4

Food-Animal Veterinary Medicine

INTRODUCTION

Food-animal veterinarians are entrusted with the safety and the security of the nation’s foods of animal origin. That responsibility is the first step in the continuum of supply-chain surveillance that safeguards the nation’s milk, meat, and eggs “from farm to fork”. Mastitis, E. coli O157:H7, salmonellosis, bovine tuberculosis, and brucellosis are some of the many diseases that threaten the safety of the food supply and are controlled on the farm by food-animal veterinarians working with food-animal producers. As the “eyes and ears” of the national animal health network, food-animal veterinarians also work to prevent and control foreign-animal disease outbreaks on the nation’s farm lands. The essential public health nature of those responsibilities has come into focus in recent years because of the expansion of global trade and the spread of infectious diseases, including newly emerging diseases, many of which are zoonotic, such as bovine spongiform encephalopathy (BSE), severe acute respiratory syndrome (SARS), highly pathogenic avian influenza (HPAI), and pandemic swine influenza (H1N1). In addition, the events of September 11, 2001 called attention to the potential vulnerabilities of agriculture to bioterrorism and the expanded roles that veterinarians must play in surveillance, early detection, and rapid response (DeHaven et al., 2006).

Foot-and-mouth disease (FMD) is arguably the greatest threat to the American food-animal economy. FMD has not come to the nation’s shores for over 80 years; the last outbreak of FMD in the United States was in 1929 (USDAAPHIS, 2007). Nevertheless, it is unrealistic to believe that FMD could never return or that other foreign animal diseases (FADs) are not a constant concern. One estimate of the economic impact of an FMD outbreak in California projected national agriculture losses of $2.3 to $69.0 billion as detection delay increased from 7 to 22 days, respectively (Carpenter et al., 2011). Assuming a detection delay of 21 days, it was estimated that every additional hour of delay would result in the slaughter of 2,000 animals and an hourly loss of $565 million.



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4 Food-Animal Veterinary Medicine INTRODUCTION Food-animal veterinarians are entrusted with the safety and the security of the nation’s foods of animal origin. That responsibility is the first step in the continuum of supply-chain surveillance that safeguards the nation’s milk, meat, and eggs “from farm to fork”. Mastitis, E. coli O157:H7, salmonellosis, bovine tuberculosis, and brucellosis are some of the many diseases that threaten the safety of the food supply and are controlled on the farm by food-animal veteri- narians working with food-animal producers. As the “eyes and ears” of the na- tional animal health network, food-animal veterinarians also work to prevent and control foreign-animal disease outbreaks on the nation’s farm lands. The essential public health nature of those responsibilities has come into focus in recent years because of the expansion of global trade and the spread of infec- tious diseases, including newly emerging diseases, many of which are zoonotic, such as bovine spongiform encephalopathy (BSE), severe acute respiratory syn- drome (SARS), highly pathogenic avian influenza (HPAI), and pandemic swine influenza (H1N1). In addition, the events of September 11, 2001 called attention to the potential vulnerabilities of agriculture to bioterrorism and the expanded roles that veterinarians must play in surveillance, early detection, and rapid re- sponse (DeHaven et al., 2006). Foot-and-mouth disease (FMD) is arguably the greatest threat to the Ameri- can food-animal economy. FMD has not come to the nation’s shores for over 80 years; the last outbreak of FMD in the United States was in 1929 (USDA- APHIS, 2007). Nevertheless, it is unrealistic to believe that FMD could never return or that other foreign animal diseases (FADs) are not a constant concern. One estimate of the economic impact of an FMD outbreak in California project- ed national agriculture losses of $2.3 to $69.0 billion as detection delay in- creased from 7 to 22 days, respectively (Carpenter et al., 2011). Assuming a detection delay of 21 days, it was estimated that every additional hour of delay would result in the slaughter of 2,000 animals and an hourly loss of $565 mil- lion. 57

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58 Workforce Needs in Veterinary Medicine The threats are not limited to FMD. A large-scale outbreak of HPAI could be catastrophic not only for human health but also for the poultry industries. With annual revenues of $40 billion, the U.S. poultry industries are the world’s largest producer and second largest exporter of poultry meat (USDA-NASS, 2009a). A single outbreak of HPAI would halt U.S. exports of poultry products and, based on experiences in Europe, could result in probable declines in domes- tic consumption (Knowles et al., 2007). Three previous cases of BSE in the United States led to a dramatic and continuing reduction in beef exports to Japa- nese and South Korean markets that cost the U.S. beef industry between $3 and $4 billion. Similar consequences could follow the diagnosis of a single case, of classic swine fever, exotic Newcastle disease, and other FADs. In today’s global marketplace where there is increased trade in agricultural commodities, the risks of any one of those diseases reaching the nation’s shores are also increasing. At best, lost global markets would recover very slowly. Moreover, the integrated nature of the U.S. financial system would send shock waves to linked industries and damage a broad sector of the U.S. economy. Of equal importance is food safety, which is affected by farm hygiene. The U.S. Centers for Disease Control and Prevention (CDC) estimate the number of foodborne illnesses in the United States each year at 48 million, with 128,000 of those cases requiring hospitalization and resulting in over 3,000 deaths (Scallan et al., 2011). Many of these disease outbreaks are of animal origin (such as E. coli O157:H7 in ground beef and Salmonella in eggs) and many have resulted in massive food recalls (especially of eggs, spinach, and ground beef). The need for stronger producer-veterinarian relationships to address these issues is rein- forced by the recent passage of the 2010 Food Safety Modernization Act, which expands the inspection power of the Food and Drug Administration (FDA) over farms and increases the need for improved hygiene on the farm. Despite their vital importance, there is concern that the services of food- animal veterinarians are now in jeopardy as numerous reports conclude that there is a critical shortage of food-animal veterinarians in the United States (AVMA, 2006; Fiala, 2006; Gwinner et al., 2006; Prince et al., 2006a,b; Sterner, 2006). Shortly after World War II, more than half of the American Veterinary Medical Association (AVMA) members were engaged in food-animal practice. In 2010, that proportion has declined to 13% translating into fewer than 11,000 practitioners caring for food-animal populations of 93 million cattle, 5.5 million sheep, 66 million hogs, 338 million laying hens, 248 million turkeys, and 8.5 billion broilers (USDA-NASS 2011 a, b, c; USDA-NASS 2012 a, b, c). AVMA demographic studies confirm that there are unmet needs across the country: there are 750 counties that each have more than 5,000 head of livestock, yet have no resident veterinarian (AVMA, 2006). In Appendix C, Figure C-1 shows a map of animal density in counties that lack a resident veterinarian. In total they are home to over 10 million food animals. This chapter explores and describes the multiple forces that underpin the reasons for the change in the numbers of food-animal veterinarians, and changes

