The importance of diversity in veterinary medicine

I would like to respond to the concern in a recent letter to the editor¹ that the Western University of Health Sciences might be manipulating the racial and cultural makeup of the incoming veterinary classes by providing the following statistics. By the year 2050, the globe will host 1 billion more people. It is estimated that 100 million of them will live in the United States. Most of those 100 million people will represent what we now recognize as minority cultures.² We will become, in reality, a true pluralistic society.

Even now, Western's applicant pool is vastly more diverse than the national applicant pool just two decades ago. The applicant pool for the College of Veterinary Medicine's 2014 class was 54% white, 14% Asian, 10% Hispanic, 2% African American, and 1% American Indian (race and ethnicity were not reported for 18%). The demographics of the admitted class are nearly identical.

Western University's campus is located in a community that is 41% white, 7% black or African American, and 7% Asian, with 3% being of two or more races and 41% being of some other race. Regardless of race, 71% identify themselves as Hispanic or Latino.³ Given these statistics, manipulating the racial and cultural makeup of the incoming classes simply to achieve diversity would seem to be unnecessary.

A common myth about diversity initiatives is that quality is sacrificed. In fact, by any measure, the strength of Western's applicant pool is the same as the strength of the applicant pool for any other college. At the time of application, our students rank in the top 2% of the national student body in grade point average and other national criteria. Furthermore, Western's graduates have proven to be competitive with other graduates. More importantly, Western's performance data to date support the proposition that the quality of its students is at least equal to the quality of students from other veterinary medical colleges.

I believe the goals of the profession and the goals of those who have raised such provocative questions about the recent JAVMA news article⁴ on diversity are mutual. We too are interested in achieving fairness, equity, open access to quality professional education (or quality education in general), and protection of the standards and qualities of the veterinary profession for which the global society holds us in such high regard. Attaining these goals while simultaneously maintaining a profession that is responsive to societal needs is a challenge. However, it behooves the veterinary profession to welcome this challenge. I appreciate the opportunity to respond to readers' concerns and hope to have further discussions about the state of the profession. Continued dialogue is crucial!

Philip D. Nelson, dvm, phd

Dean, College of Veterinary Medicine

Western University of Health Sciences

Pomona, Calif

I appreciate the opportunity to respond to some concerns expressed in a recent letter to the editor¹ regarding the news article² on diversity in the July 15, 2010, issue of JAVMA. The letter writer asked what is meant by the term cultural competence and whether its desired outcome was to improve client communication or to improve the understanding of other cultures. Although definitions of cultural competence may vary in detail among different fields and organizations, the general concept describes the ability to be able to interact effectively with people from various cultural backgrounds, especially those different from our own. Given this definition, the outcomes suggested by the reader are not mutually exclusive and, in fact, are interdependent. Thus, we should embrace the goals of improving cultural understanding, which provides an effective base for improved communication (in any setting) in an increasingly pluralistic society.

I was particularly struck by the concern expressed about Dr. Reed's reference to institutionalized practices to promote diversity. I cannot speak for Dr. Reed; however, I would like to address the importance of developing a culture of inclusivity. Mere intent to include all segments of society falls short of being effective when one recognizes that historical institutional barriers still exist for some. The fact that in the not too distant past, some policies and procedures were adopted to support exclusivity cannot be ignored. Rather, such policies and procedures must be identified and changed. There must be an affirmative response to remove such barriers and to adopt practices that result in fair and equitable decisions. Otherwise, the lasting effects of these policies will contradict the intent of the culture of inclusion.

The letter writer also alluded to the notion of mandatory diversity training with some alarm. Although some may believe that veterinary colleges are requiring students to undergo some political indoctrination to be good veterinarians, most if not all colleges of veterinary medicine attempt to promote critical thinking and analysis by exposing students to complex veterinary issues, including societal change and its impact on the profession. Students are never told what to think but rather are provided with approaches and scaffolds that can be successfully used in determining personal positions on complex issues.

