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Academic Veterinary Medicine

INTRODUCTION

The gateway to the veterinary profession in the United States is through a university-based veterinary medical education, typically at one of the 28 schools and colleges of veterinary medicine located in 26 states. The schools provide qualifying students (prepared in 2- and 4-year pre-veterinary programs) with a 4-year curriculum culminating in a Doctor of Veterinary Medicine (DVM) or the equivalent1 degree (BLS, 2010).

The academic faculty for the 28 veterinary colleges in the United States is an elite group of fewer than 4,000 members with the broad responsibility of preparing the U.S. veterinary workforce. In addition to their central obligation to prepare students to be “practice ready” (that is, ready to administer medical care) in 4 years, academic veterinary faculty also conduct research and participate in the post-graduate programs offered by most colleges of veterinary medicine, including the Master of Science (MS), Master of Public Health (MPH), Master of Preventive Veterinary Medicine (MPVM), and Doctor of Philosophy (PhD) degrees, as well as internships and residency programs. The post-graduate programs, which are housed within the veterinary science departments in U.S. colleges of agriculture and comparative medicine departments in U.S. medical schools, are designed to develop additional expertise within students for future positions in academe, industry, regulatory agencies, biomedical research, or specialty private practice.

As has been described in the earlier chapters of this report, there is a growing demand for DVMs with post-graduate training in all of the sectors that employ veterinarians. And the number of DVM graduates who seek additional training in specialty fields also is increasing. According to a 2011 survey of recent DVM graduates, 52% of the students who had accepted a job or position

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1 Veterinerae Medicini Doctoris (VMD) is the equivalent degree awarded by the University of Pennsylvania.



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9 Academic Veterinary Medicine INTRODUCTION The gateway to the veterinary profession in the United States is through a university-based veterinary medical education, typically at one of the 28 schools and colleges of veterinary medicine located in 26 states. The schools provide qualifying students (prepared in 2- and 4-year pre-veterinary programs) with a 4-year curriculum culminating in a Doctor of Veterinary Medicine (DVM) or the equivalent1 degree (BLS, 2010). The academic faculty for the 28 veterinary colleges in the United States is an elite group of fewer than 4,000 members with the broad responsibility of pre- paring the U.S. veterinary workforce. In addition to their central obligation to prepare students to be “practice ready” (that is, ready to administer medical care) in 4 years, academic veterinary faculty also conduct research and partici- pate in the post-graduate programs offered by most colleges of veterinary medi- cine, including the Master of Science (MS), Master of Public Health (MPH), Master of Preventive Veterinary Medicine (MPVM), and Doctor of Philosophy (PhD) degrees, as well as internships and residency programs. The post-graduate programs, which are housed within the veterinary science departments in U.S. colleges of agriculture and comparative medicine departments in U.S. medical schools, are designed to develop additional expertise within students for future positions in academe, industry, regulatory agencies, biomedical research, or spe- cialty private practice. As has been described in the earlier chapters of this report, there is a grow- ing demand for DVMs with post-graduate training in all of the sectors that em- ploy veterinarians. And the number of DVM graduates who seek additional training in specialty fields also is increasing. According to a 2011 survey of re- cent DVM graduates, 52% of the students who had accepted a job or position 1 Veterinerae Medicini Doctoris (VMD) is the equivalent degree awarded by the Uni- versity of Pennsylvania. 169

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170 Workforce Needs in Veterinary Medicine offer indicated that their acceptance of a position was related to advanced train- ing, up from 43.5% in 2009 (Shepherd and Pikel, 2011). The 28 U.S. veterinary schools are having increasing difficulty maintaining the high-quality faculty needed to prepare both DVMs and post-graduates. De- clining state support for faculty positions and tuition support has meant budget- ary cutbacks that have reduced hiring, caused layoffs, and eliminated whole programs (Larkin, 2010). Declining federal funding for research grants in veter- inary medicine and animal science have undercut the other sources of support for faculty member salaries. And increased demand for specialty certification, particularly those specialties related to companion-animal care (the largest em- ployment sector), has controlled the focus of the 4-year degree program and de- emphasized training for important, but less-prominent, core disciplines related to the basic sciences and public health, including the training of individuals who would become the next generation of veterinary school faculty. These trends limit the ability of veterinary colleges to fulfill their mission and to respond to important, new initiatives and needs, such as those related to One Health. More- over, no one veterinary college can provide sufficient depth on the broad range of subject matter that encompasses all of veterinary medicine. For all of these reasons, the veterinary colleges face a crisis in manpower and organization, and to survive, will need to consider new models of education for the future. This chapter examines existing formats for veterinary education and several alternative models. It explores supply and anticipated needs for faculty members at the colleges of veterinary medicine, the need for graduate academic and spe- cialty training, and the status of veterinary research. Some of the information for this chapter came from the Comparative Database compiled annually by the Association of American Veterinary Medical Colleges (AAVMC). Additional information came from responses to an exploratory questionnaire developed by the committee (and discussed later in the chapter) to collect information about current and projected numbers of faculty members, students, post-graduates, interns, and residents in colleges of veterinary medicine and departments of vet- erinary science and comparative medicine. FUNDING FOR VETERINARY EDUCATION Most U.S. veterinary colleges (with the exception of the University of Pennsylvania, Tuskegee Institute, Tufts, and Western University of Health Sci- ences) are located at land-grant universities. These colleges were established specifically to address livestock and poultry health issues related to production agriculture. Funding for the land-grant universities was derived from the sale of land given to the states by the federal government in fulfillment of the 1862 Morrill Act. The 1887 Hatch Act authorized matching funds from the U.S. De- partment of Agriculture (USDA) to support faculty and research. The programs have been highly successful in meeting local needs and providing educational opportunities for the citizens of the respective states.

