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1 Introduction The veterinary medical profession leads the world in developing a medical and scientific understanding of animals that supports society’s desire to care for and derive benefits from them. Veterinary medicine provides a foundation for the medical care of pets (companion animals); for the efficient and safe use of animals for food and other products; for the care and use of animals as research models and agents for improving human health; for understanding animals as sentinels of disease and toxic threats and as signals of ecological change; for wildlife conservation; and for supporting the lives and welfare of animals in captive environments. In the United States, the veterinary medical profession comprises a small workforce (around 92,000 professionals, about one-tenth the size of the human medical profession) educated at a relatively small number of academic institutions. More than half of the members of the workforce are companion-animal practitioners, who are by far the most visible veterinarians to the public. The public is generally unaware that a smaller, but no less important cadre of individuals are working to fulfill other societal priorities involving animals, for example, in producing meat and milk that is safe, monitoring the spread of animal infectious diseases that are transmissible to humans (zoonotic diseases) such as H5N1 avian influenza, West Nile virus, rabies, and Severe Acute Respiratory Syndrome, and for discovering new treatments for cancer and other diseases. Most would be surprised, upon reflection, to comprehend the frequency at which human and animal lives intersect daily, and the breadth of the little publicized domain of the veterinary profession. The modest size and disciplinary composition of the U.S. veterinary workforce is relatively fixed as a function of the annual number of graduates awarded the degree of Doctor of Veterinary Medicine (DVM)5 by 28 U.S. veterinary schools and colleges—approximately 2,500. Growing at a rate that has increased slowly but steadily in the last decade, the workforce in the past has been in balance with the needs of society and has made major contributions and achieved great progress in supporting critical human (and animal) needs. However, a changing environment for veterinary medicine has disturbed that balance, raising concerns inside and outside of the profession that the workforce might be insufficient to address all of what is being asked of it, placing at risk not only society’s priorities for caring and using animals, but also animal and human health, lives, and livelihoods. Some of those changes have altered the demand for traditional veterinary services, particularly in relation to the production and care of food animals both in the United States, where consolidation has resulted in fewer but larger, intensive animal-production units, and 5 At the University of Pennsylvania, the degree is called the Veterinerae Medicini Doctoris (VMD). This report uses DVM throughout to refer to both degrees. PREPUBLICATION COPY 19

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20 Workforce Needs in Veterinary Medicine globally, where food-animal production in developing countries has sharply expanded to accommodate growing urban populations who want more meat and milk in their diets. In addition to altering the kind of veterinary services needed and the way in which they are delivered, the changing footprint of food-animal production has also created concerns related to pollution, impacts on wildlife and ecosystems, food safety, and infectious diseases that have collectively expanded the purview of veterinary medicine into a newly forming discipline described as “One Health.” A key question is whether the veterinary profession is preparing adequately to address the food security and health needs of the closely-interconnected world of the 21st century through participation in the One Health discipline. The demand for veterinary services has also been modified by new advances in medical treatments for companion animals that are increasingly requested by pet owners. To deliver those treatments, a growing number of veterinarians are seeking board certification in specialty veterinary medical fields. Although it represents an advancement of the companion-animal workforce, that trend has strained the resources of veterinary colleges and schools that have attempted to provide specialty training in addition to a broadly-based education to entry-level veterinarians, without sufficient resources to do both. The biggest change affecting veterinary schools and colleges is, in fact, the decline in public support for basic veterinary education and research at the state and federal levels. A consequence of tightened budgets, the loss of funds has raised concerns that the ability of the profession to continue contributing to biomedical science and public welfare is being quickly eroded, because the pipeline of future veterinary research scientists depends on strong research and teaching programs in academe. It is not surprising that there is a strong demand for DVM- PhDs in the biomedical and pharmaceutical industries—since comparative medicine is a basis of biomedicine; however, without support for the specialty training needed by industry or the academic research training needed by both industry and academe, the pipeline of those candidates will soon be empty. How to reverse this trend is a major question and a challenge for the colleges and schools of veterinary medicine. The decline in public support for veterinary education has also placed a growing tuition burden on students, and student debt has significantly outpaced income growth, a situation exacerbated by the current economic downturn. Since 2009, women have comprised the majority of U.S. veterinarians (AVMA, 2010a). Most are companion-animal veterinarians who are more likely to work fewer hours than veterinarians in other sectors of practice, and their incomes are lower than their male counterparts (Felsted and Volk, 2000). In addition to the fact that fewer men in general are entering veterinary medicine, minorities remain at about 10% of the workforce, although efforts by the Association of American Veterinary Medical Colleges (AAVMC) have increased minority student enrollment to about 12% of the student population (Cima, 2008). The number of women in the veterinary profession has increased at the same time that corporate ownership of companion-animal veterinary clinics, such as Banfield, a division of Mars, Inc., have expanded. Those clinics employ many veterinarians as associates, but veterinary associates make less money than private practice owners. In addition, as additional veterinary schools outside the United States have come on-line, the pool of companion-animal veterinarians in the United States is growing. Therefore, there is another set of critical questions for the profession: how to adjust to the global economic slowdown, how to reduce the cost of a veterinary education, and how to maintain a strong profession, not only in companion-animal practice, but in other sectors of veterinary medicine that are important to society. PREPUBLICATION COPY

