Workforce crisis

This letter serves as a response to the article “Are we in a veterinary workforce crisis? Understanding our reality can guide us to a solution”¹ published in the September 15, 2021, JAVMA. I want to first commend you on publishing this article as it certainly made a statement that does address one of the largest issues facing our profession: staff shortage. However, I believe that the main issue in this article is the proposed solution of the authors. It hearkens back to “work/life balance” conversations in veterinary school, where it was more about being efficient and making time rather than addressing the actual issues: setting boundaries and not dancing around the seriousness of mental health.

We, as doctors, are told “when you hear hoof beats, think of horses, not zebras,” which is code for “trust your gut or your ‘knee-jerk’ reaction.” I feel as though the article missed this point by diverting the readers away from the main issue they are feeling—underappreciated and overworked—by merely commenting that they are inefficient, which is not the case. Even newer emergency models, such as the Veterinary Emergency Group (touted for having some of the highest-paid technicians and owner experience), have commented that the pandemic has changed their model of “every client gets to see a doctor before they are charged” or “every owner gets to be with their pet throughout the whole process.”¹ They are not inefficient; it is merely the demand is just too much for them to handle.

This article, though informational, does not send a stellar message to veterinarians, especially new graduates. This is an unprecedented time, and it is up to the AVMA to support them, not by telling them that they are inefficient; due to generations of inadequate pay for their support staff, they are facing major issues today.

The pandemic altered my life (both professionally and personally). I now work in a nontraditional mobile setting as a hospice veterinarian, so I may not be the best judge for this article, but I have loved ones that are. Please listen to them and for the possible solutions they have, but please respect that they are doing all they can and are given an unideal situation.

The struggle is real—the crisis in veterinary medicine and a solution

There is a disturbing disconnect between the perspective presented in the September 15, 2021, JAVMA News article titled, “Are we in a veterinary workforce crisis?”¹ and what veterinarians are experiencing nationwide.

For many, it feels like veterinary medicine is on the edge of a systemic crisis. Veterinarians are struggling with mental health challenges, pets are suffering due to limited veterinary care, emergency veterinary hospitals are closing, and pet owners are distressed because they cannot access the care their pets desperately need. Any of these issues would be a reason for concern; together, they demonstrate the crucial need to act now.

We are all aware of the mental health crisis in our profession. Suicide among veterinarians is alarming; according to the CDC, male veterinarians are 1.6 times more likely to die by suicide compared to the general population, and female veterinarians are 2.4 times more likely.² While addressing this devastating reality is multifaceted, the inability to serve our patients due to fewer qualified staff only exacerbates this issue.

Additionally, veterinarians are overwhelmed. Demand for veterinary care has increased by over 10% in the last 2 years,¹ but there are too few veterinarians and support staff to meet the increased need. Clinics are declining to accept new patients, hospitals are limiting after-hours availability, and referral practices are regularly diverting patients. Banfield estimates that by 2030 there will be 75 million pets without veterinary care because there will not be enough practicing veterinarians.³

Multiple solutions must be enacted to address this urgent situation, including increased mental health support, enlightened admission criteria to veterinary schools, empowerment of veterinary nurses, and compassion from those veterinarians serve. However, none of these will be enough without building capacity for care in veterinary medicine.

What can we do to address this crisis? One thoughtful solution is to create a career pathway for a veterinary PA, a Master’s degree–level professional who works under the direct supervision of a veterinarian to examine, diagnose, perform routine surgeries, and prescribe medications. By requiring this professional to be supervised by a DVM, any potential of negatively impacting the veterinary profession is mitigated. Instead, the veterinary PA could generate practice revenue and take pressure off the system by increasing bandwidth, thereby helping the veterinary profession fulfill its mission.

Our profession must act now rather than waste vital time researching whether our challenges do indeed exist. Without immediate, innovative solutions, such as a veterinary PA program and corresponding practice act amendments, animals and the people who care for them will suffer.

Apryl Steele, dvm, cawa

President and CEO

Dumb Friends League

Denver, Colorado

AVMA responds

We appreciate that Drs. Doll and Steele so thoughtfully read our article. With respect to 3 topics—productivity and efficiency, well-being and mental health challenges, and availability of veterinary personnel—clarification and additional information reveal we are largely in agreement.

We understand the stress and burnout veterinary teams are facing right now are very real problems. There is no doubt these remain difficult times for us, both professionally and personally. The AVMA is committed to providing resources that help, including data-informed solutions to tackle these complex issues.

A decline in productivity does not equate to veterinary professionals doing less work. Rather, it means the efficiency with which they have been working has been hampered in part by COVID-19–related protocols (eg, social distancing, curbside care, and deep cleaning) that are necessary to allow veterinarians to continue delivering services safely for patients and clients. To see the same number of patients, veterinarians need to exert more effort and work longer hours. It’s like running a mile on a treadmill compared with running a mile on a beach. The output is the same, but one takes more effort.

When gaps in efficiency are combined with greater demand for veterinary services and high turnover, the stress on practices can be considerable. Fortunately, we know from data across veterinary and human medicine that improving utilization of paraprofessionals (eg, veterinary technicians and assistants) and devoting more attention to leadership development, employee engagement, team building, and appropriate remuneration can improve efficiency and reduce turnover. All contribute to easing the stress and strain of the work environment, which—combined with more inclusive, healthy workplaces—will help get at the “actual issues” of well-being and mental health referenced by Dr. Doll.

