THE FUTURE OF THE VETERINARY PROFESSION
By Dr. Michael W. Fox BVetMed, PhD, DSc, MRCVS*
Inspired by Veterinary Information Network Dr. Paul D. Pion’s widely disseminated 2012 New Year’s message concerning the future of the veterinary profession, and by several published discussions on this topic in American and British veterinary journals, I wish to offer my own personal perspective. Being part of the problem makes us part of the solution, provided we accept that we are not simply victims of the global economic crisis but also participants therein, and to varying degrees creators thereof!
VISION & DIRECTION
Perhaps one of the reasons for the veterinary profession’s current hard times and unclear future is its historical double- vision or conflicted mission, being torn between serving the best interests of the animals and those of society and animal-owning clients which may not be in accord with those of the animals. The American Veterinary Medical Association, founded in 1863, did not include any reference in their Veterinarian’s Oath to animal welfare “as a priority of the veterinary profession” until 2011. I have long seen it torn by two often conflicting, but I believe resolvable forces and values---concern and responsibility for animal suffering, welfare and health (which is the ‘calling’ of most applicants to veterinary school), and the realities of the economy, costs of services and monetary rather than emotional and other value of animals. I find some grounds for optimism in the emerging One Health movement (1) where human health and well-being are at last being connected with animal health and welfare, and environmental/ecological health. . But for the One Health concept to be effectively implemented, the bioethics of equal consideration must be applied not only to humans but also to our treatment of animals and the environment. This is in accord with the moral imperatives of the animal rights and ‘deep’ ecology movements, long opposed by the biomedical, agricultural and other industries and business establishments.
One animal welfare resolution put forward in 2006 by over 50 veterinarians, who were members of the American Veterinary Medical Association, (AVMA) to the AVMA’s House of Delegates to simply declare that it was the position of the AVMA that animal welfare is a higher priority than economic considerations was summarily rejected. (2). An animal’s behavior is an important indicator of well-being, and integral to the formulation of welfare standards in animal production, handling, transportation and slaughter. It is no coincidence that the U.K.’s Farm Animal Welfare Committee is calling for more education within the veterinary profession and to pass on the practical fruits of farmed animal welfare science to farmer-clients (3).
CODEX VETERINARIUS & BIOETHICS
In the Codex Veterinarius drafted by the German Veterinary Association for the Protection of Animals we find the statement:
“Veterinary action for the welfare and protection of animals is guided by the principle of respect for life and the awareness that the animal has a dignity which is to be respected. Therefore protection and care for an animal can not be dependent on its economical value. In situations of diverting interests between moral obligations and economical pressure it is essential to consider carefully the respect for life against the productive use of life in all its forms of existence--- Considering carefully the opposing interests and needs, the interests of the human being should not automatically be considered to be more important than those of the animal.--- When in doubt veterinary surgeons should let themselves be guided by the principle: In dubio pro animale!”(4).
There is a growing consensus that veterinarians have an ethical obligation to advocate compassionate care regardless of the context and situational ethics in which their services are required. This is because the bioethics of compassionate care is a fundamental human responsibility and every animal’s basic right. Furthermore, compassionate care is vital to animals’ health, welfare, and physical and psychological well being. It is therefore as essential a component of holistic and preventive veterinary medicine as is caring for the land a vital aspect of sustainable agriculture.
Dr. Andrew Fraser, one of the first veterinarians to address veterinary bioethics, writes: “Animal bio-ethics is a constitution of integrated ethical principles guiding animal welfare practices and serving to control suffering. The 4 broad principles of bio-ethics have been given as: 1) responsible animal management, with appropriate overall husbandry; 2) provision for physical comfort, basic behavioral function, and animal health; 3) prevention or relief of unnecessary pain or suffering; and 4) use of sentient animal life for fully justified reasons. The role of the veterinarian in these matters is obvious and traditional, and a strong veterinary involvement should continue.” (5).
