Effects of gender on income and family planning for diplomates of the American College of Zoological Medicine

Tara M. Harrison Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC

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Samantha Morello Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI

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Kenneth Royal Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC

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Olivia Petritz Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC

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Amy Snyder Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC

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Abstract

OBJECTIVE

To evaluate income and family planning decisions of American College of Zoological Medicine (ACZM) diplomates.

SAMPLE

98 ACZM diplomates.

PROCEDURES

An online survey was sent to 201 ACZM diplomates. Participation was voluntary.

RESULTS

98 (49%) diplomates responded to the survey. The most commonly reported income categories were $90,000 to $94,999, $100,000 to $104,999, and $110,000 to $114,999. Overall, the mean of the salary-category midpoint responses was $105,357 but was $122,917 for those in academia and $94,508 for those working in zoos and aquaria. When incomes of males and females were matched (24 pairs matched for gender and age), no difference in income was observed. There were no significant differences in income between males and females with and without children. Diplomates who did not complete a residency had significantly higher incomes than diplomates who did. Sixteen of 21 (76%) females and 9 of 19 (47%) males reported delaying having children because of their career. Additionally, a higher percentage of females with children (13/20 [65%]) than males with children (3/19 [16%]) felt that having children had had a negative effect on their career. Thirty-five of 41 (85%) females without children and 4 of 9 (44%) males without children thought having children would have negatively affected their careers.

CLINICAL RELEVANCE

Although substantial differences in income between female and male ACZM diplomates were not identified, differences in family planning and perceptions of the impact of having children on their careers did exist.

Abstract

OBJECTIVE

To evaluate income and family planning decisions of American College of Zoological Medicine (ACZM) diplomates.

SAMPLE

98 ACZM diplomates.

PROCEDURES

An online survey was sent to 201 ACZM diplomates. Participation was voluntary.

RESULTS

98 (49%) diplomates responded to the survey. The most commonly reported income categories were $90,000 to $94,999, $100,000 to $104,999, and $110,000 to $114,999. Overall, the mean of the salary-category midpoint responses was $105,357 but was $122,917 for those in academia and $94,508 for those working in zoos and aquaria. When incomes of males and females were matched (24 pairs matched for gender and age), no difference in income was observed. There were no significant differences in income between males and females with and without children. Diplomates who did not complete a residency had significantly higher incomes than diplomates who did. Sixteen of 21 (76%) females and 9 of 19 (47%) males reported delaying having children because of their career. Additionally, a higher percentage of females with children (13/20 [65%]) than males with children (3/19 [16%]) felt that having children had had a negative effect on their career. Thirty-five of 41 (85%) females without children and 4 of 9 (44%) males without children thought having children would have negatively affected their careers.

CLINICAL RELEVANCE

Although substantial differences in income between female and male ACZM diplomates were not identified, differences in family planning and perceptions of the impact of having children on their careers did exist.

Introduction

Issues related to work-life balance in the veterinary profession have been topics of increasing consideration in recent years, owing in part to mounting incongruencies between educational debt and annual income and to ongoing concerns about burnout, secondary traumatic stress, and low job satisfaction. Income has been a major concern for veterinary professionals for a number of years, with many recognizing that veterinarians make substantially less than their medical counterparts despite having equivalent years of professional training, including specialty training for board-certified diplomates in veterinary medicine. The AVMA reported that mean income for board-certified veterinary specialists was $145,323 in 2018,1 contrasting sharply with the mean income of $341,000 for physician specialists.2 The mean income for board-certified veterinary specialists is higher than that for veterinarians who do not have specialty certification ($104,964 in 2018).1,3,4 However, incomes for individual veterinary specialties were not disaggregated in those reports, and income disparities and variances across and within board-certified specialties have been only minimally discussed.

The AVMA’s American Board of Veterinary Specialties recognizes 22 veterinary specialty organizations comprising 41 distinct veterinary specialties.5 Recognized by the American Board of Veterinary Specialties in 1988, the American College of Zoological Medicine (ACZM) represents a small but growing group of specialists, with 273 active-status diplomates around the world as of 2020.6 Individuals certified as specialists by the ACZM must have successfully completed a formal residency training program or obtained a minimum of 6 years of full-time work experience at an approved location (or obtained similar experiential training), been first author on at least 3 peer-reviewed publications, and passed a 2-day certifying examination. Diplomates of the ACZM work in many professional settings, including zoos and aquaria, academia, private practice, and government practice. Perhaps because of this broad range of employment environments, incomes of ACZM diplomates—particularly those who work in zoos and aquaria—have anecdotally been suggested to be lower than those of other veterinary specialists. However, historically, there have been limited data to substantiate this claim.

