University-operated veterinary teaching hospitals are currently the cornerstone of clinical teaching in veterinary medicine in the United States. Veterinary teaching hospitals were initially established in this country in the late 1800s and early 1900s for the teaching of veterinary students, and many were located at rural, land-grant institutions in proximity to colleges of agriculture. The controlled learning environment in today's veterinary teaching hospitals allows upper-level veterinary students to acquire the integrative skills necessary to bridge the gap between classroom instruction and the complexities of clinical practice.
As the standard of veterinary care increased and as veterinary practice became more sophisticated, veterinary teaching hospitals took on additional roles associated with graduate and specialty training (eg, by providing postgraduate degree and residency training programs), the provision of advanced medical and surgical care (eg, by establishing referral centers), and the generation of new knowledge to benefit animals and humans (eg, by creating research programs). Most advances in veterinary patient care to date have occurred because of the existence of veterinary teaching hospitals.
Concomitant with the increase in the standard of veterinary care has been an increase in accessibility of that care. Advanced veterinary care is currently available through a variety of settings, including solo and group veterinary practices and private specialty hospitals, many of which are located in large population centers. The high quality of care provided by these private veterinary practices combined with the convenience of their location has had an adverse impact on the caseloads of veterinary teaching hospitals, which has the potential to compromise the education of veterinary students and postgraduate veterinarians and adversely affect the generation of knowledge that comes through clinical investigation. The desire to practice specialty veterinary medicine, an activity once limited to teaching faculty positions, can now be fulfilled more lucratively and with fewer additional responsibilities in private settings comparable to the best veterinary teaching hospitals. This rivalry for caseload and specialists between universities and the private sector is occurring in a climate of stable or diminishing state support for veterinary education.
The Veterinary Medical Teaching Hospital Task Force was formed in 2004 by the Association of American Veterinary Medical Colleges and the American Association of Veterinary Clinicians to define the critical challenges facing veterinary teaching hospitals. Recruitment and retention of faculty, particularly veterinarians certified in AVMA-recognized clinical specialties, were identified as immediate and ongoing concerns. The Task Force gathered information affecting recruitment and retention through a series of meetings held in conjunction with the annual meetings of the Association of American Veterinary Medical Colleges, the American Association of Veterinary Clinicians, and the American College of Veterinary Internal Medicine. Additional information was obtained through 2 surveys. The first, conducted in 2003, sought to determine the factors that attracted faculty with clinical responsibilities to academia.1 This survey of newly hired clinical specialists revealed that perceived climate and collegiality within the hiring department were the most important factors in their decision, followed by compensation. The second survey2 was conducted by the American College of Veterinary Surgeons, which had formed an ad hoc committee to evaluate issues affecting retention of surgical specialists in academia. This survey was sent both to diplomates of the college and to the heads of clinical departments at the colleges and schools of veterinary medicine in the United States and Canada. The results indicated that there had been a net movement of surgeons from academia to private practice and cited salary, location, and nonsupportive administrations as important reasons for this shift. The survey of the heads of clinical departments revealed that there was a need for both small and large animal surgeons at the colleges and schools of veterinary medicine and that this deficit was expected to continue for at least the next 5 years.
Solutions to the problems of recruiting and retaining specialists in academia will be hard to find.2 In an attempt to further define the scope of the problem, the Veterinary Medical Teaching Hospital Task Force commissioned a survey of the colleges and schools of veterinary medicine in North America to determine workforce needs for clinical specialists.
Methodology
A survey instrument was constructed and sent to the dean of academic affairs at every accredited college and school of veterinary medicine in North America. Responses to a standard set of 8 questions concerning the college's or school's needs in regard to 19 specialty or subspecialty areas were requested. In particular, respondents were asked to indicate, for each specialty or subspecialty, the number of personnel (measured in terms of full-time equivalents) the institution currently wanted to have working in its veterinary teaching hospital during regular working hours (ie, desired hospital workforce) and the number currently employed (ie, current hospital workforce). Recognizing that faculty members often play a number of additional roles beyond clinical practice (eg, didactic teaching, committee work, and continuing education), respondents were asked to indicate the number of specialists they wished to employ to fill the indicated need (ie, desired head count) and the number of clinical specialists currently employed (ie, current head count). To gather information about the immediate needs of the colleges and schools of veterinary medicine, respondents were asked to indicate, for each specialty and subspecialty, the number of open positions that were currently funded and being recruited for and the duration of those openings. To estimate future demand, respondents were asked to project their needs for the next 3 to 8 years. Finally, respondents were asked to indicate the number of individuals currently being trained in each specialty or subspecialty at their institution. The survey was distributed in November 2005, with responses requested on or before January 16, 2006. Nonrespondents were contacted a minimum of 2 additional times.
Results
Responses were received from 28 of the 32 colleges and schools of veterinary medicine, and results were tabulated (Table 1). Data for large animal orthopedics and large animal general surgery were combined because most respondents did not subcategorize responses for the subspecialty of large animal surgery.