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Introduction 21 TABLE 1-1 Number (2010) and Earnings (2009) of Veterinarians Employed in the United States 2010 2009 Median Employment Category Number Earnings Food-animal-exclusive practice 1,109 $103,000 Food-animal-predominant practice 3,890 91,000 Mixed-animal practice 4,326 85,000 Companion-animal-predominant 5,966 91,000 practice Companion-animal-exclusive practice 41,381 97,000 Equine practice 3,743 85,000 Other private practice 1,087 79,000 College or university 6,425 103,000 Federal government 1,780 103,000 State or local government 1,099 106,000 Uniformed services 713 85,000 Industry 3,218 148,000 Other public and corporate 2,066 103,000 Other, unknown 16,766 NA NOTE: Total is greater than 90,201 because veterinarians may hold more than one position. DATA SOURCES: AVMA 2010a and AVMA, 2011aa a Most of the data on the salaries of veterinarians in the report are drawn from the biennial AVMA Compensation Surveys, which are based on a randomized, stratified-disproportionate sample of employed U.S. veterinarians (including AVMA members and nonmembers). The response rate of the Surveys is about 25%. If DVMs who are more successful are more likely to respond, the reported rate of earnings may exceed actual averages. This report examines such questions and how they relate to the size and composition of the workforce and the occupational roles of veterinarians in the public and private sector (Table 1-1). Societal needs can only be met if there are jobs filled by individuals who are qualified to address the demands of the job. Thus there is concern that for some occupations—biomedical laboratory-animal researchers, for example—jobs are remaining unfilled for long periods, while in other cases where their expertise could be applied, such as in ecosystem health, jobs for veterinarians appear to be scarce. In other instances, such as food-animal practice in rural areas and public food-safety inspection, openings exist, but the financial incentives are too low to attract qualified candidates. If salaries aren’t likely to increase, other solutions to delivering veterinary expertise would be needed. Although every profession is affected by changes that occur in society, there is a limited ability to redirect veterinary expertise to respond quickly to the changes affecting it. To begin, there is often a debate about what changes are needed or even what can be achieved. And because the size of the workforce cannot be expanded easily, a small gap in response (for example, in redirecting part of the workforce) could have large effects in the sectors affected by them (such as increasing vulnerability to disease in the $120 billion livestock sector). In addition to uncertainty, there are multiple barriers to changing the size and composition of the veterinary workforce that can only be overcome with substantial, long-term, economic and human investments. PREPUBLICATION COPY