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Food-Animal Veterinary Medicine 59 in the kind of veterinary medicine needed by food-animal producers. Among the concerns is the diminishing number of new graduates who are making a long- term commitment to food-animal practice. Inadequate mentoring and frequency of night and weekend emergency work are commonly given as the reasons for graduates’ not entering food-animal practice or leaving it after short periods. Other reasons are the inability of earnings to keep pace with the rapidly increas- ing costs of veterinary education and the need to repay educational loans. An additional reason for the lack of veterinary services in some areas is linked to rapid and fundamental changes in the social and economic structure of rural America, driven in large measure by changes in the U.S. livestock and poultry industries. Since World War II, U.S. livestock and poultry production has evolved from a “small-town America” way of life to a competitive business enterprise that emphasizes entrepreneurship, management, efficiency, and earnings. Profit margins are thin, and small producers have difficulty in competing as they are being replaced by large, intensive systems of production in which higher returns can be realized when fixed costs (such as labor and capital investments) are spread over greater numbers of animals. Most poultry, feedlot beef, and pork production in the United States now takes place in concentrated animal feeding operations (CAFOs) in which management is driven by competition and the demands of supermarket chains for ever-lower food prices. But declining food prices come from declining animal values, and increasingly, the cost of primary animal care administered by a veterinarian is commonly viewed as too expen- sive relative to the value of the individual animal. In large operations, primary care is now usually administered by adroit lay staff (Jensen et al., 2009). Figures in the 2009 U.S. Department of Agriculture (USDA) Census of Ag- riculture for the years 2002-2007 show a continuation in the trend toward an increase in very large (and small) farms and fewer middle-sized operations. However, although the overwhelming preponderance of foods of animal origin come from large operations, most U.S. farms are still small, and there is also a growing trend toward more small livestock operations, usually with more diver- sified and specialty products, fewer acres, and younger operators, many of whom also work off the farm (USDA-NASS, 2009a). They include organic farms and farms that rear small ruminants for meat and milk production. Devel- opment of these small operations is driven by a consumer movement to eat lo- cally-produced foods coupled with concerns about the environment, animal wel- fare, and the quality and safety of foods produced in concentrated animal- feeding operations. Some believe those small operations present the greatest risk for introducing a food-animal disease into the United States. Hence, food-animal practice needs for the future appear to be increasingly bisected. Animals in CAFOs and other large operations are likely to be under the supervision of highly specialized, production-medicine veterinarians who man- age the health of animals as a group, focusing on “herd health.” Those veterinar- ians are most likely to be food-animal-exclusive practitioners, recognized by AVMA as those devoting 100% of their professional activity to the care of food-

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60 Workforce Needs in Veterinary Medicine animal populations, and who, because of the complexity of the work, usually limit their practice to a single species. Appendix C, Figure C-3 is a map of the distribution of food-animal-exclusive practitioners in the United States. In contrast, animals on small farms may be under the care of mixed-food- animal practitioners, defined by AVMA as devoting over 50% of their profes- sional activities to care and the balance to the care of other species. Services are usually focused on care of individual animals, pregnancy diagnosis, and emer- gency work. Most mixed-food-animal practitioners live close to populated areas because a substantial amount of their time is devoted to companion animals. Appendix C, Figure C-4 is a map of the distribution of mixed-food-animal prac- titioners in the United States. The consequence is that livestock farmers who live far from populated areas have difficulty obtaining veterinary care. One solution may be through the use of well-trained veterinary paraprofessionals working in a team with licensed veterinarians who may be at a distant site but are in constant communication with the paraprofessionals via smart phones. Veterinarians in food-animal-predominant practice comprise the third cate- gory of AVMA-recognized food-animal practitioners. They devote 80% of their professional activities to food-animal care and the balance to the care of other species, including horses and companion animals, and are currently the largest group of veterinarians serving the food-animal industries. Over 40% of them practice in the grain states of the Midwest and in Texas, where with mixed-food- animal practitioners, they have been a critical part of the once prosperous infra- structure of small-town America. Since new graduates are not entering this type of practice anymore, food-animal-predominant veterinarians, as a group, are now composed of rapidly-aging members. As will be discussed, it is the immi- nence of this demographic shift that constitutes the most immediate challenge confronting food-animal veterinary medicine. Appendix C, Figure C-5 is a map of the distribution of food-animal-predominant practitioners in the United States. INDUSTRY CONSOLIDATION: CHANGING DEMAND FOR VETERINARY SERVICES Figure 4-1 presents the ratio of food-animal commodity prices to the price of corn (in 2006 dollars) from 2000 to 2012. Since 2006, increases in the price corn—a major component of animal feed and a significant portion of the cost of food-animal production—significantly outpaced the value of livestock products. Figure 4-1 illustrates why consolidation, management, efficiency, and in- creased productivity per animal have become so essential for the survival of the livestock and poultry industries. However, because of decreasing animal values relative to the cost of inputs, farmers are unwilling or, more likely, unable to pay veterinarians to deliver primary veterinary care. As a result, revenues for sup- porting salaries and operating costs in food-animal practices have generally de- clined.

