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    Mean educational debt incurred during veterinary school (ie, DVM debt) for fourth-year veterinary students of 30 US veterinary medical schools as reported in the annual AVMA Senior Survey, by survey year.

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    Percentage of all fourth-year veterinary students graduating with no DVM debt (n = 6,129), by survey year.

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    Percentage of male (n = 10,089) and female (35,630) fourth-year veterinary students graduating with no DVM debt, by survey year.

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    Mean age of fourth-year veterinary students graduating with (orange) and without (teal) DVM debt, by survey year.

  • 1.

    Bain B, Salois M, Ouedraogo F, Hansen C, Dutton B. 2018 AVMA & AAVMC Report on the Market for Veterinary Education. AVMA; 2020.

  • 2.

    Bain B, Ouedraogo F, Hansen C, Radich R, Salois M. 2020 economic state of the veterinary profession. AVMA; 2020.

  • 3.

    Student loan debt statistics. Educationdata.org. Accessed March 17, 2021. https://educationdata.org/student-loan-debt-statistics

  • 4.

    Economic research: student loans owned and securitized, outstanding. Federal Reserve Bank of St Louis. Accessed March 17, 2021. https://fred.stlouisfed.org/series/SLOAS

    • Search Google Scholar
    • Export Citation
  • 5.

    The CFPB must prioritize the student debt crisis as a civil rights crisis. Student Borrower Protection Center. Accessed March 17, 2021. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3781931

    • Search Google Scholar
    • Export Citation
  • 6.

    Gray K, Kaji AH, Wolfe M, et al. Influence of student loan debt on general surgery resident career and lifestyle decision-making. J Am Coll Surg. 2020;230(2):173181. doi: 10.1016/j.jamcollsurg.2019.10.016

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Pisaniello MS, Asahina AT, Bacchi S, et al. Effect of medical student debt on mental health, academic performance and specialty choice: a systematic review. BMJ Open. 2019;9(7):e029980. doi: 10.1136/bmjopen-2019-029980

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    Dickson T, Mulligan EP, DeVahl J. The toll of student debt: stress among health professions students and the promising role of financial self-efficacy on career choices. J Phys Ther Educ. 2020;34(4):339346. doi: 10.1097/jte.0000000000000162

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9.

    Rajapuram N, Langness S, Marshall MR, Sammann A. Medical student distress: the impact of gender, race, debt, and disability. PLoS One. 2020;15(12):e0243250. doi: 10.1371/journal.pone.0243250

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10.

    Gregory KP, Matthew SM, Baguley JA. Analysis of the costs of veterinary education and factors associated with financial stress among veterinary students in Australia. Aust Vet J. 2018;96(1–2):1116. doi: 10.1111/avj.12655

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11.

    Volk JO, Schimmack U, Strand EB, Vasconcelos J, Siren CW. Executive summary of the Merck Animal Health Veterinarian Wellbeing Study II. J Am Vet Med Assoc. 2020;256(11):12371244. doi: 10.2460/javma.256.11.1237

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12.

    Ouedraogo FB, Lefebvre SL, Hansen CR, Brorsen BW. Compassion satisfaction, burnout, and secondary traumatic stress among full-time veterinarians in the United States (2016–2018). J Am Vet Med Assoc. 2021;258(11):12591270. doi: 10.2460/javma.258.11.1259

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Release tables: per capital personal income by state, annual. St Louis Federal Reserve. Accessed July 15, 2021. https://fred.stlouisfed.org/release/tables?rid=110&eid=257197

    • Search Google Scholar
    • Export Citation
  • 14.

    Cost of living index by state. World Population Review. Accessed July 15, 2021. https://worldpopulationreview.com/state-rankings/cost-of-living-index-by-state

    • Search Google Scholar
    • Export Citation
  • 15.

    Harris DL, Lloyd JW. Teaching of professional skills in US colleges and schools of veterinary medicine in 2019 and comparisons with 1999 and 2009. J Am Vet Med Assoc. 2021;259(4):379384. doi: 10.2460/javma.259.4.379

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16.

    Kaiser T, Menkhoff L. Does financial education impact financial literacy and financial behavior, and if so, when? World Bank Policy Research Working Paper No. 8161. August 11, 2017. Accessed June 7, 2021. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3016931

    • Search Google Scholar
    • Export Citation

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Characteristics of and comparisons between US fourth-year veterinary students graduating with and without educational debt from 2001 through 2020

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  • 1 Veterinary Economics Division, AVMA, Schaumburg, IL
  • | 2 Publications Division, AVMA, Schaumburg, IL

Abstract

OBJECTIVE

To characterize and compare fourth-year students of US veterinary schools graduating with and without related educational debt (ie, DVM debt) from 2001 through 2020.

