Is it time for limited licensure?
A report1 in the November 1, 2009, JAVMA News indicated that more veterinary school graduates are investing in their careers with additional training. The academicians whose comments were quoted seemed to think this is a good thing. But with 43.5% of graduates pursuing advanced training and 33.3% of 2009 graduates indicating an intent to pursue board certification, I see this as a trend where more and more veterinarians are being trained to deliver a level of care far beyond what most pet owners can afford.
If this trend is an attempt to mimic the human medical model, we have forgotten an important consideration. The human model requires, in nearly all cases, a third-party payer system under which a substantial portion of each person's income is accumulated in a pool for eventual distribution to medical professionals. No such pool of money exists for veterinary medicine. Instead, the money for veterinary care comes from the discretionary income of our clients.
According to the article, Dr. Marguerite Pappaioanou has suggested that some students may feel a sense of inadequacy about entering the workforce because they have so much to learn within the span of a four-year veterinary degree program. This situation occurs because students are forced to accumulate knowledge about species they will never see, conditions they will never diagnose, and procedures they will never perform. They will then be tested by state licensing boards to be sure they are proficient in those areas. I don't know whether the push has to come from the state licensing entities or the veterinary schools, but the time has come for limited licensure. It should be obvious that true mixed animal (ie, food-producing animal, equine, and small animal) practitioners are becoming rare. Certainly, none of the 43.5% of veterinary graduates seeking advanced training nor the 33.3% seeking board certification intend to go into mixed animal practice.
If limited licensure were to occur, the body of clinical knowledge to be accumulated would be reduced to a level more easily absorbed in 4 years, hopefully lessening students' feelings of inadequacy. Perhaps then, fewer graduates will feel the need for continued training and, in some cases, the accumulation of additional debt.
There are only so many dogs and cats with complex conditions (eg, endocrinopathies and immune-mediated diseases) or requiring complex surgical procedures (eg, laminectomy or tibial plateau leveling osteotomy). In the current economic climate, there are even fewer pets owners willing and able to pay for this level of care. In this scenario, the specialist may find many more colleagues sharing a smaller pie. Those of us repairing wounds, treating itchy dogs, relieving obstructed cats, dealing with hemorrhagic gastroenteritis, and so on will continue to have clients coming through our doors.
Jeffrey A. LaCroix, DVM
Wilmington, NC
Nolen RS. More veterinary grads investing in their careers with additional training. J Am Vet Med Assoc 2009;235:1016–1018.
