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Veterinarians in Public Practice

INTRODUCTION

Public practice veterinarians employed in local, state, and federal government agencies are involved in activities to ensure food safety, safeguard animal and human health from diseases and toxins, conduct biomedical research, and facilitate trade. They play pivotal roles in addressing issues spanning agriculture to human medicine, and have a long and distinguished history of contributions to human and animal health largely unrecognized by the general public (Hoblet et al., 2003; Pappaioanou, 2004). The safe, wholesome, and inexpensive animal-based food and product supply enjoyed by United States citizens has been achieved, in part, by disease control and eradication programs managed by veterinarians and by meat and poultry inspections conducted by public practice veterinarians (King, 2000). As animals are used as models of human diseases, ranging from diabetes to cancer, veterinarians involved in biomedical research have made fundamental contributions to advances in human health (Roberts, et al., 2009; Gordon and Khanna, 2010). Veterinarians also actively participate in reducing the impact of zoonotic diseases on humans (Riddle and Mainzer, 2004).

This chapter summarizes the types of positions that veterinarians most commonly occupy in the public sector, reviews information on the numbers of veterinarians employed, and discusses key concerns and recent developments related to the public practice workforce. The committee was troubled by the state of the veterinary workforce in the public sector. Longstanding job vacancies, a looming wave of retirements, declining programmatic support for animal research, and reports of too few positions in key agencies raise questions about the ability of the government to achieve its missions to ensure food safety and prevent and respond to infectious diseases of animal and humans. The federal government has recently begun to address its veterinary workforce issues, albeit at a time of fiscal constraint. Some federal agency managers indicate that vacancies can be attributed in part to applicants not having the requisite knowledge



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6 Veterinarians in Public Practice INTRODUCTION Public practice veterinarians employed in local, state, and federal govern- ment agencies are involved in activities to ensure food safety, safeguard animal and human health from diseases and toxins, conduct biomedical research, and facilitate trade. They play pivotal roles in addressing issues spanning agriculture to human medicine, and have a long and distinguished history of contributions to human and animal health largely unrecognized by the general public (Hoblet et al., 2003; Pappaioanou, 2004). The safe, wholesome, and inexpensive animal- based food and product supply enjoyed by United States citizens has been achieved, in part, by disease control and eradication programs managed by vet- erinarians and by meat and poultry inspections conducted by public practice veterinarians (King, 2000). As animals are used as models of human diseases, ranging from diabetes to cancer, veterinarians involved in biomedical research have made fundamental contributions to advances in human health (Roberts, et al., 2009; Gordon and Khanna, 2010). Veterinarians also actively participate in reducing the impact of zoonotic diseases on humans (Riddle and Mainzer, 2004). This chapter summarizes the types of positions that veterinarians most commonly occupy in the public sector, reviews information on the numbers of veterinarians employed, and discusses key concerns and recent developments related to the public practice workforce. The committee was troubled by the state of the veterinary workforce in the public sector. Longstanding job vacan- cies, a looming wave of retirements, declining programmatic support for animal research, and reports of too few positions in key agencies raise questions about the ability of the government to achieve its missions to ensure food safety and prevent and respond to infectious diseases of animal and humans. The federal government has recently begun to address its veterinary workforce issues, albeit at a time of fiscal constraint. Some federal agency managers indicate that vacan- cies can be attributed in part to applicants not having the requisite knowledge 111

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112 Workforce Needs in Veterinary Medicine and training for positions needing to be filled, with some agencies starting edu- cational programs to address this issue. On the other hand, salaries of public practice positions are low relative to some job opportunities in the private sector and are sometimes below those offered in the public sector for positions with comparable higher education (8 years or more). Even veterinarians with ad- vanced degrees (MPH, board certification) in the Civil Service are often not offered significant pay bonuses similar to the Physicians Comparability Allow- ance/Medical Pay for MDs. This is because veterinarians who conduct similar “mission critical” activities have not been considered for equal pay as physicians (5 USC § 5948). Because a failure in the public sector’s mission-critical respon- sibility to prevent, respond and recover from catastrophic disease outbreak events would have severe consequences in terms of human illness, lost lives and livelihoods, and animal suffering, the inadequate pay for the veterinary work- force in public practice could pose a substantial risk to the nation. PUBLIC PRACTICE VETERINARIANS Veterinary Medical Officer There are two federal-government employment systems in which veterinari- ans can be hired. One is the Civil Service and the other is the Uniformed Ser- vices, such as in the Department of Defense or the Health and Human Services Public Health Service Commissioned Corps. Most, although not all, positions for veterinarians in the federal government fall under the classification Veteri- nary Medical Officer (VMO), also known by the Civil Service designation VMO 0701 (OPM, 2009). Many of the jobs held by VMOs typically involve regulatory oversight and the enforcement of rules related to domestic food safe- ty, animal care and welfare, and animal health, or regulatory activities associated with imported food and animals, such as inspecting foreign systems for equiva- lency to U.S. standards. The official areas of specialized focus within the VMO category are listed below, with a brief description of the central duty of each position.  Epidemiology - control and eradicate human and animal diseases, con- duct surveillance and investigate current diseases and emerging infectious dis- eases including zoonoses; conduct activities in the areas of food safety, food security, and biostatistics, and perform scientific review functions.  Import/Export - certify the health of animals and animal by-products for import and export and oversee quarantine.  Laboratory Animal Medicine - provide clinical support and medical treatment for laboratory animals used in research activities.  Pathology - interpret complex pathological conditions and evaluate find- ings that indicate the presence of foreign or emerging animal diseases of eco- nomic or public health significance; work with public health groups on issues pertaining to disease management.