SAMPLE

45,756 fourth-year veterinary students who participated in the annual AVMA Senior Survey from 2001 through 2020.

PROCEDURES

Survey data were summarized for variables hypothesized to be associated with DVM debt. Multivariable modeling was used to investigate associations between these variables and the likelihood of graduating with DVM debt.

RESULTS

Mean DVM debt increased fairly steadily from $56,824 in 2001 (n = 1,587) to $157,146 in 2020 (2,859). Of 45,756 students, 6,129 (13.4%) had no DVM debt. Attending Tuskegee University and having children (both men and women) were associated with an increased likelihood of DVM debt. Attending certain other veterinary schools and more recent survey year were associated with a decreased likelihood. For 2020, the likelihood of DVM debt decreased with increasing percentage of tuition paid by family and increased with increasing percentage of tuition paid by educational loans, being a woman with children, and increasing total cost of attendance. No association was found with state cost of living index or per capita income.

CLINICAL RELEVANCE

Results suggested a growing rift between US veterinary students who cannot afford tuition and fees without accumulating financially concerning levels of debt and those who have the financial ability or family situation to fully fund veterinary school. Efforts should be undertaken to recruit across socioeconomic statuses and provide meaningful scholarships to students with greatest financial needs to support diversity, equity, and inclusion in veterinary medicine.

Abstract

OBJECTIVE

To characterize and compare fourth-year students of US veterinary schools graduating with and without related educational debt (ie, DVM debt) from 2001 through 2020.

SAMPLE

45,756 fourth-year veterinary students who participated in the annual AVMA Senior Survey from 2001 through 2020.

PROCEDURES

Survey data were summarized for variables hypothesized to be associated with DVM debt. Multivariable modeling was used to investigate associations between these variables and the likelihood of graduating with DVM debt.

RESULTS

Mean DVM debt increased fairly steadily from $56,824 in 2001 (n = 1,587) to $157,146 in 2020 (2,859). Of 45,756 students, 6,129 (13.4%) had no DVM debt. Attending Tuskegee University and having children (both men and women) were associated with an increased likelihood of DVM debt. Attending certain other veterinary schools and more recent survey year were associated with a decreased likelihood. For 2020, the likelihood of DVM debt decreased with increasing percentage of tuition paid by family and increased with increasing percentage of tuition paid by educational loans, being a woman with children, and increasing total cost of attendance. No association was found with state cost of living index or per capita income.

CLINICAL RELEVANCE

Results suggested a growing rift between US veterinary students who cannot afford tuition and fees without accumulating financially concerning levels of debt and those who have the financial ability or family situation to fully fund veterinary school. Efforts should be undertaken to recruit across socioeconomic statuses and provide meaningful scholarships to students with greatest financial needs to support diversity, equity, and inclusion in veterinary medicine.

Introduction

Over the period 1999 through 2017, resident tuition at US colleges and schools of veterinary medicine (ie, veterinary schools) has increased by a mean of 205%.1 Within the profession, however, particularly among new graduates of veterinary schools, educational debt is increasing at a rate 4.5 times as fast as the rate of increase of income, pushing the debt-to-income ratio steadily upward.2 This phenomenon is not unique to the veterinary profession. With student debt increasing aggressively across the United States, it is now the second largest class of consumer debt in the country, with > $1.7 trillion in outstanding balances.35

Research in human medicine has shown how educational debt among medical students and residents can influence mental health and well-being, academic performance, career choices, lifestyle conditions, and other variables.69 To the authors’ knowledge, similar research is lacking in veterinary medicine, although 1 study10 showed an association between perceived financial stress and expected tuition debt at graduation among veterinary students in Australia. Two other studies11,12 demonstrated the adverse impacts of educational debt on indicators of well-being among veterinarians after graduation.

An important question that remains to be answered is how veterinary students graduating with no educational debt differ from those graduating with educational debt. The purpose of the study reported here was to use data from the annual AVMA Senior Survey from 2001 through 2020 to compare fourth-year veterinary students graduating with DVM debt with those who reported no such debt. The 2 main hypotheses were that there would be an association between the specific veterinary school attended and the likelihood of graduating with DVM debt and that the source of funding secured by students for tuition and fees would be a significant predictor of graduating with DVM debt.

