By Suzanne Bush
A recent report by the United States General Accounting Office (GAO) highlighted a critical gap in our nation's defense: a shortage of veterinarians. While most people understand the crucial roles veterinarians play in the health of dogs, cats, hamsters and horses, the scope of veterinary science is much broader than that. Not every American owns a pet, but every American eats, and therefore has a stake in the safety of our nation's food supply.
United States Department of Agriculture (USDA) veterinarians are pivotal to the protection of livestock and poultry, through diagnosis and control of the diseases that affect them. Additionally, through inspections at slaughter plants in the U.S. and abroad, they prevent diseased animals from slipping into the food supply.Veterinarians are central in the research aimed at solving potentially catastrophic agricultural problems such as avian influenza. They, and the animals on our farms—the sentinels that alert veterinarians to diseases—form the first line of defense against food-borne diseases, regardless of origin.
Veterinarians are also involved in programs in the Departments of Defense, Health and Human Services, Homeland Security, the Environmental Protection Agency and the Department of the Interior. In short, veterinarians protect humans as well as animals. From farms, to our nation's forests, rivers and streams, veterinarians are engaged in identifying, and preventing the spread of diseases that affect animals and that can spread from animals to humans.
Anatomy of a Crisis
It has been said that it is harder to get into veterinary school than it is to get into medical school. On its surface, the statement could be interpreted as a veterinarian's boast. But it's more complex than that. Dr. Marguerite Pappaiaoanou, the Executive Director of the Association of American Veterinary Medical Colleges (AAVMC) says that it's harder to get into veterinary school because there are not enough schools. "We have 28 colleges of veterinary medicine in the US and there are somewhere around 2500 slots open (for prospective students). We turn many students away for that reason. There's no question that the educational program is very rigorous and it requires more than the love of animals."
Pappaiaoanou says that, in contrast to schools that train doctors, nurses and dentists, veterinary school capacity has not increased in 30 years. "Despite our population having gone up by 85-100 million people with all their companion animals, we have the same number of vets graduating as we had 30 years ago. Part of the issue is that we have not added any additional schools or colleges in the US (save one privately run college) in 30 years."
But there are other issues at play, too. According to Dr. Joan Hendricks, Dean of Veterinary Medicine at the University of Pennsylvania, pay is another factor. "The number one issue is probably the income of the vets who are serving the public," she explains. Vets who work in critical positions for the USDA, the Centers for Disease Control (CDC), or who teach at veterinary schools need better compensation. "All of those jobs pay less than the highest income level veterinarians who are taking care of peoples' pets," she says.
Low Pay, High Debt
Combine the comparatively low pay with the high debt load carried by graduating veterinarians, and it's not hard to understand the enormous pressure under which veterinary education is operating. Hendricks points to the National Veterinary Medical Service Act, signed by President George Bush in 2004. The Act was intended to provide loan forgiveness for graduating veterinarians in exchange for a commitment to service in underserved geographical areas or disciplines. She says that the program is hobbled by insufficient funding.
The implications of the shortage of veterinarians are far-reaching. Beyond the possibility of fewer options for pet owners, or longer waits for horses needing care, there are concerns about what happens when diseased animals get into the food supply. Outbreaks of food-borne illnesses such as E. coli and salmonella can be lethal. Rigorous inspections at farms and slaughter houses are critical to preventing these outbreaks. The GAO report pointed out that 27 percent of the veterinarians employed by the government will be eligible to retire by 2012. That means more than 800 government veterinarians will likely need to be replaced—just as a result of retirements. That does not include the veterinarians who may leave to go into private practice, or to pursue other employment.
Limited institutional capacity, coupled with substantially-increased need for services, income disparity that drives trained veterinarians out of government service, widely-dispersed threats to the food supply from livestock diseases, and rapidly-spreading diseases in wildlife have resulted in a crisis that has largely escaped the public's attention. But the GAO report has renewed efforts by organizations like AAVMC, the American Veterinary Medical Association (AVMA) and others to generate attention and support from Congress.
