11

Conclusions and Recommendations

THE STATE OF THE VETERINARY PROFESSION: ANOTHER DEFINING MOMENT IN ITS HISTORY

The charge to the committee was “to study the broad scope of issues related to the veterinary workforce in the United States, including a study of 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.”

At this time in its storied history, the current picture of the profession is one of dynamic change and economic challenges. These conditions are altering the needs for veterinary expertise. The study was initiated at a time when there were concerns that veterinary academe was not producing sufficient U.S. graduates to fill the profession’s needs, especially in companion-animal and specialty practice. In response to the perceived future shortages, many veterinary schools have increased their enrollments, and new schools have been created in the United States and beyond, including for-profit schools, some of which have been accredited by the American Veterinary Medical Association (AVMA) Council on Education. Moreover, there are plans to build additional schools in the United States. As a result, the supply of veterinarians is gradually growing. However, since the economic downturn that started in 2008, veterinary schools have lost tens of millions of dollars in public financial support that has increased the cost of a veterinary education to students. To generate much-needed revenue, class sizes have increased, especially with higher-paying non-state residents. Concurrently, there has been an increase in the delivery of companion-animal oriented veterinary education and of graduates seeking companion-animal jobs. These combined changes have brought the profession to a critical juncture.

The committee is concerned that an unsustainable economic future is confronting the profession and calls for veterinary organizations, academe, industry,



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11 Conclusions and Recommendations THE STATE OF THE VETERINARY PROFESSION: ANOTHER DEFINING MOMENT IN ITS HISTORY The charge to the committee was “to study the broad scope of issues related to the veterinary workforce in the United States, including a study of 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 veterinari- ans seeking jobs in different sectors in the future.” At this time in its storied history, the current picture of the profession is one of dynamic change and economic challenges. These conditions are altering the needs for veterinary expertise. The study was initiated at a time when there were concerns that veterinary academe was not producing sufficient U.S. graduates to fill the profession’s needs, especially in companion-animal and specialty prac- tice. In response to the perceived future shortages, many veterinary schools have increased their enrollments, and new schools have been created in the United States and beyond, including for-profit schools, some of which have been ac- credited by the American Veterinary Medical Association (AVMA) Council on Education. Moreover, there are plans to build additional schools in the United States. As a result, the supply of veterinarians is gradually growing. However, since the economic downturn that started in 2008, veterinary schools have lost tens of millions of dollars in public financial support that has increased the cost of a veterinary education to students. To generate much-needed revenue, class sizes have increased, especially with higher-paying non-state residents. Concur- rently, there has been an increase in the delivery of companion-animal oriented veterinary education and of graduates seeking companion-animal jobs. These combined changes have brought the profession to a critical juncture. The committee is concerned that an unsustainable economic future is con- fronting the profession and calls for veterinary organizations, academe, industry, 217

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218 Workforce Needs in Veterinary Medicine government, and nongovernment organizations (NGOs) to proceed strategically and with urgency. However, for that support to be forthcoming, society must be convinced that an investment in veterinary medicine is an imperative. The pub- lic, policymakers, and even medical professionals are frequently unaware of how veterinary medicine fundamentally supports both animal and human health and well-being. Broadening the public’s understanding will require a com- mitment by veterinary leadership, the academe, and practitioners to devel- op and promote the profession as one that offers diverse career paths with many different niches for veterinarians, ranging from traditional compan- ion-animal practice to public- and private-sector positions in biomedicine, animal research, wildlife, the environment, global food production, and public health. Taxpayers must receive an adequate return on their subsidy to veterinary education and should be convinced of the benefits of subsidizing veterinary pro- fessionals. Most students come to veterinary schools to enter into the compan- ion-animal sector of the profession and instruction in the care of pet animals forms a sound base of biomedical knowledge on which the comparative medi- cine components of instruction are layered. Thus, dog anatomy is the founda- tion, and pig, cow, horse, chicken, and wildlife anatomy are efficiently delivera- ble in a comparative context. The same is true for physiology, pathology, pharmacology, toxicology, medicine, and surgery. The primary shortcomings of the small animal model of instruction relate to its emphasis on comparative management paradigms for diseases related to inbred animals, and the limited focus on population level and environmentally-based disease prevention. Epi- demiology, and environmentally-based disease prevention need to be required core courses in veterinary curricula and in certifying veterinary schools. Many of the positions that veterinarians need to fill will require additional education beyond the Doctor of Veterinary Medicine (DVM) degree. Yet the basic challenge remains funding this education. Thus, while pursuing less-costly approaches to delivering veterinary education and veterinary services is general- ly required, it is even more essential that the colleges and schools of veterinary medicine engage employers and public and private funders in their efforts to target and strengthen particular fields of veterinary expertise and research. In this chapter, the committee presents its key findings and conclusions about the state of the veterinary profession and the prospects for its future, and it explores options for how the veterinary schools and colleges can prepare their graduates to better respond to the changing societal needs for veterinary exper- tise. CONCLUSION 1: In its review of the profession, the committee found little evidence of widespread workforce shortages in veterinary medicine, alt- hough industry and some areas of academic veterinary medicine are expe- riencing shortages of veterinarians who have advanced training. The com- mittee noted a difference between workforce shortages and unmet needs for veterinarian positions. Societal needs for veterinary expertise are substan-