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Academic Veterinary Medicine 171 There is a great deal of heterogeneity across the academic institutions at which schools of veterinary medicine are located, both in terms of size and or- ganization. As a consequence, relationships to other educational units within the institution vary a great deal. For example, some programs in veterinary colleges are shared with departments in colleges of agriculture, and some schools of vet- erinary medicine are housed within larger institutional units. Opportunities for advanced training, research, and extension vary widely among colleges of veter- inary medicine. Initially, the veterinary colleges were fully funded for all of the activities supporting veterinary education from state and matching federal funds. Begin- ning in the early 1970s during an economic downturn, federal support for many of the colleges was reduced. The reduction of support coincided with a diversifi- cation in veterinary education that went beyond the original state-federal agree- ments, adding hospital training for companion-animal practice to the existing livestock and poultry programs. Costs increased as additional numbers of faculty were needed to cover training for the new species and to obtain funding for companion-animal research. During subsequent economic downturns, the states continued to reduce support for their veterinary colleges, as did USDA. During this time, there was federal funding for training in food safety and laboratory animal medicine, pri- marily to support programs for military personnel. Those programs are no longer available directly through the government, and the responsibility to provide those training activities has fallen to academic veterinary medicine. More re- cently, the realization that emerging diseases from wildlife, food animals, food, and water originate largely in animals has placed another responsibility on veter- inary educators for providing the means of identifying, diagnosing, responding to, and preventing these diseases. The greatly expanded expectations of society for the profession have not kept pace with the funding that society has been willing to spend. The current deep recession has caused many colleges to lose up to one-half of their state appropriations, and federal support continues to decline (Larkin, 2011). This erosion poses serious challenges to the ability of veterinary colleges to simulta- neously address companion-animal health along with agricultural productivity, foodborne illnesses, emerging diseases that affect agricultural production and human health, and animal welfare. If society wants to prevent diseases that affect the health of humans such as avian flu, bovine spongiform encephalopathy, E. coli 0157:H7 and Salmonella contamination of produce, then support for veterinary education and research is essential. THE EVOLVING VETERINARY CURRICULUM The curriculum in veterinary colleges is influenced by a number of factors including: changing societal needs; the Standards for Accreditation established by the American Veterinary Medical Association’s Council on Education, based

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172 Workforce Needs in Veterinary Medicine on recommendations of the Council for Higher Education Accreditation (CHEA) and sanctioned by the U.S. Department of Education (Box 9-1); the U.S. Department of Agriculture’s National Veterinary Accreditation Program for Emerging and Exotic Diseases of Animals; and by the national and state li- censing boards which administer the licensing examinations (AVMA, 2010c; USDA-APHIS, 2010c). During the early part of the 20th century, the educational efforts focused on service and support of horses for transport and draft power and later, to increase the productivity of food animals by reducing disease losses and increasing prof- itability. Foodborne illnesses were also a major issue due to poor sanitation practices in the nation’s slaughterhouses. The veterinary profession, with the assistance of academic veterinary medicine, stepped forward to provide training for meat and poultry inspection, eliminating many parasites and infectious agents that contaminated these food products. At the same time as food animal health and safety improved, the nation’s rural population migrated to urban areas. At the turn of the 20th century, 80% of the population lived in rural areas and produced the nation’s food, and horse draft power was the primary form of tilling and harvesting crops from the fields. Major changes in agricultural productivity in the United States did not occur until after World War II. The transformation that took place included improved animal health measures that permitted larger farming units, improved nutrition for livestock and poultry that included more grains in addition to pasture feed- ing, and improved genetics and management of animals which enhanced the welfare and well-being of livestock and poultry (Capper et al., 2009). This mi- gration of people from rural to urban areas provided the opportunity for U.S. society to transform its agrarian workforce into the modern society of today. BOX 9-1 Standards for Accreditation from the American Veterinary Medical Association Veterinary colleges are responsible for developing and revising professional veterinary curricula. The curricula needs to meet standards set by the Ameri- can Veterinary Medical Association’s (AVMA’s) Council on Education, which is designated by the U.S. Department of Education for official accreditation (AVMA, 2010d). There are 11 standards that need to be addressed to suc- cessfully meet full accreditation: Organization, Finances, Physical Facilities and Equipment, Clinical Resources, Library and Information Resources, Stu- dents, Admission, Faculty, Curriculum, Research Programs, and Outcomes Assessment. Full accreditation reviews by the AVMA’s Council on Education are conducted on a 7-year review cycle with accreditations updates required on an annual basis. Students graduating from accredited veterinary colleges are eligible to take national and state licensing examinations that enable them to practice as veterinarians.

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Academic Veterinary Medicine 173 As society became more urbanized, the interest in companion animals be- came of increasing importance to families. This interest called for more attention to the health and welfare of dogs, cats, pet birds, fish, and reptiles. Many of these pets were (and are today) considered members of the family and their owners now want care comparable to that afforded their children (Harris Interac- tive, 2011). Today, with more than 72 million dogs and 82 million cats, pet care and pet foods have grown to be a $41 billion industry in the United State (Burns, 2008). More than 75% of the U.S. veterinarians are in companion-animal- exclusive or companion-animal-predominant practices. This change in societal and student interest has greatly impacted the dynamics of curricular offerings in veterinary colleges. The health care of the pet is very similar to that of human medicine with the emphasis on individual animal care, including the ever- expanding disciplines of specialty care. Over the last 25 years, academic veteri- nary medicine devoted more time to addressing companion animals as the pri- mary clinical program in most veterinary colleges. More recently, the veterinary profession has expanded its training programs to address other animal species such as captive and free-ranging wildlife. With funding for human health gaining momentum in the last part of the 20th century, the study of natural diseases of animals as models for human disease became of significant interest to veterinary colleges and comparative medicine departments in medical schools. The shift from primarily large animal medicine involving horses, cattle, swine, and poultry in the last half of the century to companion animals and wild- life has required major shifts in curricular offerings. The creation of larger farm operations resulted in an increased emphasis on population health, preventive medicine, animal welfare, and food safety through management instead of the traditional emphasis on individual animal medicine, which is the hallmark of companion-animal and equine practice (Walker, 2009). The role of veterinary medicine in public health has also added a new dimension to the profession. The fact that 60% of all infectious diseases of humans are of animal origin, and 75% of emerging infectious diseases in the last decade arose from animals under- scores the need for veterinarians to be a significant part of public health teams (NRC, 2005a). Veterinary colleges are revamping their curriculums to address these challenges. However, as previous chapters have suggested, there are many other issues facing the veterinary profession that academic veterinary medicine has not fully incorporated into the veterinary curriculum, including:  animal welfare  disaster response  global health and global food security  climate change and emerging disease  ecosystem health  the role of the profession in mitigating bioterrorism

