Limitations in veterinary workforce outlook predictions

In a recent letter to the editor,¹ Dr. Bennie Osburn cites a projection from the US Bureau of Labor Statistics (BLS) that there will be an additional 22,000 jobs for veterinarians in 2020, compared with 2010.² This prediction of a 36% increase seems a bit rosier than I would expect, particularly considering reported decreases in the number of veterinary visits, the proliferation of online pharmacies and travelling vaccination clinics, and the recent changes in vaccination protocols. The BLS report has been cited as an argument in favor of increasing the veterinary class size at colleges of veterinary medicine in the United States and at AVMA-accredited institutions outside this country.

I endeavored to contact the author of the BLS report and ultimately had a discussion with Megan Sweitzer, who served as lead on the occupational outlook study for veterinarians³ and described the methodology used to develop the BLS employment prediction. When I asked whether these increases seemed accurate in light of the year-over-year decreases in number of veterinary visits, she stated that the BLS assumed that the decreases were due to the current economic climate. When I asked whether additional issues such as proliferation of online pharmacies and travelling vaccination clinics and recent changes in vaccination protocols had been taken into account, she indicated that, with the exception of the changes in vaccination protocols, she was not aware of these other issues and that these issues had not been considered. When I inquired whether the projected increase in revenue for the veterinary services sector included income for online pharmacies and travelling vaccination clinics, she stated that this revenue would indeed be included in the veterinary service sector revenue. She went on to state that because job growth predictions are tied directly to service sector revenue growth, the result would be a misleading—albeit unintentional—overstatement of job growth. Consequently, a follow-up study will now be performed by the BLS, which should be completed by September 2012.

It is critical that those who use the BLS report to support recommendations for continued growth in veterinary class size recognize its flaws. I believe that the growth in the number of veterinarians in the United States over the next decade could devastate the economy of our entire profession. It is my heartfelt plea that veterinary college deans, the Association of American Veterinary Medical Colleges, and those planning to open new veterinary colleges evaluate the impact of their decisions on the future of our profession. I recognize the challenges facing existing colleges of veterinary medicine, but we must consider these challenges in light of the welfare of the entire profession and we must also be honest with today's veterinary students about their future job prospects if the current trends continue.

Jeffrey N. Peck, dvm, dacvs

Affiliated Veterinary Specialists, Maitland, Fla

The author responds:

Dr. Peck questions my reference to a projection from the US Bureau of Labor Statistics regarding the number of additional veterinary job opportunities expected by 2020.¹ At the time I wrote my commentary, this reference represented the most recent forecast on the veterinary job market from the federal government. Since that time, the National Research Council of the National Academies of Science has released their report Workforce needs in veterinary medicine,² which is a more comprehensive assessment of the current and future needs of the profession. This report takes into consideration not only the number of veterinarians but also the animal populations and societal needs outside of the private practice roles of the profession. The report states that although there is little evidence of widespread workforce shortages in most fields in the veterinary profession at this time, there are pockets of unmet needs. Examples of areas where there are unmet needs include food safety, food security, emerging diseases, ecosystem health, basic health sciences for research and industry, and animal welfare.

The AVMA, Association of American Veterinary Medical Colleges, American Animal Hospital Association, and various corporate entities are actively working to identify key opportunities that will help the profession address these needs. These initiatives include such things as the North American Veterinary Medical Educational Consortium,³ the AVMA's Strategic Plan, the Partnership for Pet Preventive Healthcare, and the One Health Initiative. Each of these initiatives is being undertaken to make the necessary professional changes to meet the evolving needs of society in the 21st century. These opportunities require veterinary colleges to prepare new graduates for the future, but this does not necessarily require a reduction in the number of veterinary graduates. Determining optimal veterinary college enrollment requires more assessments of the numbers of veterinarians needed to address the breadth of opportunities for the profession.

Bennie I. Osburn, dvm, phd, dacvp

Dean Emeritus, Western Institute for Food Safety and Security, School of Veterinary Medicine, University of California-Davis, Davis, Calif.

Implications of Controlled Substances Act for mobile veterinary practice

As a mixed animal veterinarian engaged in ambulatory practice for small ruminants in upstate New York, I was very concerned by the JAVMA News article “Federal law could affect mobile practice.”¹ It seems that the US Drug Enforcement Administration has caused severe difficulties for practitioners such as myself by deciding to enforce the portion of the federal Controlled Substances Act saying that veterinarians are not allowed to carry controlled substances in their vehicles, other than the specific amounts of drugs they intend to use during the day for previously scheduled appointments (presumably already dispensed in individual amounts). While acknowledging the Drug Enforcement Administration's role in preventing the abuse of controlled substances, I believe that it is unwise for them to enforce this provision. I don't believe that it could possibly be more dangerous to have a single bottle of butorphanol in a lockbox in one's truck, compared with having individual syringes that could get lost or dropped. Also, imagine the headaches trying to account for waste in the syringe hub or trying to dispose of drugs that were dispensed but not used.