Since the 1980s, more women than men have entered the veterinary profession, with women accounting for 69.3% of the profession in 2019.1 Despite this shift, there is evidence that a gender-based income gap persists in the profession.1,7 Furthermore, as the veterinary profession has become increasingly feminized, questions have arisen regarding the impact of one’s career choices on the ability to have children and raise a family. Women in professional careers tend to delay having children until later in life and are less likely to have children than their male counterparts.8 In support of this, a 2015 study9 of diplomates of the American College of Veterinary Surgeons found that female surgeons were significantly more likely to delay having children until after completing a residency and less likely to have children than their male counterparts.

Previous unpublished data from one of the authors (TMH) indicate that annual salaries for ACZM diplomates typically range from $80,000 to $94,999 and that a typical income gap of $15,000 exists between male and female diplomates. However, a formal survey has not been performed to substantiate these preliminary findings. The objectives of the study reported here were to survey ACZM diplomates to determine annual income overall and with respect to employment type and gender and to identify trends related to work-life balance and various aspects of family planning.

Materials and Methods

Survey

A 127-item online survey (Supplementary Appendix S1) based on one previously used to collect data on diplomates of the American College of Veterinary Surgeons7 was developed and sent to 201 ACZM diplomates (106 [53%] females and 95 [47%] males) classified as active members in 2018 and for which the college had an active email address. The survey was approved by the North Carolina State University Institutional Review Board (Protocol No. 14081).

The survey was distributed by email with a link to an online survey platform (REDCap; Vanderbilt University). A brief introduction explaining the purpose of the survey was included, and survey responses were anonymous. The survey contained questions regarding career type, job title, annual income, benefits, gender, race and ethnicity, job location, whether respondents had children, whether respondents had chosen to delay having children, whether having children had affected respondents’ career, allowed maternity leave respondents had received, and whether respondents felt that gender had affected their career. Open-ended options were available for comments. The survey consisted of branching logic, so that questions appeared on the basis of answers to previous responses. Respondents could skip any question they wanted to or that they felt did not apply to them. For most questions, respondents could choose only a single answer, but some questions (eg, a question regarding benefits provided by their employer) asked respondents to choose all options that applied.

Data analysis

Survey results were exported into a statistical software program (SPSS version 26; IBM). Descriptive statistics (eg, mean, median, and SD) were calculated, and inferential tests (eg, independent samples t tests and Wilcoxon rank sum tests) were performed. Values of P ≤ 0.05 were considered significant. Owing to the various sample sets and outcomes evaluated, which limited instances of de facto multiple testing, unadjusted P values were reported. Effect size estimates were calculated by means of the Cohen d method.10 Midpoint coding was used for the categorical variables of income, age, and graduation year, and estimated values of descriptive statistics were calculated for respondents grouped on the basis of gender, employment type, residency status, and parental status. Propensity score matching was used to control for confounding associated with age.11 Incomes reported as ≥ $200,000 (ie, the highest category available in the survey) were coded as $200,000 for statistical analyses. Incomes reported as < $30,000 to $34,999 (ie, the lowest category available in the survey) were included in the category of $30,000 to $34,999. Ages reported as ≥ 71 years (ie, the highest category available in the survey) were coded as 71 for statistical analyses. Binary logistic regression was used to determine whether age, gender, or residency status was associated with income, with income < $100,000 versus income ≥ $125,000 as the dependent variable. For these analyses, incomes in the middle of the income distribution were omitted to better identify factors associated with extremes of income.