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174 Workforce Needs in Veterinary Medicine These areas are largely ignored at this point by academic veterinary medi- cine because of limited funding and qualified faculty. Traditional Curriculum Approach The curriculum commonly used for much of the last century was structured as a lock-step program which offered disciplines focused on animal health in a limited number of species. The first year was devoted to normal form and func- tion, i.e., anatomy, physiology, histology, etc. The second year introduced stu- dents to abnormal form and function which included pathology, microbiology, immunology, and pharmacology. The third year included large and small animal diseases, large and small animal surgery, regulatory medicine, and other topics. In some colleges clinical medicine was permitted in the junior year. Most of the entire fourth year was devoted to clinical rotations through all species of ani- mals, both large and small. Most colleges coordinated acceptable extern rota- tions in veterinary practices so that students would appreciate the type of activi- ties they would be facing when they entered practice. Core and Track Curriculum Approach The continuing expansion of the opportunities and species of animals now served by veterinary medicine makes it very difficult to address all of the train- ing needs in a 4-year program. In the 1970s and 80s, some colleges undertook curricular revision. One of the options considered was the core and track curric- ulum (Pritchard, 1989). The first two years were devoted to normal and abnor- mal form and function, similar to what had been offered in the curriculum used over most of the previous century. But in addition, the core and track curriculum offered a more comprehensive comparative approach. This was based on the presumption that all students needed to meet a basic understanding of veterinary medicine before they focused on a limited number of species. During the first year, students were able to take a small number of elective courses recommend- ed for their respective track. In the second and third years, the number of elec- tives increased as students completed their preparatory courses and defined a clinical emphasis for their fourth year. Students took courses covering clinical medicine for all species in their third year. The elective courses provided infor- mation beyond the core that all students are required to know. The fourth year was devoted to companion animals; equine; food animals; food/small animals; small/large animals; zoological medicine and/or individual programs including additional research, and public health. Systems Curriculum Approach Recently, there has been interest in a systems approach that again focuses on a comprehensive core knowledge and competence for all students. The first

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Academic Veterinary Medicine 175 year focuses on normal form and function with case-based studies with small groups of students and an instructor. The second year is devoted to core abnor- mal form and function, again with case-based clinical problem solving studies as part of each week’s curricular exercise. Approximately, two-thirds of the third year is focused on one of three species that the students select for in-depth study—companion, equine, or food/wildlife tracks. The entire fourth year focus- es on the species studied in the third year. If the student wishes to take one of the other two species offerings, they may take those courses in the fourth year. The students would have less clinical experience; however, they will have the di- dactic lectures and laboratories for the two tracks. Problem-Based Learning and Distributed Clinical Curriculum Approach The other curriculum which has been used by a few veterinary colleges in the United States is the problem-based curriculum (http://www.westernu.edu/ veterinary-about). Small groups of students start with a clinical case early in the first year. With faculty serving as discussion leaders/facilitators, the students are expected to work through a case each week. Some supplemental lectures are given to provide specific information to assure that students are given the sup- port that may be missing from textbooks. In some colleges, the students begin clinical rotation externships for exposure to veterinary practices during the third year. The fourth year is a distributed clinical program with most of the clinical instruction provided by practicing veterinarians during their clinical extern rota- tions. Clinical Training Programs There are currently two types of clinical training programs to support the various curriculum approaches: Traditional Clinical Training The “traditional clinical training” approach is used to support the tradition- al, “core and track”, and the systems approaches to the veterinary curriculum. Traditional clinical training involves a central teaching hospital where the facul- ty of the college uses client-owned large and small animals to serve as the case material for hands-on clinical training. Students gain experience in taking histo- ries, conducting physical examinations, determining the appropriate diagnostic tests or imaging needs, collecting samples, and then reviewing and analyzing the information prior to making a diagnosis. Once the diagnosis is determined, stu- dents consider the appropriate treatment options, including the need for appro- priate surgical procedures and the medical therapy that is to be recommended for the patient. Follow-up procedures for continuing therapy or recovery from sur- gery are prescribed for the owners. The students are expected to act as the lead

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176 Workforce Needs in Veterinary Medicine clinician in these procedures under the faculty member’s guidance and supervi- sion. The students are also expected to gain experience in communicating with clients and colleagues. Many of the cases require additional review of the litera- ture by the student and reporting the findings back to the faculty and colleagues. This type of instruction usually involves the entire fourth year of the veterinary curriculum. Most veterinary colleges provide opportunities for fourth year stu- dents to rotate out of the academic teaching hospitals to veterinary practices to gain “real world” experience for the more routine procedures. This system has produced graduates with excellent skills in observation and analysis of case in- formation for making diagnosis and treatment of animals. It utilizes the infor- mation that is given in the previous three years and provides a uniform educa- tional experience and monitoring of the student’s educational experiences. Most veterinary colleges have secondary and tertiary hospitals which further expose students to the challenges associated with more complex cases and is an ad- vantage over those students who do most of their training in private practices. Distributed Clinical Training The “distributed clinical training” model is a more recent approach to veter- inary clinical training both inside and outside the United States (http://www. westernu.edu/veterinary-about). It was introduced with the problem-based cur- riculum. For the most part, private practice veterinarians agree to provide in- struction to students through a prescribed period of clinical service in their prac- tices. Third year students have 2-week rotations to introduce them to the clinical operations and to gain observational skills and animal-handling skills. Fourth year students spend more time with the practicing veterinarian doing hands-on handling and treatment of animal patients. In some instances, the students rotate through specialty practices. In all of these instances the practices are expected to generate their operating income. The students also report to a faculty coordinator to discuss their cases with the faculty member, usually accomplished by elec- tronic communication. Typically, the cases are primary or secondary level cases, unless there is an unusual specialized case. The distributed clinical model allows the students to see more cases, see a variety of client-veterinarian and business relationships, and as such, students may develop better social interactions with clients. NEW CONCEPTS IN VETERINARY EDUCATION The current decline in state budgets to operate veterinary colleges, and the increasing demand for veterinary service including specialty training and exposure to different animal species, prompted the Association of American Veterinary Medical Colleges (AAVMC) to explore other means of facilitating