We also agree with Dr. Steele that it’s important to look carefully at how our current workforce numbers and structure may or may not match existing and anticipated service needs. With that in mind, we are familiar with Dr. Steele’s comment that by 2030 there will be 75 million pets without veterinary care because there will not be enough practicing veterinarians because a substantial portion of that estimated 75 million is based on data from an AVMA survey that 30% of animals (cats, dogs, horses, and birds) do not see a veterinarian at least once a year.¹ Not mentioned by Dr. Steele were the major reasons why 30% of pet owners do not seek to obtain veterinary care: cost and lack of perceived value. Less than 10% of pet owners responding to that survey indicated that failure to obtain care was the result of difficulty finding or accessing a veterinarian. This suggests access to care challenges are fundamentally driven by cost and perceived value, not by location, distance, or the number of veterinarians. In fact, if we try to address this by focusing solely on growing the supply of veterinarians, we could inadvertently find ourselves increasing the cost of care, thereby making the problem worse. That is because labor is one of the largest cost centers within a veterinary practice. We can expand veterinary service capacity by adding more talent. However, we can also expand service capacity through improved efficiency, which has the corresponding benefit of being generally cost reducing.

This said, we can see how having some extra hands could help alleviate the stress and strain practitioners and their teams are feeling right now. However, we also recognize that expanding the supply of veterinarians will take time (at least 4 years or more). Similarly, developing and integrating a new type of veterinary paraprofessional will take time, and even then, it is not clear to what extent such an individual will be able to practice under current state practice acts. As they do practice, the profession will need to become comfortable with the associated legal responsibilities. The paraprofessional will take on legal responsibility for any medical decision-making, but so may any supervising veterinarians. Modifying practice acts to address these multiple issues will take even more time.

Alternatively, it seems an approach that helps veterinarians and veterinary professionals deliver care more efficiently and effectively through increased and responsible use of technology, better utilization and remuneration of our veterinary technicians and assistants, and an improved workplace environment can deliver multiple benefits, including potentially lower cost, reduced team member stress and burnout, and improved mental health, well-being, and job satisfaction, with the likelihood that results can be delivered in a timelier fashion.

Finally, we believe taking a data-informed view on the workforce challenges our profession is experiencing is worth the investment. Much like the SOAP model routinely used in veterinary medicine to deliver the best health outcomes for our patients, if we are to successfully make choices that will address our workforce issues, we need to collect subjective and objective information, assess that information, and then develop an appropriate treatment plan.

Matthew Salois, PhD

Chief Economist

Gail Golab, PhD, DVM, MANZCVS, DACAW

Chief Veterinary Officer

AVMA

Schaumburg, Illinois

High school to DVM degree in 6 years: adapting to current realities

The reality of educational costs is painfully clear: a majority of veterinary students graduate with overwhelming loan debt resulting from excessive tuition. While it may seem premature to call the situation a crisis, it certainly is a major problem that is not being arrested but is instead accelerating.¹

Tuition at US veterinary schools tripled during the last 20 years, having increased annually by more than double the consumer price index. Currently, the median tuition is $32,000 for in-state students and $53,000 for nonresidents. The average veterinary graduate owes $174,000, and starting salaries are in the mid $80,000s.^2,3 Thus, the debt-to-income ratio is 2:1 (ie, double the desired 1:1 figure). This crushing burden is damaging the careers and personal lives of too many of our veterinary graduates.

The good news is that practice salaries are increasing,³ as are privately funded college scholarships. Nevertheless, income improvements and philanthropy will cover only a small part of student debt: additional actions are needed.

Colleges could consider trimming low priority academic programs and projects, then transferring the budget savings to support tuition reduction: efficiency and affordability go hand in hand. However, downsizing is a tricky business and is unlikely to happen except in response to an actual financial emergency. It seems that colleges want to find a solution to student debt, but they don’t want to pay for it.^1,2,3,4,5 Here is a handy solution for the dilemma.

The least painful change that could make the biggest difference would be to promote a program that already exists: namely, a 6-year path to the DVM degree.^4,5 The traditional 8-year experience is nice but not necessary. Completing preveterinary requirements in 2 years has been available at some US colleges for decades, and similar arrangements are AVMA accredited at a number of veterinary schools worldwide. A 6-year path avoids 2 years of undergraduate tuition and living expenses (an estimated $40,000, depending on the institution) and also allows students to complete their veterinary degree and earn a professional salary 2 years sooner (say, $85,000 per year, depending on specialty and location). The total benefit would be around $200,000, which is more than the median debt! Colleges offering a shorter path to becoming a veterinarian would also gain a market advantage. It is hard to understand why we are ignoring the 6-year curriculum.

Changing the way it is will require more than happy talk and good intentions^1,2,3,4: it will take bold leadership and sustained purposeful actions. If nothing changes, student debt will continue to grow and the damage will become even more severe.

“We cannot solve our problems using the same thinking that created them.”—Albert Einstein

Peter Eyre, DVM&S, BVMS, BSc, PhD

Professor and Dean Emeritus

Virginia-Maryland College of Veterinary Medicine

Virginia Tech

Blacksburg, Virginia