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Food-Animal Veterinary Medicine 61 FIGURE 4-1 The value of livestock products relative to corn from 2000-2012. SOURCE: Schnepf, 2011. Calculations by CRS using data from USDA-NASS, July 31, 2011. The Food Supply Veterinary Coalition (FSVC) (Andrus et al., 2006) was formed by leaders in the veterinary medical profession to analyze workforce needs and used an expert-judgment forecasting method (the Delphi method) to predict trends. FSVC panelists were not in agreement about workforce needs in any major food-animal sector except poultry; they did not agree on predicted manpower needs for dairy, beef, or swine practice. They did not see the need to increase the number of graduates in poultry medicine. They recognized that con- solidation reduced demand for traditional veterinary services, but there was wide disagreement on the long-term effect on the profession. Some panelists saw op- portunities for veterinarians to provide new, value-added services to large pro- ducers that would far outweigh losses due to consolidation; others expressed a concern that jobs for veterinarians would decrease. The next section of the report examines more closely some of the trends in segments of industry and their implications for the veterinary workforce. The Poultry Industries The U.S. poultry industries were the first of the livestock sectors to consoli- date and integrate. That occurred after World War II when the poultry industries originated the vertically integrated production model that is now the norm. The broiler industry introduced the model in the 1960s, and the turkey industry adopted the model in the 1970s. As will be discussed, the hog industry followed the trend beginning in the 1980s.

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62 Workforce Needs in Veterinary Medicine Poultry veterinarians play a vital role in flock health and management for the turkey, broiler, and egg-producing industries. The American College of Poultry Veterinarians (ACPV), the professional organization of certified poul- try-health professionals in North America, has 315 members in the United States and Canada. ACPV was formed in 1991, and over 200 diplomates joined in the following 5 years. However, from 1995 to 2005, the college grew by approxi- mately 9 new members annually. Members are dispersed in the poultry indus- tries, their allied industries, federal and state diagnostic laboratories, and aca- deme. The numbers are small in view of the U.S. industries’ productivity—8.9 billion broilers produced per year and more than 90 billion eggs obtained from 336 million laying hens. Layers are housed principally in the Northeast, Appala- chia, and the Corn Belt regions, whereas broiler production is principally in the Southeast (see Appendix C Figures 6a and 6b [USDA-NASS, 2009a]). Production of both broilers and eggs increased for many years but has re- cently leveled off because of the maturation of domestic markets. As a result, there is currently no serious shortage of poultry veterinarians in the United States (Glisson and Hofacre, 2006). The FSVC (Andrus et al., 2006) projected a 4.11% increase in the demand for poultry veterinarians between 2004 and 2016. The estimates of Glisson and Hofacre (2006) project three to five new job op- portunities per year for veterinarians in live-poultry production, technical ser- vices, or diagnostic laboratories. Those estimates do not appear to include poul- try veterinarians employed in research and the pharmaceutical industry, where they are involved in product development, including vaccine development, li- censing, and provision of technical services to producers; poultry expertise is in demand in this sector of the pharmaceutical industry. Poultry veterinarians in poultry-producing states commonly hold faculty positions in universities where they provide instruction, maintain poultry- research programs, and provide services in state diagnostic laboratories. Those in live-poultry production are employed primarily by integrator companies that contract with producers; there are few independent veterinary consultants in poultry medicine. To be eligible for positions with integrators, the overwhelm- ing majority of poultry veterinarians undergo specialized post-DVM training in poultry husbandry, disease diagnosis, health management, environmental man- agement, animal welfare, and food safety. There are few specialized training programs: five are active in U.S. veterinary schools, but only three currently report enrolled students. Veterinarians employed in production facilities are responsible for imple- menting and managing programs to prevent disease in company flocks. Poultry veterinarians typically work in multiple locations, and each facility functions as a closed system. Health and biosecurity programs are developed in conjunc- tion with production managers and flock supervisors, many of whom have un- dergraduate degrees in poultry husbandry (Glisson and Hofacre, 2006). To be effective in those positions, it is important for poultry veterinarians to have both first-hand knowledge of primary bird care and the skills in handling managerial issues.

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Food-Animal Veterinary Medicine 63 Although the poultry industry employs comparatively few veterinarians, they are supported by an infrastructure of flock supervisors or their equivalent who assume major responsibilities for the everyday care of flocks and can aug- ment surge capacity if emergencies arise. In recognition of the importance of their duties, flock supervisors are provided with opportunities for continuing education in health-care management and biosecurity policies by their corporate employers, by the poultry federation, or through industry-supported courses giv- en by colleges of animal science and veterinary medicine. Broiler companies maintain a cadre of field technicians who are skilled in recognizing problems, conducting field necropsies, and collecting appropriate diagnostic specimens for laboratory submission. Turkey and layer companies provide similar support to their contract producers, and several states certify poultry technicians who are involved in regulatory affairs for the industry. The poultry industries have expe- rienced repeated outbreaks of avian influenza, laryngotracheitis, and other infec- tions and have a strong commitment to the continuing education of producers, flock supervisors, and poultry staff, in addition to their veterinarians. The pro- grams provide a model for the livestock industries in general. Public concerns about multiple-drug resistant organisms, waste disposal from large poultry operations, animal welfare, and food-safety regulations are increasingly important and occupy more and more of the poultry veterinarians’ time, taking them away from their immediate responsibilities for flock health. Those administrative tasks are likely to increase in the future and will add to the opportunities for poultry veterinarians to contribute to the industry. Growth of the movement to use locally-produced food, including free-range and backyard flocks, is a concern for the poultry industry because it implies po- tential sites for foreign-animal diseases, including exotic Newcastle disease and avian influenza, to gain access to the United States. Mixed-food-animal veteri- narians usually provide health care and disease surveillance for these birds, which require having knowledge about the symptoms of those and other infec- tions. The Swine Industry The nation’s swine industry has undergone massive reorganization, consoli- dation, and changes in scale of operation in the last 25 years, with the number of hog farms declining by more than 70% since 1992—from more than 240,000 to fewer than 70,000 in 2008 (Figure 4-2). Despite this, the hog inventory has re- mained stable at around 62 million animals. In Iowa, the nation’s leading pro- ducer, the number of farms with pigs declined by 83%, from 59,134 in 1978 to 10,205 in 2002 (Honeyman and Duffy, 2006). Throughout the period of consoli- dation, the total breeding-herd inventory declined from some 10 million to 6 million sows, but, because of better management and housing, litter sizes have progressively increased with survival, and the annual pig crop has risen by over 30% since 1980 (USDA-NASS, 2009b).