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Academic Veterinary Medicine 177 veterinary education which resulted in the Foresight Project report (Willis et al., 2007). The report includes the concept of centers of excellence/emphasis, dis- tance learning, shared virtual curricula, and the utilization of pod casts and itin- erant faculty, among other things. To further facilitate these initiatives, the AAVMC has taken the lead in a collaborative effort with a number of other or- ganizations in the North American Veterinary Medical Education Consortium (NAVMEC) that will focus on the transformation in veterinary medical educa- tion that many feel is critical for the profession at this time (AAVMC, 2009a). Examples of alternative means of education from the Foresight and NAVMEC reports are discussed below. Centers of Emphasis Centers of Emphasis (sometimes called centers of excellence) would be de- veloped in locations where there are appropriate species of animals to provide instructive hands-on experience. For instance, a regional or national food-animal center established where a significant number of a particular livestock species is located, would provide the opportunity for students to gain experience with the rapidly changing management of large, food-animal production units (Miller and Prasse, 2006; Troutt and Osburn, 2008). The centers would not replace instruc- tion in individual food-animal medicine currently taught at veterinary colleges, but would increase the in-depth experiences of students with large-population health practices in production settings. This approach maximizes the benefits of limited resources, locates the training near livestock populations, and concen- trates faculty expertise from multiple schools and colleges to focus on the spe- cies, permitting one location for a core of faculty rather than only one or two faculty members per institution. The centers would serve as the primary center for training 4th year students for a portion of their clinical (8 to 12-week) rota- tions, as well as specialists and graduate students. Faculty would be able to con- duct research related to the species and regional environment, staying abreast of all things of importance to the species. For instance, the food-animal center could provide more instruction on environmental health, animal welfare, nutri- tion, food safety, and waste management as well as an understanding of the im- portance of the economics of the production system. Similar centers could be developed for companion-animal practices in met- ropolitan areas where the specialty hospitals would have the case load for resi- dency training and clinical trials, as well as rotating students from veterinary college community practices. These types of practices should be geared toward self-supporting operations with a faculty research component for instructing residents and 4th year veterinary students wishing to be exposed to selective specialty rotations. A center that is situated in a location with a large number of animals would permit clinical trials to be more easily accomplished.

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178 Workforce Needs in Veterinary Medicine Financial Support for Centers of Emphasis Given the importance of food animals to the U.S. food supply, economy, and public health, a case can be made that supporting a food-animal center is in the national public interest (and should therefore be partially supported with federal tax dollars). Currently, the cost of the infrastructure to train the veteri- nary workforce that provides services to maintain the health of food animals across the nation and produce the highest quality and safest food in the world is carried by only 26 states. (Some states with no veterinary college have in the past provided non-resident tuition for a limited number of students for states with veterinary colleges. These numbers and the amount of non-resident tuition dollars have been declining, however). Other centers could be established for equine health, poultry health, swine health, food safety, public health training, laboratory-animal medicine, and wild- life and marine ecosystems. The success of these centers will be dependent upon the willingness of veterinary colleges to share faculty and administration of these centers, and to pursue creative funding arrangements involving stakehold- ers. Distance Learning The technology for distance learning continues to improve and is serving as a valuable means of delivering education to many students. This form of educa- tion for professional schools is now taking shape, particularly for post-graduate education courses such as the Master of Public Health program at the University of Minnesota (http://www.cvm.umn.edu/edu/). As part of the degree require- ments, the Minnesota program includes some on-campus courses and some de- livered through distance learning. A number of veterinary colleges have joined the University of Minnesota Program. This is particularly helpful to those indi- viduals who cannot afford to leave their job or are doing dual degree work, but can take the courses in the evenings or on weekends. Distance learning could provide education to large numbers of students across the world. It requires special methods of delivery as well as the ability for students to ask questions during or following lectures. In other instances, where the information is transmitted over long distances, it will require local faculty to serve as discussants as a follow-up to the lectures and to help students apply the concepts delivered in lectures into practice. This means of instruction is best suited for lecture formats, as clinical training requires hands-on involvement. More recently, telemedicine and Internet-based videoconferencing software has become available as adjuncts to clinical case instruction, diagnostics, and even management of clinical cases. Robotic surgical techniques can be conducted on cases located thousands of miles away, again through the use of electronic tech- nology.