Materials and Methods

Survey

The AVMA Senior Survey is an annual survey of fourth-year students of US veterinary colleges and schools that is administered 2 to 3 weeks prior to their graduation. Participation is voluntary and anonymous. The number of US veterinary colleges or schools represented in these surveys ranged from 27 in 2001 to 30 in 2020. Response rates ranged from 71.4% in 2001 to 88.6% in 2020.

For the present study, responses to the following questions common to all survey years were used: age, gender (male or female), marital status, children (yes or no), degree earned prior to veterinary school (yes or no; only 1 of various types allowed), veterinary school attended, and amount of educational debt. Educational debt (including Federal Student Aid and private loans) was defined in the survey as “tuition, fees, books, supplies, and equipment required for the enrollment or attendance of a student at an eligible educational institution,” including “expenses for special needs services incurred by or for special needs students in connection with their enrollment or attendance” and room and board for students enrolled on at least a half-time basis. For questions concerning educational debt, respondents were asked to report 2 numbers: the amount of educational debt that they had on entry to veterinary school (ie, pre-DVM debt) and the amount that they expected to have on graduation. The amount of debt incurred during veterinary school (ie, DVM debt) was then calculated for the study by subtracting the former amount from the latter amount.

In 2020, the survey was expanded to include questions about whether students had experienced a major life event (eg, marriage, divorce, birth of a child, death of a parent or family member, major health incident, or pet illness) during veterinary school that may have impacted their financial status, whether they had pursued a dual degree, and whether they had been required to repeat courses, extending their time in veterinary school. The survey also included a question about whether students had paid resident or nonresident tuition for each year of veterinary school. Those responses were used, along with published tuition fees and costs of attendance, to estimate the mean total cost of attendance for each student. In 2019 and 2020, surveys also included a question about the source of funding for veterinary school tuition payments (options: parents or other family member, scholarships or grants, personal savings, loans, and other), the number of animals that respondents were financially responsible for, and whether respondents had adhered to a budget to manage expenses. Finally, for 2020, total cost data, as published by each college of veterinary medicine, as well as local per capita income (as reported by the St Louis Federal Reserve13) and a state cost of living (COL) index14 were appended to the survey data to estimate relative impact on likelihood of DVM debt.

Statistical analysis

Descriptive statistics were computed. Categorical data are reported as proportions or percentages. Continuous data were tested for normality and are reported as mean ± SE.

The χ2 test was used to compare distributions of various demographic and financial characteristics between students graduating with versus without DVM debt. Mean values for continuous variables were compared between students with and without DVM debt with the Student t test.

To assess the relative contribution of demographic characteristics to the likelihood of graduating with DVM debt (dependent variable), 2 multivariable logistic regression models were generated. The listed variables common to all surveys, which were hypothesized a priori to be associated with DVM debt, were included as independent variables in the first model. In the second model, demographic variables, the listed variables specific to the 2020 survey, state COL index, and the logarithm of state per capita income were included as independent variables. School was omitted from the second model to increase the robustness of the estimates, and the logarithm of the total cost of attendance was included as a proxy for this variable instead. Both models also included interaction terms for gender by marital status and gender by children status. An OR > 1 indicates an increased likelihood of graduating with debt, whereas an OR < 1 indicates a decreased likelihood.

The correlation between having DVM debt and total cost of attendance was also computed for 2020 as the Pearson correlation coefficient (r). Values of P < 0.05 were considered significant for all analyses.

Results

DVM debt and pre-DVM debt

Over the study period, DVM debt for fourth-year veterinary students of US veterinary schools (n = 45,756) increased fairly steadily from a mean ± SE of $56,824 ± 907 in 2001 (n = 1,587) to $157,146 ± 2,059 in 2020 (2,859), representing a mean increase of approximately $5,280 or 5.6% per year (Figure 1). Excluding students who reported no DVM debt, these values were $67,198 ± 794 in 2001 to $188,853 ± 1,899 in 2020.

Figure 1
Figure 1

Mean educational debt incurred during veterinary school (ie, DVM debt) for fourth-year veterinary students of 30 US veterinary medical schools as reported in the annual AVMA Senior Survey, by survey year.