More importantly, consider how this affects our care of animals. I, like most veterinarians, have had occasions when an animal did not die after receiving the proper dose of euthanasia solution, and I always keep extra nearby for just such a situation. One of the veterinarians in the article stated that he was now euthanizing animals with a handgun. Is keeping a handgun in a lockbox in your car safer than keeping a bottle of euthanasia solution? Given how far our profession has come in regard to chemical restraint, analgesia, and providing our patients a smooth transition into death, are we now going to go back to simply shooting them in the head?

Gillian Ferguson, dvm

Bluestone Veterinary Services, Red Hook, NY.

I was horrified to read the recent JAVMA News article “Federal law could affect mobile practice.”¹ If the Drug Enforcement Administration, by enforcing the rule that veterinarians in ambulatory or mobile practice cannot routinely carry controlled substances in their vehicles, is causing veterinarians to use lidocaine for an eye enucleation and a gun for euthanasia, then all of us have a moral duty to contact our congressional representatives and demand that the legislation be changed to allow more reasonable use of controlled drugs for sedation, anesthesia, and euthanasia in ambulatory and mobile practice. This article upset me as no other I have read in 20 years of practice. I have just finished writing my senators and congressman, the White House, and the Humane Society of the United States to ask for help with this situation. I urge every veterinarian to do the same and to do so now.

Ellen Harrison, dvm

Annapolis, Md.

Thank you for the recent JAVMA News article⁹ regarding the announcement by the US Drug Enforcement Administration that veterinarians are violating federal law if they routinely carry controlled substances in their vehicles. As someone who provides mobile pet hospice and euthanasia services, I have long been concerned by this legislation. Multiple segments of the veterinary profession, including mobile veterinary practitioners, large animal practitioners, and wildlife veterinarians, are affected by this legislation. Recently, I've been contacted by many colleagues worried that they are practicing illegally, especially in California.

There is a strong movement in this country toward providing in-home hospice care and euthanasia services for animal patients, large and small. While I appreciate that the Drug Enforcement Administration has said that veterinarians would be allowed to carry the volume of controlled drugs intended to be used during the day, quality home veterinary care simply cannot continue without the ability to carry controlled drugs in amounts beyond those predicted at the beginning of any particular day. For my in-home pet hospice and euthanasia practice, for example, we may start the day with two patients on the schedule and end the day with 12 or more. Our doctors have little spare time to return home and gather more supplies. Enforcing the current legislation will severely limit veterinarians’ ability to relieve or end animal suffering as efficiently and compassionately as possible.

Every week, new veterinary practices begin offering end-of-life veterinary services. On average, 4 mobile practices are signing up each month with the In-home Pet Euthanasia Directory,² which currently lists 180 practices that provide in-home pet hospice and euthanasia services. Those of us involved in end-of-life care as well as our clients recognize the value that in-home veterinary services provide, and it is my hope that every pet and family has access to home hospice and euthanasia services within the next 10 years. Groups like the International Association of Animal Hospice and Palliative Care are working to make this a reality.

High-quality veterinary medical services should always be available outside the clinic setting for small animals, farm animals, and wildlife. I earnestly request that the AVMA, through its Governmental Relations Division and other divisions, work to identify elected officials who are sympathetic to modifying the federal Controlled Substances Act and actively pursue passage of legislation to allow mobile practitioners to carry controlled drugs with them. Please continue to provide leadership on this issue, post updates, and offer those of us in the field the opportunity to get involved. I look forward to learning what can be done to modify this legislation. We can be a strong, collective voice, and I personally would be honored to be on the front lines advocating for commonsense change.

Kathleen Cooney, dvm, ms

Home to Heaven PC, Loveland, Colo.

The AVMA responds:

We appreciate the letters from Drs. Cooney, Ferguson, and Harrison. The AVMA is equally concerned with the current US Drug Enforcement Administration (DEA) rules and the uncertainty and angst that possible enforcement by the DEA has triggered in mobile practitioners.

When the AVMA first heard from veterinarians about the challenges associated with adhering to current DEA regulations while still providing complete ambulatory veterinary care, we initiated discussions with members of the DEA headquarters staff in Washington, DC. Although we found DEA headquarters staff to be sympathetic to veterinary practice needs, they were clear that the Controlled Substances Act does not allow for veterinarians to lawfully transport and use controlled substances remotely. They also maintain that the provisions of the law cannot be changed through rulemaking and that a statutory change is required. And, although we understand that tradition holds that the medical bag veterinarians carry with them is an extension of their DEA-registered principal place of business, this thinking certainly would not preclude a local DEA field office from enforcing the rules. Likewise, a veterinarian could face a variety of penalties should law enforcement find controlled substances in his or her vehicle during the course of an unrelated event, such as a traffic violation or accident.

The volunteer leaders of the Council on Biologic and Therapeutic Agents and the Clinical Practitioners Advisory Committee have created a subcommittee to help the AVMA address this issue, and under their direction, the AVMA Governmental Relations Division is actively analyzing legislative options. We have engaged stakeholders and other communities impacted by these regulations during these discussions and will continue to keep interested parties informed. In the meantime, relevant information for veterinarians on following current DEA registration, recordkeeping, and security rules is available on the AVMA website.¹

Ashley Shelton Morgan, dvm

Assistant Director, AVMA Governmental Relations Division, Washington, DC.

Lynne White-Shim, ms, dvm

Assistant Director, AVMA Scientific Activities Division, Schaumburg, Ill.