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64 Workforce Needs in Veterinary Medicine Fewer and larger farms assumed an increasing share of the total output by improving yields and reducing costs of production. Table 4-1 presents the in- crease in number of farms selling over 5,000 pigs per year from 1994 to 2006. By 2008, farms with over 2,000 sows represented over 85% of inventory (USDA-NASS, 2009b). Consolidation advanced at unprecedented rates in the 1990s, continues more slowly today, and is expected to persist for at least the next decade (Key and McBride 2007). Those changes have resulted in what Carr and Kefalas (2009a) term “the hollowing out” of small towns in the United States, especially in the Midwest Corn Belt, with declining populations and prosperity and reduced demand for food-animal veterinary services. Large swine operations succeeded in increasing efficiency of production by making use of new technologies, including improved genetics, artificial insemi- nation, more efficient feeding programs with better feed-to-weight-gain ratios, environmentally-controlled buildings, highly-efficient production systems, and strict sanitary (biosecurity) measures for workers to prevent disease from enter- ing or leaving the buildings (Honeyman and Duffy, 2006). Those measures not only improved herd health but permitted one person to efficiently manage the production of much larger numbers of pigs than in the past and in the process altered the requirements for veterinary services. FIGURE 4-2 Number of hog operations, 1984-2008, in thousands. SOURCE: USDA- NASS, 2009b. TABLE 4-1 Number of Farms Producing Pigs, 1994-2006 Number of farms (in thousands) Farm size (Number of pigs) 1994 1998 2000 2003 2006 0 - 4,999 208 120.3 84.2 71.3 63.5 >5,000 0 1.83 2.0 2.27 2.47 SOURCE: National Pork Board, 2011.

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Food-Animal Veterinary Medicine 65 As consolidation has proceeded, the industry has concentrated its operations in specific geographic regions of the country, creating high pig densities in some counties and low densities in others. That is illustrated in Appendix C, Figure C- 7, which shows the striking changes in distribution of pigs in the United States from 1992 to 1997 during the period of rapid consolidation of the industry. The change is also illustrated in Appendix C, Figure C-8, which shows the number of hogs per square mile by county in Iowa in 1987 and 2002. The pig inventory was relatively evenly distributed through all counties of Iowa in 1987; by 2002 this was substantially changed, inventories in counties in the south of Iowa were substantially reduced while those in counties in the north and west of the state along the Minnesota border were greatly increased. Those locations were select- ed based on economic factors, including access to packing plants, local prices of corn, transportation facilities, and other established service infrastructures. In contrast to the poultry industry, veterinarians in private practice serve a significant portion of the swine industry. Consolidation and regionalization of the industry, particularly in Iowa and Minnesota, has permitted some veterinary practices to grow and provide a variety of swine health, managerial, and market- ing services to their clients. Veterinarians in these practices are infrequently in- volved in primary animal care, because it is more cost-effective for the producer to assign such duties to herdsmen who have been trained by veterinarians to fulfill specific, specialized tasks. Instead, one veterinary practice may be given responsibility for the overall health of large herds of sows and pigs. Animals are usually in multiple locations where producers are tied by contract to large swine integrators. Such integrated networks of producers are in marked contrast with the traditional system of independent family farms involved in farrow-to-finish production, where food-animal veterinarians would typically provide primary care for some 10,000 sows. The new responsibilities create much greater expec- tations of detailed knowledge of swine physiology, nutrition, pathology, herd health economics, management, and marketing than in the past. To meet those needs, a demanding, specialized system of education in swine health manage- ment is needed that involves both high-quality academic and practice-based training. Mounting calls for more veterinary oversight in animal welfare, zoono- tic diseases, food safety, and antimicrobial resistance are also likely to have a substantial effect on the need to further expand the range of services that veteri- nary practices should offer and the educational programs needed to prepare stu- dents for successful careers in the industry. In view of these needs, it is gratify- ing that a new Center of Excellence in Swine Medicine Education has been created at Iowa State College of Veterinary Medicine in collaboration with the Audubon-Manning Veterinary Clinic. The swine industry consolidation may be the cause of the overall decline in food-animal veterinary services in several rural states where swine operations had predominated. Large declines in the number of food-animal-exclusive and food-animal-predominant veterinarians in Iowa, Illinois, Indiana, Kansas, Min- nesota, Missouri, North Carolina, Nebraska, and Texas between 2001 and 2007 (see Appendix C, Table 1) closely parallel the progress of consolidation and the

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66 Workforce Needs in Veterinary Medicine change in the geographic distribution of the swine industry. Although it may not have been the only factor involved, lost opportunity because of swine industry consolidation has almost certainly been a contributor to the rural population’s flight from America’s heartland. Iowa, in common with other Midwestern states, felt the brunt of this population flight that left small rural towns in a weakened state. Loss of resident food-animal veterinarians is just one manifestation of the decline. The number of Iowa veterinarians who were members of the American As- sociation of Swine Veterinarians (AASV) dropped from 401 in 1993 to 217 in 2004—a decline of 46% in 11 years (Honeyman and Duffy, 2006). Parallel changes are seen throughout the nation. Most swine veterinarians belong to AASV; in 1995, AASV had about 1,400 members; by 2008, the number had decreased to 769—a decline of 45% in 13 years. This was due in part to resigna- tions of mixed-food-animal practitioners, but also to a shift to specialization in a single species by food-animal practitioners. Figure 4-3 shows membership of AASV by year of graduation from veterinary school. AASV averaged 22 new members per year in the 15 years from 1976 to 1990 but just 12 new members per year in the 15 years from 1991 to 2006. This number is consistent with an- ecdotal estimates that suggest the need for 10 to 15 new graduates per year, de- pending on the swine industry economy. If a working career is considered to be 30 years, the addition of only 12 new graduates per year can be projected to yield an AASV membership of 360 veter- inarians, and not all will be in clinical practice. Estimates of future workforce needs in swine medicine will depend on the structure, organization, and success of clinical practices to invest in the local community. Workforce needs will also depend on the competence of farm staff, their knowledge, expertise, and stability in their jobs. The better they are trained, the more of them a single veterinarian can supervise. Presently, there are few training programs for food-animal veterinary technicians in the swine industry. AASV is beginning to address that issue, recognizing that a skilled infrastructure of animal care is in the best interest of animal health and the industry. In addi- tion, veterinarians are required in the conduct of basic and applied research on swine diseases, nutrition, welfare, food safety, environmental impacts, and in regulatory services—all fields that are inadequately supported today. The Dairy Industry The dairy industry is more diverse than the poultry or swine industries. Alt- hough consolidation is progressing more slowly, the number of dairy farms in the United States fell by 88%, from 648,000 operations in 1970 to 75,000 in 2006 (MacDonald et al., 2007); conversely, the size of herds has increased (Fig- ure 4-4).