A "Sobering and Frightening" Report
Dr. W. Ron DeHaven, Chief Executive Officer of the AVMA testified in a hearing before the U.S. Senate Subcommittee on Oversight of Government Management in early 2009. He reflected on why the GAO report on the shortage of veterinarians was both "sobering and frightening." He cited data that reveal the human cost of food-borne illnesses such as Campylobacter, E. coli and salmonella, which in aggregate, "are responsible for an estimated 76 million human illnesses, 300,000 hospitalizations and 5,000 deaths in the United States every year."
DeHaven pointed to a study conducted by Kansas State University, which projected that the shortage of food supply veterinarians will continue to worsen by four or five percent over the next several years. "As our nation continues to rely on protein-based diets," he testified, "the number of food animals required to meet this need will rise proportionately with population growth. And it is clear that this desire for meat products is growing." He said that more than 85 billion pounds of meat and poultry are processed in the U.S. annually.
The AAVMC's Pappaiaoanou sees the origins of the problem in the disappearance of family farms that coincided with the consolidation of the farm industry in the U.S. "Many people go and get their meat from the supermarket and it's nicely packaged, and there's a real disconnect from the animals where that meat comes from." She says that farms used to be the places where young people developed an interest in veterinary work.
Public Support Crucial
Faced with multiple crises in the economy, employment, health care, defense and the environment, can Americans—and elected officials—handle another complex crisis that requires both funding and political will? Pappaiaoanou says that people need to see the problem in its proper context. She says that if people see veterinarians strictly as caretakers of companion animals, they're likely to dismiss the need for government intervention. "In the earlier days it was the agriculture industry in our states that funded the veterinary schools." But there has been a shift from food supply veterinarians to companion animal care, which doesn't generate public support. Hendricks agrees. "It feels like a frill to people, especially if they don't have pets," she says.
"Why would we want our tax dollars to go to people who care for our dogs and cats?" Pappaiaoanou asks. "Why don't individual benefactors who have a lot of money give endowments (to fund education of veterinarians)? But in terms of our national preparedness, our food, emergency preparedness and response, these problems cross boundaries." She says that there are veterinary schools in 26 states, but every state benefits from the research they do and the veterinarians they educate. Think about Lyme disease, West Nile Virus, bovine spongiform encephalopathy (mad cow disease), and most recently the influenza widely known as swine flu. Veterinarians have been key players in identification, treatment and control of the underlying causes of these diseases.
Increasing capacity in veterinary schools is not simply a matter of building new classrooms. In his testimony, DeHaven outlined the unique facility requirements for veterinary schools. "This is not generic university space. It is unique teaching, diagnostic, laboratory and research space that must include special safety, restraint and animal-handling features that are not commonly found on American campuses."
Another factor affecting veterinary schools, says Hendricks of the University of Pennsylvania, is the cost of educating veterinarians. "The main limit for us is we can't afford any more personnel to teach them. It's very labor intensive. There's a very high teacher-to-student ratio. They have to have a lot of practice actually being a vet when they're in school." That's because graduating veterinarians start working as veterinarians; they don't become residents and continue their educations.
Pappaiaoanou says that the dilemma facing veterinary schools has parallels elsewhere in the U.S. educational system. "The state support for higher education is being dramatically cut. It really speaks to, as a society, what are our priorities. Where are we putting our money, and where are we not putting our money?"
Competing for diminishing resources demands a strategy that informs the public and encourages activism. "It would be great if we could build that constituency that would ask Congress to provide the resources. Right now it's a huge workforce shortage," she says. And that workforce shortage has implications for every American. "All the other health professions have added schools and/or increased class sizes. We're unfortunately the poster child for having been on a plateau for way, way too long."
Hendricks agrees. She fears that the public won't understand the dimensions of the crisis until we wake up to a catastrophe resulting from a broken surveillance system, and believes the complex dilemma can be summed up simply. "Veterinary budget cuts hurt people, too," she says.