ECONOMIC & ETHICAL CONFLICTS
By being primarily a service profession for the livestock and other animal industries where economics and profit margins often take precedence over animal health and welfare, the veterinary profession in this sector has become marginalized by compromising its primary responsibilities as a voice of reason, sound veterinary medical science, bioethics and empathy for the animals. Animals can and do experience pain and pleasure, fear and terror (6).
One blatant example of economic concerns trumping animal welfare concerns is in the transportation of pigs to slaughter, where the economies of transportation justify extreme overcrowding that can result in some economic losses when some pigs succumb to the stress and their carcasses become unfit for human consumption, ( so called ‘slimy cutters’). Likewise the economies of scale justify large dairy herds, huge hog and poultry factories, and massive beef feedlots. But the costs in animal welfare and health, as well as the environmental and public health costs, have been too long discounted.
VETERINARY STUDENTS & EDUCATION
In a 1981 article that I wrote for Modern Veterinary Practice (Jan. p 53-54) entitled “Is there a future for the veterinary profession” I observed that the farmed animal sector was being taken over by animal scientists developing intensive production systems. It was also around this time that the number of women being accepted into veterinary school began to increase, more than one Vet college dean and professor telling me that this was good because many would drop out or only work part-time during their child-bearing and rearing years so this would not saturate the profession with too many graduates. Certainly the gender-related empathy factor would be good for the animals I believed. Gender-linked differences in moral philosophy may well be a contributing factor associated with the evident shortages today of veterinarians in the food animal and laboratory animal medicine sectors (7).
Also in my travels around the U.S. at that time veterinarians shared their concerns to me that too many veterinarians were being graduated and seeking entry into the companion animal sector, leading to intensified competition and saturation in some urban and suburban areas. A study of the veterinary work force published in 1985 concluded that a 20% decrease in the number of veterinary college graduates was called for to balance workforce supply and demand, ( 8) but since then new schools have opened and classes grown larger. Several veterinary colleges in the U.S. are currently increasing class size to generate more revenue and to ostensibly provide more veterinarians for the food animal sector, according to Inside Higher Ed on-line, Feb 8, 2012. The opening of new veterinary schools, as in Utah and Arizona, may be unwise, even from a university business perspective.
The financial crisis affects so many people in all walks of life today, and comes down hard on new veterinary graduates carrying hefty student loans and who are finding it difficult to get a job and secure an income that comes close in inflation-adjusted dollars to meet their loan payments. Some may be forced to take jobs that are contrary to their ethics and professional aspirations. Assistance with these loans should be provided by veterinary schools that have encouraged larger classes and are in the business of producing ever more graduates---a profit-driven enterprise indeed—and have, arguably, been irresponsible in not fully considering the future employment opportunities for their students. Lobbying for better funding from government, industry and non-profit organization sources, scholarships for students, or debt-payments for pledging to work in much needed sectors such as overseas aid and development and emergency services, and in poor neighborhoods in the U.S. to help low-income animal owners (like the People’s Dispensary for Sick Animals in the U.K.) might be enlightened professional self-interest. Opposition from private veterinary business enterprises that may feel threatened by such initiatives could, in many instances, be assuaged by engaging them in referrals and consultations.
To possibly help rectify the shortage of veterinarians in the food animal sector the multinational drug company Pfizer Animal Health has teamed with the American Veterinary Medical Foundation to award $2,500 scholarships to more than 225 veterinary students in the US (9). In a Jan. 19, 2012 press release from the AVMA, Dr Rene Carlson, AVMA president, stated "There are a number of economic issues, pressures and stresses impacting the profession, including cuts in state funding to veterinary schools and a decrease in the public's utilization and perceived value of our services. The challenges before us are complex, yet there are great potential opportunities for increased animal health and welfare if we pursue them. Over the past two years there have been $104 million in state cuts to veterinary medical education and those cuts directly impact the tuition that students pay. As a result, tuitions, on average, have doubled over the past ten years ($9,134 in 2001 for in-state students to $18,326 in 2011). In addition, the true overall cost of attending a veterinary medical program is about $41,000 per year, leaving students with an average debt of more than $140,000.”