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Veterinarians in Public Practice 113  Product Development - review and ensure the safety and effectiveness of drugs, biologics, devices, and feed for domestic and companion animals.  Public Health - develop and participate in the prevention, surveillance, detection, control, and regulation of human and animal health vulnerabilities from agro- or bio-terrorism threats; zoonoses and foreign animal diseases, and conditions that render meat and poultry products unfit for human consumption.  Toxicology - investigate concerns related to animal feed and evaluate pesticide, industrial, chemical, and mycotoxin contaminants in animal feed.  Wildlife - provide medical and surgical expertise and program admin- istration for captive and free roaming wildlife, including epidemiological, patho- logical, and toxicological investigations.  Zoological Animal Medicine - provide a comprehensive animal health program in a zoo’s collection.  Clinical Care - provide medical and surgical management of domestic animals not included in biomedical research, wildlife, or zoo populations, such as work animals. VMO positions are also likely to carry organizational or functional titles re- lated to their work, such as Chief Scientist, Research Director, Program Manag- er, Grant Manager, Policy Fellow or Policy Analyst, Occupational Health and Safety Officer, Bio-security Specialist, and Environmental Health Officer. Some hold titles related to one of the many disciplinary fields of veterinary research, including Risk Assessor, Microbiologist, Pathologist, Chemist, and Toxicolo- gist. Some of these positions require advanced degrees and participation in gov- ernment training programs. It is difficult to obtain a firm number for veterinarians employed in the fed- eral government because some hold jobs that are not specifically classified by the Office of Personnel Management or Human Resources as being in the VMO 701 Series. Some non-VMO jobs are simply classified with the term “veteri- nary,” however additional veterinarians are in positions with more generic titles, and many government jobs for which veterinarians qualify are neither specifical- ly classified nor advertised to require a veterinary degree, such as research sci- entists working at the National Institutes of Health. Individuals with a veterinary degree can be found at all levels of government, including as elected officials in the U.S. Congress. FEDERAL AGENCY EMPLOYERS OF VETERINARIANS In 2009, the Government Accountability Office (GAO) released a report on the numbers of veterinarians employed by the federal government (GAO, 2009). The report is the best available source of information to date and is cited heavily here, augmented with more recent data collected by the National Association of Federal Veterinarians (NAFV), the VMO Federal Talent Management Advisory Council (TMAC) and the U.S. Office of Personnel Management (OPM).

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114 Workforce Needs in Veterinary Medicine The GAO found 13 major units of the federal government that reported em- ployment of veterinarians (see Table 6-1). In 2008, agencies reported 3,058 fed- erally-employed veterinarians, 2,900 who work in the U.S. Departments of Ag- riculture (USDA), Defense (DOD), and Health and Human Services (HHS). The total number includes veterinarians hired as VMOs in the Civil and Uniformed Services and those holding other non-veterinary position titles. In 2011, the TMAC released an update of the numbers of federally employed veterinarians for 2010, based on its survey of the agencies (Table 6-1). Comparison of the data sets suggests that the number of veterinarians employed increased in some agencies and declined in others, with virtually no change in the total. U.S. Department of Agriculture Food Safety and Inspection Service The USDA is the largest single employer of veterinarians in the federal government. Of the 1,809 veterinarians at USDA in 2010, the Food Safety and Inspection Service (FSIS) employed an estimated 1,068, up from 1,043 in 2008 (GAO, 2009; VMO TMAC, 2011). A majority held positions as Public Health Veterinarians (classified as VMOs) in the Office of Field Operations, identifying diseased animals and enforcing humane slaughter and food safety regulations at slaughter and processing operations. Other veterinarians in FSIS develop policy and public health risk assessments; provide expertise in chemistry, toxicology, pathology, and microbiology laboratories; conduct international programs; and serve as managers and executives. TABLE 6-1 Veterinarians in the U.S. Government in 2008 and 2010 Number of Veterinarians Major Federal Agency 2008 2010 U.S. Department of Agriculture 1,771 1,809 U.S. Department of Defense 841 853 U.S. Department of Health and Human Services 316 322 U.S. Department of Veterans Affairs 37 17 U.S. Department of the Interior 24 34 U.S. Department of Homeland Security 16 7 Smithsonian Institution 16 10 U.S. Environmental Protection Agency 13 3 U.S. Agency for International Development 8 0 U.S. Department of Commerce 9 2 National Aeronautics and Space Administration 5 0 U.S. Department of Energy 1 No data U.S. Department of Justice 1 No data Total 3058 3057 DATA SOURCE: GAO, 2009 and VMO TMAC, 2011.

