out applicants with an interest in comparative medicine, and admissions committees should be encouraged to select applicants with interests outside private clinical practice.

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National Need and Priorities for Veterinarians in Biomedical Research All veterinary schools should offer at least elective courses in laboratory animal medicine, and more veterinary schools should require coursework in laboratory animal medicine. AVMA’s National Examination Board should re-evaluate its emphasis on comparative and laboratory animal medicine in light of current societal needs. All comparative medicine veterinarians should actively seek out and mentor students with an aptitude for and interest in comparative medicine. To address concerns about the large debt burden faced by graduates of veterinary colleges, a debt-repayment initiative similar to the NIH Clinical Research Loan Repayment Program authorized by the Clinical Research Enhancement Act (H.R. 2498) should be initiated. Each awardee institution should take full advantage of its T32 award by utilizing all of the trainee positions for which they receive funding (between 4 and 6 trainees per year). In addition, if the current T32 program becomes maximally utilized, NIH should consider increasing funding to this program to accommodate additional awardee institutions. The requirement for one year post-DVM experience is unnecessarily placing barriers for DVM graduates wanting to enter training programs immediately after graduation. This requirement should be removed from T32 granting stipulations. NIH should consider emphasizing that the T32 award for veterinarians funded by NCRR can be utilized to train DVM researchers in integrative and whole animal-oriented research approaches and that the one year residency requirement should be removed as a contingency to receiving support through a T32 award. Research institutions and schools of veterinary medicine should encourage and support postgraduate veterinarians to apply for F32 awards. More veterinary schools should seek support through the NIH MSTP mechanism to strengthen their dual-degree (DVM-PhD) programs. Schools of veterinary medicine, faculty advisors, and research mentors should actively encourage young DVM researchers to apply for K awards and further actively provide the support necessary for young DVM researchers to successfully compete for these awards.

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National Need and Priorities for Veterinarians in Biomedical Research ACLAM and ACVP should facilitate the registration of their respective residency programs with the VIRMP. Granting agencies, current residency programs, and veterinary medical schools should be charged with developing new avenues to fund laboratory anmal residencies. Residency programs should aggressively recruit applicants through veterinary student clubs, national meetings, career days, etc. Academic institutions should be encouraged to provide faculty appointments to comparative medicine veterinarians that support biomedical research. This will integrate veterinarians into ongoing research programs and more fully utilize their expertise and training. Institutions should consider hiring additional support staff to assist with regulatory tasks, to allow veterinarians more time to interact with investigators and ongoing research programs. Professional societies and training programs should actively recruit interested private practice veterinarians into residency and research training programs to retrain for careers in comparative medicine.