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Conclusions and Recommendations 219 tial and growing, but the potential contributions of veterinary medicine are not realized because appropriate positions in relevant sectors are lacking. As the committee examined the question of whether the supply of and the demand for veterinarians were in balance in a given sector, it struggled to ra- tionalize the apparent need for veterinary services with the economics of today’s veterinary marketplace. Personnel shortages occur when well-paid positions are not filled. Such shortages exist, for example, in industry, where employers can- not fill high-paying positions with veterinarians who have advanced training in biochemistry, biochemical mechanisms of diseases, basic pharmacology and toxicology, pathology, laboratory-animal medicine, and regulatory toxicology. These experts are in demand and can command salaries that are well beyond those of professorial ranked faculty. Similarly, veterinary colleges are in need of basic scientists who can leverage extramural research support for programs. In the committee’s view, opportunities for highly-trained veterinarians in industry and the basic sciences are growing, and the new and vacant positions represent a clear shortage because there are few qualified individuals to fill those jobs. Those shortages can be addressed by equipping future veterinarians with the skills required by these positions and by eliminating barriers to their employ- ment. In contrast, unmet needs occur in settings where well-paying veterinary po- sitions are lacking. That includes situations in which positions exist, but offer salaries too low to attract candidates, as well as instances in which expertise in comparative medicine might be relevant, but positions that explicitly require veterinary expertise do not exist. By expanding appropriately-paid employment opportunities that use different kinds of veterinary skills, including rethinking how veterinary services are provided, society can better capture the benefits of veterinary expertise. For example, in situations where the low density of small farms with marginal resources cannot financially support positions for full-time food-animal (FA) veterinarians, alternatives to conventional veterinary practice, including an expanded use of technicians under the supervision of veterinarians, will be important. In wildlife and ecosystem health, development of thoughtful measures to manage the health of terrestrial and aquatic wildlife, conservation of threatened and endangered species, and control of emerging infectious and toxi- cological agents could benefit from greater involvement by veterinarians. Veter- inarians are not prevented from entering those fields now, but developing sus- tained funding for veterinary positions will require efforts to promote a wider understanding of the value of veterinary services among public and philanthrop- ic supporters of wildlife and the environment. As noted in chapter 10, the goal of balancing supply and demand is to match jobs that require particular kinds of skills with persons who have those skills. Strictly on the basis of financial return on educational investment as an in- dicator of the market demand for veterinary expertise, there is no substantial profession-wide shortage of veterinarians. Increases in salaries and benefits are smaller than the increases in the cost of a veterinary education for students. Ac-