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Veterinarians in Public Practice 115 In 2008, FSIS reported vacancies of 166 veterinarian (15% of the FSIS vet- erinary workforce) positions assigned primarily in slaughter plants. Officials and veterinarians attribute those vacancies to several factors, including the physical and emotionally grueling nature of the work in slaughter plants, the remote loca- tion of many of the plants, the negative effects of staff shortages, the lack of opportunity for training and promotions especially for new graduate hires, and low pay compared to private practice. However, by 2011, the FSIS vacancy rate was reduced, possibly due to the effect of the economic recession, and to direct- hire authority granted by OPM. In February 2009, shortages of FSIS veterinari- ans were identified in 39 of the 50 states. In September 2011, the FSIS website listed only 25 locations in 18 states with vacant positions (FSIS, 2010). Animal and Plant Health Inspection Service In 2010, the Animal and Plant Health Inspection Service (APHIS) has an estimated 695 veterinarians, up from 667 in 2008, who are engaged in protecting the health of animals in U.S. agricultural production (GAO, 2009; VMO TMAC, 2011). Their jobs include performing duties such as the diagnosis, control and eradication of animal diseases; developing policy and risk assessments; planning and implementing emergency responses to foreign animal disease incursions; leading and working on international teams and overseas programs; enforcing the Animal Welfare Act; and serving as managers and executives. APHIS man- agers have expressed concern that the supply of veterinarians generally, and veterinary pathologists in particular, will not be adequate to fill vacancies in the future. Agricultural Research Service The Agricultural Research Service (ARS) employed 57 veterinarians 2008. In 2010, that number declined to 40 (GAO, 2009; VMO TMAC, 2011). These veterinarians, most of whom are required to have a Ph.D. degree in addition to the DVM, conduct critical research to develop solutions for high priorities in food safety, zoonotic diseases and agricultural problems. ARS reported that the agency is 12% short of its goal of employing 65 veterinarians. The agency as- serts that there are too few qualified candidates willing to work in government given the disparity in salary levels between federal positions for DVM/PhDs and those in the pharmaceutical and other sectors. National Institute of Food and Agriculture (formerly Cooperative State Research, Education and Extension Service) The National Institute of Food and Agriculture (NIFA) added 2 veterinari- ans in 2010 to increase its total to 6 (GAO, 2009; VMO TMAC, 2011). The as-

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116 Workforce Needs in Veterinary Medicine signments of those veterinarians are to plan, develop, organize, and manage an- imal health and food safety related research and educational programs in coordi- nation with land grant universities, other federal agencies and national and inter- national partners. They help support the work of state extension veterinarians. Some oversee grant programs that allocate millions of dollars for research and education. U.S. Department of Defense Army and Air Force The 853 veterinarians employed by the DOD in 2010 serve mainly in the Army as authorized active service members (506) or Army reservists (266). Many of those veterinarians are responsible for the food safety of thousands of troops around the world. Others conduct research on medical defenses against chemical and biological warfare threat agents, conduct intelligence work, care for service animals, and provide for veterinary services on military installations. The Air Force has 88 veterinarians who track infectious diseases, ensure the food safety and health of personnel, and are responsible for enforcing Occupa- tional Safety and Health programs. There are veterinarians in critical manage- ment and military leadership positions. In 2008, the Army reserves reported a shortage of 34 veterinarians (12%) but that gap was filled by the addition of 93 reservists in 2010 (GAO, 2009; VMO TMAC, 2011). U.S. Department of Health and Human Services Food and Drug Administration Of the 322 veterinarians employed by the Department of Health and Human Services in 2010, 154 held positions with the Food and Drug Administration (FDA). Within FDA, the Center for Veterinary Medicine (CVM) employs 116 DVMs, an increase of 10% from the number reported to GAO in 2008. The Cen- ter attributed the expansion to the approval of FDA-wide direct hiring authority for VMO positions in 2009 (CVM, 2010). Veterinarians in CVM ensure that food and drugs for animals are safe, and ensure that food from medically-treated animals is safe for human consumption. Veterinarians in other FDA units con- tribute to work on the safety of drugs, cosmetics, and medical devices. The GAO report indicated that FDA expected 10-20% growth in jobs requiring veterinari- ans over the next five years. National Institutes of Health The National Institutes of Health (NIH), which focuses on biomedical re- search primarily for human health, reported employing 85 veterinarians in 2008