Citation: Journal of the American Veterinary Medical Association 260, 5; 10.2460/javma.21.06.0280

Overall, 6,129 of 45,756 (13.4%) students reported having no DVM debt (Supplementary Figure S1). No clear linear trend was noted in proportions of those graduating with no DVM debt over the 20-year study period, with the lowest proportion (10.0%) observed in 2013 and the highest (18.2%) in 2019 (Figure 2).

Figure 2
Figure 2

Percentage of all fourth-year veterinary students graduating with no DVM debt (n = 6,129), by survey year.

Citation: Journal of the American Veterinary Medical Association 260, 5; 10.2460/javma.21.06.0280

Regarding pre-DVM debt, a steady increase over time was observed among students with DVM debt, from a mean ± SE pre-DVM debt of $644 ± 30 in 2001 (n = 1,342) to a mean of $15,998 ± 600 in 2020 (2,379). Students with no DVM debt, on the other hand, had a less predictable pattern (Supplementary Figure S2), beginning with a mean pre-DVM debt of $0 in 2001 (n = 245), peaking at a mean ± SE of $10,954 ± 2,048 in 2011 (288), and then returning to a mean of $0 in 2014 (303) through 2020 (480).

DVM debt and veterinary school

The distribution of fourth-year students with no DVM debt differed among veterinary schools. Over the study period, the University of Georgia had the largest proportion of students with no DVM debt at 19.9%, followed by Texas A&M University at 19.0%, University of California-Davis at 18.3%, and University of Pennsylvania at 17.4% (Supplementary Figure S3). Veterinary schools with the lowest proportion of students reporting no DVM debt were Western University of Health Sciences at 8.4%, University of Minnesota at 8.3%, Iowa State University at 7.9%, and Tuskegee University at 7.6%. Furthermore, overall, the schools with the largest proportion of tuition and fees covered by parents or other family members were Texas A&M University at 34.7%, Tufts University at 34.4%, University of California-Davis at 33.3%, and University of Florida at 32.8%. Veterinary schools with the lowest proportion of tuition and fees covered by parents or other family members were Lincoln Memorial University at 19.1%, Michigan State University at 18.2%, Iowa State University at 17.4%, and Tuskegee University at 7.5%.

In 2020, the mean estimated total cost of attendance for fourth-year students graduating with DVM debt ($244,084 ± 1,207) was a mean of approximately $8,200 more than the cost of attendance for those without debt ($235,848 ± 2.672; P = 0.005). However, the correlation between these 2 variables was negligible (r = 0.05).

DVM debt and demographic characteristics

No significant difference was identified between genders in the likelihood of DVM debt, across survey years and overall (Figure 3). Overall, 13.3% (4,741/35,630) of women and 13.6% (1,377/10,089) of men had no DVM debt (P = 0.38).

Figure 3
Figure 3

Percentage of male (n = 10,089) and female (35,630) fourth-year veterinary students graduating with no DVM debt, by survey year.

Citation: Journal of the American Veterinary Medical Association 260, 5; 10.2460/javma.21.06.0280

In general, students with DVM debt were a few months older than those with no DVM debt (Figure 4). Over the study period, the mean ± SE age of students with and without DVM debt was 27.7 ± 02 and 27.4 ± 0.05 years, respectively, representing a significant (P < 0.001) but unremarkable difference.

Figure 4
Figure 4

Mean age of fourth-year veterinary students graduating with (orange) and without (teal) DVM debt, by survey year.

Citation: Journal of the American Veterinary Medical Association 260, 5; 10.2460/javma.21.06.0280

Over the study period, no significant difference was found in the proportion of students paying resident or nonresident tuition with respect to the likelihood of having DVM debt. Overall, 13.5% of students paying resident tuition reported no DVM debt, compared with 13.1% of students paying nonresident tuition.

DVM debt and source of tuition funding (2020)

For students with no DVM debt participating in the 2020 survey, the mean percentage of tuition and fees covered by parents or other family members was 77.1 ± 1.4%, compared with 14.4 ± 0.5% for students with DVM debt (P < 0.001). On average, scholarships or grants covered 9.6 ± 1.0% of tuition and fees for students with no debt, compared with 8.1 ± 0.3% for those with debt (P = 0.07). Personal savings covered a mean of 5.0 ± 0.3% and 12.1 ± 1.1% of tuition and fees for those with or without debt, respectively (P < 0.001). The proportion of students who had a budget did not differ significantly (P = 0.80) between those with (52.4% [2,413/4,601]) and without (52.0% [507/975]) DVM debt.

