In response to changes in food animal production systems, much thought and discussion have been devoted to the recruitment, education, training, and retention of veterinarians for FSVM. It has been predicted in some studies1,2 that there will be a decreased need for FSVM practitioners because increased consolidation of the dairy industry is following the already consolidated and vertically integrated swine and poultry industries. Other investigators3,4 have considered the increased age of many food animal practitioners and new opportunities in food safety and projected a shortage of veterinarians dedicated to careers in FSVM. Most authors1–8 agree that changes in food animal production and agriculture will impact FSVM practitioners.
Thus far, the focus has been on recruitment and retention of veterinarians in FSVM, primarily on the basis of current veterinary roles.3,4 Although these 2 reports, as well as other reports, provide valuable insights into the motivations of veterinary students and practitioners, the information cannot be properly evaluated independently. Changes happening in food animal agriculture must be taken into account when considering the role the veterinary medical profession will play in providing proper service for FSVM. Although several possibilities exist for food animal production industries,7 a long-term trend toward fewer farms with more cows and increased production per cow seems likely.2,8
In 2005, 49.5% of US milk was produced on dairies consisting of > 500 cows, and almost half of that (21.7% of US milk) was produced on dairies with ≥ 2,000 cows.9 Larger dairies often employ lay staff to perform technical duties traditionally performed by veterinarians.2 One report10 that detailed milk production costs in 2000 indicated little difference in veterinary and medicine costs among farms when the farms were classified on the basis of number of milking cows per operation. However, in that report,10 the category for veterinary and medicine costs included expenses for breeding and rBST. A more precise description of veterinary and medicine costs is provided in an older study,11 which indicates that large farms spend just over half as much money on veterinary service per animal, compared with expenditures for small farms. Furthermore, a smaller percentage of the animal health budget for large farms is spent on veterinary products and service, compared with the percentage for smaller farms.12 Given this continuing pattern in production demographics and hiring practices, it is likely that the demand for technical services delivered by veterinarians will decrease. The domination of large farms will exert economic pressures on labor and services that will force the veterinary profession to adapt. Large dairies will demand primary health care services that maximize economic returns to the farm.
Some farms will hire veterinarians as full-time employees; others, assuming current trends continue, will use farm personnel (trained and supervised by veterinarians) as the primary health care providers.2 In this scenario, the role of a veterinarian as the primary technical service provider will be reduced. To maintain client services to these farms, the price, structure, or delivery of veterinary services must be adapted or essentially face exclusion. Numerous authors7,13–18 have called for restructuring of the veterinary profession to meet changing needs. The information provided here expands on those reports by proposing that food animal service be provided by credentialed veterinary technicians, cites the justification for this approach, and includes benefits and problems in implementation of this proposal.
A Model for Use of Veterinary Technicians by Food Animal Practitioners
Veterinary technicians are used extensively in companion animal veterinary medicine to perform various technical and supportive tasks. This allows veterinarians to engage in diagnostic and disease management roles on more animals per day. The cost of a veterinarian is therefore spread over several clients, and lessexpensive personnel (ie, veterinary technicians) are substituted when appropriate. This model has been poorly adopted by food animal practitioners, which offers an opportunity to restructure the delivery of onfarm health care services to meet economic pressures of the food animal production industry. Some FSVM practitioners are already using veterinary technicians to administer injections, collect feed samples, assess animal body condition, monitor health program indices, and perform other technical duties.19,20 There are additional duties for which veterinary technicians are trained and which they could perform on farms, including castration, dehorning, assistance with dystocia, repair of uterine or vaginal prolapse, venipuncture, hoof trimming, necropsy, collection of milk samples, and inputting and processing of data.21 In its accreditation policies and procedures, the AVMA Committee on Veterinary Technician Education and Activities requires that students be trained to obtain a thorough patient history and obtain objective patient data (rectal temperature, pulse rate and character, respiration rate, and auscultation of heart and lungs). Given this training requirement for veterinary technicians in AVMA-accredited programs and the few additional diagnostic procedures performed on farms for individual-animal care, the need for a veterinarian to be on a farm to deliver primary health care may not be justified.
Instead, we propose an alternative system. A veterinary technician would collect patient history and key objective patient data on the farm and then report to a veterinarian via telephone, e-mail, or other electronic communication. The veterinarian would make a diagnosis predicated on these data (as well as any additional information requested) and then prescribe treatment. When the treatment is within the purview of a veterinary technician, the technician would provide that treatment to the animal. When the treatment is beyond the skill level or legal right of a veterinary technician, the veterinarian would proceed to the farm and provide that treatment.