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Veterinarians in Public Practice 117 and 92 in 2010 (GAO, 2009; VMO TMAC, 2011). These individuals hold vari- ous positions from management to laboratory animal care and research. They conduct basic scientific and translational research in the intramural research program, are administrators of the external research programs, and provide dis- ease surveillance and diagnostic expertise. According to the 2009 GAO report, NIH faces challenges recruiting veterinarians who have specialization in labora- tory animal medicine and veterinary pathology; NIH forecasts significant short- ages for at least the next 10 years in these veterinary specialties. Centers for Disease Control and Prevention Between 2008 and 2010, the Centers for Disease Control and Prevention (CDC) increased the number of veterinarians it employed from 77 to 90 (GAO, 2009; VMO TMAC, 2011). The agency reported to the GAO that veterinarians contribute to human health programs through their veterinary science and public health expertise. Veterinarians work to identify, prevent and control public health threats through applied epidemiology, laboratory animal medicine, toxi- cology, technical assistance, consultation, surveillance, field and clinical inves- tigations, and human-animal interface research. They support public health training and activities among state, local, tribal, and global health programs. Veterinarians provide expertise in public health emergency preparedness and provide surge capacity following public health disasters, global disease out- breaks, and terrorist attacks. They serve CDC in jobs that prevent the entry of imported animals and animal products that pose human health risks. CDC re- ported to the GAO that they could enhance veterinary contributions to public health; however no specific shortages were noted. Office of the Assistant Secretary for Preparedness and Response This agency employed 2 veterinarians in 2008 with critical public health re- sponsibilities. Some of those responsibilities include developing effective re- sponse programs to public health emergencies. They identify, coordinate, and provide qualified veterinary medical personnel for events requiring emergency and disaster-related veterinary services to affected animal populations, including household pets and service animals, in or outside of shelter locations until local infrastructures are reestablished. This Office reported to the GAO that they need more veterinarians but no specific number was offered. Other Federal Agencies Fewer numbers of veterinarians are employed by other federal agencies. Veterinarians at two of those agencies, the Department of Veterans Affairs (17 veterinarians in 2010), and the Environmental Protection Agency (3 veterinari-

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118 Workforce Needs in Veterinary Medicine ans in 2010) address research and other activities associated with protecting hu- man health; neither reported shortages related to meeting their missions (VMO TMAC, 2011). Three other agencies use veterinarians to address animal health issues (often with human health ramifications). They include the Department of Homeland Security (DHS), which has oversight responsibility for the security of the national food supply. DHS reported a veterinary workforce of 7 in 2010, a decline from 16 in 2008. The Department of the Interior markedly increased its veterinary workforce from 24 to 34 between 2008 and 2010. The agency has responsibility for monitoring wildlife on federal lands. The Smithsonian Institu- tion lost veterinarians that provide care for zoo animals and conduct research, down from 16 to 10 in the same period). All three agencies had reported con- cerns to GAO that too few veterinarians were involved in carrying out their mis- sion. The Fish and Wildlife Service increased the number of veterinarians it em- ploys from 4 to 10 between 2008 and 2010 (GAO, 2009; VMO TMAC, 2011). The role of veterinarians in wildlife and ecosystem health is discussed in greater detail in Chapter 7. VETERINARIANS IN STATE GOVERNMENT Veterinarians who are employed by state governments are typically in- volved in one or more of the activities across the “One Health” spectrum: public health, agriculture and food; animal welfare; and wildlife and the environment (AVMA, 2008). The committee could not find aggregate information on the number of state-employed veterinarians. However, in 2010, research surveys by the American Veterinary Medical Association (AVMA) found 1,099 veterinari- ans employed in state and local governments (AVMA, 2011b). Veterinarians at land-grant colleges and universities are also state employees, but those are iden- tified by AVMA as being employed by a “college or university”. There were 6,425 individuals in that category. Some of them are employed at private colleg- es and universities (AVMA, 2011b). Chapter 9 discusses veterinarians in academia. However, in addition to their roles as veterinary school faculty members, many are involved in operating vet- erinary diagnostic laboratories on behalf of their respective state and as part of the National Animal Health Laboratory Network (NAHLN). In this regard they perform tests for endemic animal diseases and conduct surveillance of foreign animal diseases (USDA-APHIS, 2010a). That work is complemented by state veterinarians (SVs), which usually are housed in a state’s agriculture or environment department, and occasionally in a state-supported school of veterinary medicine. The office of the SV is usually involved in the certification of veterinarians who wish to practice in a state. There are SVs in all 50 states, and they have broad responsibility for monitoring diseases and other threats (such as animal abuse) to companion and food animals within the state. As noted in Chapter 7, a handful of states employ veterinarians