Factors associated with DVM debt

The first multivariable model (involving 20 years of data) indicated that the only variables associated with an increased likelihood of graduating with DVM debt were attending Tuskegee University and having children (both men and women). Conversely, variables associated with a decreased likelihood included more recent survey year and attending Auburn University, University of California-Davis, University of Georgia, North Carolina State University, University of Pennsylvania, University of Tennessee, Texas A&M University, and Tufts University. No association was found for marital status by gender (Table 1). Omission of veterinary schools from the model resulted in no substantial (ie, < 20%) changes in parameter estimates, supporting the robustness of these findings.

Table 1

Results of multivariable logistic regression showing the relative contribution of various characteristics to the likelihood of fourth-year veterinary students (n = 44,463*) who participated in the annual AVMA Senior Survey graduating with educational debt incurred during veterinary school (ie, DVM debt) in 2001 through 2020.

CharacteristicOR (95% CI)P value
Survey year0.977 (0.972–0.982)< 0.001
Age (y)1.008 (0.999–1.017)0.10
Male (vs female)1.188 (0.094–15.002)0.89
Male with (vs without) children1.387 (1.113–1.727)0.004
Female with (vs without) children1.352 (1.127–1.623)0.001
Marital status (yes vs no)
Single or never married1.276 (0.369–4.412)0.70
Married1.514 (0.438–5.240)0.51
Divorced2.793 (0.787–9.914)0.11
Highest degrees obtained before veterinary school (yes vs no)
Admitted to veterinary school before undergraduate degree completed1.213 (0.586–2.510)0.60
Bachelor’s1.662 (0.806–3.429)0.17
Master’s1.648 (0.792–3.428)0.18
Doctorate1.251 (0.561–2.793)0.58
Other professional degree (eg, JD or MD)0.840 (0.353–1.998)0.69
Other degree2.288 (0.912–5.744)0.08
Veterinary school attended (yes vs no)
Auburn University0.647 (0.420–0.994)0.047
University of California-Davis0.551 (0.359–0.847)0.007
Colorado State University1.070 (0.689–1.663)0.76
Cornell University0.666 (0.431–1.028)0.07
University of Florida0.694 (0.448–1.076)0.10
University of Georgia0.508 (0.331–0.781)0.002
University of Illinois0.830 (0.537–1.282)0.41
Iowa State University1.447 (0.926–2.262)0.10
Kansas State University1.053 (0.677–1.638)0.82
Lincoln Memorial University1.481 (0.82–2.636)0.18
Louisiana State University0.691 (0.447–1.070)0.10
Michigan State University1.212 (0.778–1.890)0.39
University of Minnesota1.387 (0.884–2.175)0.16
Mississippi State University0.804 (0.517–1.251)0.33
University of Missouri1.037 (0.664–1.618)0.87
North Carolina State University0.606 (0.392–0.936)0.02
The Ohio State University1.316 (0.850–2.038)0.22
Oklahoma State University0.762 (0.491–1.182)0.23
Oregon State University1.158 (0.730–1.922)0.49
University of Pennsylvania0.617 (0.398–0.956)0.03
Purdue University0.943 (0.601–1.479)0.80
University of Tennessee0.635 (0.410–0.983)0.04
Texas A&M University0.527 (0.344–0.807)0.003
Tufts University0.585 (0.378–0.905)0.02
Tuskegee University1.637 (1.016–2.638)0.04
Virginia-Maryland CVM0.785 (0.509–1.212)0.27
Washington State University0.887 (0.571–1.377)0.59
Western University of Health1.381 (0.869–2.194)0.17
Sciences
University of Wisconsin-Madison1.184 (0.755–1.856)0.46

Only respondents with data for all variables were included in the analyses.

The interaction between marital status and gender was also included in the model; however, none of the possible combinations of marital status and gender were significant and, in the interest of brevity, were not reported here.

The model omitted observations for Midwestern University, which was represented by only 213 students.

CVM = College of Veterinary Medicine.

An OR > 1 indicates an increased likelihood of graduating with debt, whereas an OR < 1 indicates a decreased likelihood.