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Academic Veterinary Medicine 179 Virtual Curriculum A number of medical school programs are now developing virtual curricu- lum models. This type of program requires a think tank approach for developing the best course materials and the appropriate teaching delivery, including a well- designed outcomes delivery system. The approach best suited for lecture formats is to use the problem-based learning model and organize discussion sessions through a chat room format. This type of instruction does raise concerns about cybersecurity and copyright infringement; it also cannot provide the type of in- struction that requires skills assessments and animal handling. One important aspect is the potential to use groups of experts to provide the information to stu- dents globally, providing the latest and most relevant peer-reviewed information to students all over the world. On-line texts that are continually updated with current information would be of significant importance to the profession. Considerations for Veterinary Educators A number of new subject matter items have arisen over the years which need attention in the veterinary medical curriculum. NAVMEC is in the process of evaluating these, which include core competencies, new initiatives such as One Health, and pre-veterinary requirements. Some of the new subject matters areas of significant importance to the veterinary profession include animal wel- fare for all species, disaster response, and a broader set of issues related to pub- lic health, including food safety and security, zoonotic diseases, global food production, and ecosystem health. For the profession to grow, it must demon- strate to society that it has a relevant role to play in addressing future societal issues; thus, inclusion of this information in the curriculum is essential. Different models for a veterinary education program are likely to have pros and cons. Ultimately, the value of the program can be assessed by weighing the costs of providing a curriculum against its ability to serve the broadest needs of society. Since few, if any, programs can meet all needs, collaboration and coor- dination between schools of veterinary medicine is essential. The AAVMC as the common coordinator for academic veterinary medicine could work more closely with stakeholders and the colleges to assess the workforce needs, includ- ing recommending alterations in curricular offerings to assure that academic veterinary medicine is responsible for meeting the diverse needs of the profes- sion. NAVMEC has initiated such a process by holding 3 national meetings with over 400 stakeholders to gain their input on what academic veterinary medicine has been addressing and by considering the societal opportunities that the future holds for the profession. Chapter 10 discusses the economic considerations related to a basic veteri- nary education, from the perspective of the educational system and of veterinary students. In the remainder of this chapter, the role of faculty as a source of ex- pertise for advanced instruction and as the foundation for veterinary medicine is

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Academic Veterinary Medicine 187 FIGURE 9-4 Residency and internship position notifications submitted to the American Association of Veterinary Clinicians, 1988-2009. However, the current training programs and certifying examinations for res- idents emphasize clinical procedures rather than the research experience needed to train individuals for academic positions. Research training is an essential foundation skill for faculty to conduct investigations that advance scientific knowledge, develop the major breakthroughs required to address animal health, and study animal models for human disease needs. In addition to academe, cred- ible research training of residents also builds the expertise that private industry and the public sector are clamoring for in job candidates, as described in other chapters of this report. Moreover, for large animal specialties, there is a need for specialists who are familiar with contemporary livestock practices, nutrition, genetics and ani- mal welfare, as well as an understanding of the economics of the industry, how to assess retail needs, and the biosecurity, food safety, and disaster response issues associated with large populations of animals. In the future, veterinarians need to be familiar with policy issues relating to water and air quality, environ- mental management of waste, and the impacts of production units on feed and food crops. These subjects must be addressed if veterinary medicine is to remain relevant to producers in the livestock and poultry industries. Specialty Training is Not Publicly Supported A major conflict facing the veterinary colleges is that, in spite of the de- mand, most do not have the funding required to meet the needs for advanced specialty training. On the one hand, veterinary colleges are the most logical place for obtaining specialty training. The academic environment has the diverse caseload and expertise in many core disciplines such as pathology, clinical pa- thology, imaging, microbiology, cell biology, immunology and epidemiology,

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188 Workforce Needs in Veterinary Medicine which enhances residency training. Veterinary colleges also have the basic sci- entists who have the research backgrounds and equipment to provide residents with the in-depth guidance in research methodologies and to provide appropriate mentoring for studies on complex clinical diseases. Veterinary colleges are able to train residents to make presentations of the results of their studies in clinical rounds and at national conferences. Some medical schools provide focused areas of expertise in comparative medicine that accommodate comparative medical pathology and laboratory animal training. On the other hand, the rapid growth of specialties and the need for training has been pursued in the face of inadequate infrastructure support, such as core funding for faculty, and adequate resources and equipment for the training envi- ronment. Veterinary colleges are funded using public resources to train entry level veterinarians, with very little support for specialty education. Specialty colleges require two or more faculty mentors to train residents, placing pressure on the schools to hire more faculty, typically an individual with a clinical spe- cialty. In some instances, colleges are located in communities with inadequate caseloads to fully support the appropriate training environment for the specialty, causing some colleges to develop satellite clinics in locations which support specialty training. This has made the advanced training for specialists a viable alternative and has improved clinical experiences for both residents and profes- sional students. But these opportunities are limited. Comparable research expe- riences are much more limited. Some veterinary colleges use residents as in- structors for veterinary students, which can be an important part of residency training, but it also detracts from the specialty training activities due to the con- siderable time and effort required to adequately supervise and train the profes- sional students. Although AVMA has been a significant supporter of specialty training, it has done so with minimal consultation with veterinary colleges. This is causing a dilemma with the colleges since they have to provide the infrastructure and faculty to provide this training with little or no funding or infrastructure support. Federal agencies and industry also benefit from having the veterinary colleges train specialists for their respective workforces. Although they sometimes pro- vide stipends for training specialists, they give minimal or no contributions to infrastructure or faculty salaries. From a financial perspective, the colleges are unlikely to have the resources to continue with their post-DVM programs and to provide what is required for entry level DVM training, particularly in light of the declining state support. Clinical Faculty Expertise is not Being Replenished A major concern of academic veterinary medicine is the failure of trained specialists to remain in the academic environment. When board-certified spe- cialists join a veterinary faculty, the veterinary teaching hospital clinical practic- es are enhanced. This trend has been important for moving the teaching hospi-

