Veterinary School Update

We took the pulse of where veterinary education is and what the prospects are for future equine veterinarians.
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There is a noticeable change to the business of educating veterinary students in today's world.

The wonderful benefit about a veterinary education is that it can provide you with a stepping stone to a number of career pursuits, not just in clinical practice, but also in industry, research, government or leadership roles.

It is a tough process not only to get in to a DVM program, but to finish. Then the job hunt begins. Many practitioners who are reading this might have graduated from veterinary school decades ago and, in the process of interviewing prospective job seekers, have seen a considerable difference in focus these days. Part of an older practitioner’s trial by fire involved 24x7 care in all kinds of weather and working conditions, many similar to the tales of James Herriot.

Those of you more newly graduated see your veterinary education through a different lens that is often clouded by immense educational debt with a trumpet call for work-life balance that obviates being available to clients all the time.

The Current State of Veterinary Education

For older practitioners, there is a noticeable change to the business of educating veterinary students in today’s world. there is more focus on veterinary practice using technology and specialization. there is a trend toward clinical practice in urban environments while there remains a shortage of food animal and large animal practitioners in rural locales.

In 1986, 23% of the veterinary workforce treated food animals. This declined to 7% of the workforce by 2007, and today it has further dwindled. Many remaining veterinarians who work with large animals tend to be older practitioners who will likely retire in the not-too-distant future.

The Canadian Veterinary Journal (CVJ) posted an op/ed (2018) in which the author (Dr. Bryce Fleming) remarked, “The ever-advancing standard of care combined with the modern concept of personal life balance has created a new standard of professionalism for veterinarians. It is getting nearly impossible to meet current professional expectations anywhere outside of large urban centers. There is an assumption within our own ranks that every case should have specialists with advanced technology and that every veterinarian should be working standardized shifts never to exceed the bureaucratic norm of 40 hours.”

What Are Veterinary Schools Looking For?

For those applying to veterinary school, the AVMA has posted a publication entitled “Vet School Admission 101.” Its opening statements bear repeating here: “Why are grades important? They indicate intelligence, study habits and dedication and drive to succeed.” The message goes on to say “Veterinary schools are looking for well-rounded students. They’re looking for future leaders. You can make yourself a better candidate by getting good (or great) grades, as well as experience and leadership skills.”

In reply to the aforementioned CVJ op/ed, Dr. H. J. Rumney noted, “I feel that some changes in the admission requirements for veterinary school are warranted. Academic ability is obviously very important, but is a questionable indicator of intellect or intelligence in real-world situations. Students should have a better understanding of the various roles that the veterinary profession plays in the world outside of the urban and academic setting.”

Demographics and Diversity

The Texas Higher Education Coordinating Board compared demographics of students nationwide: In 1999, white students comprised 91% compared to around 79% since 2014. the predominant gender of students now is female. The main focus of graduates is for veterinary care of companion animals, especially in urban areas. Students in the nationwide class of 2024 expressed their desire to practice in a community location of 20% rural, 18% urban and over 60% in the suburbs. Expansion in student diversity includes outreach to financial and cultural factors, although ethnicity is certainly a major component of diversity. The AVMA is implementing programs to improve diversity outreach to include African-American, Hispanic, Asian and Native American students. The American Association of Veterinary Medical Colleges (AAVMC) is actively working on a national strategic recruitment plan to present veterinary medicine as a possible career to kindergarten through 12th graders in an attempt to improve diversity and invite more people into the profession. More recruitment efforts by the universities are necessary. In 2019, the AAVMC reported that students attending U.S. veterinary colleges numbered 71.1% white, 11.1% Hispanic and 2.8% African-American. Clinical faculty is comprised of 10.3% underrepresented people, described by AAVMC as “populations of individuals whose advancement in veterinary medicine has been impacted due to legal, cultural or social climate impediments in the US, specifically by gender, race, ethnicity, geographic, socioeconomic and educational disadvantages.” There are 101 private and public black colleges or universities (HBCU) in the United States that are accredited. Of these, 17 offer pre-veterinary programs. Less than 1% of the overall national applicant pool for veterinary school comes from an HBCU. Tuskegee University has a higher number of black students than most. The National Association of Black Veterinarians (NABV) is making concerted efforts to increase awareness and to increase the number of African- Americans and other diverse ethnicities within the veterinary profession.

Schools Offering DVM Degrees

There are 30 veterinary schools in 27 states, with Alabama, California and Tennessee offering two programs each. These DVM programs are members of the AAVMC. The AAVMC membership includes 44 veterinary colleges and schools around the world, with 30 of them in the United States. The newest U.S. DVM programs are at the Midwestern University in Arizona, which began in 2014, and the Lincoln Memorial University in Tennessee. A three-year DVM program in Tucson just opened at the University of Arizona, with its first class attending in fall 2020.