In this model, the use of veterinary technicians to travel to the farm, assess a problem, and provide treatment would allow veterinarians to pursue duties more appropriate for their professional training. Effective, professional, and cost-efficient health care is maintained for the veterinarian's clients while enabling veterinarians to pursue more value-added activities.
Justification for the Model
Technical services—The demand for delivery of technical services as a part of veterinary care to food animals will continue, although delivery of these services by veterinarians most likely will be unprofitable for producers and veterinarians at current market costs. Shifting the veterinary educational focus from technical service on individual animals to diagnostic and management services for groups and herds of animals has been problematic. In surveys that detailed what bovine practitioners believed were important skills for entry-level veterinarians to possess, 12 of the top 15 desired proficiencies were individual-animal skills that could be performed by a veterinary technician.22 These included administration of injections; oral administration of medication; venipuncture; IV administration of fluids; collection and examination of feces for detection of parasites; auscultation of the lungs, heart, and gastrointestinal tract; necropsy; manual assistance with birth of calves; subconjunctival injections; and insertion of IV catheters.22 Furthermore, in another survey23 conducted by the same group of authors in which they evaluated the desired proficiency for surgical, anesthesia, and restraint skills, 10 of the top 14 skills could be accomplished by a trained veterinary technician (including castration, dehorning, IV or IM administration of sedatives, hoof examination and treatment, insertion of implants into the ear, tattooing, repair of a uterine or vaginal prolapse, removal of supernumerary teats, and casting an animal for restraint). These results illustrate opportunities for veterinary technicians to provide many services currently delivered by veterinarians.
The shift from primary health care delivery to more herd health management may promote recruitment and retention of veterinarians in FSVM. In a survey3 that evaluated factors affecting the career choice of veterinary students, one important issue was whether students believed a career in FSVM would be intellectually challenging and permit them to fully use their veterinary education. This concern appears to be justified in light of the basic technical tasks expected of food animal practitioners and the fact that in other veterinary careers, basic technical services are delivered by credentialed veterinary technicians. The retention of veterinarians in FSVM has also been problematic,2 perhaps for similar reasons.
Colleges and schools of veterinary medicine are endeavoring to change their FSVM curricula to meet the need for more veterinarians in positions that involve use of population and preventive medicine skills. Students graduate with expectations that they will use these skills in private practice, and they may become disillusioned and change career paths to pursue new interests or another lifestyle. In fact, roughly half of new food animal practitioners leave that sector of the veterinary medical profession within 5 years after graduation.2 On the basis of surveys18,22,23 of private practice veterinarians, it appears that practitioners need veterinary technicians, whereas veterinary medical schools are endeavoring to produce veterinarians.
Economics—The emphasis on efficient production of food sources in the United States has resulted in decreasing values for these products (Tables 1).9,11 Although this has been advantageous for consumers, food producers, specifically livestock producers, have been forced to maintain profits while receiving lower prices for their products. In response, the poultry and swine sectors have changed their use of veterinary service to a population management role based on a lower value per animal for their industries. However, dairy producers and, to a smaller extent, beef producers have tried to maintain their traditional veterinarian-producer relationship, which is primarily based on individual-animal medicine.
Expenditures of livestock producers on animal health have been described elsewhere.12,24 When those data are adjusted for inflation, comparison reveals that only dairy and beef producers are paying more for veterinary services and products than they did 5 years earlier (Tables 2). Data from the USDA Economic Research Service from 1982 to 2005 confirm this has been a continuous trend (Figure 1).10
Value* of commodities from livestock production in the United States for the period from 1970 to 2000.9,11
Although veterinary costs may be increasing, surveys25,26 have revealed that starting salaries for new graduates are not keeping pace with indebtedness for veterinary students. From 1997 to 2006, the ratio of student debt to entry-level salary for a new veterinarian has increased 15% (from 1.45 in 1997 to 1.65 in 2006), whereas the same ratio has increased 12% (from 1.56 in 1997 to 1.83 in 2006) for new graduates entering large animal–exclusive practice. Despite a lower student indebtedness for those who enter large animal–exclusive practice, the ability to repay debt has been listed as a reason veterinary students change from FSVM into other career paths.5 Perhaps misconceptions concerning potential for future earnings,4 ability of spouses or significant others to find employment,3,4 specialties available, or other misinformation are responsible for students' views.