I see the tuition-free contracts being set up with drug companies and State funding for those students who will pledge to serve in the food animal sector as a stop-gap at best. The debate in the U.K to offer a non-clinical degree in veterinary science for graduates to work in various sectors of the business industry and government and to ‘farm out’ food animal medicine and surgery to select schools rather than have them all offer this section of the veterinary teaching curriculum as a cost-saving are not without some merit. But the latter, when coupled with the closing of state veterinary services (the U.S. government closing 259 USDA offices across the country in 2012), and ignoring demographics of concentrated farmed animal operations, could be a threat to both food safety and homeland security.
Evolve or perish is a biological aphorism relevant to the future of our profession which I would call ‘noble’ if it were not so caught up in some sectors as a mere service to animal-based industries that put economics before animal health and well-being. As the percentage of veterinary college graduates seeing advanced training increases, the DVM/VMD degree is being seen as an ‘entry- level degree’ (10). The net result of new DVM graduates feeling inadequate and compensating for a lack of practical clinical experience through mentorship and internship programs by electing instead to work toward board-certification in some specialty such as internal medicine or dermatology, aside from the promise of higher incomes, remains to be seen. As more graduates work toward certification in various specialty fields, particularly in the companion animal sector, we may soon find there is an increasing shortage of general practitioners in some demographic areas. This is a recognized regional problem in human health care industry. Increasing service costs to clients could mean fewer companion animals receive adequate veterinary care.
Veterinarian Jeffrey A. LaCroix (11) calls for a limited licensure where veterinary students would elect to specialize in either companion animal or food animal medicine, for example, at the start of their education rather than investing in subsequent postgraduate specialization. He contends that “In the current economic climate, there are even fewer pet owners willing and able to pay for this (specialist-referral) level of care. In this scenario, the specialist may find many more colleagues sharing a smaller pie.”
There are surely veterinary students who would like to work with wild animals but not in a laboratory or conventional zoo and circus setting, or with farmed animals under organic and other humane husbandry systems, especially in the aid programs for ‘developing’ countries. But funding is often lacking in these sectors, and having to pay off hefty student loans can leave veterinary graduates with few options outside of the commercial and animal research industry sectors.
I find the collective indifference and historical support of organized veterinary medicine in the global proliferation of confined animal production operations (CAPOs) since the end of World War 2, as an egregious conflict of interest and abdication of primary responsibilities for animal health and welfare. It is in part responsible for the serious zoonotic pandemics arising from these inhumane animal production systems, notably swine and avian influenza, and food-born bacterial pathogens, many strains of which now have evolved multiple antibiotic resistance. The risks of antibiotics as livestock and poultry feed additives have been down-played for decades by animal industry pandering veterinary authorities and organizations.
To be charitable to the private food animal veterinary sector and put idealism aside, the fact remains that food animal veterinary practices were forced by the economic juggernaut of industrial agriculture’s ‘progress’ to get either get out or get in and support their farming clients as thousands of family farms and rural communities went under (12). Many successfully transitioned through ‘mixed’ practice to exclusively companion animal and pleasure horse practice. But many impoverished rural communities today, like several counties in Minnesota, including those with thousands of animals in CAPOs and smaller livestock operations, have no veterinary services (13).
At the 2010 annual gathering of the American Association of Bovine Practitioners (14) concerns were voiced that certain veterinary procedures and treatments, once the profession’s exclusive service-provisions to livestock farmers and horse owners, had been legally re-classified as animal husbandry practices in Oklahoma. An attempt to do the same in Iowa did not get out of committee. Such legislative initiatives to remove routine animal care from state veterinary practice acts are indeed alarming. But this is the ultimate way of the CAPO system which organized veterinary medicine still supports to its ultimate nemesis. Stock-keepers, for economic reasons, take on a para-veterinary role in these operations, and should have some State University certification perhaps. It might indeed be wise for State Veterinary Colleges to develop para-veterinary courses in animal husbandry, behavior, health care and welfare to certify the operators and animal care supervisors working in CAPOs, certification being mandatory 3-5 years after such state and federally funded initiatives are implemented
I find grounds for hope when veterinary schools develop and offer degree programs, postgraduate internships and residencies, as well as advanced degrees to enable students to work in the following emergent (and emergency) animal sectors that are calling for veterinarians to help with animal health and welfare problems, and also wildlife preservation and habitat restoration. These emergent sectors are notably in extensive, organic and other less intensive animal husbandry (including aquaculture) systems, and in wildlife medicine where veterinary expertise can be crucial in efforts to save endangered species and other wildlife and their habitats as well as addressing new ‘emerging’ zoonotic diseases. Specializing in ‘exotic’ animal medicine to serve those who keep various wild species as ‘pets’ or as a hobby, and who support the often illegal market trade in wildlife, is an ethically questionable professional pursuit. It is a justifiable veterinary specialty when it is rationalized that these animals often do need veterinary care, but in the process this indirectly encourages trade and ownership, and the omnipresent risks of zoonotic diseases and depredation of wild populations when the animals have not been bred and born in captivity.