Current and projected workforce needs for clinical specialists at 28 colleges and schools of veterinary medicine in the United States and Canada.
| Veterinary specialty and subspecialty | Mean desired hospital workforce | Total current head count | Total desired head count | Total open positions | Mean duration (mo) | Total future need | Total current trainees | Projected surplus or deficit |
|---|---|---|---|---|---|---|---|---|
| Anesthesiology | 2.6 | 78 | 109 | 20 | 10.0 | 48 | 27 | −11 |
| Behavior | 0.9 | 17 | 33 | 1 | 48.0 | 28 | 9 | 2 |
| Dentistry | 1.0 | 10.2 | 35.5 | 3 | 16.6 | 25.5 | 9 | 0 |
| Dermatology | 1.3 | 38 | 55 | 6 | 8.6 | 30 | 19 | 0 |
| Emergency and critical care | 2.1 | 45 | 84 | 10 | 5.8 | 48 | 38 | 3 |
| Internal medicine | ||||||||
| Small animal | 3.5 | 130 | 142 | 10 | 10.0 | 56 | 95 | 22 |
| Large animal | 3.4 | 122 | 142 | 9 | 7.8 | 49 | 74 | 16 |
| Cardiology | 1.3 | 38 | 59 | 6 | 13.4 | 30 | 25 | 2 |
| Neurology | 1.5 | 34.5 | 64 | 11 | 12.3 | 37 | 25 | −3 |
| Oncology | 1.8 | 39.2 | 77 | 14 | 10.6 | 43 | 31 | −1 |
| Nutrition | 0.8 | 17 | 30 | 3 | 8.6 | 18.5 | 7 | −1 |
| Ophthalmology | 1.7 | 45.6 | 73 | 13 | 11.6 | 34 | 30 | −3 |
| Radiology | 3.0 | 89.5 | 128 | 21 | 15.3 | 60 | 44 | −6 |
| Radiation oncology | 1.0 | 17.5 | 40.5 | 3 | 14.0 | 26 | 8 | 0 |
| Surgery | ||||||||
| Small animal orthopedics | 2.0 | 57.5 | 73.5 | 7 | 18.1 | 34 | 42.5 | 7 |
| Small animal general | 2.1 | 71.5 | 91.5 | 12 | 21.2 | 40 | 52.5 | 6 |
| Large animal surgery | 3.4 | 113 | 133 | 12 | 9.3 | 51 | 70 | 11 |
| Theriogenology | 2.5 | 75 | 96 | 7 | 14.0 | 46 | 30 | 3 |
Workforce needs were determined from responses to a survey sent to the dean of academic affairs at each institution. Except for number of active diplomates and where otherwise indicated, results are given in terms of full-time equivalents. Desired hospital workforce represents the number of personnel the institution currently wanted to have working in its veterinary teaching hospital during regular working hours. Current and desired head count represent numbers of specialists needed to fill the indicated workforce needs (desired) and the number of clinical specialists currently employed (current). Total open positions represents number of positions currently funded and being recruited for. Future need represents projected needs for the next 3 to 8 years. Projected surplus or deficit was calculated by use of the following formula: (total current trainees/3) - total open positions.
Without exception, the total desired head count (ie, the total number of specialists desired by the 28 responding colleges and schools of veterinary medicine to fill the institutions' needs for clinical specialty practice) was greater than the total current head count (ie, the total number of clinical specialists currently employed by the 28 responding institutions). Open, funded positions were identified in all specialties and subspecialties, with mean time that such positions had been open ranging from 5.8 months to 48.0 months.
Respondents indicated that they anticipated a need to add substantial numbers of specialists over the next 3 to 8 years. As an index of the degree that the need for new specialists was being met, the number of currently open positions in each specialty was subtracted from the number of trainees in that specialty divided by 3 (because most programs are 3 years in duration) to determine the projected surplus or deficit of specialists. Surpluses (in terms of academic opportunities) were identified in the specialties of theriogenology, behavior, emergency and critical care, small animal internal medicine, large animal internal medicine, cardiology, small animal orthopedics, small animal general surgery, and large animal surgery. Deficits were identified in the specialties of anesthesiology, neurology, oncology, nutrition, ophthalmology, and radiology.
Discussion
Results of the present study indicate that there currently is a shortage of clinical specialists in veterinary academia and that the future needs of veterinary academia are not being met by the current production level of new specialists, particularly in the specialties of anesthesiology, neurology, oncology, nutrition, ophthalmology, and radiology. Open, funded positions in academia were identified for all of the specialties and subspecialties included in the present study, with the total number of such openings ranging from 1 to 21. Beyond this, findings of the present study suggest that the demand for clinical specialists in academia will remain high for the next 3 to 8 years, with this demand likely to become even greater if the capacity of and services offered at the existing colleges and schools of veterinary medicine are increased to meet the anticipated future shortage of veterinarians.