Regardless, the ability to repay debt is a concern. Median debt of veterinarians graduating in 2006 was $100,805, and 45.5% of graduates with debt owed > $100,000.25 To service this debt, new graduates in FSVM cannot afford a lower starting salary, which reflects the lower value of technical veterinary services to producers; instead, they must find ways to increase the value of their time spent serving clients in industries that have decreasing-valued products.
In contrast, veterinary technicians earn between $26,560 and $30,500/y27 or $10.93/h28 and have (on average) $20,000 of educational debt.29 Veterinary technicians offer the opportunity for food animal producers to retain educated, appropriately trained service personnel at a fraction of the cost. Therefore, use of veterinariansupervised veterinary technicians to deliver primary health care would provide a more cost-effective strategy, compared with the use of veterinarians and untrained laypersons. Trained, educated, and credentialed veterinary technicians who are supervised by licensed veterinarians should be able to provide a similar standard of care as that for a veterinarian but at a reduced cost. In contrast, laypersons employed by a farm may have little or no formal training in delivering primary health care to livestock. Even though the services laypersons deliver are less expensive, compared with costs for services delivered by veterinarians or veterinary technicians, the treatment outcome may be quite different.
Veterinary costs as a percentage of production value for hogs (diamonds), cow-calf beef cattle (squares), and milk (triangles) in the United States from 1982 to 2004.10 856 Views: Food Supply Veterinary Medicine JAVMA, Vol 231, No. 6, September 15, 2007
Citation: Journal of the American Veterinary Medical Association 231, 6; 10.2460/javma.231.6.854
Veterinary medical schools have responded to changes in FSVM with an increased focus on production medicine at the herd or flock level. The veterinary medical profession should now respond by providing low-cost professional service through improved use of veterinary technicians.
Increased FSVM recruitment—Given the increased attention that the veterinary literature, veterinary medical schools, and veterinary profession have focused on recruiting students into FSVM, a moderate increase in FSVM graduates should be expected. Conflicting reports1–4 on the need for FSVM practitioners, at least in the private sector, predict the possibility that these new graduates will enter an industry with a surplus of labor.2 Currently, some large dairies are finding it cheaper to hire veterinarians trained in other countries or laypersons that can be trained to perform technical duties expected of traditional veterinary service. Although conflicting accounts exist, reports11,12 in which investigators separated expenses for veterinary service and products from those for breeding and rBST indicate that large farms spend fewer dollars per animal on veterinarians than do smaller farms. Additionally, a smaller percentage of the animal health budget for large farms is spent on the purchase of veterinary services and products, compared with that for smaller farms.12 If these trends continue and consolidation of the cattle industry mirrors that of the swine and poultry industries, even to a small degree, the need for high-priced veterinary service and therefore veterinarians will severely decline.2,11
Benefits of Adopting the Veterinary Technician Model
Adoption of the aforementioned model or other similar models for the use of veterinary technicians will have 5 main benefits.
• It will retain clients for FSVM veterinarians by offering appropriately priced services for basic technical work while enabling veterinarians to deliver more value-added services.
Food animal veterinarians in the United States have become victims of their own success; they have eradicated or severely restricted diseases responsible for devastation of the cattle, swine, and poultry industries. Diseases that remain are common, repetitive, and often related to management and nutritional factors on farms.14 The repetitive nature of many of these conditions has allowed veterinarians to set up standard operating protocols for initial treatment by on-farm personnel. Furthermore, as farms grow larger, they can increasingly justify training and paying an individual or team to provide on-farm primary health care delivery. Veterinarians are being excluded from delivery of individual-animal care because on-farm personnel can provide it at lower cost. Once excluded from these technical duties, some veterinarians are also removed or choose to be excluded from providing consulting and management services. If, instead, veterinary practices offer multiple-leveled service to meet cost-conscious needs of producers, they could retain those clients for both technical and managerial services.
• It will maintain a VCPR that will facilitate more education in and more direct supervision of treatment compliance and preventive medicine practices.