Results

Demographics

Ninety-eight of the 201 (49%) ACZM diplomates responded to the survey. Of the 98 respondents, 29 (30%) were male, 67 (68%) were female, and 2 (2%) did not select a gender response. The participation rate for females (67/106 [63%]) was significantly (P < 0.01) higher than the rate for males (29/95 [31%]). Time since graduation was significantly (P = 0.01) higher for males (mean graduation year, 1995; median, 1995) than females (mean graduation year, 2002; median, 2005). Survey respondents were graduates of 24 US-based and 9 international veterinary colleges. The most commonly reported values for educational debt at graduation were $100,000 to $150,000 (12/98 [12%]) and $150,001 to $200,000 (12/98 [12%]), but for females, the most commonly reported educational debt category was $150,001 to $200,000 (11/67), and for males, the most commonly reported educational debt category was < $50,000 (6/29). The most commonly reported age categories were 36 to 40 years (21/98 [21%]) and 41 to 45 years (18/98 [18%]); 3 (3%) individuals did not choose an age category. Midpoint mean age was 43 years (SD, 9.5 years) for female respondents and 48 years (SD, 10.2 years) for male respondents, with male respondents being significantly (P = 0.02) older than female respondents. All 67 female respondents provided information on race and ethnicity; 66 (99%) identified as white, and 1 (1%) identified as Hispanic or Latino. Of the 28 male respondents who provided information on race and ethnicity, 24 (86%) identified as white, 3 (11%) identified as Hispanic or Latino, and 1 (< 1%) identified as Asian or Pacific Islander. Sixty-six female, and all 29 male respondents provided information on relationship status. Of these, 16 (24%) female and 3 (10%) male respondents reported being single and never married, 39 (59%) female and 22 (76%) male respondents reported being married or in a domestic partnership, 9 (14%) female and 4 (14%) male respondents reported being divorced, and 2 (3%) female respondents reported being widows.

Employment type

Sixty-two (63%; 44 females, 17 males, and 1 who did not specify their gender) respondents worked at a zoological institution or aquarium, 24 (24%; 15 females and 9 males) worked in academia, and 10 (10%; 7 females, 2 males, and 1 who did not specify their gender) worked in other areas (eg, general practice, private practice, government, or industry); the remaining 2 (2%; 1 female and 1 male) did not select an employment type.

All 9 males who worked in academia were either tenured professors (n = 8) or an assistant professor in a tenure track (1). The 15 females who worked in academia consisted of 6 assistant professors in a tenure track, 1 assistant professor in a clinical track, 1 tenured associate professor, 1 associate professor in a clinical track, 2 tenured professors, 1 professor in a clinical track, and 3 in other academic positions. Of the 62 respondents who worked at a zoological institution or aquarium, 29 (22 females and 7 males) were associate veterinarians, 12 (8 females and 4 males) were chief veterinarians, 6 (4 females and 2 males) were directors, and 13 (9 females and 4 males) held other positions; 2 did not indicate their job position.

Income

Respondents were asked to report their annual income by selecting from categories ranging from $30,000 to $199,999 in $4,999 increments (eg, $30,000 to $34,999, $35,000 to $39,999, and $40,000 to $44,999), with a single category for respondents with annual income ≥ $200,000. The most commonly selected incomes were $110,000 to $114,999, $100,000 to $104,999, $90,000 to $94,999, and $75,000 to $79,999 (Figure 1). Two female respondents reported annual incomes < $30,000, and these 2 respondents were included in the category of $30,000 to $34,999. Mean midpoint annual income was $105,357 (median, $102,500; SD, $30,787). Mean midpoint annual income for respondents in academia was $122,917 (median, $130,000; SD, $28,117), and mean midpoint annual income for respondents working in a zoological institution or aquarium was $94,508 (median, $92,500; SD, $20,990). Significant differences in annual income were found for all females versus all males and for females working in academia versus males working in academia, but not for females versus males working in zoos or aquaria or for females versus males working in other careers (Table 1). Cohen d effect size estimates indicated a moderate difference (d = 0.57) with respect to income for all female versus male respondents, a large difference (d = 0.83) with respect to female versus male respondents working in academia, and a small-to-moderate difference (d = 0.39) with respect to female versus male respondents working in zoos and aquaria.

Figure 1
Figure 1

Frequency distributions of annual income for female (n = 67) and male (29) diplomates of the American College of Zoological Medicine.

Citation: Journal of the American Veterinary Medical Association 260, 2; 10.2460/javma.20.05.0250

Annual incomes of female and male diplomates of the American College of Zoological Medicine by employment type and gender.