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22 Workforce Needs in Veterinary Medicine BOX 1-1 Statement of Task An expert committee will be charged to study the broad scope of issues related to the veterinary workforce in the United States. The study will explore historical changes in the size and characteristics of the veterinary workforce; assess the demographics and adequacy of the current supply of veterinarians in different occupational categories and sectors of the economy; and identify incentives, disincentives, and other factors that are likely to affect the numbers of veterinarians seeking jobs in different sectors in the future. The study will also examine trends affecting the kinds of jobs available to veterinarians and assess future demand for veterinary expertise in existing and new employment sectors. The study will examine the current and future capacity of universities and colleges to provide sufficient numbers of adequately trained veterinarians and identify training needs relative to the demand for specific expertise. A report will present the findings of the study, and identify options for meeting requirements for a veterinary workforce. For some time, the veterinary profession and the colleges of veterinary medicine have been asking if the veterinary educational system should expand, and if so, in what ways, to meet these changing workplace demands. Hence, in 2007, the American Veterinary Medical Association, the Association of American Veterinary Medical Colleges, the Burroughs-Welcome Foundation, the American Animal Hospital Association, and Bayer Animal Health, Inc. approached the National Research Council (NRC) to ask it to undertake a study of the broad scope of issues related to the veterinary workforce in the United States. The study committee established by the NRC (see Appendix A for bios of committee members) was charged with preparing a report that describes the adequacy of the current supply of veterinarians in different occupational categories and employment sectors, evaluates trends that would affect the kinds of jobs available to veterinarians in the future, and identifies the options for meeting the requirements of a veterinary workforce. Box 1-1 contains the formal statement of task for the study. Over the course of 2007 to 2009, the committee held six meetings and interviewed more than a dozen experts on veterinary workforce issues in academe, as well as in public, private, and industrial practice. The committee developed and distributed exploratory questionnaires to veterinarians and employers in different sectors to obtain preliminary insights that could be integrated with other information, such as membership surveys and data from veterinary associations to discern trends. Appendixes B, D, and G contain the questionnaires used by the committee. The report has been long in the making, in part because of the inconsistent ways in which organized veterinary medicine compiles data, rendering it difficult to analyze long-term trends in the profession. Accurate predictions for the future are rooted in understanding these trends. Chapters 2, 3, and 4 of the report examine data, information, and trends in the private practice of companion-animal, equine, and food-animal medicine, respectively. Appendix C contains supplementary material related to food-animal practice. Chapter 5 explores information from companies in the biomedical and pharmaceutical industries and the specialty colleges that seek to produce specialists who are in demand in those industries. Chapter 6 examines public practice—the employment of veterinarians by states and the federal government, who oversee areas of significant national interests. Appendix E provides a list of recruitment tools available to agencies of the federal government for attracting veterinary talent. Chapter 7 examines the role PREPUBLICATION COPY

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Introduction 23 of veterinarians in wildlife and ecosystem health, where many important scientific and veterinary challenges are now emerging, and Appendix F contains a list of short courses available to prepare students for careers in these fields. Chapter 8 makes a case for extending the concept of One Health to the issue of global food security. Chapter 9 explores the challenges facing the veterinary medical schools, which sit at the center of the supply pipeline for veterinary expertise. Chapter 10 contains an economic lens through which to view the workforce supply and demand issues. Finally, Chapter 11 provides the committee’s overarching analysis, findings, conclusions, and major recommendations. The changes facing the profession are serious and consequential, and it is critical that the attention of all sectors concerned with the need for veterinary expertise (and as this report shows, there are many) be engaged in supporting the evolution of the profession. This report is the first comprehensive review of the profession since the 1988 Pew National Veterinary Education Program report, Future Directions for Veterinary Medicine. In the intervening 24 years, veterinarians have made impressive contributions to human and animal health through clinical service, innovation, and research. Increasingly, however, concerns are mounting about the slow pace with which the recommendations of the Pew Report are being implemented. Because the pace of change is unlikely to abate, the committee urges the veterinary profession to review its place in society and analyze its future directions more regularly and with a greater sense of urgency. This report provides additional evidence of the need for essential and more rapid adjustments in support of a profession that is presently critical to the social well-being of the American people and will almost certainly become more important as the 21st century unfolds. PREPUBLICATION COPY

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24 Workforce Needs in Veterinary Medicine PREPUBLICATION COPY