I am unaware of a formal program in “diversity training” at any veterinary medical college. That said, the importance of communication training is universally recognized as a priority throughout the veterinary profession, and such training would be ineffective if cultural, generational, gender, and ethnic differences were not considered. Training in communication is most effective when the training is interwoven throughout the curriculum rather than delivered as a separate course. Some may interpret this pervasive approach as “institutionalizing” communication training, whereas others may even see it as indoctrination.

The concept of “institutionalized diversity” should be thought of as one that moves beyond mere policies and procedures created out of fairness. Its goal is to enhance the capacity of our veterinary education institutions to function effectively in diverse environments. This involves not only recognizing inequities that still exist and fixing them but also creating an inclusive environment that embraces diversity at all levels.

Suzie J. Kovacs, msc

College of Veterinary Medicine

Western University of Health Sciences

Pomona, Calif

As we reflect on diversity in veterinary medicine and the letter¹ from Dr. Parker in the September 15, 2010, issue of JAVMA, we welcome the opportunity to endorse the Association of American Veterinary Medical Colleges' response² and to contribute our own alternative perspective.

There is no question that substantial demographic shifts in the US population are underway. For example, in the 2000 census, 72.5% of California children under age five were nonwhite. In addition, the US Latino population grew 58% in the past decade, so that Latinos now outnumber African Americans in the United States.

Although specifics vary, the trends are clear from Michigan (Dr. Parker's home state) to Texas, Florida to Alaska, and Massachusetts to Hawaii. Historical pathways to success in veterinary medicine, as reflected in Dr. Parker's perspective, will not ensure that we continue to effectively meet society's future needs. In human health, research indicates that racial and ethnic minorities receive lower-quality health care, even after controlling for income, insurance, and other critical factors. In animal health, research indicates that nonwhite pet owners are less likely to seek veterinary care for their pets, after correcting for income, education, age, and nearly all other factors that impact demand for pet health care.³

As the demographics of the US population continue to change, consumer preferences for veterinary services will also evolve; cultural foundations will be critical. Lessons from Hurricane Katrina about the strong human-animal bond in minority communities suggest that we may not fully understand the demand for pet health care in these evolving markets. Veterinary services must be readily available to previously underserved communities without negative influences of geographic or cultural barriers. A focus on intercultural communication and inclusive environments will be crucial. Only veterinarians who are truly competent in a multicultural society will reach the full potential of their medical training, to the benefit of animals, animal owners, veterinarians, veterinary practices, the veterinary profession, and society. Far from being offensive, the reality is that the most effective way to achieve such multicultural competence is to ensure that the diversity of the veterinary student body and the profession itself mirrors that of society. As an added benefit, learning outcomes in general are stronger when originating from a diverse educational environment. However, the US veterinary medical profession was 92.4% white in the 2000 census, and current US veterinary student populations are similar.

Achieving greater diversity is a long-term endeavor and will hinge on actions of both organized veterinary medicine and academia. Changes in accreditation could provide an important and desirable piece of this puzzle. We applaud diversity initiatives of both the AVMA and the Association of American Veterinary Medical Colleges and are working diligently in Michigan to build an effective partnership between the university and the state veterinary association on this issue. Similar initiatives across all colleges and schools of veterinary medicine and all veterinary medical associations (state, local, species-specific, and specialty organizations) should be considered. Only such a broad-based, prospective approach will ensure true relevance and full ability to address the critical scientific issues the profession faces on a daily basis.