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Food-Animal Veterinary Medicine 67 160 Number of New Members 140 120 100 80 New Members 60 40 20 0 1966 - 1971 - 1976 1981 - 1986 - 1991 - 1996 - 2001 - 1970 1975 1980 1985 1990 1995 2000 2006 5-year periods FIGURE 4-3 New members of American Association of Swine Veterinarians, 1966- 2006. SOURCE: American Association of Swine Veterinarians. Year FIGURE 4-4 Number and average size of dairy farms in the United States, in thousands, 1970-2006. SOURCE: MacDonald et al., 2007. As in every other aspect of livestock production, the movement toward greater specialization and herd size is driven by the economies of scale and low- er costs of production. Large dairy enterprises use fewer resources per cow and generate returns that, on the average, substantially exceed the cost of operation. Small enterprises, in contrast, are reported to incur economic losses (MacDonald et al., 2007). Costs per hundredweight of milk produced decline by nearly one-

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80 Workforce Needs in Veterinary Medicine TABLE 4-7 Number of U.S. Veterinarians in AVMA Membership by Category1 1 2 3 4 5 6 7 Total Percent of 4 Year Large Animal (LA) Total LA Small Animal Mixed All Food FTEs Members 1966 1,861 1,861 4,700 7,917 26,632 5,820 21.85 1971 1,700 1,700 7,050 8,583 25,665 5,992 23.35 1976 1,958 1,958 9,524 9,437 27,889 6,677 23.94 19812 1,113 1,113 12,210 11,153 33,545 6,690 19.94 1986 4,024 4,024 17,682 13,344 46,625 10,696 22.94 1987 4,023 4,023 18,984 13,479 48,646 10,763 22.12 1988 4,020 4,020 19,885 13,502 50,612 10,771 21.28 1989 4,054 4,054 20,721 13,420 52,027 10,764 20.69 1990 4,086 4,086 22,056 13,769 53,299 10,971 20.58 1991 4,122 4,122 22,920 13,757 55,157 11,001 19.94 1992 4,243 4,243 23,967 13,944 56,421 11,215 19.88 1993 4,280 4,280 24,682 14,047 58,099 11,304 19.46 1994 4,289 4,289 24,493 13,988 59,360 11,283 19.01 LAE LAP SAE SAP 1995 1,805 4,078 5,883 22,839 5,376 3,148 54,852 6,641 12.11 1996 1,857 4,078 5,935 23,635 5,514 3,215 55,252 6,727 12.17 1997 1,860 4,024 5,884 24,567 5,661 3,207 56,694 6,683 11.79 1998 1,771 3,802 5,573 24,727 5,528 3,097 57,052 6,361 11.15 1999 1,894 3,876 5,770 26,235 5,717 3,418 60,829 6,704 11.02 2001 2,195 3,583 5,778 30,460 6,399 3,909 72,423 7,016 9.69 2002^ 2,142 3,013 5,154 30,999 5,953 3,666 72,598 6,385 8.80 2003 2,253 3,273 5,526 32,391 6,285 3,882 76,026 6,812 8.96 2004 2,285 3,145 5,430 33,417 6,324 3,890 77,889 6,746 8.66 2005 2,268 3,047 5,315 34,022 6,244 3,900 79,569 6,656 8.36 20063 993 4,150 5,143 37,137 5,688 4,376 84,946 6,501 7.65 20072 1,048 4,042 5,090 38,974 5,811 4,345 87,946 6,454 7.34 NOTE: FTE=full-time equivalent, LAE=large-animal exclusive, LAP=large-animal pre- dominant, SAE=small-animal exclusive, SAP=small-animal predominant. 1 Includes actively employed AVMA members and verified nonmembers in the Member- ship Database. Between 1996 and 1995, veterinarians from all countries were included. After 1995, numbers reflect U.S. members only. 2 Includes only actively employed AVMA members. 3 Veterinarians may hold multiple positions (counted in multiple categories). ^2002 is based on estimated percentages and the end of year total number of veterinarians from the 2002 Membership Report. 4 2001-2005 Equine/Small Animal species code was pulled from Mixed Animal. These numbers will be different than what is published. SOURCE: AVMA.

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Food-Animal Veterinary Medicine 81 FIGURE 4-10 Changes in the composition of the food-animal workforce. NOTE: LA=large-animal, Mix=mixed-animal, FTEs=full-time equivalents. There are no data on 2000; figures for 2000 are averages of the 1999 and 2001 values. SOURCE: Based on membership data of the AVMA. From 1995 to 2007, the total number of LAE and LAP veterinarians de- clined by 13%, from 5,883 to 5,090. Because the numbers of mixed-food-animal practitioners had increased as described above, the total food-animal FTEs did not change much from 1995 to 2007 (Table 4-7, column 6). Thus, although the total FTEs in food-animal practice have changed very little during this time pe- riod, the composition of the workforce has been changing toward mixed-food- animal practice. More food animals are in consolidated livestock facilities that generally require veterinarians with full-time, specialized commitment to food- animal practice, but an overall decline in the demand in food-animal practice and an increase in reliance on companion-animal care to supplement incomes is pushing professional services towards mixed-food-animal practice and delivery of traditional food-animal veterinary services. There are other changes in the demographics of rural America that may im- pact the directions of food-animal veterinary practice and explain the rise in numbers of mixed-food-animal veterinarians. Urban areas continue to spread into the countryside and usurp large tracts of farmland. In addition, more isolat- ed, low-density, large lot developments are occurring with increasing frequency further out in the rural countryside, especially in some of America’s richest farmland (Heimlich and Anderson 2001). Across the country these areas are described as under intense pressure from development (AFT, 2011). For exam- ple, the population of Tulare County, a center of California’s dairy industry in- creased by 20% between 2000 and 2010, in the same period the population of Calumet County, Wisconsin increased by 20.5%, and Lancaster County, the heart of Pennsylvania’s dairy industry, by 10%. The increasing populations co- exist with farming operations and expand opportunities for companion-animal and equine care in regions that were once purely agricultural and the realm of food-animal-exclusive and food-animal-predominant veterinarians.

