The importance of veterinary career awareness

We commend Drs. Pritt and Case on their recent Viewpoint article, “The importance of veterinary career awareness,”¹ and agree that it is important to expose veterinary students to nonclinical career opportunities during their professional training. We would like to call attention to a major research training program that has been doing just that for more than 2 decades. We are referring to the National Veterinary Scholars Program and its associated National Veterinary Scholars Symposium. This program was started more than 25 years ago, with strategic input from individuals throughout the veterinary research community, and is part of an ongoing effort to strengthen veterinary and biomedical science by providing research training for veterinary students.

The National Veterinary Scholars Program and its associated annual symposium are responsive to recommendations articulated in the National Institutes of Health's Physician-Scientist Task Force Report,² and seek to educate veterinary students about rewarding and productive scientific careers in government, industry, and academia and encourage and inspire them to pursue such opportunities. The annual National Veterinary Scholars Symposium has become the capstone event for veterinary students engaged in summer research programs across the nation. The participation of the National Institutes of Health, animal health industries such as Boehringer-Ingelheim, and major veterinary organizations such as the AVMA, American Veterinary Medical Foundation, and Association of American Veterinary Medical Colleges is a testament to the success and importance of this effort in providing veterinary students information about careers in veterinary research.

Attendance at the annual National Veterinary Scholars Symposium has grown steadily from < 100 in 2000 to > 600 in 2017. More importantly, the percentage of students who indicate they are more than likely to pursue a research career increases significantly as a result of participating in a summer research program and attending the symposium. Survey data indicate that the objectives of exposing students to high-quality science and inspiring them to pursue research careers are being met, and participating students have commented in post-symposium surveys that the meeting crystalized for them the numerous research-related career paths available.

Further efforts to highlight the diverse and fulfilling career opportunities available to veterinarians are needed, but we believe that progress is being made.

Harry W. Dickerson, bvsc, phd

Associate Dean, Research and Graduate Affairs College of Veterinary Medicine University of Georgia Athens, Ga

Roberto Alva, dvm, phd

Executive Director Veterinary Scholars Program Boehringer Ingelheim Athens, Ga

Michael Atchison, phd

Director, VMD-PhD Program School of Veterinary Medicine University of Pennsylvania Philadelphia, Pa

Andrew T. Maccabe, dvm, mph, jd

Chief Executive Officer Association of American Veterinary Medical Colleges Washington, DC

Sue VandeWoude, dvm

Associate Dean for Research College of Veterinary Medicine and Biomedical Sciences Colorado State University Fort Collins, Colo

Vilma Yuzbasiyan-Gurkan, phd

Associate Dean for Research Director, Comparative Medicine and Integrative Biology Graduate Program College of Veterinary Medicine Michigan State University East Lansing, Mich

The authors respond:

We thank Dickerson et al for their letter describing the National Veterinary Scholars Program and the associated National Veterinary Scholars Symposium, which have provided an outstanding platform for promoting research careers for veterinarians for many years. Efforts like this, and others found in veterinary schools accredited by the AVMA Council on Education, are an important part of veterinary professional education as it relates to career awareness. We would suggest that a cohesive effort be undertaken to gather information on and benchmark similar programs. Doing so will raise awareness of these opportunities among veterinary and preveterinary students as well as nonacademic veterinarians who serve as mentors, while also allowing for celebration of successes.

Heather Case, dvm, mph

Chief Executive Officer International Council for Veterinary Assessment Bismarck, ND

Stacy L. Pritt, dvm, ms, mba

University of Texas Southwestern Medical Center Dallas, Tex

Further thoughts on standards of care

I have advocated for the use of written standards of care (SOCs) at most every practice with which I have consulted over the past quarter century so I have no issue with the broad concept of SOCs. However, I do not believe it is true, as suggested in the recent commentary by Dr. Gary Block,¹ ‘that veterinarians who provide care that falls below the SOC “commonly do so because of owners’ financial limitations.”

In my experience, practices that provide care that falls below the SOC often do so because of resistance to the development of written standards. Thus, when consulting with practices, I usually start with development of written SOCs for healthy patients (ie, patients with an American Society of Anesthesiologists physical status classification of 1), as I find that I can typically get team buy-in with virtually no effort at this level. Initially, there may be some resistance from some of the practice veterinarians who prefer to maintain old habits. But, once practice owners discover their staff's enthusiastic support of these initial SOCs, most practices willingly start to expand and broaden them. To keep the written SOCs dynamic, I recommended the inclusion of a proviso that for every day of paid continuing education, attendees are required—and empowered—to add one improvement to the existing written SOCs for review over the next 90 days.