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Veterinarians in Public Practice 119 in fish and wildlife departments. Some veterinarians are involved in carrying out disease control programs or testing meat for antibiotic residues. In addition to an SV, all 50 states have a designated public health veterinar- ian (PHV), most of whom hold positions in their state’s Department of Health. The work of a state’s PHV is primarily focused on zoonotic disease control and prevention. They interact with other elements of the public health system, from doctors to emergency rooms, to address the exposure of the public to risks from animals and animal products (NASPHV, 2011). SALARIES OF PUBLIC PRACTICE VETERINARIANS Salaries Reported by the American Veterinary Medical Association Every two years, the American Veterinary Medical Association (AVMA) conducts a survey of U.S. veterinarians for salary information.1 For 2009, the mean salary reported by members with veterinary positions in state government was $108,806. Uniformed (military) service employees reported a mean salary of $92,172, while employees in federal government reported a mean salary of $111,964 (AVMA, 2011a). Salary and Compensation of Federal Employees In contrast to the AVMA, the OPM Central Personnel Data File reported the average salary of federally-employed 701 Series veterinarians in 2009 to be $93,062. Federal VMOs make more on average than their counterparts in the 0600 Series (positions in medical, hospital, dental and public health), but that may be attributable to the group’s longer average length of service (see Table 6-2), so there is a concern that they are paid less than physicians performing similar duties (OPM, 2010). Salaries for VMOs vary across federal agencies, with the lowest reported by FSIS and the highest by NIH. Table 6-3 provides information from the 2009 GAO report and estimates developed by the National Association of Federal Veterinarians (NAFV), based on its membership data (Michael Gilsdorf, NAFV, personal communication, December 1, 2010). The differences in pay reflect nu- merous factors, such as length of service and the average grade level of the vet- erinary workforce at each agency. 1 AVMA salary data are drawn from the biennial AVMA Compensation Survey, which is based on a randomized, stratified sample of employed U.S. veterinarians (including AVMA members and nonmembers). The response rate of the Survey is about 25%. If DVMs who are more successful are more likely to respond, the reported rate of earnings may exceed actual averages.

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120 Workforce Needs in Veterinary Medicine TABLE 6-2 2009 Average Annual Salaries of Federal Employees 701 Permanent All Federal Appointment All 600 Series Employees Number Employed 1,878 234,266 2,038,183 Average Salary $93,062 $78,013 $71,887 Average Age 52.4 47.5 46.2 Average Length 13.5 10.5 13.9 of Service SOURCE: OPM, 2010. TABLE 6-3 Reported Mean Salary Levels for Federal Veterinarians Mean Salary Estimates Government National Association of Agency Accountability Office Federal Veterinarians Food Safety and Inspection $77,678 $81,998 Service (USDA) Animal and Plant Health $90,000 $82,997 Inspection Service Agricultural Research Service (USDA) $102,081 No data Centers for Disease Control and $90,000 $93,964 Prevention (HHS) National Institutes of Health (HHS) $115,000 $100,000 Food and Drug Administration (HHS) $85,000 $91,863 NOTE: USDA=U.S. Department of Agriculture; HHS=U.S. Department of Health and Human Services. SOURCE: Estimates adapted from GAO (2009), and National Association of Federal Veterinarians (2010). In 2009, at the request of USDA, the OPM raised the entry grade level for newly hired veterinarians from GS-9 to GS-11. Almost 75% of FSIS veterinari- ans were at grade level GS-12 or below and are now part of a pay-banding pilot program that eliminates the GS Grade categories to determine if this can im- prove the salaries of veterinarians in FSIS based on performance. In contrast, 90% of APHIS and 62% of ARS veterinarians are at grade level GS-12 or above. The report also noted that APHIS routinely sourced experienced veteri- narians from FSIS, offering greater pay, training, and working conditions than its sister agency. The GAO report did not explore the level of education required by different agency positions, except that ARS indicated that its requirement for candidates to have PhDs in addition to the DVM degree put it in direct competi- tion with private industry, where salaries are significantly higher.