In the second multivariable model (2020 data only), from which veterinary school was excluded, the percentage of tuition paid by parents or other family members had a protective association with graduating with DVM debt, whereby for each additional percentage of tuition paid by those sources, the likelihood of graduating with DVM debt decreased by 2.1%. (Table 2). On the other hand, for each additional percentage of tuition paid through educational loans, the likelihood of graduating with DVM debt increased by 14.2%. In addition, women with children were 3 times as likely to have DVM debt as were women without children, but no similar association was found for men. Furthermore, as the total cost of attendance increased by 10%, the likelihood of graduating with DVM debt increased by 170%. Variables with no significant association with DVM debt included age, gender, experiencing a major life event that impacted financial status, needing to repeat courses in veterinary school, pursuing and financing a dual degree, having a budget, number of animals financially responsible for during veterinary school, state COL index, and state per capita income.

Table 2

Results of multivariable logistic regression showing the relative contribution of various characteristics to the likelihood of fourth-year veterinary students (n = 2,844) who participated in the 2020 AVMA Senior Survey graduating with DVM debt.

CharacteristicOR (95% CI)P value
Age0.970 (0.918–1.025)0.08
Male (vs female)1.276 (0.820–1.984)0.28
Male with (vs without) children1.054 (0.218–5.094)0.95
Female with (vs without) children3.011 (1.025–8.884)0.045
Total cost of attendance2.599 (1.317–5.126)0.006
Percentage of tuition paid by (yes vs no):
Parents or other family members0.979 (0.963–0.995)0.009
Scholarships or grants0.998 (0.981–1.015)0.78
Educational loans1.142 (1.102–1.184)< 0.001
Personal savings0.994 (0.977–1.011)0.50
Major life event that impacted financial status (yes vs no)1.372 (0.942–1.996)0.12
Repeated courses in veterinary school (yes vs no)1.597 (0.673–3.793)0.29
Pursued and financed a dual degree (yes vs no)1.046 (0.484–2.262)0.91
Having a budget0.973 (0.707–1.338)0.87
No. of animals financially responsible for during veterinary school0.937 (0.855–1.026)0.16
Log (per capita income)0.999 (0.986–1.013)0.92
COL index2.599 (1.317–5.126)0.006

COL = State cost of living index.

Discussion

One aim of the present study was to understand the population of fourth-year veterinary students who reported incurring no debt while attending US veterinary colleges or schools. We observed 45,756 students over 20 years who reported their anticipated educational debt levels at graduation, 13.4% of whom had no DVM debt. Over the period under investigation, 2001 through 2020, inflation-adjusted debt increased by 3.5% each year, while inflation averaged 2.1% per annum. Although the mean debt of these students increased fairly steadily over the evaluated period, the percentage of students reporting no debt increased after 2013, peaked in 2019, and fell again in 2020, showing no linear trend.

On closer examination, although the mean reported pre-DVM debt among students graduating with DVM debt increased over time, the mean pre-DVM debt of students graduating with no DVM debt was more unpredictable but generally lower than those with DVM debt, persisting at $0 since 2014. The reason for the peaks in mean pre-DVM debt in 2008 (when mean pre-DVM debt for students with no DVM debt exceeded that for students with DVM debt) and 2011 for students with no DVM debt, followed by no pre-DVM debt from 2014 onward, remains unclear. Post hoc review of the data revealed no potential response errors, and the observed peaks and nadirs for students with no debt was not explained by proportions of students who entered veterinary school after obtaining another degree.

The first multivariable model including data for all survey years indicated that students were more likely to have DVM debt if they had children, and this finding was independent of marital status. However, in the second multivariable that excluded school and included data for 2020 only, this association was no longer significant. This difference could be interpreted as indicating that the school attended somehow influenced the likelihood of DVM debt for students with children, perhaps through the offering of different levels and types of support measures for parents. The impact of such support measures on DVM debt would be interesting to explore in future studies.

As hypothesized, certain veterinary schools were more likely or less likely, compared with all other schools, to have students graduating with no DVM debt. Veterinary schools differ substantially with respect to cost, as well as the mean percentage of tuition and fees paid by parents, which likely accounted for the association with no debt for some schools.

Overall, 13.6% of men and 13.2% of women had no DVM debt, representing an unremarkable and nonsignificant difference that carried through after controlling for other factors in multivariable analyses. Mean age was also comparable between those with (27.7 years) and without (27.4 years) DVM debt. Although this 0.3-year mean difference was significant on bivariable analysis, the association between age and DVM debt status was no longer significant after controlling for other factors. We therefore concluded that age and gender alone likely have no meaningful influence on whether a veterinary student graduates with or without DVM debt and that these variables do not need to be used in targeted debt mitigation campaigns.