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82 Workforce Needs in Veterinary Medicine The growing movement toward small farming operations and locally-grown and specialty-food markets with increased demand for primary veterinary care may have had an additional effect in supporting mixed-food-animal practices. Appendix C, Table C-1 details the change in distribution of mixed-food-animal veterinarians by state and shows that increases in mixed-animal practice have occurred in all but six states. In view of these trends, the veterinary profession needs to consider how it will be able to meet the needs of all food-animal pro- ducers. Aging and Attrition The food-animal-exclusive, food-animal-predominant, and mixed-food- animal practice categories have different age compositions, and they are chang- ing at different rates. Figures 4-11, 4-12, and 4-13 provide a snapshot of changes in the age structure of each category of food-animal practice between 2001 and 2007. AVMA membership data (Appendix C, Tables C-2a,b; 3a,b; and 4a,b) show that food-animal practitioners, as a group, are aging in general, with the food-animal-predominant category approaching retirement age the fastest. That is important because food-animal-predominant veterinarians currently make up 50% of the FTEs in food-animal practice (Table 4-8). It is also the segment of food-animal practice that is attracting the fewest new graduates, and as will be discussed later, has the lowest salary. In 2007, there were 4,042 AVMA members in food-animal-predominant practice in the United States (Table 4-7), with 57% of that group being over 50 years old (Figure 4-12). This is in contrast to 50% and 43% of AVMA members being 50 years and older in food-animal-exclusive and mixed-food-animal prac- tice, respectively (Figures 4-11 and 4-13). Fewer and fewer graduates have en- tered food-animal-predominant practice for over two decades. Consequently, this sector of the profession is facing an uncertain future. FIGURE 4-11 Age groups within food-animal-exclusive practice, 2001 and 2007.

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Food-Animal Veterinary Medicine 83 FIGURE 4-12 Age groups within food-animal-predominant practice, 2001 and 2007. FIGURE 4-13 Age groups within mixed-food-animal practice, 2001 and 2007. Mixed-food-animal practitioners have an average age of 47 years, and the group is aging more slowly than the other two categories of food-animal prac- tice. However, the percentage of mixed-food-animal practitioners under 50 years old declined by more than 10 percent between 2001 and 2007 (Figure 4-13). Appendix C contains several maps (Figures C-12a, b; C-13a, b; and C-14a, b) that show the geographic distribution of food-animal practitioners by age groups, which vary by category of practice. Most of the states that have large numbers of food-animal-predominant practitioners are in the Midwest (Appen- dix C, Figure C-5) so this region is likely to be the most severely affected by the change in demographics. The shortfall is not strictly sex-driven: comparatively few women have entered this branch of veterinary medicine, and fewer men are going into the field (Chieffo et al., 2008).

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84 Workforce Needs in Veterinary Medicine Recruitment of Graduates into Food-Animal Practice According to information from AVMA, 531 graduates of the class of 1989 entered food-animal practice (Figure 4-14). In 2009, the number was 203—a drop of 62% in 20 years. The decline occurred in all three categories of food-animal practice and is attributed to the economy and the decrease in availability of jobs in food-animal practice. There is great pressure to increase the number of graduates going into food-animal practice, but the profession may first need to consider the nature of the opportunities that are available and the education needed by food-animal veterinarians. The greatest decline involved the numbers of graduates entering food- animal-predominant practice, which fell from 229 in 1989 to 34 in 2009—a de- crease of 85%. Entry of graduates into mixed-food-animal practice also de- clined, falling from 253 to 147—a decrease of 42%. The number of graduates entering food-animal-exclusive practice, presumably with the goal of serving intensive systems of production focused on a single species, increased from 1989 to 2007 and then decreased by nearly 70% from 2007 to 2009. Inasmuch as starting salaries were nearly $10,000/year more in food-animal-exclusive than in food-animal-predominant and mixed-animal practices (discussed later in this chapter), the decrease was most likely due to a decline in the number of food- animal-exclusive positions available. What will be the size of the future food-animal workforce in comparison to today? In 2007 there were 5,100 food-animal-exclusive and food-animal- predominant practitioners who were members of AVMA (Table 4-8), and ap- proximately 994 of them were over the age of 60 (Figures 4-10 and 4-11). Be- cause of the physical and strenuous nature of food-animal practice, the length of an average career is generally assumed to be 30 years, about 5 years shorter than that of practitioners in either companion-animal or equine medicine. If half of the practitioners over 60 were to retire in the next 5 years, the addition of 99 new graduates each year would be required to maintain the 2007 level of 5,100 practitioners in the future, not accounting for those who retire early or work part-time. From 2006-2007, an average of 74 graduates each year indicated their inten- tion to pursue food-animal-exclusive and food-animal-predominant practices (Shepherd, 2008). If this level of new additions to the food-animal workforce continues, the number of food-animal-exclusive and predominant practitioners will shrink the present workforce. As half of new food-animal practitioners can be expected to leave food-animal practice within 5 years (Remsburg et al., 2007; Jelinski et al., 2008), the workforce may potentially decline dramatically. On the other hand, if food-animal-exclusive practice becomes less physically intensive and more supervisory, those that stay may work for more years than in tradition- al food-animal practice.

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Food-Animal Veterinary Medicine 85 FIGURE 4-14 Career selection of veterinary graduates entering food-animal practice. NOTE: LA Ex=large-animal exclusive, LA Pred=large-animal-predominant, Mix FA= mixed-food-animals. SOURCE: Data courtesy of AVMA. TABLE 4-8 Starting Salaries and Mean Debt for New Graduates, 1989-2011 Mean starting salaries ($) Salary growth/year (percent) Practice Type 1989 2007 2010-11 1989-2007 2010-11 Food-animal exclusive 25,210 62,424 71,096 4.65 3.1 Food-animal predominant 26,663 57,744 67,338 4.10 8.5 Mixed-food-animal 23,961 58,522 62,655 4.15 .5 Mean Debt ($) Debt growth/year (percent) 27,726 119,802 142,613 7.6 6.5 NOTE: Response rates of annual surveys of graduating DVMs are typically greater than 90%. SOURCE: Chieffo et al., 2008; Shepherd and Pikel, 2011. Starting Salaries and Student Debt From 1989 to the present, starting salaries for new graduates entering food- animal-exclusive practice are higher ($71,096) and have grown faster than those entering either food-animal-predominant or mixed-food-animal practice, accord- ing to exit surveys of new graduates (Table 4-8). Student debt, however, has grown even faster, increasing at a rate of 7.6% each year between 1989 and 2007, and by 6.5% between 2010 and 2011. Students now owe an average of $142,613 upon graduation. In 1989, educational debt was approximately 110% of starting salaries. In 2011, those entering food-animal-predominant practice face debts of around 205% of their initial salary. Although interest rates on gov- ernment-backed educational loans in 2010 were capped at 6.8%, the debt burden mortgages the future for those wishing to enter food-animal practice. State and federal grants to help graduates with their debt burden are useful but will not overcome the depressed market for associates in food-animal veterinary practice.