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220 Workforce Needs in Veterinary Medicine cording to the 2011 AVMA Report on Veterinary Compensation, companion- animal-exclusive practitioners’ mean and median incomes are increasing. How- ever, companion-animal-practice income growth has slowed. In recent years, public-practice and corporate-practice incomes have increased slightly. Food- animal exclusive, equine, and mixed-animal practice median incomes were growing before 2007, but in 2007-2009 a sudden decline occurred. Unmet needs for appropriately-compensated positions exist in the public sector for veterinarians who have specialized training in epidemiology, food safety, wildlife and ecosystem health, and public health. Jobs in those fields generally offer salaries that are much lower than those in the private sector, many have salaries that are too low to attract top candidates, and some are not advertised with a requirement for a veterinary degree, so many of the positions remain unfilled by veterinarians. Public-practice veterinarians are essential for maintaining the safety of foods of animal origin and for controlling diseases of wildlife and livestock, including zoonotic diseases. An insufficient workforce of public-practice veterinarians places at risk the health of American citizens, the well-being of the nation’s food-animal industry, the health of U.S. wildlife re- sources, and the U.S. economy. Recommendation 1A: Industry veterinary workforce shortages can be addressed by deeper partnerships between academe and indus- trial employers of veterinarians. Academe should more actively seek industry biomedical research partnerships, student mentor- ing, and opportunities in the curriculum to expose students to cor- porate practice. The establishment of student clubs for pathology and laboratory-animal sci- ence at veterinary colleges, as recently initiated by the American College of La- boratory Medicine, the American Society of Laboratory Animal Practitioners, and the American College of Veterinary Pathologists (ACVP) is a favorable development, as is industry support for internships and training positions through the ACVP/STP [Society of Toxicologic Pathology] Coalition for Veter- inary Pathology Fellows. Industrial externships could bring greater exposure to career opportunities in pathology, laboratory animal medicine, and toxicology. The Virginia-Maryland Government and Corporate Practice track is another example. Given the limited resources of veterinary colleges, consideration should be given to partnering with such programs or tracking options in veteri- nary colleges to offer the best opportunity for channeling students into careers in laboratory-animal medicine, pathology, and comparative biomedical research. Recommendation 1B: To meet the needs for positions for veteri- narians in public practice, the committee urges state and federal governments to re-examine their policies on remuneration, re- cruitment, and retention of veterinarians.

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Conclusions and Recommendations 221 It is encouraging that the U.S. Office of Personnel and Management has formed the Talent Management Advisory Committee to bring agencies together in a forum to discuss a strategic workforce plan regarding current and future federal needs for veterinarians. State and federal agencies, especially ones that target food safety and wildlife and ecologic sustainability, should articulate the full value of the veterinary profession to their missions and take steps to support a coherent plan to strengthen the profession’s role in research, food safety, ani- mal welfare, public health, and ecologic sustainability. The public interest is put at significant risk when attention to workforce needs related to these issues is not addressed. A number of personnel policies—from recruitment strategies and hiring practices to retention initiatives, including child care and parental leave that might attract female candidates—should change to improve the federal gov- ernment’s opportunity to employ veterinarians. Recommendation 1C: The Association of American Veterinary Medical Colleges, American Animal Hospital Association, and American Veterinary Medical Association should develop realistic strategies for meeting companion-animal veterinary medical work- force needs. Building such a strategy requires reliable national data on consumer demand for companion-animal care, the economics of private practice, the role of veterinary technicians in extending companion-animal care, and the implications for the profession of growth in accredited and non-accredited veterinary schools both inside and outside the United States. The demand for a veterinary education among U.S. citizens remains high, yet the economic reality regarding student educational costs in relation to mod- est practice incomes is worrisome. Companion-animal veterinary medicine has come to dominate the curriculum and resources of veterinary schools, some- times to the detriment of other fields of veterinary medicine, so it is important to understand as clearly as possible the demand for needs for companion-animal services, and to plan accordingly by developing a strategy to support the clinical faculty, specialists, and others required to train new companion-animal practi- tioners and companion-animal paraprofessionals. A growing part of the future companion-animal veterinary workforce will consist of veterinarians who grad- uated from colleges outside the United States. The impacts of that trend on U.S. veterinary schools, companion-animal practitioners, and the quality of and ac- cess to a veterinary education, particularly as the profession attempts to increase the numbers of underrepresented minorities in its ranks, must be studied closely. This analysis must be approached in the context of meeting the need for veteri- nary services in all sectors of the profession, and seek to balance the actual de- mand for companion-animal veterinary medical practitioners with the capacity to meet those needs within current and future economic realities.