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Academic Veterinary Medicine 189 tals to becoming secondary and tertiary referral centers, increasing income for the hospitals, and providing veterinary students with challenging cases as part of their clinical training. The residency programs would appear to be training ade- quate numbers of specialists to meet the academic needs, however many of these individuals will be attracted to private companion-animal practice because sala- ries of specialists in private practice are considerably higher than those in uni- versities, so there is little incentive to stay. In short, the veterinary schools are on an unsustainable trajectory. In the current climate of decreasing state budgets and a decline in discre- tionary spending for specialty services, it is increasingly difficult for veterinary schools to continue to be the principal source of specialty training. Until there is a clear indication of state, federal, industrial or philanthropic support, the role of academic veterinary medicine in future training of specialists is at risk. Veterinary colleges need to be in a dialogue with AVMA and AAVMC to determine the number of specialists needed to supply all employment sectors so planning and acquisition of infrastructure support can be obtained for the train- ing of current and future specialists. Where critical shortages are occurring na- tionally for trained public practice veterinarians such as laboratory animal medi- cine, pathology, epidemiology, microbiology, and toxicology, public support to produce those veterinarians is warranted. Academic (Research) Training Veterinary medical colleges, veterinary science departments, and compara- tive medicine departments are the principal academic environments at which DVM/MS/PhDs are trained. A number of veterinarians may also pursue ad- vanced degrees in schools of medicine, public health, law, agriculture, and busi- ness. All of these diverse training opportunities are important for the veterinary profession to grow in order to meet societal expectations. Traditionally, graduate academic programs leading to MS and PhD degrees have been 2- and 4-year programs, respectively, and are discipline-based, for example, microbiology or pharmacology. Because many current scientific and biomedical challenges are complex, programs have begun to emphasize multi- disciplinary training, involving two or more disciplines. Regardless, the goal of the programs is to provide graduates with a sound base in one or more disci- plines along with the critical analytical skills needed to carry out independent research. Post-graduate training is of great importance for preparing the public practice veterinarians in the federal and state workforce, including the disci- plines and practices of critical importance for the health and well-being of ani- mals, the environment, and humans, such as pathology, ecology, epidemiology, virology, infectious diseases, comparative medicine, and public health. Similar specialty or graduate training, especially in pathology, toxicology and laboratory animal medicine, are needed in the pharmaceuticals and biologics industries to perform the critical testing of pharmaceuticals and biologics for safety and effi-

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190 Workforce Needs in Veterinary Medicine cacy before these products are used in human trials. Veterinary pharmacologists, pathologists, microbiologists, virologists, toxicologists, and laboratory animal veterinarians are needed by these same industries and public agencies like the Food and Drug Administration. In addition, members of the veterinary school faculty must have advanced education before they are in a position to train fu- ture veterinarians and post-graduate veterinarians for these critical roles. However, in stark contrast to the number of DVM graduates entering spe- cialty training, far fewer are seeking advanced academic degrees. Based on the information from the committee’s survey of veterinary schools, departments of veterinary science, and departments of comparative medicine, Figure 9-5 shows the total number of students enrolled in educational training programs in those institutions in 2007, as well as the numbers of students expected to be enrolled in 2010 and 2016. Although the numbers of students seeking advanced academic degrees (MS, PhD) would initially appear to be equal or greater than those ob- taining advanced training in clinical residencies, that is not the case, because they include not only DVMs but also students with a Bachelor degree. The proportion of DVM students pursuing a PhD degree can be estimated from the AAVMC Comparative Database (AAVMC, 2009b) which indicates that the number of DVM graduates enrolled in PhD programs from 2007 through 2011 years will be, on average, 83 per year. That would suggest that about one quarter of the total PhD enrollment in the veterinary colleges and as- sociated departments that responded to the survey (Figure 9-5) are DVMs, as- suming a 4-year PhD program. That number is reasonably consistent with the responses to the committee’s survey indicating that, across all colleges of veteri- nary medicine, 61 PhD degrees would be awarded to DVM graduates in 2007, a number expected to increase to 101 by 2016. As Figure 9-6 illustrates, that is a much smaller number than the graduates receiving board certification in the same time periods. Implications of the Lack of Interest in Graduate Academic Training It is clear that most veterinary students are not seeking academic training to pursue academic careers. Instead they are more inclined to enter clinical resi- dency programs, and veterinary schools are attempting to accommodate that interest. Veterinary educators have not cultivated a sufficient interest among veterinary students, nor provided sufficient training opportunities to prepare the next generation of research scientists for academic, industrial, and public service positions. In addition, there are multiple factors that may dissuade students from entering PhD programs, beginning with the length of time needed to obtain graduate degrees following the previous eight years to attain the DVM degree, the amount of student debt carried by students after graduating from veterinary schools, and the lack of public or private support of graduate student stipends. For students inclined to pursue a career in the academe, there is the difficult

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Academic Veterinary Medicine 191 g 14000 12067 12000 10866 10354 10000 Total Number of Students 8000 2007 2010 2016 6000 4000 2000 1756 1576 1414 1224 1056 948 1052 874 969 724 526 602 250 280 333 0 DVM/VMD MS Ph.D. Postdoc Intern Clin. Resident FIGURE 9-5 Total numbers of DVM/VMD and post-graduate students in 2007 and pro- jected for 2010 and 2016, as reported by institutions responding to committee survey. g 450 408 400 351 350 316 300 Number of Graduates 250 2007 2010 200 2016 150 101 100 91 81 50 0 DVM/PhD Clin. Resident FIGURE 9-6 Number of recipients of PhDs and board certifications (DVMs) in 2007 and projected for 2010 and 2016, as reported by institutions responding to committee survey.