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86 Workforce Needs in Veterinary Medicine Compensation In a survey of members’ compensation in 2007, AVMA found that food- animal-exclusive practice owners earned the highest median income ($139,000) of all branches of private practice. In AVMA’s 2009 survey (AVMA, 2010a), the figure dropped to $133,000 (Figure 4-15), possibly due in part to the effect of the recession that began in 2006. The reported income of this group had in- creased previously by 16% from 2005 to 2007 (Burns, 2009). In 2009, mixed- food-animal and food-animal-predominant practice owners had median incomes of $103,000, somewhat less than practice owners in the other branches of private practice; this circumstance may be an impediment in attracting and retaining graduates in food-animal medicine with substantial educational debts. In 2009, the annual median salary of food-animal-exclusive associates was $79,000, while food-animal-predominant and mixed-food-animal associates earned medi- an incomes of $73,000, the same as associates in companion-animal- predominant practice. In contrast, companion-animal-exclusive associates had an annual median income of $85,000. The salary difference is consistent with a view that the problem in food-animal practice in rural America is one primarily of unmet needs and not one of shortages. In other words, demand is there but compensation is too low for veterinarians to survive in rural practice. 160,000 140,000 120,000 100,000 Owner 80,000 Associate 60,000 40,000 20,000 0 FAE FAP Mix CAE CAP EQU Category FIGURE 4-15 2009 median incomes of practice owners and associates by category. NOTE: FAE=Food-animal-exclusive; FAP=Food-animal-predominant; Mix=Mixed-animal; CAE=companion-animal-exclusive; CAP=companion-animal-predominant; EQU=equine veterinary practice. SOURCE: Adapted from AVMA, 2011a2, Burns 2009. 2 Veterinarian salary data are drawn from the biennial AVMA Compensation Surveys, which are based on a randomized, stratified sample of employed U.S. veterinarians (in- cluding 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.

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Food-Animal Veterinary Medicine 87 FUTURE DIRECTIONS IN FOOD-ANIMAL VETERINARY MEDICINE With the changing nature of food-animal production in America, the overall demand for traditional veterinary services has declined. Nevertheless, if future food-animal veterinarians can master a broad understanding of the complex challenges of production medicine, there is a great potential to redefine the role of food-animal medicine in the intensive livestock and poultry industries, while at the same time fulfilling the profession’s responsibilities to an American pub- lic concerned with food safety, drug residues, animal welfare, and stewardship of the environment. If not, the veterinary medical profession is in danger of re- linquishing 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 (King, 2000). Large dairies already routinely use consultants to advise on such issues as housing, communication, employee training, nutrition, and environmental regulations—matters that are frequently seen by producers as “outside the realms of veterinary medicine” (DSI, 2006). Because of the profession’s declining presence in food-animal care, the nation is losing the all important food-animal veterinarian-producer relationship upon which the health and welfare of livestock populations depend. For the veterinary profession, this is untenable. A Vision for Food-Animal Veterinary Medical Education To ensure their future in food-animal medicine, veterinary graduates should be well-grounded in the specialized aspects of the livestock or poultry industries they wish to serve and have the skills needed by these increasingly intensive, specialized, and concentrated industries. This direction was advocated by the late Otto Radostits (2002) who wrote that “meeting the needs of progres- sive livestock producers is a full time career for a progressive food-animal prac- titioner and is not a part time job.” J. B. Herrick was among the first to redefine how veterinary services should be offered to livestock operations and popularized the term production medicine. Herrick emphasized a food-systems approach to food-animal services and de- fined production medicine in 1990 as “the utilization of many facets of produc- tion, e.g. nutrition, environment, genetics, and health, into a well-managed pro- gram monitored by records” (Herrick, 1990). With a few notable exceptions, progress in moving food-animal practice in that direction in the intervening two decades has been inadequate. The Food Supply Veterinary Medicine Commis- sion (Andrus et al., 2006) drew attention to the thin supply of new graduates entering food-animal veterinary medicine and to the lack of focus on this field by many veterinary schools. Veterinary schools are accused of being slow in their willingness to change and develop curricula that meet the needs of the dy- namically changing livestock industries and of an increasingly apprehensive public. Nielsen (2001) is harshly critical, stating that there has been a failure to

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88 Workforce Needs in Veterinary Medicine provide graduates with sufficient entry-level competence to practice modern health and production management in herds of food-producing animals. Large producers who dominate the livestock industries seek veterinarians who are either exclusively or predominantly committed to food-animal practice. Implicit in this is the need for food-animal veterinarians who understand produc- tion systems, can read farm records, and can use them to make decisions aimed at increasing herd health, productivity, and the overall profitability of the farm- ing operation. It is these objective services that farmers seek and for which they are willing to pay. Veterinary practitioners also need to know how to charge for their consultative services. Many either don’t know how to charge or don’t like to charge for consulting and would rather bill for primary care or pregnancy exams instead. In veterinary academe, some faculty members recognize that food-animal curricula must fundamentally change, but the present state-based infrastructure of veterinary education and declining budgets make change difficult. To succeed will require veterinary schools and colleges to share resources and work together to create on-line courses in production medicine and centers of educational ex- cellence that can efficiently provide comprehensive, high-quality veterinary ed- ucation for the nation. As a start, an accepted definition of a herd health man- agement program should be developed so the goals of the profession are delineated. Food-animal veterinary medicine is now specialized by food-animal species and focused expertise in the nutrition, reproduction, genetics, housing, econom- ics, risk management, etc. of the relevant species. Authorities in each of these areas are present in veterinary schools and industry across the country and no one school can afford to provide positions in all of the areas. Creation of virtual “centers of emphasis” in the theoretical aspects of poultry, dairy, beef, and swine medicine could be created making use of recognized experts in academe, food-animal practice, the livestock industry, and the pharmaceutical industry and others to provide a portfolio of essential on-line courses in food systems. The courses should be easily available to veterinary students in the United States and internationally. The benefits of consortia in food-animal veterinary medicine have been re- viewed by Miller and Prasse (2006). Troutt and Osburn (2008) proposed the creation of regional centers in veterinary education for the dairy industry. In their model, senior students from cooperating veterinary schools would spend part of, or their entire fourth year at an established regional center. Two-year residency programs would be included in the center program. The University of California at Davis Veterinary Medicine Teaching and Research Center at Tula- re, California, the Iowa State Swine Medicine Education Center partnered with the Audubon Manning Veterinary Clinic, and the recent USDA grant to create a National Center of Excellence in Dairy Production Medical Education for Veter- inary Students provide encouraging examples. These initiatives could prepare veterinary graduates to fully and successfully participate in the dynamically changing food-animal industries of this country and beyond.

