Letters to the Editor

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The benefits of international engagement

We want to thank AVMA President John de Jong for his May president's column entitled “The importance of building relationships with our international colleagues.”1 As holders of the International Veterinary Congress Prize, we have collectively spent many decades working in international veterinary medicine, and we appreciate that Dr. de Jong mentions several salient points in his column. He notes that veterinary colleagues across the globe have common objectives aimed at improving the lives of people and animals. Further, he mentions building relationships with veterinary associations worldwide and suggests that because the AVMA represents American interests on the world stage, we have the ability to influence global policies related to veterinary medicine and tackle issues such as antimicrobial resistance and disaster preparedness and response on a worldwide scale.

These are important considerations. Additionally, we would like to mention that as intercontinental travel and trade increase, so does the potential for importation of pests and pathogens that are exotic to our animal industries and thereby substantial threats to our economic well-being. Some of these pests and pathogens are also zoonotic and, therefore, a threat to humans as well.

When (not if) we experience a widespread outbreak of an exotic disease here in the United States, the expertise and experience of our international colleagues will be important assets and resources for us. Veterinarians who have worked where such diseases are enzootic have advice and approaches to disease control based on experience that we may not have. If we have cultivated prior relationships, then communication and cooperation with these international colleagues and our ability to protect our own animal industries will be enhanced and augmented.

In his closing paragraph, Dr. de Jong notes that working collectively to “address the challenges and opportunities facing veterinary medicine at home and abroad” is critical and that “we must continue to have a seat at the international table.” These are wise words for the future. As climate change expands the ranges of diseases and disease vectors and as more frequent intercontinental travel and trade increase the risk that exotic pathogens will be introduced to the United States, our knowledge must also expand so that veterinarians can stay ahead of the curve when it comes to our role in maintaining the health and well-being of animals and humans alike.

Congratulations and support should go to Dr. de Jong for his very rational and proper concern for strong and solid international involvements.

Andrew A. Clark, DVM

Pendleton, Ore

David E. Swayne, DVM, PhD

Athens, Ga

Linda L. Logan, DVM, PhD

College Station, Tex

Terry S. Wollen, DVM

Mansfield, Conn

1. De Jong JH. President's Column: the importance of building relationships with international colleagues. J Am Vet Med Assoc 2019;254;1010.

Educational debt and the Public Service Loan Forgiveness Program

The Public Service Loan Forgiveness Program (PSLFP) is a valuable tool for student loan forgiveness that is often overlooked by veterinarians with educational debt. This program, which was created in the College Cost Reduction and Access Act of 2007, grants forgiveness of qualifying federal student loan debt after 10 years of service with a qualifying employer (generally, governmental, military, and nonprofit employers) and 120 on-time qualifying monthly payments. Professionals in other fields, including medicine, pharmacy, dentistry, and law, are positioning themselves to take advantage of the PSLFP,1,2 and veterinarians must not be left behind.

The recent report by Bain and Salois3 on starting salaries, indebtedness, and employment for individuals graduating from US colleges of veterinary medicine in 2018 indicated that only 1.8% of new graduates had accepted positions with the federal government and lower percentages had accepted positions with other PSLFP-eligible employers such as nonprofit organizations.

The existence of the PSLFP can and should attract indebted veterinarians to federal government service or service with other qualifying employers, and its provisions may perhaps be sufficient to overcome the often-low starting salaries associated with these positions.

Initial media coverage of the PSLFP was negative, with many outlets reporting that only a miniscule percentage of the first cohort of borrowers eligible for the program at the end of 2017 received forgiveness. However, there is expected to be a snowball effect as more and more borrowers become eligible for and are granted loan forgiveness through the program. As of March 2019, 864 individuals have received loan repayment through this program and 10,000 applications are still pending, out of > 73,000 applications received. However, > 2.1 million employment forms have been certified, representing > $97 billion in student loan debt.4

The PSLFP will have a profound impact on educational debt over the coming years. Veterinarians have the highest debt-to-income ratio of any health-care profession.5 We must not overlook this valuable tool out of fear of the program's present track record. We owe it to ourselves to take any lifeline that is available, and this is a great one.

Diana Care, DVM, MPH

Sumrall, Miss

  • 1. Lynch A, Best T, Gutierrez SC, et al. What should I do with my student loans? A proposed strategy for educational debt management. J Grad Med Educ 2018;10:1115.

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  • 2. Notareschi V, Ulbrich TR. Is the Public Service Loan Forgiveness program right for you? Am J Health-System Pharmacy 2017;74:15281531.

  • 3. Bain B, Salois M. Employment, starting salaries, and educational indebtedness of year-2018 graduates of US veterinary medical colleges. J Am Vet Med Assoc 2019;254:10611066.

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  • 4. US Department of Education. Federal student aid. Available at: studentaid.ed.gov/sa/about/data-center/student/loan-forgiveness/pslf-data. Accessed May 15, 2019.

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  • 5. Chisholm-Burns MA, Spivey CA, Stallworth S, et al. Educational debt crisis: analysis of debt and income among pharmacists, physicians, dentists, optometrists, and veterinarians [published online ahead of print Mar 29, 2019]. Am J Pharmaceutical Educ doi: 10.5688/ajpe7460.

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Emphasizing the value of less invasive testing

I read with interest the recent Pathology in Practice report1 describing a cat with notoedric acariasis. I certainly agree that it was interesting to report the histologic changes associated with Notoedres infection. However, I was surprised that a minimum database was apparently not obtained. Cytologic examination and skin scrapings should always be performed prior to more invasive procedures when evaluating animals with crusts, papules, pustules, and similar lesions. I realize that the authors stated that less invasive initial testing was not performed at the owner's request. However, I worry that readers may conclude from the report that skin biopsy is a reasonable first step for a cat with a similar history and physical examination findings. As stated by the authors, less invasive tests would likely have yielded positive results had they been performed.

Paul Bloom, DVM

Allergy, Skin and Ear Clinic for Pets Livonia, Mich

Department of Small Animal Clinical Sciences

College of Veterinary Medicine Michigan

State University

East Lansing, Mich

1. Tobias JR, Steed JR, Banovic F. Pathology in Practice. J Am Vet Med Assoc 2019;254:11631165.

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