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192 Workforce Needs in Veterinary Medicine reality of having to obtain external research funding to cover a portion of one’s own salary, as well as to support technicians and graduate students. NIH grants for graduate students do not provide faculty salary support, so the costs of train- ing graduate students are drawn from internal resources that could have been used to fulfill the states’ commitment to train entry level veterinarians. In some cases, there are issues associated with spousal/partner hires for finding two posi- tions for professional faculty recruitments. Yet, veterinary schools are in desperate need of trained graduates for faculty positions in structural biology, physiology, pharmacology, pathology, clinical pathology, infectious diseases of animals and zoonotic diseases, virology, mi- crobiology, food safety, epidemiology, and nutrition. The needs include individ- uals with advanced training with select infectious agents (which require bio- secure facilities), alternative immunological or pharmaceuticals for preventing or treating diseases, epidemiological modeling, and comparative medicine. In the near future, the profession will have major setbacks if adequately-trained professionals are no longer available in veterinary colleges. Within academic veterinary medicine, the demand for veterinarians with advanced training for instructional and research purposes is far outstripping the available candidates. As noted earlier in this chapter, there were 260 vacant fac- ulty positions in 2007. The positions needed by 2016 are projected to be 572 (new positions and replacements for retirees). However, there is little evidence that the academic veterinary community will meet its own needs let alone those required for state diagnostic laboratories, federal research and regulatory agen- cies, or for high-paying jobs in the pharmaceutical and biologics industry, for positions in research, safety studies, and efficacy trials, among others. A notable bright spot, however, is the increased growth of and interest in MPH and MPVM programs (Box 9-2). Extramural Support for Graduate Academic Training The principal source of public funding for graduate training was from the National Institutes of Health (NIH) and in particular, the National Center for Research Resources (NCRR), which provided most support for veterinarians pursuing advanced degrees in research. For example, NCRR provided three year training grants to DVMs pursuing a PhD degree at one of 14 Institutional Train- ing programs around the United States that focus on various aspects of compara- tive medicine. NCRR offered pre-doctoral and summer training grants as well. At the time this report was released, NCRR programs were being reorganized under NIH’s new Office of Research Infrastructure Programs. As noted in Chap- ter 6, a number of other NIH institutes provide funding for advanced training of veterinarians, and there are some funding and training opportunities available from the Department of Homeland Security (DHS).

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Academic Veterinary Medicine 193 BOX 9-2 Increasing Number of Master’s Programs In contrast to the relatively modest growth of DVM/PhD candidates, the number of DVMs pursuing Master’s degrees in public health (MPH) or pre- ventative medicine (MPVM) has increased sharply, because the number of veterinary colleges offering such programs has grown from 4 in 2004 to 22 in 2008, and the number of students who enrolled had increased from 30-40 in 2004 to 274 in 2007. Based on the committee’s survey, veterinary colleges predict student enrollments in the MPH programs to increase to approxi- mately 500 by 2016. The increase in the number of programs has been a response to the growing awareness of the role of veterinarians in infectious disease-related issues, including zoonotic disease and bioterrorism. Other agencies, such as USDA, do not provide any support specifically for advanced academic training in veterinary medicine, although a modest level of fellowship support is available, albeit with stipends that are significantly lower than those from NIH. It is a concern that USDA, which employs the largest number of public practice veterinarians and which has longstanding vacancies, due in part to a lack of qualified candidates, does not support graduate research and educational opportunities for veterinarians (GAO, 2009). The mission of the land grant partnership between states and the federal government has a broader scope than just increasing animal production. Individ- uals with advanced training are needed to address the multidisciplinary problems and issues facing U.S. agriculture, such as the control of zoonotic diseases, food safety, animal welfare, and environmental quality. Failure to address these is- sues will lead to losses of sustainable agricultural infrastructure in the United States. Among the needs of USDA, for example, is a future workforce of re- searchers who are trained to work with pathogens that can threaten human and animal health. Hands-on training would come from work in Biosafety level 3 (BSL-3) Ag and BSL-4 facilities mentored by the experienced workforce with expertise in those fields. RESEARCH IN ACADEMIC VETERINARY MEDICINE Research in academic veterinary medicine is essential to advance the pro- fession, and to forge progress in animal health, biomedical sciences, and ecosys- tem health. Research is an important mission of the veterinary colleges that goes hand in hand with developing the next generation of scientists, some of whom will become veterinary faculty. Over the last five years, the amount and diversi- ty of research funding that supports veterinary research has increased signifi- cantly, which demonstrates the broader role that veterinarians are now playing in

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194 Workforce Needs in Veterinary Medicine human and animal research. Table 9-3 compares research expenditures of veter- inary schools in 2002-2003 to that in 2008-2009 (NRC, 2005a; Buss et al., 2006; AAVMC, 2009a). In that time period, total research funding to veterinary col- leges increased by 57%, from $321 million to $503 million. The most significant increase was in funding from the agencies within U.S. Department of Health and Human Services. Support from NIH, the Centers for Disease Control and Pre- vention (CDC) and the Food and Drug Administration (FDA) grew by 81%, from $155 million to $280 million during the same time period. Funding from industry and private sources also grew significantly, as did support from other federal agencies, such as the Department of Homeland Security. Not surprisingly, however, some colleges of veterinary medicine are able to attract more research dollars than others. As Table 9-4 shows, more than half of NIH funding to veterinary colleges went to 5 institutions. For perspective, the total funds awarded to all veterinary colleges was approximately $171 million, about 0.7% of the NIH extramural funds awarded to all institutions in 2011 (BRIMR, 2012). TABLE 9-3 Funding for Veterinary Research Amount (millions) Number of Awards Funding Source 2002-03 2008-09 2002-03 2008-09 National Institutes of Health; 155.6 280.64 1,247 1,337 Centers for Disease Control and Prevention; Food and Drug Administration U.S. Department of Agriculture 34.4 37.18 595 637 Department of Defense 5.9 5.99 53 64 Environmental Protection Agency 1.8 2.98 31 20 National Aeronautic and 2.6 2.7 24 12 Space Agency National Science Foundation 3.5 3.56 48 43 Department of Interior 0.8 7.25 34 26 Other Federal Agencies 7.6 16.13 116 119 State Agencies 38.8 41.3 558 356 Industry 25.2 36.85 942 1,160 Private 30.4 42.36 1,291 1,961 Other 14.6 26.11 855 523 Total 321.2 503.05 5,794 6,405 SOURCE: NRC, 2005a; AAVMC, 2009a.

