Economic challenges could be compounded by expanding veterinary education

I read with frustration the November 1 JAVMA News article “Veterinary education continues expanding.”¹ In the article, education consultant Mark Cushing is reported to have suggested that because of continued human population growth and the high percentage of America's pets that receive no regular veterinary care, there continues to be a need for more veterinarians. Cushing is quoted as stating that “a profession that limits its future is marginalizing itself” and warns against arguing that there are too many veterinarians.

I would challenge Mr. Cushing to spend at least a month with large animal and mixed animal practice owners to get a truer perspective of the current state of our profession. My husband and I are mixed animal practitioners in a small town located about 90 miles outside Atlanta and have seen our client base shrink considerably since 2008. Clients increasingly decline routine health care recommendations. Breeders are rare, and many spay and neuter surgeries are deferred or performed at taxpayer-subsidized low-cost clinics. Mobile and low-cost vaccination options that remove veterinarians entirely from the exam room have gained appeal, small animal dental cleanings are being performed without anesthesia at grooming facilities, and laypersons offer cheap equine teeth floating. Gasoline, medications, insurance, and licensing fees for practice owners are increasing. Clients shop for the best price by telephone and fill their prescriptions at local discount stores or through online pharmacies. Staff lost through attrition is not replaced, and new graduates hungry for their first real paycheck replace more seasoned doctors deserving of modest raises. Struggling smalltown clinics are being bought out and consolidated into corporations that enjoy high-volume buying power and can negotiate favorable contracts with testing laboratories. In short, today's veterinarians work harder and longer, earning less with which to secure their future.

By contrast, the expansion and staffing of new and existing veterinary schools is already big business. Lobbyists, developers, consultants, and school administrators have convinced state governments that their citizens, food supply, and pets will be endangered unless veterinary school enrollment increases.

If our profession does nothing to prevent the marginalization of existing veterinarians, the large crop of new graduates will quickly join their ranks, struggling to reinvent themselves and vying for shrinking animal-care dollars. Those of us navigating this new economy do not see more clients waiting longer to be served by a shrinking pool of doctors. Instead, we see fewer clients in our exam room and on the farm as animal owners turn to a burgeoning array of low-cost alternatives. “Build it and they will come” may work for veterinary schools, but for many of today's practice owners, it is the stuff of a bygone era.

Pam Milligan, dvm

Chattahoochee Veterinary PC, Cleveland, Ga.

Dog breed identification

I read the recent article by Simpson et al¹ on rethinking dog breed identification in veterinary practice, and worried that following the authors' suggestion that veterinarians “adopt a policy to avoid visual breed identification of any dog of unknown lineage” could have unexpected consequences.

Consider a news announcement that a 6-year-old child was bitten by a brown American shelter dog and anyone knowing its location should call public health authorities. Or consider an advertisement for a lost brown American shelter dog.

Let's be sure we have a disease before we suggest such a radical treatment with unknown side effects.

Raymond J. Schuerger, dvm

Thornwood Veterinary Hospital, Pittsburgh, Pa.

The authors respond:

I want to thank Dr. Schuerger for his comments on our article.¹ Research indicates breed misidentification currently exists as a “disease” process with many adverse consequences, as evidenced most prominently by breed-specific legislation. Studies comparing visual identification with results of DNA analysis for individual dogs have begun to shed light on the scope of the problem.^2,3 In fact, since the submission of our article, additional information has come to light supporting the conclusion by Voith et al² that visual identification of the predominant breed of mixed-breed dogs was correct only 25% of the time. Using larger samples of dogs and respondents, Croy et al³ found that visual identification of predominant breed was correct only 27% of the time. Thus, it appears the error rate with visual breed identification is high enough to warrant a “treatment.”

As scientists, veterinarians are advocates for disease prevention and health maintenance. Veterinarians need to think of breed identification in terms of any other information entered into the medical record. Even if all clinical signs were to point to a diagnosis of diabetes mellitus, a veterinarian would not make a definitive diagnosis absent the results of specific diagnostic testing. Similarly, a veterinarian should not make an identification of a dog's breed without sufficient confirmatory evidence. If one is averse to use of the term mixed breed, American shelter dog or American adopted dog can be used, so long as the same term is used consistently for all records. This is not all that different from the terms the veterinary profession adopted long ago to refer to mixed-breed cats (ie, domestic shorthair, domestic mediumhair, and domestic longhair).

Almost everyone now has access to a digital camera and a color printer. Consequently, advertising a lost pet with a detailed description and picture is very plausible. Furthermore, a full description of the dog is much more descriptive than a simple breed designation determined on the basis of visual inspection. Authorities are more likely to catch the correct dog if it is described as a 40-lb brown short-haired blue-eyed mixed-breed male dog with a white spot on its chest, as opposed to a pit bull mix.

Much like the paradigmatic shift in pain management that has occurred over the past 25 years, a similar change needs to occur with canine breed identification. There is a growing wealth of scientific information available showing that visual identification of dog breed is flawed. Thus, we as a profession need to embrace change and have a scientific basis for breed identification.

Robert Simpson, dvm

Kingston Animal Hospital, PC, Kingston, Tenn.

Caregiver placebo effects

Congratulations to Drs. Conzemius and Evans for their outstanding article¹ describing caregiver placebo effects among pet owners and clinicians. In human medicine, placebo effects can potentially provide some psychologic benefits to patients who are susceptible. In veterinary medicine, however, patients are unlikely to derive any of the benefits that their caretakers believe their pets are getting as a result of a placebo.

I hope the authors (or others with access to similar study records) would follow up with the participants of their study to address whether some individuals are more prone to caregiver placebo effects than others.² If certain clients or clinicians are more prone to caregiver placebo effects in general, then this might help explain the apparent efficacy of many alternative therapies. One can imagine that a client or clinician prone to seeing placebo effects would, on finding success with a particular alternative therapy, be more likely to find success with other alternative therapies. In this manner, an alternative therapy could readily develop a devoted following of self-selected users prone to seeing high rates of success. In particular, it would be interesting to learn whether there is an association between the extent of the caregiver placebo effect and individual clients' and clinicians' use of and attitudes toward alternative therapies in general.

As the authors noted, there are numerous implications of caregiver placebo effects that are crucial to veterinary practice. I applaud J AVMA for publishing their article, which is destined to become a classic.

Edmund K. LeGrand, dvm, phd

Crossville, Tenn.