Employment type Females Males P value
No. Mean Median SD No. Mean Median SD
All 67 $99,067 $92,500 $27,517 29 $133,534 $112,500 $89,616 0.05
Zoos and aquaria 44 $92,443 $87,500 $22,076 17 $99,852 $102,500 $17,331 0.18
Academia 15 $115,333 $117,500 $30,921 9 $135,556 $137,500 $17,668 0.05
Other 7 $148,571 $127,500 $80,775 2 $118,750 $118,750 $65,407 0.64

Data were obtained through an online survey. Respondents were asked to report their annual income by selecting from categories ranging from $30,000 to $199,999 in $4,999 increments (eg, $30,000 to $34,999), and midpoint coding was used. Other employment types included private practice, specialty practice, government, and industry.

Because of the significantly older age of male versus female respondents, propensity score matching was used to establish 24 matched pairs for further analysis of gender differences in income accounting for age. The nearest-neighbor matching criterion was applied to match respondents; the greedy matching technique was used to remove respondents who had already been matched. A paired-samples t test was used to compare income between genders for the 24 matched pairs. For these respondents, annual income was not significantly (P = 0.71) different between males (mean, $107,916; SD, $24,313) and females (mean, $106,041; SD, $25,600). Sample sizes were too small for additional propensity score matching techniques that involved employment type or parental status.

Fifty-five of the 67 (82%) female respondents and 20 of the 29 (69%) male respondents indicated that they had completed a residency program to qualify for board certification. Income was significantly (P < 0.01) lower for individuals who had completed a residency (75/96; mean, $98,467; median, $92,500; SD, $27,069) than for individuals who had not (21/96; mean, $124,167; median, $127,500; SD, $29,179).

Binary logistic regression was used to determine whether age, gender, or residency status was associated with the odds of having an income < $100,000 versus ≥ $125,000. Age was significantly (P < 0.01) associated with the odds of having a high versus low income, but gender and residency status were not.

Mean midpoint annual income for the 55 females who completed a residency (mean, $96,500; median, $92,500; SD, $28,131) was significantly (P = 0.04) less than the mean midpoint annual income for the 12 females who did not complete a residency (mean, $110,833; median, $110,000; SD, $21,777). However, mean midpoint graduation year for females who did not complete a residency (mean, 1995; median, 2000) was significantly (P = 0.03) lower than mean midpoint graduation year for females who did complete a residency (mean, 2003; median, 2005). Mean midpoint annual income for the 20 males who completed a residency (mean, $103,875; median, $102,500; SD, $23,723) was significantly (P < 0.01) less than the mean midpoint annual income for the 9 males who did not complete a residency (mean, $141,944; median, $137,500; SD, $29,229). Mean midpoint graduation year for males who did not complete a residency (mean, 1988; median 1995) was significantly (P = 0.03) lower than mean midpoint graduation year for males who did complete a residency (mean, 1998; median, 2005).

Mean midpoint annual income for the 19 males with children (mean, $115,395; median, $112,500; SD, $26,250) was not significantly (P = 0.73) different from mean income for the 10 males without children (mean, $116,250; median, $107,500; SD, $39,603). Similarly, mean midpoint annual income for the 21 females with children (mean, $105,714; median, $102,500; SD, $23,942) was not significantly (P = 0.16) different from mean income for the 43 females without children (mean, $95,814; median, $92,500; SD, $29,544). Finally, mean income for males with children was not significantly (P = 0.23) different from mean income for females with children, and mean income for males without children was not significantly (P = 0.26) different from mean income for females without children. Cohen d effect size estimates indicated a small difference in income between males with and without children (d = 0.06) and a small-to-moderate difference (d = 0.41) between females with and without children. Differences in income between males and females with children were small to moderate (d = 0.37), whereas differences in income between males and females without children were moderate (d = 0.63).

Parental status

Individuals without children

Forty-three of 64 (67%) female respondents and 10 of 29 (34%) male respondents reported that they did not have children. Of these respondents without children, 15 females and 3 males were single and never married, 21 females and 7 males were married or in a domestic partnership, and 7 females were divorced. The most common age range category for the 43 females without children was 31 to 35 years (14 females in this category). No particular age range category was more common than any of the others for males without children; for these respondents, mean midpoint age was 51.3 years (SD, 13.8 years).

