Financial expectations of first-year veterinary students

We applaud the authors of the recent report¹ on financial expectations of first-year veterinary students because this type of information is long overdue. However, we believe the analysis is incomplete and misses three key points regarding educational debt of veterinary students.

First, in calculating the internal rate of return (IRR) of pursuing a veterinary education, the authors assumed that there were no direct costs of attending veterinary college other than accumulated debt. We contend, however, that total cost of attendance, including tuition, fees, and living expenses, should have been used instead. According to the University of Minnesota website,² total in-state tuition and fees for the 4-year veterinary degree program are currently $134,183, but the total cost of attendance is $203,196 for residents and $307,913 for nonresidents. The authors also did not take into account anticipated annual increases in tuition and living expenses or interest accumulating on student loans. Thus, we believe that reported IRRs are overestimates.

Second, the authors did not account for all Minnesota veterinary tuition classification differences among students. While some students qualify for resident tuition, others will pay nonresident tuition, and some may qualify for special reciprocity tuition rates. Total cost of attendance will differ among these groups, and this difference is not reflected in calculations in which mean educational debt of $166,769 was used.

Third, the authors state that calculating IRRs for students who use income-driven repayment plans for their debts was beyond the scope of their study, but we believe this was an unfortunate omission. Although projecting costs associated with income-driven repayment plans has challenges, suggesting that income taxes owed on the forgiven debt may reduce the benefit of debt forgiveness ignores published data on veterinary earnings.³ Even given the tax on forgiven debt, because most high-debt borrowers would pay only limited amounts of principal and interest under most income-driven repayment plans, the overall repayment cost would still likely be much less than the cost for standard repayment plans.

Measuring the expectations of incoming veterinary students is vital. However, for students to have an accurate projection of the return on their veterinary school investment, total costs for each borrowing population as well as the impact of income-driven loan repayment options should be considered.

Tony Bartels, dvm, mba

Paul D. Pion, dvm

VIN Foundation Davis, Calif

James F. Wilson, dvm, jd

Priority Veterinary Management Consultants Yardley, Pa

The authors respond:

We thank Drs. Bartels, Pion, and Wilson for their interest in our study and their thoughtful comments. We are pleased to see that our article has generated discussion and appreciate the opportunity to provide clarification.

Drs. Bartels, Pion, and Wilson suggest that our internal rate of return (IRR) estimates did not account for potential tuition increases, living expenses, or differences in residency status. This is incorrect. We asked each student about his or her individual expectations for debt and calculated the IRR for each individual. Thus, if a student expected to accumulate debt as a result of tuition increases, living expenses, or nonresident tuition, this expectation was factored into his or her IRR calculation.

In addition, it may be inappropriate to count living expenses as a cost of veterinary education. Living expenses are incurred whether or not someone attends veterinary school. In other words, the total cost of attendance that Drs. Bartels, Pion, and Wilson report includes some expenses—such as food and housing—that a person would have to pay for even if he or she did not attend veterinary school. Such costs are not relevant in calculating the rate of return on a veterinary education.

We agree with Drs. Bartels, Pion, and Wilson that income-based repayment plans can be advantageous to some students. In our article, we stated that the IRRs in our study may understate the true return to students using these plans because such students will not have to repay their full debts. However, it is also possible for a borrower to have insufficient savings to pay the tax bill associated with debt forgiveness. If a borrower must take out a new loan at a higher interest rate than the student loan, then this borrower may not be better off. Modeling the effects of income-based repayment plans would have required assumptions about federal and state income tax rates 20 years from now, whether borrowers would have adequate savings to pay the taxes or would need to take out new loans, and the interest rates on these new loans. Because we would have had to make essentially arbitrary assumptions about these variables, we concluded that it was not possible to accurately estimate the effect of income-based repayment plans and opted to simply warn readers that our IRRs could be understated.

Finally, Drs. Bartels, Pion, and Wilson note the need to provide students with accurate projections of the returns to veterinary education. We agree that such projections are vitally important. However, producing them was not the goal of our study. Rather, our study measured what students expected their returns to be. Our results can provide a starting point for future analyses of the actual returns by allowing researchers to assess the accuracy of students’ expectations.

Veterinary educational debt is an important issue and we are pleased to contribute to the discussion. This topic is in need of further study; we encourage further dialogue and investigation.

The views expressed herein are those of the authors and not necessarily those of the Federal Reserve Bank of Minneapolis or the Federal Reserve System.