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222 Workforce Needs in Veterinary Medicine CONCLUSION 2: The decade-long decline in funding of education and research has jeopardized the profession’s future capacity to serve societal needs. Veterinary medicine has made immense contributions to human well-being but is losing the breadth of its intellectual base as a consequence of reduced pub- lic funding for veterinary education and research. The trend jeopardizes the vig- or of veterinary medicine, threatens the profession’s future, and urgently re- quires a change in direction. The profession will not be able to fulfill its responsibilities to society without maintaining a pool of high-quality scientific investigators and robust research programs. The number of students who are exposed to sophisticated fundamental and applied research is declining. Crucial investments in the infrastructure of basic and translational research are not being made, and the creation of new veterinary basic-science faculty is fading. Research is declining in veterinary colleges on such topics as molecular genetics, molecular oncology, gene therapy, stem cells, immunology, virology, toxicology, pharmacology, and epidemiology, and the profession’s responsibilities in food safety and ecosystem health are also not being met. It is in those fields that some of the most important advances in com- parative medicine can be expected and will define the profession in the years to come. Recommendation 2: Veterinary academe should increase its com- mitment to research, developing future faculty, and encouraging current faculty to work across disciplinary and professional boundaries. The Association of American Veterinary Medical Col- leges is well positioned to take on this challenge. Veterinary schools need to demonstrate a commitment to building the kind of faculty that can lead cross-disciplinary and inter-professional studies, to find partners to support graduate training, and to develop collaborations with entities outside the veterinary schools to seek research and other support. Effective re- search programs require long-term commitments by teams of investigators. In addition, research-based educational environments draw students to re- search careers, an essential process for sustaining the profession’s intellectual core. The report National Need and Priorities for Veterinarians in Biomedical Research (NRC, 2004) offers several suggestions for attracting students to re- search careers, including acquainting students with research opportunities throughout veterinary school, including in the curriculum, actively seeking stu- dents with an interest in research, and working to find support for post-graduate research training. There are unique opportunities for the profession to build research programs in the biomedical sciences. Comparative veterinary medicine addresses a broad spectrum of spontaneously-occurring diseases that are homologues of diseases in humans and could be funded by the National Institutes of Health (NIH). Many

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Conclusions and Recommendations 223 spontaneous tumors in dogs and cats are models of tumors in humans and pro- vide excellent opportunities for studying basic cancer biology and testing cancer therapeutic agents. Spontaneous models of metabolic diseases in pets are also available and uniquely important for gene therapy and stem-cell studies. But these opportunities and resources have been underutilized. The total NIH funding of the nation’s 28 veterinary schools and colleges in 2010 was about $280 million—less than the NIH funding for any one of the nation’s top medical schools. Veterinary schools must improve their ability to attract funding if they expect to remain in the mainstream of biomedical re- search, by hiring more DVM-PhD mentors to attract grants and provide graduate training of veterinarians at the doctoral level, both in the biomedical field and in research projects of primary importance to animals. CONCLUSION 3: The current return on investment for veterinary educa- tion is unsustainable and the cost of veterinary education is at a crisis point. The profession may be at risk for lowering the quality of applicants to the profession and the quality of veterinary education. The veterinary profes- sion has been slow to respond to these challenges. Starting salaries in private practice increased by 148% beyond inflation in the 20 years from 1987 to 2007, but mean debt increased by 285% in the same period. The financial return on investment in veterinary education is below that of other professions for which students might be qualified. For about the same number of years of training, veterinarians make much less than dentists and about the same as pharmacists, who can graduate with the required PharmD in as little as 6 years. Although there is some risk in using current earnings infor- mation to approximate expected lifetime earnings of current students, it is clear that the financial reward for a veterinary education is well below the bench- marks of other types of training in health professions. The committee agrees that a foreboding scenario exists: the ratio of student debt-to-average starting salary is more than 2 to 1 (Figure 11-1). In the absence of additional growth in salaries or reduction in costs of a vet- erinary education, the return on investment in a veterinary education may con- tinue to decrease. Eventually, more students will recognize the disjunction be- tween tuition and income, and the quality of applicants to veterinary schools will decline. Veterinary medicine needs to make a much better case to the public in regard to its value in state and federal budgets and to be more creative and effec- tive in seeking sources of revenue besides increases in tuition and class sizes. Recommendation 3a: Professional veterinary organizations, aca- deme, industry, and government should work together with a sense of urgency to stimulate the collective actions needed to ensure eco- nomic sustainability of veterinary colleges, practices, and students. A national consortium or committee should be jointly supported to