Primary health care delivered by veterinary technicians and supervised by veterinarians will provide more opportunities for cost-effective onfarm education and maintain a VCPR. We have previously mentioned the cost-effective nature of veterinary technicians in health care delivery (ie, expecting similar treatment outcomes at a lower cost). Additionally, veterinary technicians could be used for intensive, on-farm training sessions in tasks such as milking, IV administration of treatments, correction of dystocia, and involvement in beef quality assurance programs. The proposed model would fulfill conditions for a VCPR30 because a veterinarian has been asked to supervise the care of an animal; is familiar with the animal's medical history, objective patient data, and farm conditions through communication with the veterinary technician and regular herd health service; and is available to provide emergency service (in person or through instructions to the veterinary technician).
As a result of increased education of producers and more active involvement in individual-animal health care (ie, a VCPR), the proposed model offers opportunities to remain engaged in treatment decisions that entail animal welfare, judicious use of antimicrobials, and farm profitability. By staying involved in these issues, the VCPR can also serve as a basis for third-party verification for consumer concerns.
• It will provide services to rural producers who could not otherwise support a veterinary practice.
Use of veterinary technicians in rural practice allows 1 veterinarian to provide services for a much larger geographic area. As described previously, when a veterinary technician spends time traveling to and from most farms and delivering most of the basic treatments, the cost associated with treatment delivery is reduced. Furthermore, the larger geographic area provides more clients to which veterinarians can offer managerial and consulting services. Currently, a similar system that would empower licensed health care providers has been proposed in the Commonwealth of Pennsylvania to address increasing cost and lower availability of physicians.31 Large or isolated dairies could also contract with a veterinary clinic to provide the entire daytime health care for a herd. This may be a more cost-effective option than hiring poorly trained laypersons and provides a way to maintain a VCPR with rural and isolated producers.
• By maintaining and increasing service to producers, veterinary technicians can provide more appropriate surveillance for diseases through extensive training and oversight.
Rapid recognition of a foreign animal disease is a critical component to restricting its spread and subsequent economic impact.32 Delays of an hour or day can dramatically increase the spread and scope of an outbreak of a foreign animal disease. For example, if foot-and-mouth disease had been recognized in the United Kingdom before the infected swine were brought to slaughter, the potential to decrease the impact of the 2001 outbreak would have been much greater. In the United States, private practice veterinarians have been the first line of defense against outbreaks of foreign animal diseases.13 However, the decreased contact time trained professionals have with consolidated food animal production units increases the length of time that such an outbreak could go unrecognized. Instead, based on the proposed model, farms could be assured services provided by credentialed veterinary technicians, which would increase the ability to rapidly recognize a disease, quarantine an affected herd or flock, and limit the scope of an outbreak. Currently, USDA APHIS employs 1 veterinary technician for every 1.5 veterinarians in its veterinary services program.33 Clearly, the USDA views veterinary technicians as valid and competent members of the veterinary medical profession; food animal veterinarians in private practice should do the same.
• It will afford veterinarians the time necessary to deliver production medicine services to meet current and future needs of food animal producers.
Time is one of the most common obstacles to learning new skills as a practicing veterinarian. Implementing this or other models for use of veterinary technicians will increase the amount of time veterinarians have available to engage in continuing education while retaining their client base. Courses in production medicine, business management classes, and alternative track residency programs can be pursued and completed by veterinarians who use remote-access veterinary technicians to deliver on-farm services. The knowledge gained may be used to expand service offerings or create additional demand by producers. This would allow veterinarians to move their practice from a commodity service susceptible to intense price competition to a service based on provision of higher value. Use of veterinary technicians can provide a way for practicing veterinarians to acquire new skills while maintaining current skills and practice profitability.
Problems With Implementation
Four current or potential obstacles exist for implementation of veterinary technician practice models.
• Laws governing technicians may be an impediment.
Each state regulates the legal right for veterinary technicians to perform specific duties and provides requirements for specific veterinarian supervision. In Pennsylvania, the Veterinary Medicine Practice Act34 directs that veterinary technicians are prohibited from performing the following acts: surgery, providing a diagnosis, providing a prognosis, providing a prescription (including treatments, medications, or appliances), or attesting to health status. Certified veterinary technicians are allowed to perform a number of duties under immediate, direct, and indirect veterinarian supervision. Immediate supervision is defined as a veterinarian is within visual and audible range of a veterinary technician. Direct supervision is defined as a veterinarian has given oral or written instructions to a certified veterinary technician, is on the premises, and is easily and quickly available to assist the technician. Indirect supervision is the least strict and is defined as a veterinarian is not on the premises but is acquainted with the keeping and care of the animal or animals by virtue of an examination of the animal or animals or medically appropriate and timely visits to the premises where the animal or animals are kept, and the veterinarian has given written or oral instructions to the certified veterinary technician for treatment of the patient or patients.