Christine Lim, dvm

Department of Veterinary Clinical Sciences College of Veterinary Medicine University of Minnesota Saint Paul, Minn

Sam Schulhofer-Wohl, phd

Federal Reserve Bank of Minneapolis Minneapolis, Minn

Margaret Root Kustritz, dvm, phd

Department of Veterinary Clinical Sciences College of Veterinary Medicine University of Minnesota Saint Paul, Minn

Laura Molgaard, dvm

Office of Academic and Student Affairs College of Veterinary Medicine University of Minnesota Saint Paul, Minn

David Lee, dvm, mba

Veterinary Medical Center College of Veterinary Medicine University of Minnesota Saint Paul, Minn

The downfalls of gestation stalls

In a recent JAVMA commentary, Parsons and Deen¹ appear to argue that differences within the veterinary profession regarding the use of gestation stalls for pregnant sows are due to the complexity of sow welfare issues.¹ Although I agree that sow welfare issues can be quite complex, I believe that the welfare implications of gestation stalls are more straightforward than they initially appear. When considering only individual housing, there is no welfare benefit to gestation stalls that cannot be achieved with individual housing in larger stalls. Thus, the use of gestation stalls seems to be solely a matter of economics.

Obviously, economics is important, and we must be realistic. However, the results of various referenda calling for an end to the use of gestation stalls and the recent actions of various retailers to remove gestation stalls from their supply chains seem to suggest that Americans are not willing to confine sows to gestation stalls for purely economic reasons. Some in the pork industry, including some veterinarians, have accepted this social ethic. Others fight it, claiming that the public is not educated regarding the issues and does not understand, for example, that gestation stalls prevent injuries. This argument is invalid, though, because larger individual stalls also prevent injuries.

Certainly, we can recognize the complexity of sow welfare issues and help educate the public in that regard. However, the fact that stereotypies are seen with both stalls and group housing does not make stalls acceptable; it just means that we also need to work on welfare problems in group housing. That stereotypies may be coping behaviors does not mean that stalls are acceptable; it just means that we need to work on providing conditions that do not require such coping strategies. That stereotypies may be due to hunger does not mean that stalls are acceptable; it just means that we need to take steps to deal with the problem of sow hunger.

As Parsons and Deen note, we need to determine what matters to the animals themselves. I hypothesize that, given a choice, sows would choose stalls that allow them to turn around over stalls that do not. If so, then the welfare issue is not just one of individual versus group housing, but of individual housing in gestation stalls versus individual housing in stalls more spacious than what is currently provided, and there is no welfare advantage to justify the use of gestation stalls over larger individual stalls.

V. Wensley Koch, dvm

Loveland, Colo

The authors respond:

There are many differences within the veterinary profession concerning the evaluation of gestation stalls, and these differences, in turn, contribute to the complexity of this topic. We would contend that an argument for simplicity is really an argument that only certain viewpoints or approaches are valid in the evaluation of welfare concerns.

As suggested by Dr. Koch, realism is needed in evaluating sow housing alternatives. To our knowledge, there are no sow farms of any size that use a housing system based on the large individual stalls described by Dr. Koch. Creating a housing system consisting of individual stalls large enough to allow sows to turn around without impedance or injury would, in our opinion, be economically unviable. Further, we would argue that the investments required to build such large individual stalls could be better used in other ways that would more efficiently improve the welfare of gestating sows.

Simply providing larger individual stalls would also not necessarily allow sows to express all of their natural behaviors. The behavioral repertoire of sows is far richer than simply being able to turn around. In particular, group housing provides the opportunity for conspecific interactions—both positive and negative—that represent natural behaviors for a species that is inherently social. Large individual stalls would preclude sows from pursuing social behaviors.

The choice, therefore, is between group housing and stalls, and Dr. Koch is correct that welfare concerns such as hunger and mitigating the negative effects of conspecific aggression require further work. Farmers are actively pursuing systems that reduce these concerns.

Finally, we are concerned that Dr. Koch interpreted our commentary as a defense of gestation stalls. This was not our intent or our purpose. Instead, we argue that discussions of animal welfare require a greater understanding of all of the issues and concerns in play and that any absolutist approach should be suspect.