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224 Workforce Needs in Veterinary Medicine bring together initiatives that focus on the economic sustainability of the profession in all sectors of service, education, and research. Previous groups have called for change and coordination in the nation’s ap- proach to veterinary education and its costs. In 2011, the North American Veter- inary Medical Education Consortium report Roadmap for Veterinary Medical Education in the 21st Century: Responsive, Collaborative, Flexible provided a wide array of options. To thrive in an era of economic constraints, veterinary schools and colleges must develop innovative teaching methods and new collab- orative relationships, and the profession must develop new business models. A consortium of key veterinary organizations, deans, industry, government, and economists is needed to seek solutions that address the sustainability of the pro- fession and of veterinary service to society. A central issue for the future of veterinary medical education is the role of research in the coming years. New organizational models and methods to ad- dress research frontiers will be needed to assure the intellectual integrity of vet- erinary education. The profession’s ability to respond to evolving threats to ani- mal and human health depend on attracting and sustaining outstanding scientists to the disciplines that support veterinary medical education. Recommendation 3b: As part of a comprehensive strategy to ad- dress the economic sustainability of the veterinary profession, the working groups appointed by the consortium should create nation- ally shared curricula. 140,000 120,000 Annual Salary ($) 100,000 80,000 60,000 40,000 20,000 0 2006 2007 2008 2009 2010 2011 Year Food animal Companion animal Equine Student Debt FIGURE 11-1 Student debt and mean starting salary for new DVM graduates. DATA SOURCE: AVMA Market Statistics, 2006-2011.

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Conclusions and Recommendations 225 The growth of distance education and webinars offers an opportunity to achieve this goal. The emerging power of distance education provides the great- est opportunity for advancing food-animal veterinary education at a compara- tively modest cost. Webinars and similar technologies can lead to continuing- education credits for veterinarians. Teaching veterinary students from other de- veloped and developing countries should be encouraged to extend the reach of U.S. academic programs and to capture the potential revenue that these sources can generate. Recommendation 3c: U.S. veterinary colleges should evaluate and implement alternative options for the delivery of veterinary educa- tion and research. Veterinary teaching is evolving and some non-traditional models are now used by AVMA-accredited veterinary colleges. Alternative models for veteri- nary education, and those that spread the cost of specialty training, in particular, need to be evaluated by inter-professional committees to identify those that hold promise for improving the efficiency of veterinary medical education and re- search in the United States. Some of the alternatives that should be evaluated further are described below. An Alternative Model for Teaching Hospitals Small-animal teaching hospitals have become the profession’s secondary- care and tertiary-care centers. Concurrently, they have expanded their roles in training residents for specialty-board certification, which requires the expense of additional equipment and faculty to supervise residency programs. The costs of operating a specialized-care center could be readily passed on to animal owners if veterinary schools provided instructional opportunities at comprehensive small-animal medical centers in sizable urban or metropolitan areas. High-quality specialty practices developed through university-driven or university-private sector collaborations in which veterinary schools or colleges hold a controlling and standard-setting interest can offer exceptional resources of both infrastructure and highly-trained specialists. Large urban or metropolitan teaching hospitals should provide core services in community and specialty practice. Veterinary faculty of such centers would have more time to pursue basic and clinical research, conduct clinical trials, and teach evidence-based medicine to veterinary students and residents, relying on a great array of cases, state-of-the-art instrumentation, specialized support staffs, and data-retrieval systems made available by the associated university. Likewise, the instruction of veterinary students and residents in equine medicine and surgery would be best accomplished in clinics situated in areas that have adequate populations of hors- es to ensure the large caseload needed for strong teaching and clinical-research programs.