The Joint Task Force on Diversity

of the Michigan Veterinary Medical

Association (MVMA) and the College

of Veterinary Medicine (CVM) at

Michigan State University (MSU)

James W. Lloyd, dvm, phd

President, MVMA

Okemos, Mich

Associate Dean, CVM, MSU

East Lansing, Mich

Frank Carmona, dvm

President-elect

Paula Rode, dvm

Past-president

Karlene Belyea, mba

Executive Director

MVMA Okemos, Mich

Charles E. DeCamp, dvm, ms

Chairperson

Department of Small Animal

Clinical Sciences

Patricia M. Lowrie, ms

Assistant to the Dean

Director, Women's Resource Center

Christopher M. Brown, bvsc, phd

Dean CVM, MSU

East Lansing, Mich

More on cultivating veterinarian-scientists

We applaud Dr. Marshak's recent commentary, “The vanishing veterinarian-scientist?”¹ but disagree that clinical specialties are contributing to decreasing numbers of veterinarian-scientists. Clinical specialists comprise more than 20% of veterinary school faculty,^2,a including nearly 700 diplomates of the American College of Veterinary Internal Medicine (ACVIM). Hundreds of scientific research abstracts by ACVIM diplomates and trainees are presented at the annual ACVIM Forum, reflecting a vibrant organization embracing the science-to-medicine continuum and the clinical specialties in general. In fact, we believe clinical specialty training is fundamental to a successful research career as a veterinary scientist. Advanced clinical training affords a unique perspective on practical problems worthy of scientific investigation and the skills to translate scientific discovery to clinical practice. The facts indicate that clinical specialists are disproportionately represented in academia and research, uniquely suited to such careers, and committed to the evolution of clinical practice through research and veterinary education.

Clinical specialties such as the ACVIM are strong advocates of the veterinary scientific community. The ACVIM sponsors the Merial Summer Scholars Research program, encouraging veterinary students to choose scientific careers. The ACVIM Foundation has provided more than $1 million in veterinary research grants and created a postresidency research fellowship that is a model for creating future academic clinician-scientists. The ACVIM brought the issue of declining recruitment and retention of academic faculty to the American Board of Veterinary Specialties and sponsored the North American Veterinary Medical Educational Consortium meetings. Lastly, we robustly support the one-medicine concept through forum programming and other national meetings³ and through collaboration with the American College of Physicians. We believe that one medicine provides the most powerful rationale upon which veterinarian-scientists may ultimately prosper.

Although recruitment and retention of academic clinical specialists have become progressively challenging,⁴ clinical specialists are a fraction of the pool of potential veterinarian-scientists that our profession ultimately needs to cultivate if we are to address critical needs in veterinary research.² However, there are a number of existing challenges in this regard, starting with the recruitment process at the preveterinary and veterinary student levels. At the graduate level, research dollars available for veterinary research comprise 1% to 2% of the total federal biomedical research budget, forcing veterinary scientists to compete for a small pool of funds. Young tenure-track investigators are especially challenged by this situation. Additional academic responsibilities (development and delivery of the veterinary educational curriculum, administrative duties, and clinical service) also play a role. In addition, academic compensation has not kept up with compensation in the private sector, at least with regard to salary and schedule. These factors have a substantial effect on the decision by veterinarians to enter or remain in academia, regardless of whether they are or become clinical specialists.

Compared with other national professional organizations, the specialty organizations are small and resource poor and there has been no unified, effective voice speaking for the clinical specialties or the veterinary scientific community. For these and other reasons, we sincerely appreciate Dr. Marshak's opinions and professional advocacy as well as the opportunity to give voice to the specialists whose professional lives are dedicated to advancing clinical practice, the evolution of our profession, and one medicine.