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Veterinarians in Public Practice 121 Retirements A 2006 study supported by the Food Supply Veterinary Medical Consorti- um estimated that for the 12-year forecast period of 2004 to 2016, the average annual shortage of public practice veterinarians would be 6.86% of the total fed- eral veterinary workforce (Andrus, 2006). Based on projected retirements reported by the federal agencies to GAO, filling the shortage in federal public practice can be only characterized as daunt- ing. The GAO reported that 27% (approximately 697) of the veterinarians em- ployed by APHIS, FSIS, ARS, FDA, and the Army will be eligible to retire be- tween 2009 and 2012. As noted above, these agencies collectively reported 206 vacancies in 2009—166 in FSIS, 6 in ARS, and 34 in the Army (GAO, 2009). If these reports are accurate, there will be a need for approximately 740 veterinari- ans for positions in the federal government by 2012. Given the current rate of hiring by the agencies, filling that gap is unlikely. Data from the OPM Central Personnel Data File shows that over the last four years, 438 permanent VMO positions were filled across all agencies. Of the 100 positions filled in 2009, 30% of the positions were filled with job candidates age 50 and above (OPM, 2010). Between 2006 and 2008 an average of 71% of new hires by FSIS were veterinarians in private practice; only 14% on average were new graduates (GAO, 2009). As a result of these hiring practices, VMOs are older (average age 52.4) than the balance of the federal workforce (average age 46.2) (OPM, 2010). Although the current economic crisis and improved recruitment benefit pro- grams in some agencies has retarded this exodus, the U.S. federal veterinary workforce is facing an impending mass retirement. As a result, the protection of animal and public health could be weakened, making workforce planning in the federal government critically important. FUTURE SUPPLY OF PUBLIC PRACTICE VETERINARIANS Based on the employment decisions of newly-minted DVMs, few are inter- ested in immediately pursuing public service positions. In an AAMVC survey of 2,396 of the 2010 graduates of U.S. veterinary colleges, about three-quarters (1,827) reported accepting a job offer or advanced educational opportunity, such as a residency or graduate program. Of those, 38 (2.5%) had accepted a position in the uniformed services, and 3 (0.2%) had accepted a position in the federal government. None reported taking a state-level position. However, 760 gradu- ates (49.2%) were accepting a position in an advanced education program, so it might be expected that a small number of those will be future candidates for public sector positions (Shepherd, 2010). However, the 2010 OPM VMO Stra- tegic Workforce Plan, “acknowledged that veterinary schools are limited in the number of graduates they can produce and private industry compensation pack- ages are highly competitive.” There is clearly a need to find ways to prepare and recruit DVMs for public practice.

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122 Workforce Needs in Veterinary Medicine Examples of Federal Recruitment and Training The primary requirement for the majority of federal positions is a DVM, but federal agencies are finding it difficult to hire new graduates who have basic training in public health that is required of these entry level government jobs or who have an interest in work in public practice. The committee’s assessment that multiple factors contribute to this situation, including a lack of awareness about public practice and few mentors in the field, the movement of curriculum away from the public practice sciences, and students’ need to pursue higher- paying jobs to service education debt. Although the salary levels in the federal government are lower for entry level jobs relative to the private practice sector, there are incentives that can be offered to candidates. Appendix E contains a list of recruitment tools that were identified for that purpose by USDA and the Of- fice of Management and Budget. Given the number of women entering veteri- nary school, additional incentives to consider are those that could increase the recruitment and retention of women, such as policies that accommodate family formation, parental leave, and childcare (Williams and Ceci, 2012). With the recent economic crisis and the attention that GAO brought to the status of the federal veterinary workforce, a steady improvement in the recruit- ment and retention offers has occurred, resulting in fewer vacancies in key fed- eral departments, especially the FSIS. Some agencies have active programs to attract veterinary students. For example, FSIS established a program in 2001 that employs veterinary students for 6 weeks in the summer. The students are paid to work with a VMO in meat and poultry plants as well as in other parts of the agency, learning about food safety and animal welfare regulations (FSIS, 2010). An FDA Veterinary Clerkship Program provides fourth-year veterinary students with work experience at the FDA’s Center for Veterinary Medicine, which approves new animal drugs, evaluates claims of new drugs, sets policies for the use of antibiotics in medicated animal feeds and conducts a number of other regulatory activities. Students participate in the program on a volunteer basis (FDA, 2010). Several of the agencies told GAO that the positions for which they hire vet- erinarians require advanced training in laboratory animal medicine and patholo- gy. As this is the same kind of expertise in demand by private industry, some agencies have recognized that if they want candidates with the advanced skills, they will need to provide support for that training. Two such programs are de- scribed below. Centers for Disease Control and Prevention Support for Laboratory Animal Medicine In 2008, CDC started a two-year residency program (Laboratory Animal Medicine Residency Program) designed to address a shortage of veterinarians