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Academic Veterinary Medicine 195 TABLE 9-4 National Institute of Health Funding to Veterinary Colleges, 2011 Funding for Veterinary Rank College Medicine 1 University of California, Davis $24,630,734 2 Colorado State University, Fort Collins $18,641,724 3 University of Pennsylvania $18,423,516 4 Cornell University, Ithaca $16,799,182 5 University of Wisconsin, Madison $9,411,401 6 University of Missouri-Columbia $8,304,053 7 Michigan State University $8,132,386 8 Louisiana State University A&M College, Baton Rouge $7,862,278 9 Iowa State University $6,869,067 10 Washington State University $6,446,399 11 Tufts University Boston $5,398,692 12 Ohio State University $4,526,233 13 Kansas State University $4,364,856 14 North Carolina State University, Raleigh $4,359,214 15 University of Georgia $3,875,194 16 Texas A&M University System $3,334,201 17 University of Minnesota Twin Cities $3,160,379 18 University of Illinois Urbana-Champaign $2,715,721 19 Purdue University West Lafayette $2,709,182 20 Oklahoma State University Stillwater $2,468,411 21 University of Tennessee Knoxville $2,415,177 22 Virginia Polytechnic Institute and State University $1,335,146 23 University of Florida $1,247,198 24 Tuskegee University $884,127 25 Texas Agrilife Research $815,048 26 Oregon State University $794,828 27 Auburn University At Auburn $375,520 28 Mississippi State University $337,379 Grand Total $170,637,246 Mean $6,094,187 Median $4,117,204 SOURCE: BRIMR, 2012.

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196 Workforce Needs in Veterinary Medicine NIH awards data also show that departmental and other units outside of vet- erinary colleges that provide post-DVM training, for example in laboratory ani- mal medicine and pathology, are more successful in attracting research funding than some colleges (BRIMR, 2012). Heavy teaching and clinical service loads, along with an institutional culture that some would contend does not place a high enough value on scholarship, undermines the competitiveness of veterinary schools in attracting research funding. There is a very long list of research areas in which the veterinary profession is well-positioned to play a major role. For example, a better understanding of the causes of human cancer, nutritional diseases, genetic diseases, and respirato- ry diseases are especially relevant to research with companion animals that live in the same environment as humans. The key to assuring that the profession re- mains a part of the critical research that is in front of us is to have the future workforce recruited and directed towards these issues. However, the sole de- pendence of veterinary medicine on NIH funding, which only supports animal research related to human diseases, is insufficient. Veterinary medicine has a responsibility to address animal disease for the sake of animals. As Table 9-3 shows, support from USDA, which has historically played critical roles in food safety research and research to prevent and control infec- tious diseases in livestock and poultry, was relatively flat in the five-year time period between 2002-3 and 2008-9. It is noteworthy that the agency has not ex- panded the involvement of veterinary medicine in its pursuit of new research issues related to a litany of concerns: the control of infectious and zoonotic dis- eases, antibiotic resistance, antibiotic alternatives, changing animal production environments, identification and control of the sources of foodborne diseases in meat and produce (for example E. coli O157:H7), the role of animal welfare in food safety, and the interaction of wildlife and natural ecosystems with food animals (NRC, 2005a; Jay, 2007, 2008). Two National Research Council reports, the “Critical Needs of Research in Veterinary Science” (NRC 2005a) and “Animal Health at the Crossroads: Pre- venting, Detecting and Diagnosis of Animal Diseases” (NRC 2005b) address the urgency of the need for increased funding and support for veterinary science. Currently, federal funding ranks from poor to modest for addressing animal dis- eases in production environments, wildlife, and for food safety and human health. Much of veterinary research is directed to the recognition of the cause of diseases; definition and diagnosis of diseases; response in the form of vaccines, pharmaceuticals, and management around the disease; and/or prevention. The latter is critical in the case of One Health as the profession works to prevent the spread of infectious disease to people. In addition to this, animals serve as senti- nels of environmental threats, as demonstrated by the recent case of melamine in pet food. USDA, along with counterpart mission agencies that address human and ecological concerns, could provide the spark to ignite the collaborative re- search activities related to One Health (King et al., 2008).

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Academic Veterinary Medicine 197 A major deterrent to the continued advancement of research in veterinary medicine is the lack of interest on the part of any federal or state agency or of industry and commodity groups to provide sufficient support for any of the ani- mal species or their ecosystems. Veterinary medicine is the profession between human and animal health; it works at the interface of food and the environment. Animal diseases that affect the efficiency of food production, the spread of pathogens through ecosystems to fruits, vegetables and nuts, and the emergence of diseases from wildlife are all areas that require attention for funding from government and philanthropic organizations in order for the profession to thrive. This is essential for all of humankind as well as for maintenance of the quality of life and a sustainable global ecosystem. The forecast through 2016, as reported to the committee, indicates a lack of educational programs devoted to training future academicians, public practice professionals, and biomedical scientists, and the lack of an incentive structure to bring more students into these fields. Additional faculty members are needed to address the diverse curricular, research, service, and outreach activities demand- ed by stakeholders, and in particular, to fill the roles the profession hopes to play in addressing One Health issues. That includes a need for expertise in ecosystem health, global health, food safety, animal welfare, disease recognition, response, recovery and prevention, and biosecurity. However, this is only likely to happen with national investments in academic veterinary medicine to train the future workforce in these fields, and a commitment on the part of veterinary colleges to give these issues greater priority. Without new faculty members, the future of veterinary medicine is unsus- tainable. In the future, trained scientists in the scientific disciplines basic to vet- erinary medicine will be in critical need of support. Allowing faculty salaries to be supported on federal training grants and making federal facilities available for the type of educational training that addresses national needs are two partial solutions. The concept of Centers of Emphasis related to national needs would also be an ideal means of leveraging expertise across the veterinary schools. Despite increasing demands for an expansion of veterinary expertise and re- search over the last decade, the veterinary workforce has not grown significantly (NRC, 2005a). The potential for the profession and its impacts on society will only be reached if there is adequate infrastructure and financial resources to de- velop a more highly-trained veterinary workforce. Until that occurs, critical na- tional needs will remain unattended.