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226 Workforce Needs in Veterinary Medicine Alternative Models for Specialty Training The main rationale for state support of veterinary schools is to train entry- level veterinarians. However, increasing numbers of graduates seek advanced training—whose requirements are dictated by specialty boards—and this causes veterinary schools to assume increased costs. Public support of faculty engaged in specialty training is minimal or nonexistent in most state budgets, and there is essentially no federal support. Therefore, the schools need to become more in- dependent of the influence of specialty boards. In addition, veterinary schools and colleges must work together through partnerships and group efforts, includ- ing other organizations and industry, to leverage resources and capabilities for providing alternatives to specialty training in veterinary schools. There are op- portunities to meet the clinical challenges through inter-school collaborations; by relying more on talent in private veterinary practices, specialty practices, industry, and agencies; and by enlisting the support of government, NGOs, and other stakeholders. Alternative Models for Matriculation and Training Most veterinary students in the United States are admitted to veterinary schools after completing pre-veterinary studies over the course of a 4-year un- dergraduate program. After graduation from veterinary school, many students seek internships and residencies in the belief that they will increase their earn- ings. Few students decide to stay in school for another 4 years (or more) in pur- suit of a PhD. Although the dearth of support for graduate training is one reason, the overall costs and length of time involved before a person can capitalize on the training are so great as to be deterrents. One potential solution to the prob- lem is to encourage more students to apply to veterinary school after only 1-2 years of undergraduate study. In the UK, students may apply directly after high school and enter a 5-year veterinary curriculum. American students who have sufficiently strong academic records are also admitted directly from high school into 5-year veterinary curricula in the UK. Those students spend 3 years less than the norm in most programs in the United States and this fuels the argument for reducing the length of pre-veterinary education in this country. Joint Degree Programs Another recommended approach to address the need for more veterinarians who have advanced degrees is to develop more joint degree programs in veteri- nary colleges and schools. There are now several joint DVM-MPH, DVM-PhD, and DVM-MBA programs. The University of Pennsylvania’s School of Veteri- nary Medicine illustrates the effectiveness of this approach. It has had a joint VMD-PhD program in place since 1971; of its 63 graduates, 85% are engaged in research and about two-thirds are in academe. Seeking funding to increase the

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Conclusions and Recommendations 227 number of such programs would have the combined effect of making a PhD degree more attractive, increasing the pool of potential veterinary faculty, and broadening the base of veterinary medicine. For DVM-PhDs to succeed in aca- deme there is likely to be a need for postdoctoral training of most PhDs pursuing this career path. Facilitating that avenue and exposure to a variety of career op- tions for DVM-PhDs should be core components of such dual-degree programs. CONCLUSION 4: The veterinary profession is losing its presence in food- animal production and care. With the changing nature of food-animal production in America, the de- mand for traditional veterinary services has declined, creating two related prob- lems: how to develop production medicine to serve the dynamically-changing and increasingly-intensive livestock and poultry industries; and, how to provide veterinary services in the rural United States where fewer and more widely dis- persed farms make it is difficult for food-animal clinicians to remain in practice. Veterinary academia has been slow to respond to educational needs in food- animal production medicine. Large producers who dominate the livestock indus- tries seek veterinarians who are either exclusively or predominantly committed to food-animal practice, who can understand production systems, can read farm records and can use them to make decisions aimed at increasing herd health, productivity, and the overall profitability of the farming operation. It is these services producers seek and for which they are willing to pay. At the same time the profession must develop its role in monitoring food safety, drug residues, animal welfare, nutrient management, and stewardship of the environment. If the profession does not move more deliberately in this direction it is in danger of relinquishing its role in animal production to others who are able to consider the economic needs of producers but who have less understanding of the complexity of animal health and public health. Recommendation 4a: To increase the economic value of veterinary services to producers, the education of food-animal practitioners should be reoriented towards herd health and interventions aimed at improving the financial health of the farm operation. Veterinary schools and colleges should work together to achieve this goal by creating centers of emphasis on food-animal medicine. The most compelling case for creating centers of emphasis is in those disci- plines where small numbers of students are involved and where it is difficult for each school or college to justify faculty costs. Such is the case for food-animal medicine. As the livestock industry has consolidated, it has also divided produc- tion into specialized units. Consequently, no one school or college can afford faculty expertise in all the specialized needs of every species. Schools and col- leges should collaborate to create a portfolio of on-line courses on the diversity of specialized educational needs in production medicine. These programs should