For practices that are worried about having legally defensible SOCs, I recommend adopting the American Animal Hospital Association Standards of Accreditation, regardless of whether they are an association member, because these standards have been accepted in court in many cases. In addition, I recommend that practices implement a standard protocol for each visit that includes assigning body condition, dental condition, pain, and quality of life scores and linking hospitalization level to treatment plan expectations.

To expect the AVMA or any membership association to establish all-inclusive healthcare SOCs for veterinary practices is, I believe, unrealistic. Even with my approach, I ensure that practices understand that the written SOCs provide some degree of “clinical freedom,” where the art and science of healthcare delivery come together for the sake of the animal, client, and practice.

Thomas E. Catanzaro, dvm, mha

CEO Veterinary Consulting International Lakewood, Colo

Time to get serious about antimicrobial stewardship in the commercial pet industry

A recent outbreak of multidrug-resistant (MDR) Campylobacter infection in humans that was eventually linked to contact with puppies sold through pet stores¹ highlights the need for judicious antimicrobial use in companion animals and for expanded antimicrobial stewardship efforts in the commercial pet industry. During the outbreak investigation, widespread prophylactic administration of antimicrobials to puppies was reported, and this practice may have led to the emergence and spread of the MDR Campylobacter jejuni strain.² This strain was resistant to fluoroquinolones, macrolides, and most β-lactam antimicrobials, leaving carbapenems as the only antimicrobials available for treatment of human patients with severe illness.¹

Emergence of MDR bacteria affects veterinarians, animal breeders, pet stores, and pet owners. The cost of antimicrobials needed to treat MDR bacterial infections may be prohibitive for some clients, and toxic effects associated with them may prevent their use. In addition, MDR bacteria can spread rapidly and cause poor outcomes in animals and humans.³ Although all people are susceptible to infection, young children, people older than 65 years, and immunocompromised individuals are at risk for serious illness when household animals (often without clinical signs) shed MDR bacteria in their feces.

Efforts to improve antimicrobial stewardship are underway in the United States. The AVMA's Task Force on Antimicrobial Stewardship in Companion Animal Practice released a report providing guidance for implementing antimicrobial stewardship,⁴ and the AVMA formed a multidisciplinary Committee on Antimicrobials to support animal health and welfare.⁵ Veterinary curriculums covering topics such as antimicrobial resistance (AMR) and stewardship are being implemented nationwide.⁶

Currently, we don't know the burden of or trends in AMR in companion animals or whether stewardship efforts in companion animal practices and the pet industry will lead to reductions in animal and human infections. If we want to get serious about reducing the burden of AMR in companion animals, we can start by measuring the problem. Since the 1990s, the National Antimicrobial Resistance Monitoring System, a collaboration between state and federal partners, has tracked antimicrobial-resistant bacteria in humans, retail meat, and food animals at slaughter to monitor trends in AMR and inform government decision-making. A similar laboratory-based surveillance system to detect AMR infections in companion animals that can be integrated with human data will require a partnership between veterinary practitioners, veterinary diagnostic laboratories, the pet industry and public health officials.

In the United States, improvements in companion animal husbandry and hygiene, owner education, and the use of alternatives to antimicrobials are crucial for prevention and control of MDR infections in humans and animals and can lead to reductions in unnecessary antimicrobial use. One feature of successful antimicrobial stewardship for companion animals will be the development of and access to low-cost, accurate diagnostic tests that can help reduce reliance on empiric antimicrobial treatment for relief of clinical signs. In the United Kingdom and Europe, companion animal stewardship programs that reduce antimicrobial use and focus on infection prevention activities and diagnostic testing have had success in reducing AMR infections in animals.⁷ We recommend that industry groups work with veterinarians, breeders, and pet advocates to establish stewardship principles and practices in breeding, distribution, transportation, and retail environments.

Now is the time for the commercial pet industry, veterinarians, and public health officials to act to reduce unnecessary antimicrobial use, before MDR strains, such as the Campylobacter strain that sickened people in the recent outbreak, become more common.

Mark E. Laughlin, dvm, mph-vph

Cindy R. Friedman, md

Megin Nichols, dvm, mph

Division of Foodborne, Waterborne, and Environmental Diseases National Center for Emerging and Zoonotic Infectious Diseases Centers for Disease Control and Prevention Atlanta, Ga

Disclaimer: The conclusions and opinions in this letter are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.