For respondents who did not have children, a significantly (P = 0.83) higher percentage of females (23/42 [55%]) than males (3/6 [50%]) reported that they chose to not have children because of their career. Additionally, a significantly (P = 0.01) higher percentage of females (35/41 [85%]) than males (4/9 [44%]) without children indicated that they thought having children would negatively affect their career development. Of 51 respondents who reported their employment type, 8 of 9 respondents in academia indicated that they thought having children would negatively affect their career development, along with 27 of 36 respondents at a zoological institution or aquarium, 1 of 2 respondents in specialty practice, 1 of 2 respondents in general practice, and 1 of 2 respondents in government work.

Individuals with children

Twenty-one of 64 (33%) female respondents and 19 of 29 (66%) male respondents reported that they had children. Of these respondents with children, 17 females and 15 males were married or in a domestic partnership, 2 females and 4 males were divorced, and 2 females were widows. The most common age range categories were 36 to 40 years for the 21 females (7 females in this category) and 46 to 50 years for the 19 males (7 males in this category). Nine females and 7 males indicated they chose to have children within their first 5 years of full-time employment, and 4 females and 4 males indicated they chose to have children > 5 years after starting full-time employment.

The percentage of females who delayed having children because of their career (16/21 [76%]) was not significantly (P = 0.06) different from the percentage of males who did (9/19 [47%]). However, a significantly (P < 0.01) higher percentage of males (9/19 [47%]) than females (1/20 [5%]) felt that having children had a positive effect on their career, and a significantly (P < 0.01) higher percentage of females (13/20 [65%]) than males (3/19 [16%]) felt that their career development had been negatively impacted by having children. A higher percentage of males (7/19 [37%]) than females (6/20 [30%]) indicated that having a family did not have a positive or negative impact on their career, but this difference was not significant (P = 0.65).

Discussion

Results of the present study indicate that there were significant differences in income between female and male ACZM diplomates and, in particular, between female and male ACZM diplomates working in academia. However, when propensity score matching was used to control for age, there was no significant gender difference for this smaller subset of respondents, possibly because of sampling errors or the small sample size. Incomes for ACZM diplomates working at zoos and aquaria were more varied and did not differ significantly between females and males. Importantly, there was a significant difference in graduation year between females and males, and this likely contributed to the differences we found in incomes between females and males overall and within academia. Individuals who graduated earlier likely had more professional experience at the time of survey, resulting in higher incomes, than those who graduated more recently, and similar findings have been reported previously for the veterinary profession.1,7

Diplomates who responded to the present survey reported a wide range of incomes, including 2 respondents who reported working full-time but earning < $30,000 a year. Although we did not test for differences in income among employment types, respondents working in academia (mean midpoint annual income, $122,917) made, on average, approximately $28,000 more than respondents working in zoos and aquaria (mean, $94,508). However, this was still less than the reported mean income for veterinary specialists in general who had just finished a residency program ($129,026).4 Mean midpoint annual salary for all respondents in the present study was $105,357, which was $22,463 more than the mean income reported for 2018 veterinary school graduates who accepted full-time positions in private practice ($82,894).1 In the present study, 8 of the 98 respondents reported annual incomes between $75,000 and $79,999 and 19 reported annual incomes between $80,000 and $84,999, consistent with the mean income reported for 2018 veterinary school graduates who accepted full-time positions in private practice ($82,894).1 However, mean midpoint annual incomes for females ($99,067) and males ($133,534) in the present study were higher than this. According to a 2016 report from the Association of Zoos and Aquariums,12 mean annual income was $102,936 for head veterinarians (ie, veterinarians with > 8 years of experience who may or may not be an ACZM diplomate; n = 84), $112,725 for aquarium veterinarians (12), and $100,097 for zoo veterinarians (54). These mean values were comparable to the mean annual income for all ACZM diplomates in the present study ($105,357) but higher than the mean income for ACZM diplomates working in zoos and aquaria ($94,508). However, nearly half the institutions included in the Association of Zoos and Aquariums survey (46/85 [54%]) had annual budgets of > $20 million,12 which might have accounted for the higher incomes reported in that survey.