The development of clinical specialties in veterinary medicine began with the recognition of the American College of Veterinary Radiology by the AVMA in 1962. From the 1960s until the mid-1980s, specialty practice was primarily confined to veterinary teaching hospitals. Since the mid-1980s, however, there has been an explosive increase in the number of private specialty practices, particularly practices that treat companion animals. The resulting increased availability of advanced veterinary care has benefited innumerable animals and their owners and has increased the career opportunities for veterinarians with specialty training. However, these additional career opportunities make recruitment and retention of veterinary specialists in academia more difficult.
The problems of recruitment and retention of specialists in academia are not confined to veterinary medicine and are mirrored in other health professions, including dentistry. A 2002 survey3 of 54 colleges and schools of dentistry in the United States indicated that there were > 300 vacancies at that time and that for 42% of these vacancies, there were no qualified applicants. The large number of vacancies was attributed, in part, to the loss of 9% of all full-time academic dentists in 2001 to 2002, with most of these individuals leaving to enter private practice. A primary factor cited for leaving academia was the increasing gap in income between private practice and academia. Other factors include the high level of student debt, the perceived quality of the work environment, and the increasing requirements for scholarship.4,5 The issues cited by dentists mirror those identified in a recent survey of veterinary surgeons.2
The job market for veterinary specialists represents the interaction of a number of forces, including the number of current diplomates in a given specialty, the production rate of new diplomates, the demand for diplomates' services, and the rates of retirement from the specialty and the profession. The number of current diplomates in a specialty is the primary determinant of the current and future supply. In addition to determining the potential number of applicants for any given job opportunity, the number of current diplomates in any specialty determines the number of diplomates that can be in training in that specialty at any given time, the requirements of the training program, and the examination process for attaining diplomate status. The number of specialists in training has historically also been limited by the amount of funding allocated by colleges and schools of veterinary medicine for residency training. Innovative approaches to increasing the number of individuals in specialty training that have been instituted include development of private practice residency programs, development of university–private practice cooperative residency programs, and private funding of university residency training with covenants for employment after certification. Such approaches must be further explored if the apparent demand is to be met.
The current market demand for clinical specialists in nonacademic positions has not been quantified, but presumably must be unmet. The Web sites of the American College of Veterinary Surgeons and the American College of Veterinary Internal Medicine contain hundreds of postings seeking veterinarians with specialty training. In the present study, we identified 168 positions in academia that are currently funded but open, and we projected a need for > 700 clinical specialists in academia over the next 3 to 8 years. The current production rate across all clinical specialties of approximately 200 diplomates per year would barely supply the existing needs of the colleges. If the current ratio of academic to private practice diplomates (ie, approx 1 diplomate in academia for every 3 in private practice) is maintained, then > 2,400 diplomates would need to be trained during the next 8 years.
The current difficulty that colleges and schools of veterinary medicine face in attracting clinical specialists has been termed a crisis. Who will teach future veterinary students and sustain specialty training programs are important questions facing the colleges and schools of veterinary medicine, the specialty groups, and, ultimately, the profession as a whole.6,7 The AVMA has identified a current shortage of veterinarians in a number of areas and projects a future shortage of 15,000 veterinarians over the next 20 years. To that end, the Veterinary Workforce Expansion Act has been proposed to increase the capacity of our colleges to train veterinarians. Although the needs identified (eg, veterinary research, public practice, pathology, and food animal practice) do not currently include the clinical specialty disciplines, any increase in the capacity for training veterinarians will demand an expansion of training opportunities. For the profession to continue to prosper, methods of increasing the rate of production of veterinary specialists must be determined. For the specialty groups, methods of training and examination must be examined to determine whether an expansion of opportunities can be accommodated. For the colleges and schools of veterinary medicine, changes must be made to make academia more attractive to today's veterinary specialists.
In his recent essay,8 Dr. Robert Marshak wrote that a principal purpose of clinical training is to develop a capacity for critical thinking, the need for which spans our profession. Marshak also wrote that “there are serious disadvantages to any arrangement for clinical training that is not firmly centered and concentrated in a school's small and large animal hospitals.”8 Whether we agree or disagree with his statement, it deserves debate within the veterinary profession. The best veterinary teaching hospitals create educational climates where critical thinking is taught in an environment of scientific inquiry. Are there other environments where critical thinking can be taught? How will we ensure that a population of veterinarians who want to teach and have the time to do it well will continue to exist? Where will advances in clinical veterinary medicine crop up in the future? Finally, if we, as veterinarians, won't support veterinary teaching hospitals, how can we expect the public to do so?9 Let's use some of that capacity for critical thinking and move to solutions for these problems.
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Marshak RR. Veterinary schools and the profession: a search for bearings in the new century. J Am Vet Med Assoc 2005;227:1234–1238.