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Food-Animal Veterinary Medicine 89 Providing Veterinary Services to Rural America In the last 25 years, many farms that produced food animals have gone out of business which resulted in food-animal practitioners being unable to survive. This difficulty is not new; in 1982, a National Research Council committee re- port Specialized Veterinary Manpower Needs Through 1990 (NRC, 1982) noted that “the problem is in large part a matter of the economics of food-animal veter- inary practice, [and] areas with perceived shortages commonly do not provide satisfactory remuneration.” The report raises a question that is as salient today as it was in 1982: Are there unmet needs for food-animal veterinarians in rural America because of economic circumstances, or are there real shortages with adequate compensation but inadequate numbers of food-animal veterinarians? (NRC, 1982). The changing circumstances of food-animal veterinarians in rural America should not be viewed in isolation but in the broad context of the changing de- mographics of small-town America and the impact of concentrated-feeding op- erations on these societies. These once flourishing rural communities are de- scribed as suffering from “a slow acting wasting disease” being transformed by the flight of so many young people (Carr and Kefalas, 2009a, b; see also Artz, 2003; Romer and Wolverton, 2010). Appendix C, Figure C-2 illustrates changes in population in the United States between 1990 and 2000. Carr and Kefalas (2009a) describe local ownership as suffocated by the rise of CAFOs and large box-stores with the result that the rural middle-class of merchants, bankers, and professionals has left. Moreover, as farming operations increase in size, the American-born workforce is progressively replaced by migrant labor (Wiscon- sinWatch.org, 11/21/11). Carr and Kefalas (2009b) further report that 42% of Mid-western farmers now earn less than $20,000 per year making it difficult for them to afford professional veterinary services and highlighting the need for a different system of food-animal care. To attract more students into rural practice, several state legislatures have passed or are considering legislation to provide educational-loan forgiveness to graduates who move into rural and underserved areas. The federal Veterinary Medicine Loan Repayment Program has also made awards to veterinarians will- ing to practice for at least three years in areas designated by the Secretary of Agriculture as having shortages in food-animal or public practice veterinarians. The average award size (to cover federal and commercial loans taken to attend an AVMA-accredited college of veterinary medicine) was $96,582 (USDA- NIFA, 2010). In the present economic climate, those initiatives are important as they will immediately help debt-burdened graduates to accept positions in un- derserved areas of America. In the longer-term however, additional solutions are needed as half of the graduates entering food-animal practice are reported to leave within 5 years (Remsberg et al., 2007; Jelinski et al., 2009). To change these demographics, the veterinary profession has to make a concerted effort to recruit and retain more students in food-animal veterinary medicine. In the past, most students who went into food-animal practice have

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90 Workforce Needs in Veterinary Medicine come from rural backgrounds or have had other previous experiences with live- stock or poultry farming (Schmitz et al., 2007; Jelinski et al., 2008). This is a diminishing population. Furthermore, as livestock and poultry operations are increasingly housed within biosecure facilities, the opportunity for students even from rural background to gain farm experience is diminishing. In view of this, the profession has to look to urban and peri-urban communities and recognize that students from these backgrounds, including students from minority groups that are underrepresented in veterinary medicine, who may know little about their food supply may be unaware of the significant opportunities that food- animal veterinary medicine has to offer. The digital media provides numerous ways of addressing that issue—social media, on-line programs, webinars, and other forms of communication should be prepared to educate high school and college students and the general public about the importance of food-animal medicine to society with regard to food-animal health and welfare, food safety, and environmental health. Such programs could also be aimed at correcting mis- conceptions about livestock and poultry farming that currently abound and bias students away from considering careers in agriculture. Expanding the Role of Veterinary Paraprofessionals As a goal, the veterinary profession should endeavor to provide health care to the largest possible population of livestock and poultry. For economic and other reasons the profession is presently not meeting this goal. In view of this, the committee supports a proposal to integrate rigorously-trained and creden- tialed food-animal veterinary paraprofessionals (veterinary technicians or indi- viduals with veterinary training) working in health-care teams with licensed veterinarians who may be at a distant site (Remsberg et al., 2007). This is simi- lar to the expanding system of health care in the medical profession in which nurse practitioners in rural locations are linked digitally to physicians who are located distantly. For food-animal paraprofessionals to become part of a veteri- nary health-care system, state practice acts will need to be modified to permit paraprofessionals to administer primary care services provided that they are sub- ject to collaborative oversight (and constant communication) with licensed prac- titioners who may be in a different location. This approach offers the potential for clinicians to provide affordable patient care as well as for providing care for patients in underserved rural areas without reducing quality. The system can also improve animal-disease surveillance and provide surge capacity in rural Ameri- ca should emergencies arise. The food supply is a matter of national security and public health, but gen- erally taken for granted by the American public. As is discussed in Chapter 6, the job of safeguarding food and overseeing the welfare of food animals is a shared responsibility of the private and public sector. Neglecting that responsi- bility poses significant risks. Additional considerations for strengthening the veterinary oversight of the food-animal sector and the need for research in food- animal health are explored in the final chapter of the report, Chapter 11.