In the present study, individuals who completed a residency to meet qualifications for board certification had lower incomes than those who did not. However, year of graduation was lower, or longer ago, for those who did not do a residency, suggesting an experience differential between these 2 groups. Further, in our binary logistic regression, residency status was not significantly associated with having a high versus low income. The criteria for becoming an ACZM diplomate have always included residency and nonresidency or experiential routes. It is likely that as the number of residency programs has increased over the years, more individuals have pursued residency training, accounting for the higher mean year of graduation for respondents who completed a residency.

Although ACZM diplomates do not always complete a residency, they must have had a minimum of 6 years of experience working in zoological, aquarium, wildlife, or exotic animal medicine and been first author on at least 3 peer-reviewed publications. Incomes for ACZM diplomates who responded to the present survey were not substantially different from incomes reported for new veterinary school graduates, which seems incongruous given the additional years of training and experience that these specialists offer. This lack of difference in income could be attributed to the fact that most employers of ACZM diplomates are nonprofit institutions that cannot pay high salaries or to the fact that there are many individuals competing for a small number of jobs, driving down salaries.

The most commonly reported values for educational debt at graduation in the present study were $100,000 to $150,000 (12/98 [12%]) and $150,001 to $200,000 (12/98 [12%]), which was consistent with reported educational debt for veterinary college graduates in general.1 This high educational debt combined with the additional training required to become an ACZM diplomate and the generally low incomes for ACZM diplomates, compared with incomes for other veterinary specialists, may have an effect on which individuals choose to become ACZM diplomates.

Females now account for 69.3% of the veterinary profession.1 The ACZM membership and respondents to this survey, therefore, accurately reflect the changing demographic of the veterinary profession. Other studies1315 have examined the effects of gender on family planning for veterinarians. In the present study, 24 of 40 (60%) respondents waited to have children until within or after their first 5 years of starting full-time employment. This could have been ≥ 5 years after graduation from veterinary school or even longer for those who pursued postgraduate (residency) training. Waiting until they are older to have children is not unusual for women in the veterinary profession and has become increasingly common in the US; however, having children when older increases the risks of complications associated with becoming pregnant and maintaining a pregnancy and the possibility of birth defects.1620 Interestingly, a significantly (P = 0.01) higher percentage of females (35/41 [85%]) than males (4/9 [44%]) without children in the present study indicated that they thought having children would negatively affect their career, and a significantly (P < 0.01) higher percentage of females (13/20 [65%]) than males (3/19 [16%]) with children felt that their career development had been negatively impacted by having children. This was despite the finding that a minority of women (21/64 [33%]) and a majority of men (19/29 [66%]) had children and only 3 of 19 (16%) males felt that their career development had been negatively impacted by having children. Respondents worked primarily in academia, zoological institutions, or aquariums. Our results suggested that at least for women, zoological medicine may be selecting for individuals, and women in particular, willing to prioritize their career over having children and that women who want to have children may be selecting other specialties or careers as a result. These results compare to those of a previously published study9 on American College of Veterinary Surgeons diplomates. However, we were not able to identify individuals who did not want to have children for reasons other than their career, and this may have introduced some bias in the study.

Being aware of possible income disparities between male and female ACZM diplomates and between ACZM diplomates and diplomates of other veterinary specialty organizations could help ACZM diplomates negotiate more effectively when starting a job or looking for a raise in income. Research has shown that individuals who enter into negotiations with a more ambitious target tend to get more than individuals who aim for moderate targets.21 Studies such as the present one and others that provide transparent income data for professionals are helpful in providing the workforce the tools necessary to be financially successful.5,7

In conclusion, results of the present study, although only initial, indicated that, on average, ACZM diplomates make less than other similarly trained veterinary specialists and that there are differences in income depending on employment type for ACZM diplomates. A higher percentage of female than male ACZM diplomates in this study did not have children. Individuals who did have children often waited a long time to have children and frequently reported that having children negatively affected their career. Additional research on this topic is needed, but to continue to attract a wide variety of veterinarians to careers in zoological medicine, incomes must be maximized and factors that negatively affect family planning must be minimized. We hope that our findings may help in the design of future studies to further evaluate these issues.

Supplementary Materials

Supplementary materials are posted online at the journal website: avmajournals.avma.org

Acknowledgments

No third-party funding or support was received in connection with this study or the writing or publication of the manuscript. The authors declare that there were no conflicts of interest.

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