Eleanor Hawkins, dvm, dacvim

Jean Hall, dvm, phd, dacvim

Leah Cohn, dvm, phd, dacvim

Virginia Buechner-Maxwell, dvm, ms, dacvim

Mark Oyama, dvm, dacvim

Michelle Henry Barton, dvm, phd, dacvim

Natasha Olby, vetmb, phd, mrcvs, dacvim

Chand Khanna, dvm, phd, dacvim

Steve Marks, bvsc, ms, dacvim

Dianne McFarlane, dvm, phd, dacvim

Jeffrey Toll, vmd, dacvim

Board of Regents

American College of Veterinary

Internal Medicine

Lakewood, Colo

Thoughts on staying relevant in food animal care

In reading the recent JAVMA news report on the American Association of Bovine Practitioners Annual Meeting,¹ I was disturbed to learn that certain veterinary procedures and treatments, once the profession's exclusive domain, had been legally reclassified as animal husbandry practices in Oklahoma. An attempt to do the same thing in Iowa did not get out of committee, which is surely a good thing for the animals that would have been affected. Such legislative initiatives to remove routine animal care from state veterinary practice acts are indeed alarming, but perhaps this is the inevitable outcome of the growth in concentrated animal feeding operations (CAFOs).

It appears to me that pig, poultry, and cattle producers, along with other nonveterinarians, are converging to exclude the veterinary profession, except as teachers and consultants, from their traditional roles in farm animal health, fertility, disease prevention, and welfare.

Veterinarians in the food animal sector have vital animal health and welfare expertise that no economic system should exclude, and few individuals without veterinary education are sufficiently qualified, be it by education or experience, to take their place.

The decline in the quality and diversity of rural life in North America, as industrial farming and CAFOs become more widespread, parallels the demise of traditional large animal veterinary practice. This now means that in many states, such as Minnesota, there are insufficient numbers of veterinarians to serve the food animal industry and ensure food safety and security. Some counties in southwestern Minnesota have a ratio of farm animals to veterinarians as high as 100,000:1, and several counties in western Minnesota have no veterinarians at all.²

Should state and federal public funds be provided to veterinary students who pledge to work with CAFOs for an agreed number of years? In my opinion, it may be in the best interests of society to phase out all CAFOs as a failed venture that cannot be rectified simply by more regulations, drugs, and vaccines or improved stockmanship.

Instead, fostering the adoption of more sustainable farming practices would be a win-win situation for all, especially the animals. Providing state and federal funding and subsidies to encourage such farming practices would give long-term security to veterinary students who elect to work in food animal veterinary medicine.

In the interim, perhaps it might be wise for the veterinary schools and colleges to develop paraveterinary courses in animal husbandry, behavior, health care, and welfare to certify operators and animal care supervisors working in CAFOs.

Michael W. Fox, dsc, phd, bvetmed

Fox's Pen Inc

Golden Valley, Minn

Additional information on the behavior of oral mast cell tumors

I read with interest the retrospective case series by Hillman et al.¹ Any new information that sheds light on the behavior of oral mast cell tumors is helpful, especially since so little has been published about oral mast cell tumor behavior in dogs. The methodology states that cytologic testing of the submandibular lymph nodes in 36 dogs was used for evidence of regional lymph node metastasis.

It is important to note that the metastatic status of the mandibular lymph node may not reflect the status of other lymphocentrums. In a previous study,² 45% of oral or maxillofacial neoplasms that were evaluated metastasized to other regional lymphocentrums not amendable to fine-needle aspiration on the basis of their location. These other lymphocentrums include the parotid and medial retropharyngeal lymph nodes. Results of cytologic evaluation of the mandibular lymph node correlate with results of histologic examination; however, results may fail to indicate the presence of regional metastasis.

If all 3 lymphocentrums (parotid, mandibular, and medial retropharyngeal) had been evaluated, the conclusions in the study by Hillman et al¹ regarding the expression of chemokine receptor type 7 by cancer cells and the lack of a relationship with nodal metastasis or survival time may have been different.

Evaluation of the parotid, mandibular, and medial retropharyngeal lymphocentrums should be standard procedure in evaluating metastasis from oral neoplasms, especially when cytologic examination of fine-needle aspirates from the mandibular lymphocentrum does not reveal metastasis.

Sharon Hoffman, dvm, davdc

North Florida Veterinary Dentistry & Oral Surgery

Jacksonville, Fla