In 2020, after controlling for COL, per capita income, and total cost of education (including tuition and fees and COL expenses), women with (vs without) children were 3 times as likely to have DVM debt, whereas no similar association was found for men with children. This finding requires further investigation to understand why having children disproportionately impacts females over males with respect to DVM debt.

Perhaps the most insightful finding of the study reported here involved the source of funds for tuition and fees in 2020. For veterinary students graduating with no DVM debt, a mean of 77% of tuition and fees was paid by parents or other family members, compared with a mean of only 14% for those graduating with DVM debt. These data supported the supposition that students are able to graduate with no DVM debt primarily because their parents or family members paid their tuition and fees. A closer look revealed that 19.6% of students with no DVM debt had up to 50% of tuition and fees covered by parents or other family members, 10.4% had 50% to 75% covered, 22.9% had 76% to 90% covered, and 47.1% had > 90% covered by those sources. Overall, the steady increase in mean debt levels despite the increase in numbers of students with no DVM debt suggested that the rift between those who can and cannot afford to cover tuition and fees through family members or other sources is also increasing. A potential ramification of this rift is underrepresentation of people of lower socioeconomic statuses in veterinary schools, resulting in a less diverse profession less suited to appropriately serve a diverse animal owner population. Consequently, we believe it imperative that veterinary students, especially those recruited from an economically diverse spectrum, be armed with information and understand the options available to them to best manage their debt. Prospective students should be encouraged to consider a local veterinary school to avoid nonresident tuition and other costs associated with attending a school in a state outside their home.

The lack of a significant difference in the mean percentage of tuition paid by scholarships or grants between students with (8.1%) and without (9.6%) DVM debt was surprising, as we expected that such funding sources would help to protect against DVM debt. The proportion of students who applied for such funding and received or did not receive it remains unknown and could help to understand whether available financial resources were being utilized. We recommend that prospective and current veterinary students, particularly those who lack personal or family resources to fund their tuition, be made aware of scholarships and grants that may be accessible because of their unique situation and loan forgiveness programs designed to attract candidates to sectors where the demand for veterinarians is high. Such information is available from the American Veterinary Medical Foundation (www.avmf.org/programs/student-scholarships), American Association of Veterinary Medical Colleges (www.aavmc.org/becoming-a-veterinarian/funding-your-degree), and AVMA (www.avma.org/about/savma/studentfinancialresources/scholarship-loan-repayment-and-forgiveness-veterinary-medical-student-loans).

Given the high proportions of veterinary students with debt in the present study, the increasing debt levels, and the established adverse impacts of debt on well-being of veterinarians,11,12 we would also recommend that veterinary schools include debt management topics among the required courses in their curricula, as many schools have already done.15 Indeed, research has shown an association between financial self-efficacy and lower ratings of stress from student loan debt among graduate students in health-care fields.8 Conversely, recent research has also shown that although financial literacy can increase one’s knowledge of finance, it does little to change financial behaviors.16 Additional research is warranted that looks specifically at improving our understanding of financial behavior to better influence financial outcomes and decisions.

Overall, except for funding sources, the present study revealed surprisingly few variables that differed between fourth-year veterinary students graduating with or without DVM debt and might be leveraged or considered with the aim of increasing the likelihood of future students graduating without debt. Remarkably, no associations were found between DVM debt status and repeating courses, having a budget, experiencing a major life event that impacted financial status, pursuing a dual degree, and the number of animals owned. Nonetheless, we maintain our recommendation that students not only create a budget but adhere to it given our finding that, as total cost of attendance increased by 10%, the likelihood of graduating with debt increased by 170%. Additional research is warranted to understand the influence of educational debt status on academic performance, career choices, lifestyle conditions, and other characteristics of veterinary students.

In conclusion, our findings indicated an increasing rift between US fourth-year veterinary students graduating with debt levels exceeding hundreds of thousands of dollars and those graduating without debt. This pattern suggested an increasing disparity between those who cannot afford tuition and fees without accumulating financially concerning levels of debt and those who have the financial ability or family situation to fully fund veterinary school. Such a disparity suggests an increasing dichotomy in the population of veterinary students between those who can afford to pay and those who cannot. This dichotomy is diametrically opposed to efforts to foster diversity, equity, and inclusion across the veterinary profession. To help mitigate these effects and expand the reach and impact of veterinary medicine to better serve a diverse population, it is imperative that efforts be made to attract or recruit students to veterinary medicine across socioeconomic statuses and that substantial scholarships and grants be available to assist them with tuition and fees. We believe that without such financial assistance, initiatives to promote diversity, equity, and inclusion within veterinary medicine are unlikely to fully achieve their intended impact.