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228 Workforce Needs in Veterinary Medicine include all food-animal species including small ruminants. Practical application of this knowledge should take place at centers of emphasis where students can gain experience in management and research in food-animal health and produc- tivity. There are models of successful centers in which advanced practical training and research is available, such as the Agricultural Research Service Meat Ani- mal Research Center at Clay Center, Nebraska; the Swine Center of Excellence at Iowa State University in conjunction with the Audubon-Manning Veterinary Clinic; the University of California-Davis Dairy Center at the Veterinary Medi- cal Teaching and Research Center at Tulare, California; and the recently formed National Center of Excellence in Dairy Production Medicine Education for Vet- erinarians funded by USDA that is a collaboration among the veterinary schools of the Universities of Georgia, Minnesota, Illinois, and Kansas State University. Forming centers of emphasis (or excellence) is not a new idea, but it needs to be revisited and nurtured by veterinary leaders and affected stakeholders. In addi- tion to advancing the quality of food-animal education, the committee sees the advantages of a strategically-planned network of cooperating centers for reduc- ing a duplication of effort, faculty salaries, and facilities. The centers will develop only as entrepreneurial deans and faculty initiate inter-institutional discussion, formulate creative ideas, use distance education, and attract funding from industry, public-health agencies, foundations, interna- tional organizations, and federal and international governments. Maintaining flexibility in center programs will be an on-going challenge. A system of regular review or accreditation should be put in place at the time centers are created. Recommendation 4b: The veterinary profession should formulate new ways of delivering cost-effective services to rural America, us- ing veterinary technicians to extend animal health services to un- derserved areas. In rural areas where there are too few farms to support a full-time veterinar- ian, the profession should develop a system of animal-health care that uses digi- tal and information technologies to integrate licensed clinicians with rigorously trained paraprofessionals. For this to be accomplished, the AVMA and other professional associations will need to enter a dialogue with officials to modify state practice acts to permit credentialed veterinary technicians to administer livestock-health services provided that they are subject to collaborative over- sight (and constant communication) with licensed practitioners who may be in distant locations. Veterinary technicians and other paraprofessionals working with food-animal veterinarians in this way have the potential to provide afforda- ble, high-quality care to rural America, and their role should be expanded. Other fields of medicine have developed paraprofessionals, such as nurse practitioners and certified nurse anesthetists, who do not compete with but rather compliment and extend the influence of the professionals overseeing them. In food-animal practice, such a system can also be used to strengthen the nation’s capacity for