However, the proposed supervision of onfarm veterinary technicians does not fit neatly into any of the aforementioned categories. Wireless technology available in many areas easily allows for auditory and visual communication without a veterinarian being on the premises. In addition to auditory communication, the use of digital imaging has been used to accurately describe body condition scores35 and has the potential to aid in diagnostic evaluations.
Although laws and regulations concerning the practice of veterinary medicine are specific for each state, a review of the information for all states is beyond the scope of this report. The authors are most familiar with laws governing the Commonwealth of Pennsylvania and will use them as an example. The model proposed in this report would not violate the laws of Pennsylvania because a veterinarian would diagnose the problem, offer a prognosis, and prescribe treatment, which would then be delivered by a veterinary technician. Surgery or other more involved interventions would still be performed by a veterinarian at a later time. The lack of clarity in the Veterinary Medical Practice Act for Pennsylvania may result in a reluctance to pursue adoption of a model for use of veterinary technicians, but it does not explicitly exclude it.
• It is essential to maintain producer confidence in veterinary service delivered by veterinary technicians.
Some producers will object to the substitution of on-farm health care delivered by veterinary technicians for that provided by veterinarians. However, an unpublished survey conducted in 2006 through an Internet listserv (ie, DAIRY-L) by one of the authors (DWR) found that 62% of dairy producers were comfortable with veterinary technicians administering treatment after a veterinarian established a diagnosis. Internet surveys are inherently biased against producers without access to or comfort with the Internet. However, with the exception of plain-sect communities, producers familiar with computers and the Internet are likely to constitute the majority of future food animal producers. As with many new ideas, early innovators are likely to quickly accept or even request service by veterinary technicians because of the cost benefits.
• It will be crucial to convince veterinarians that veterinary technicians are competent practice members available to perform on-farm health care delivery.
Some FSVM veterinarians in private practice are already using veterinary technicians,19,20 and government agencies will likely continue their hiring practices, given the lack of available and interested veterinarians. Most FSVM veterinarians may have to choose between reduced demand for services, career changes, or innovative thinking.2,11,13,14 If there is continued consolidation in food animal production units, veterinarians will be forced to look for alternative models to serve their clients.
• It may be difficult to find adequately trained and interested veterinary technicians.
As of May 1, 2007, there were 140 AVMA-accredited veterinary technician schools in North America, with 16 offering 4-year degrees and 5 offering distance-learning opportunities. Most of these schools focus on companion animal education to meet the current demand. Initial demand for food animal veterinary technicians can be met by students currently enrolled in veterinary technician schools or by current veterinary technicians who have an interest in working with food animals. Further development of this model should result in a subsequent increase in demand for food animal technicians; increased recruitment efforts can then be initiated. Pursuing a 2or 4-year degree to become a veterinary technician offers the population of rural students an excellent opportunity to achieve a higher education while maintaining rural and outdoor lifestyles. Growing up in a rural environment has been identified as a determinant factor in veterinary students who pursue a career in FSVM.1 Furthermore, it has been suggested36 that educational cost and subsequent indebtedness can discriminate against students from a rural background. The lower educational cost and reduced potential debt load would allow rural students with an interest in FSVM to pursue a career as a veterinary technician.
Conclusions
The food animal production industry is undergoing change that profoundly affects the veterinary medical profession that serves it. Whereas much has been studied, written, and opined about an upcoming shortage of veterinarians in FSVM, the roles of these veterinarians have not been examined in light of the changing demand for veterinary service. Veterinarians in FSVM should seize this opportunity to change the roles they play in their clients' farms. The use of veterinary technicians to deliver on-farm individual-animal care is one such opportunity. It will allow veterinary practices to expand services to meet their clients' needs, reduce vulnerability to an undetected outbreak of a foreign animal disease, and allow veterinarians to deliver additional training and educational programs to clients.
ABBREVIATIONS
| FSVM | Food supply veterinary medicine |
| rBST | Recombinant bovine somatotropin |
| VCPR | Veterinarian-client-patient relationship |
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