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Veterinarians in Public Practice 123 working in biomedical research. The program is a partnership with Emory Uni- versity's Robert W. Woodruff Health Sciences Center, and includes 200 hours of academic coursework at Emory University. This is combined with 2,000 hours of hands-on experience in CDC's high-containment laboratory facilities as well as experience in infectious-disease research with a CDC mentor. Graduates of the program will be proficient in the daily treatment of laboratory animals, working in high-containment laboratories, designing scientific experiments and the use of animal models and administration of lab-animal medicine programs (CDC, 2008). National Cancer Institute Support for Training in Pathology To encourage the development of veterinarians in biomedical sciences, the National Cancer Institute’s Center for Cancer Research, in collaboration with the National Institute of Allergy and Infectious Diseases, the National Institute of Diabetes and Digestive and Kidney Diseases, and The National Heart, Lung, and Blood Institute, have established graduate education partnerships with sev- eral colleges of veterinary medicine. The program includes a residency and PhD training support for those with a DVM in comparative pathology (NCI, 2010). The Role of a Veterinary Education Most government agencies assume that veterinarians with a DVM are edu- cated in the basic sciences of epidemiology, food safety, public health, patholo- gy, and food-animal production and population health. However, the committee found a general lack of understanding by members of the veterinary profession (and recent graduates) about the job availability and requirements for which veterinarians could qualify in the federal government. One reason is the predom- inance of clinical practitioners among veterinary school faculty members that made clinical instruction an increasing focus of most veterinary curricula. As a result, instruction in core disciplines, particularly those central to the expertise of public practice veterinarians, has decreased. The foundational knowledge required by most of the VMO positions in the federal and state governments include the professional knowledge of veterinary medical concepts, principles, and practices concerned with the full range of an- imal health and disease, ante mortem and post mortem, and the basic sciences. This includes knowledge of basic production and husbandry practices, the use of animal drugs, biologics, and antibiotics relevant to food safety and public health, and practices for humane handling and slaughter. In addition, candidates need to be familiar with the pathology of various foreign and other diseases with public health and economic significance, and have an understanding of microbiology, parasitology, toxicology, physiology, chemistry, anatomy, epidemiology, and surveillance.

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124 Workforce Needs in Veterinary Medicine For most veterinary students, the last opportunity to learn the basic sciences is as students in the DVM program. Most continuing education offered to DVMs is for enhancing and developing additional clinical skills and hospital manage- ment. Veterinary college curricula have lost ground in preparing the DVM for public practice over the last several decades, and consequently, many govern- ment agencies that hire DVMs need to provide additional training to bring them to agency standards. To meet the increased needs in this area, schools should encourage public practice careers for both pre-veterinary and veterinary stu- dents. Many colleges of veterinary medicine are implementing programs to en- courage DVM students and graduate students to enter public practice and food supply veterinary medicine through the rationale for One Health (AVMA, 2008). However, resource limitations and financial constraints have reduced the capacity of academic institutions to implement effective and sustainable educa- tional programs. One approach to filling the need for public practice veterinari- ans has been the development of DVM programs in conjunction with a Masters of Public Health (MPH). The committee found thirteen colleges of veterinary medicine that offer dual DVM/MPH degrees. At the University of Illinois, for example, students can transfer a portion of the credits earned for the DVM de- gree toward an MPH degree. However, without matching what is required in various MPH programs with government talent needs and strategic planning, this additional educational and financial burden may not reap the benefits in- tended. It is critical that academic programs work closely with the OPM and the Talent Management Advisory Council to match government needs with educa- tional programs. Another strategy would be to match admission criteria with workforce needs. Schools could target recruitment and offer scholarship programs for stu- dents with public practice interests (Prince et al., 2006). Admission criteria could be modified to select for a broader range of skills required for public prac- tice. Colleges that are aware of public practice competencies developed by gov- ernment are seeking ways to attract a more diverse pool of students by putting emphasis on written and oral communication and leadership skills. The Food-Animal Production Medicine Consortium, a partnership formed by several veterinary colleges (California, Illinois, Michigan, and Florida) to provide food-animal and food safety educational and research programs, operat- ed for more than a decade but lost momentum; there may be lessons learned from that experience (Troutt, 1994). More recently, Miller and Prasse (2006) recommended concentrating faculty into Centers of Excellence so that instruc- tional quality and accuracy of information delivered can be maintained. These Centers would seek to hire faculty with public practice, public health and food supply veterinary medicine experience, or establish ways to use the expertise of such individuals. There is a cadre of experienced and talented veterinarians working in government who, by the nature of their employment and regulatory limitations to professional practice, may not hold advanced degrees but have research grants or extensive publications. These veterinarians are often available

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Veterinarians in Public Practice 125 to take adjunct and full or part-time faculty appointments to help train the next generation of public practice veterinarians. Working with government agencies at the state and federal levels, Centers could match strategic government needs to develop continuing educational programs in food safety, epidemiology, pa- thology, zoonotic diseases, environmental hazards, and other public health sci- ences. There is a great potential for agencies to outsource mission-focused train- ing and education and potentially partner with public practice Centers of Excellence or Institutes. Additional efforts by academia, veterinary professional organizations and the public sector are needed to increase the exposure of pre-veterinary and veter- inary students to opportunities and important career paths that are available to veterinarians in public practice. For example, more postgraduate fellowships for public practice veterinarians are needed; paid public practice externships should be increased; and more student and postgraduate internships should be devel- oped with national and international experiences. ADDRESSING THE RISK OF GAPS IN THE PUBLIC VETERINARY WORKFORCE An overarching critique contained in the GAO report was that agencies had conducted very little assessment of the kind of veterinary expertise that they need. FSIS was criticized specifically for not responding to a 2004 GAO rec- ommendation that the agency assess “whether it has enough inspection re- sources, including veterinarians, dedicated to humane handling and slaughter activities.” GAO repeated the recommendation in its 2009 report, adding food safety to the list of responsibilities for which the agency should assess the suffi- ciency of its resources. The GAO’s review of veterinary positions in the gov- ernment concluded that, in addition to current vacancies, an impending wave of retirements, and the absence of a comprehensive assessment of federal veteri- nary workforce needs, the government is likely to miss recruitment opportuni- ties, use veterinarians inefficiently, and experience an insufficient workforce during critical disease outbreaks (GAO, 2009). The last element of the GAO critique—an insufficient workforce during critical disease outbreaks—is particularly worrisome in light of the declining numbers of veterinarians engaged in private food-animal practice, described in Chapter 4. With less routine veterinary oversight in the private sector, the chance of an outbreak is increased. When an outbreak of disease in food animals occurs, veterinarians in the public and private sector are called on to coordinate activities in control and recovery operations. If no surge capacity exists in either the private or public sector, the spread of disease will be much more difficult to manage. The “poster child” for that kind of event is the 2002-2003 outbreak of exotic Newcastle disease of poultry, which ultimately required 1,250 veterinari- ans and a supporting workforce of nearly 5,000 working for almost a year to control the disease.