Perhaps all first year veterinary students should take a basic introductory pre-clinical course in applied bioethics (15), with an emphasis on animal welfare science and the ecology, ethics, and economics of domestic and wild animal diseases that tie in with sustainable and healthful food production, soil, water and other resource management, conservation and preservation practices, and with genetic preservation in terms of the biodiversity of both seed-stock and breed-stock. Such a course could be revisited in the final year to help give clarity and resolution to their future professional goals. Learning the elements of indigenous wisdom especially concerning sustainable agricultural practices, medicinal and food plants, ---ethnoveterinary medicine---and the adaptive and productive traits of rare breeds and their inherent biological value, would broaden the vision of students if not also their future career choices and opportunities.
Veterinarians have been a unique association for millennia. As interlocutors between people, animals and their environments, the veterinarians’ role and knowledge, both empathic and scientific, was highly valued by society. Indeed, according to Professor Calvin Schwabe in his book Cattle, Priests and Progress in Medicine, (16) the earliest veterinarians were the priest-healer members of ancient Egypt's many dynasties. But today fewer farm animals are being given the same individual attention or quality of veterinary care and husbandry that they once enjoyed. There are few veterinary experts with the knowledge of good livestock husbandry, ethology, pasture and range management, and ecological farming practices to advise society in these areas. Their value is no longer recognized and most have been forced out of business along with family farms as the decline in rural communities' quality of life followed the industrialization of western agriculture.
Veterinarians in companion animal practice, also dealing with ‘exotic’ animals, face ethical dilemmas on a daily basis, one recent survey (17) indicating “an urgent need for ethics educational tools and approaches specifically designed with veterinary surgeons in mind.” This, in addition to escalating costs of ‘state of the art’ diagnostics and treatments, and the pressure to practice more costly, ‘defensive’ medicine in the light of the Texas court ruling (18) that animal owners can sue for “sentimental” or “intrinsic” damages following accidental death of an animal patient hopefully, not from gross negligence, make running a small animal practice increasingly challenging.
Real progress in veterinary and human medicine will come not in correcting the problems of dysfunctional and often over-capitalized animal and human health care business enterprises, but in client education, and in a paradigm shift toward a more holistic, integrative One Health approach to health care and maintenance, rather than profiting from treating disease and suffering, and in the process simply preserving the status quo. This status quo is protected to a significant degree by vested corporate interests, the influence of which in veterinary schools has increased significantly in recent years and is now being questioned (19).
I look to the veterinary profession to take a leadership role in this bioethical and One Health revolution revolution, or else, as public health veterinarian and epidemiologist Dr.P. Arambulo observes, it will ‘be marginalized’ as the one-health movement progresses, and “be stereotyped, tethered within their professional confines” (20).
At the community level in the U.S., as revelaed in the report by the Humane Society of the U.S. released Jan.27, 2012, entitled “Pets for Life---A New Community Understanding”, there is great need and potential for economically blighted communities to link with veterinarians and animal shelters to help increase access to services by removing cost barriers to animal care and veterinary services so as to improve community animal health and reduce shelter overpopulation.