Supplementary Materials

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

Acknowledgments

The AVMA Senior Surveys were funded by the AVMA.

Drs. Bain, Lefebvre, and Salois are employees of the AVMA. The authors declare that there were no conflicts of interest.

Opinions expressed are not necessarily those of the AVMA.

References

  • 1.

    Bain B, Salois M, Ouedraogo F, Hansen C, Dutton B. 2018 AVMA & AAVMC Report on the Market for Veterinary Education. AVMA; 2020.

  • 2.

    Bain B, Ouedraogo F, Hansen C, Radich R, Salois M. 2020 economic state of the veterinary profession. AVMA; 2020.

  • 3.

    Student loan debt statistics. Educationdata.org. Accessed March 17, 2021. https://educationdata.org/student-loan-debt-statistics

  • 4.

    Economic research: student loans owned and securitized, outstanding. Federal Reserve Bank of St Louis. Accessed March 17, 2021. https://fred.stlouisfed.org/series/SLOAS

    • Search Google Scholar
    • Export Citation
  • 5.

    The CFPB must prioritize the student debt crisis as a civil rights crisis. Student Borrower Protection Center. Accessed March 17, 2021. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3781931

    • Search Google Scholar
    • Export Citation
  • 6.

    Gray K, Kaji AH, Wolfe M, et al. Influence of student loan debt on general surgery resident career and lifestyle decision-making. J Am Coll Surg. 2020;230(2):173181. doi: 10.1016/j.jamcollsurg.2019.10.016

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Pisaniello MS, Asahina AT, Bacchi S, et al. Effect of medical student debt on mental health, academic performance and specialty choice: a systematic review. BMJ Open. 2019;9(7):e029980. doi: 10.1136/bmjopen-2019-029980

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    Dickson T, Mulligan EP, DeVahl J. The toll of student debt: stress among health professions students and the promising role of financial self-efficacy on career choices. J Phys Ther Educ. 2020;34(4):339346. doi: 10.1097/jte.0000000000000162

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9.

    Rajapuram N, Langness S, Marshall MR, Sammann A. Medical student distress: the impact of gender, race, debt, and disability. PLoS One. 2020;15(12):e0243250. doi: 10.1371/journal.pone.0243250

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10.

    Gregory KP, Matthew SM, Baguley JA. Analysis of the costs of veterinary education and factors associated with financial stress among veterinary students in Australia. Aust Vet J. 2018;96(1–2):1116. doi: 10.1111/avj.12655

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11.

    Volk JO, Schimmack U, Strand EB, Vasconcelos J, Siren CW. Executive summary of the Merck Animal Health Veterinarian Wellbeing Study II. J Am Vet Med Assoc. 2020;256(11):12371244. doi: 10.2460/javma.256.11.1237

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12.

    Ouedraogo FB, Lefebvre SL, Hansen CR, Brorsen BW. Compassion satisfaction, burnout, and secondary traumatic stress among full-time veterinarians in the United States (2016–2018). J Am Vet Med Assoc. 2021;258(11):12591270. doi: 10.2460/javma.258.11.1259

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Release tables: per capital personal income by state, annual. St Louis Federal Reserve. Accessed July 15, 2021. https://fred.stlouisfed.org/release/tables?rid=110&eid=257197

    • Search Google Scholar
    • Export Citation
  • 14.

    Cost of living index by state. World Population Review. Accessed July 15, 2021. https://worldpopulationreview.com/state-rankings/cost-of-living-index-by-state

    • Search Google Scholar
    • Export Citation
  • 15.

    Harris DL, Lloyd JW. Teaching of professional skills in US colleges and schools of veterinary medicine in 2019 and comparisons with 1999 and 2009. J Am Vet Med Assoc. 2021;259(4):379384. doi: 10.2460/javma.259.4.379

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16.

    Kaiser T, Menkhoff L. Does financial education impact financial literacy and financial behavior, and if so, when? World Bank Policy Research Working Paper No. 8161. August 11, 2017. Accessed June 7, 2021. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3016931

    • Search Google Scholar
    • Export Citation

Contributor Notes

Corresponding author: Dr. Bain (bbain@avma.org)