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126 Workforce Needs in Veterinary Medicine As Chapter 4 points out, foot-and-mouth disease (FMD) is the foreign ani- mal disease of greatest concern to the United States, having large populations of cattle and swine that would be susceptible to the disease. One of GAO’s recom- mendations, directed at the Secretary of Homeland Security, was for a coordi- nated, interagency effort to identify the data necessary to model the spread of FMD in wildlife and how best to gather the data (GAO, 2009). An FMD out- break in the United States could have an economic impact of between $9 and $50 billion (NRC, 2010). Although USDA recently has begun planning for a potential FMD outbreak (USDA-APHIS, 2010b), it is difficult to understand why staggering cost esti- mates such as these have not motivated a more substantial investment in the infrastructure and planning to prevent, mitigate, and respond to such a disease threat. Several recent reports have called for greater surveillance, coordination, and workforce planning and coordination to address threats from animal diseas- es, including zoonoses (NRC 2005; IOM and NRC, 2009). Additionally, there is a concern that if a pandemic event were to arise re- quiring 40% of the VMO workforce to divert attention to the event, federal agencies may be unable to perform their critical missions, placing at risk the health of the American public. Essentially, agencies with a veterinary workforce must ensure they can provide the VMO personnel needed during a catastrophic or emergency event, while maintaining the VMO workforce needed to achieve each agency’s day-to-day mission (OPM, 2010) As the committee explored the demand for public practice veterinarians, it found long-standing vacancies that would appear to indicate a shortage of ap- propriate candidates. As opposed to a shortage, however, the committee con- cluded that a long-term persistence of openings for veterinarians in some federal agencies may indicate that other factors are influencing the ability to fill posi- tions; for example, a tacit decision not to increase the hiring of veterinarians (by raising salaries or offering incentives); the inability to make the working condi- tions more attractive; and the existence of internal and external competition for a limited number of candidates, such as those with advanced degrees or special- ized knowledge and skills such as pathology. The committee also saw connections to issues beyond the federal govern- ment’s policies for recruitment and retention. The inability to resolve the prob- lem of long-standing vacancies may be related to trends in funding for agricul- tural science, and animal science, in particular. Federal funding for research in many aspects of animal science in general has declined by as much as 44% in the last two decades, accompanied by shrinking faculty and new student num- bers, to the point at which some have called the situation a crisis (Roberts et al., 2009). Veterinary groups now routinely call for additional spending on animal diagnostics, food supply security, and veterinary manpower (AVMA, 2009b) or decry unstable funding for programs such as the USDA Food-Animal Residue Avoidance Databank, which had to be temporary rescued by private donations in 2009 until federal funding was restored (AVMA, 2009c). The current level of priority for issues related to the veterinary care of animals and research on ani-

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Veterinarians in Public Practice 127 mal health seems incongruent with the potential consequences of continuing vulnerabilities in both animal and public health. The committee concludes that the current national investment in veterinary research and training for public health veterinarians is inadequate. Following the publication of the 2009 GAO report, the OPM created the TMAC to collect information and provide advice on a strategy to address federal veterinary workforce needs. In a plan developed for implementation between 2011 and 2015, the OPM is now exploring three key areas:  creating innovative and coordinated approaches to recruiting and hiring students, mid-career professionals, and retirees to meet agency needs  streamlining the hiring process to create a positive experience for appli- cants and managers, and  implementing programs and initiatives that will encourage current veter- inary employees to remain within federal service. It is encouraging that a Workforce Task Force now exists and that a strate- gic plan has been developed for the federal workforce. The committee is hopeful that federal agencies will be able to clearly articulate the full value of the veteri- nary medical profession to their missions, and take steps to support a coherent plan to strengthen their role in research, food safety, animal welfare, and public health.