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Conclusions and Recommendations 229 animal-health surveillance and emergency planning in rural America. The sys- tem has the potential for private-public partnerships. CONCLUSION 5: Global food security is one of the most pressing chal- lenges of the 21st century. The food and water security and safety concerns confronting the world today are far more daunting than anything veteri- nary medicine has previously had to confront. Because these challenges are enormously complex, they will require the veterinary profession to engage in interdisciplinary and interprofessional One Health solutions. It is increasingly clear that agricultural science, veterinary medicine, and other disciplines must work together to deliver sufficient, safe food to sustain the world’s growing population. The problems need to be addressed by a com- bination of veterinary research, academic program innovation, advances in and adoption of technology, knowledge extension, and veterinary faculty and practi- tioner professional development. These issues need greater public attention, greater financial resources, and a focused strategic approach. In 2011, the world’s population reached 7 billion, on its way to 9 billion by 2050. Almost all the growth will be in the developing world where urbanization is proceeding with a speed and intensity that is unprecedented in human history. The urban transition is generating wealth, greatly increasing demand for animal protein, and forever changing the developing world’s agricultural systems. Pres- ently, rising demand is being met by expanding populations of low-producing animals. This is environmentally destructive and unsustainable. To meet de- mand, protect the environment, and make systems more sustainable, the veteri- nary profession in the United States should help to increase the efficiency of livestock and poultry production, increasing animal yields while reducing their numbers. Animal-health hazards that accompany increased intensity of produc- tion in warm humid climates must be understood and anticipated and outbreaks of new and re-emerging infectious diseases controlled as they can jeopardize human health and the resilience of food security systems. Issues of waste recy- cling must also be solved. All of these challenges are immensely difficult and further complicated by climate change. To find solutions will require the wide- spread collaborations that are embodied in the concept of One Health. The challenges substantially expand the traditional roles of veterinary medi- cine and redefine the profession’s needed competencies. The veterinary academe appears hesitant to emphasize the One Health initiative and global food security, because few well-paying job opportunities are advertised for graduates. Howev- er, the task of meeting the growing needs for safe, nutritious, and affordable food for the world’s growing population is urgent and must be accomplished. Recommendation 5: Veterinary medical organizations and the deans of veterinary colleges should work to increase the visibility, standing, and potential of the profession to address global food se- curity. Establishing a One Health think tank with the goal of ad-

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230 Workforce Needs in Veterinary Medicine vancing food-animal husbandry and welfare policies, ecosystem health standards, and the capacity of the veterinary profession in the developing world would help future generations of veterinari- ans to collaborate across professions, disciplines and cultures. A part of this body should also consider the necessary competencies required of U.S. veterinary graduates to address the global chal- lenges of food and water safety and security, and the health of wild- life and ecosystems. Society tends to view veterinary medicine through the narrow lens of com- panion-animal medicine. The profession has not done enough to expand recog- nition of its immense responsibilities in addressing global food security and re- silience. Tackling the multiple dimensions of One Health and sustainable food security will require a new, broader definition of veterinary medicine, of its foundational competencies, and of the focus that veterinary research must take. To accomplish that, deans should work together across campuses, organizations, and professions to define key One Health competencies that can be adopted into curricula and research program models. The Association of American Veterinary Medical Colleges (AAVMC) should lead an effort with the AVMA and other professional organizations, vet- erinary and otherwise, to change our research and professional development programs to address local, national, and global cross-disciplinary challenges. Examples of activities to which veterinarians could contribute include Feed the Future, the U.S. global-hunger and food-security initiative, and PREDICT, a global early-warning system to detect and reduce the effects of emerging diseas- es that move between wildlife, domestic animals, and people. The Food and Drug Administration is beginning to implement the Food Safety Modernization Act, which will require veterinary medical research on ways to prevent food contamination and on issues of food safety on the farm. Other programs are funded by different agencies to address the effects of climate on ecosystem health, wildlife, and the movement of plant, animal, and human diseases. A Profession with a Unique History and Bold Future The chaos of interdependent societies of the early 21st century—with soar- ing human populations, global warming, exotic-species invasions, overharvest- ing of wildlife, infectious-disease outbreaks, and chemical contamination—has created opportunities for veterinary medicine to be more relevant than at any other time in history. Veterinary medicine began as a profession that focused on the health and utility of horses; it then helped to improve the productivity and well-being of food animals and the safety of milk, meat, and eggs; later, it undertook basic research and improved animal health and evaluation in concert with academic, government, and private laboratories; it countered diseases of pet animals and

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Conclusions and Recommendations 231 helped to sustain the human-animal bond; it enhanced the health and reproduc- tion of zoo animals; and now it is increasingly caring for entire communities of free-ranging wildlife in a host of ecosystems. Times are challenging, but the veterinary profession continues to create its own future and now faces many options for remaining relevant to societal needs and being economically sound. The broad assignment is clear: the profession must collaborate within and be- yond its bounds, and it must proclaim and demonstrate its relevance to the pub- lic and to decision-makers to ensure its continued success.