Thomas D. Parsons, vmd, phd

Department of Clinical Studies New Bolton Center School of Veterinary Medicine University of Pennsylvania Kennett Square, Pa

John Deen, dvm, phd

Department of Veterinary Population Medicine College of Veterinary Medicine University of Minnesota Saint Paul, Minn

Calcium carbonate urolithiasis in male versus female goats

I wanted to comment on the report by Nwaokorie et al¹ on risk factors for calcium carbonate urolithiasis in goats. This is an excellent article with important information for small ruminant practitioners. In their results, the authors state that “Males were approximately 196 times as likely to develop calcium carbonate uroliths as were females.” I contend, however, that it would be more accurate to say that males were approximately 196 times as likely to be examined at a veterinary hospital because of calcium carbonate urolithiasis as were females. To my knowledge, there are no data to suggest that females do not develop urinary calculi at a rate equal to males, just that because of differences in male and female tract anatomy, urinary calculi are more likely to pass freely and cause no noticeable distress in females. A similar comment might be made about the statement that neutered male goats were more likely to have calcium carbonate uroliths, given that there are far more neutered goats in the population of goats likely to be seen by a veterinarian.

Joe Snyder, dvm

Portland, Ore

The authors respond:

We would like to thank Dr. Snyder for his thoughtful comments on our report.¹

In his letter, Dr. Snyder questions our statement that “Males were approximately 196 times as likely to develop calcium carbonate uroliths as were females,” suggesting that it would be more accurate to say that “males were approximately 196 times as likely to be examined at veterinary hospitals because of calcium carbonate urolithiasis as were females.” We agree that both statements likely are true, but suggest that the statement that “calcium carbonate uroliths were approximately 196 times as likely to be detected in males as in females” encompasses both statements and might be a more accurate way to express our findings.

Dr. Snyder states that “To my knowledge, there are no data to suggest that females do not develop urinary calculi at a rate equal to males, just that because of differences in male and female urinary tract anatomy, urinary calculi are more likely to pass freely and cause no noticeable distress in females.” We agree that there is a paucity of objective data describing urolithiasis in female goats. It is well documented that male urinary tract anatomy (long and narrow urethra, S-shaped sigmoid flexure, and the presence of a urethral process) plays a role in the detection of uroliths.² However, without prospective studies designed to identify goats of either sex with subclinical disease, the true prevalence of urolithiasis in female goats will remain unknown.

Finally, Dr. Snyder comments that “there are far more neutered goats in the population of goats likely to be seen by a veterinarian.” This was true for goats with urolithiasis in our study. However, our control population, which consisted of goats examined at veterinary teaching hospitals in the United States during the same period as our study (information was obtained from the Veterinary Medical Database), contained more sexually intact males (n = 3,838) than neutered males (1,976).

Urinary tract disease impacts owners of pet and production animals both financially and emotionally. We encourage the goat industry to support clinical and investigative research to further our knowledge and care of goats worldwide.

Eugene E. Nwaokorie, dvm, ms

Carl A. Osborne, dvm, phd

Jody P. Lulich, dvm, phd

Lisa K. Ulrich

Lori A. Koehler

Michelle T. Buettner

Minnesota Urolith Center Department of Veterinary Clinical Sciences College of Veterinary Medicine University of Minnesota, Saint Paul Minn

Thomas F. Fletcher, dvm, phd

Department of Veterinary Biosciences College of Veterinary Medicine University of Minnesota Saint Paul, Minn

Hurricane Katrina's aftermath beyond New Orleans

I was disheartened to read the recent JAVMA News retrospective on Hurricane Katrina.¹ While the information is factual, I was surprised by the limited scope of the writer's interview pool. I appreciate that both outsider (VMAT members) and insider (local veterinarians) points of view were included, but I feel the article lacked a full understanding and coverage of the storm's effects on the region. From the article, one might assume that the damage was limited to the New Orleans and surrounding southeastern Louisiana region, when in fact the scope of the storm extended from Texas to the Florida panhandle and north to Tennessee. The most destructive aspect of any hurricane is the eastern edge, where the winds are stronger and the storm surge is higher. For Hurricane Katrina, this encompassed the Mississippi, Alabama, and Florida coastlines and areas inland for approximately 150 miles. While the author does note that the article only covers “a few among the many veterinarians who have stories from the storm,” it would have been nice to hear stories from some of these other affected areas. I would point out that the accompanying article² discussing the PETS Act included Dr. Brigid Elchos, deputy state veterinarian for Mississippi.

As a Mississippian affected by Hurricane Katrina both then and now, I would have liked to have seen a more diverse effort. As part of my master's thesis, I developed a survey asking Mississippi veterinarians about their personal and professional experiences with disasters. Responses to this survey provided many revelations on what my state's veterinarians experienced and how they have overcome losses to prepare for the future. I sincerely hope that the nation as well as our profession has not forgotten the gravity of the situation and the multitude of lives affected throughout the southeastern region.

Katie Ebers, dvm, ms

Hattiesburg, Miss