On a personal note, when I entered the U.K’s Royal Veterinary College, on a full-tuition, board and lodging scholarship in 1956, and with a realistic view of the profession having been ‘seeing mixed practice’ for five years prior as a high school student, it was with the passionate conviction that animals’ health and welfare must come first before human pecuniary interests: and that whatever academic and professional skills I might acquire from my formal education would be ultimately tested in-field (today referred to as evidence based medicine), and refined accordingly. I saw the human-animal bond in dire need of repair through education and a greater understanding of animal behavior, emotions, and socio-environmental needs. These were subjects not yet included in the veterinary teaching curriculum, but which were highly relevant to companion and farmed animal, as well as laboratory and zoo animal health and well-being.
It is a tragedy that animals wild and domestic suffer the consequences of economic hard times and the demands of an out of balance human population with its driving market economy of consumerism and underbelly of dire poverty. Re-defining the roles of the veterinary profession in these times is critical not only to the future of the profession but of civilization itself. Putting animals and nature first (21) may be enlightened self-interest for the establishment of civil society, but it is an admittedly improbable paradigm shift or evolutionary step considering the nature of the human psyche. But establishing a higher priority of concern for wild and domestic animals and the natural environment over trivial and harmful human needs and demands would be a significant step toward a more sustainable economy and a better world for all. I believe that this is the veterinary profession’s challenge and duty today with its expertise (if not the authority in a reasonable world), to more effectively advocate.
1. Burns, Katie, Spreading the one-health concept JAVMA 240:112-115, 2012 and M.W.Fox, Healing Animals & The Vision of One Health. CreateSpace books & Amazon.com, 2011
2. JAVMA June 15, 2006, pages 1837-1839
3. Vet Rec 170:2-3, 2012
4. Burgermeister S, & Fikuart K., ALTEX. 15(4):209-212. 1998 Ethical guiding principles for veterinary behaviour with respect to the welfare and protection of animals. Tierärztliche Vereinigung für Tierschutz, D-Hamburg.
5. Fraser A. p. 932 in Merck Veterinary Manual. Rahway, NJ: Merck & Co. 1991
6. McMillan,Frank D., (ed), Mental Health and Well-Being in Animals. Ames Iowa, Blackwell, 2005.
7. Narver, Heather Lyons, Demographics, moral orientation, and veterinary shortages in food animal and laboratory animal medicine. JAVMA 230:1798-1804, 2007
8. Wise, J.K & Kushman, J.E. Synopsis of veterinary medical manpower study: demand and supply from 1980-2000. JAVMA 187:358-361, 1985
9. Larkin, M. Pfizer, AVMF partner to hand out hundreds of scholarships. JAVMA 235: 1022-1023, 2009
10. Nolen, R. S. More veterinary grads investing in their careers with additional training. JAVMA 2009 235: 1016-1018, 2009
11. LaCroix, Jeffrey A. Is it time for limited licensure? JAVMA. 235: 1401, 2009
12. Fox, Michael W. Agricide: The Hidden Crisis that Affects Us All. New York, Shocken Books, 1986
13. Minding the Herd: Does Minnesota face a food-animal vet shortage”? Minnesota: University of Minnesota Alumni Association magazine, Vol.10, No1/Fall 2010
14. JAVMA, Oct 15, 2010, p866-868)
15. Fox, Michael W. Bringing Life to Ethics: Global Bioethics for a Humane Society Albany, NY, State University of New York Press 2001
16. Schwabe, Calvin, Cattle, Priests and Progress in Medicine, Minnesota, University of Minnesota Press 1978
17. Batchelor, C.E.M. & McKeegan, D.E.F. Survey of frequency and perceived stressfulness of ethical dilemmas encountered in UK veterinary practice, Vet Rec 170: 19-20, 2012
18. JAVMA 240: 128-129, 2012
19. Dally, Michelle, Ethical considerations raised by the provision of freebies to veterinary students. JAVMA 238:1551-1554, 2011.
20. Arambulo P 111. Veterinary public health in the age of “one health”. JAVMA 2011;239:48-49.
21. Fox, Michael W. Animals and Nature First. CreatSpace books and Amazon.com 2011.