Other DVM programs currently being developed include the private Long Island University (LIU) College of Veterinary Medicine in New York and Texas Tech University School of Veterinary Medicine. Both have received a “letter of reasonable assurance” that means it is likely that the schools will receive provisional and eventually full accreditation provided they meet the criteria for the plans presented to the AVMA Council of Education. The first DVM students at LIU begin their program in August 2020; Texas Tech will graduate their first class in 2025.

A report from the Bureau of Labor Statistics predicted that growth in veterinary employment will increase by 18% between 2018-2028. Many in the industry acknowledge the need for more veterinary education to fill the gap created by open veterinary positions with not enough veterinarians to fill the jobs.

Between 2009 and 2016, applicants to U.S. DVM programs remained fairly steady, ranging from 6,143 to 6,789 applications. In 2019, worldwide AAVMC member institutions had over 8,000 applicants for a little more than 4,000 seats. While many U.S. schools have expanded their class size within the capacity of their infrastructure, most programs seat 100-135 students each class. For the class of 2023, U.S. veterinary programs averaged 11 applicants per available first-year seats.

Nearly 80% of 8,152 candidates for the class of 2024 are first-time applicants; about 18% are applying for the second time; and about 3% are third-time applicants.

Since 1980, available seats for veterinary students throughout U.S. schools and colleges has increased by 2%, and between 2009-2019, seats have increased by 2.4% for first-year applicants. For the 2020 academic year, the total enrollment in U.S. Colleges of Veterinary Medicine is 13,548. In 1980, nearly 70% were male and about 35% female; by 2020, male enrollment averages around 20% with women enrollment exceeding 80% [Annual Data Report 2019-2020. Association of American Veterinary Medical Colleges, Jan 2020; pp. 1-64].

In 2019, a little more than 3,000 students graduated from veterinary schools across the country, with another 1,500 or so graduating from international colleges of veterinary medicine. The U.S. class of 2022 will graduate more than 3,200 students.

In 2019, as many as 423 DVM students in the USA enrolled in dual-degree programs that include 66 students in MS/MA; 236 students in Master of Public Health; and 162 students in PhD programs. As an example, Colorado State University offers multiple dual-degree options: DVM + MBA; DVM + MPH; DVM + Toxicology; DVM +PhD; DVM + MS in Animal Science; and Food Animal Veterinary Career Incentive Program. The length of most programs is five years; a PhD is seven to eight years.

Clinical Skills Lab Training

At the Access to Veterinary Care Symposium, students commented that they do not feel prepared for clinical practice. “According to some attendees, the rise of specialists within the veterinary industry has decreased the number of general practitioners in academia and practicing in the field, which has led to young veterinarians not being exposed to basic care,” said Dr. Michael Blackwell, director of the Program for Pet Health Equity at the University of Tennessee-Knoxville, in an interview with JAVMA News. “Many veterinary students only learn the gold standard, which doesn’t necessarily prepare them to think creatively after graduation when they’re practicing, according to some attendees.” (To read the entire article, go to AVMA.org and search for “veterinary care for all.”)

With this concern in mind, the veterinary schools at Wisconsin and Tufts are providing students the opportunity to practice basic care with animals from low-income owners.

A disquieting experience in vet school 35 years ago centered around having to take dogs from the pound and put them into a clinical shock situation, with the end result of euthanasia. This clinical skills lab on live animals was an inherent part of the learning process of veterinary education decades ago. It was uncomfortable and sad despite the understanding that the experience could help us save many more animal lives over the course of our careers.

Other memories persist of wanting and seeking opportunities to practice suturing live horse tissue, running nasogastric tubes into horses, performing elective surgeries on live animals, experiencing reproductive palpation, castration and a number of basic skills needed to start out in equine practice.

While in vet school in the 1980s, it was difficult to obtain these opportunities as a budding equine practitioner due to the lack of case numbers and the cost of horses, despite only a small percentage of classmates being interested in pursuing equine practice. At the time, it was stated that we would learn many of these skills once at our first job. This put a great burden on potential employers and did little to ensure confidence as a new graduate starting a career as an equine veterinarian.

With today’s technology, it is now possible to provide students with learning experiences beyond working on live animals. For instance, clinical skills labs at many veterinary schools use an equine head and neck simulator to practice jugular vein draws, an equine GI tract to practice belly taps, or canine forelegs for insertion of IV catheters. Skin pads allow practice of suture placement and patterns. Plastic limbs provide for practice of bandaging techniques. Computers enable anesthesia simulations, so students learn to correct patient abnormalities as they occur in real time. And besides life-size plastic cows to simulate bovine reproductive tracts and dystocia, a full-size equine simulator allows rectal palpation to familiarize students with the feeling and internal location of intestinal placement, so important for assessment of colic conditions. Such simulations have multiple advantages—they help students build confidence, relieve anxiety about doing procedures, and help to minimize incorrect techniques before working on live patients.

Such simulation labs are available at veterinary colleges at Cornell, Iowa State, University of Illinois, University of Wisconsin, University of Florida, Washington State, Virginia- Maryland, the Ohio State University, Lincoln Memorial and Ross University.

Internships and Residency Programs

About half of new graduates enter private practice (or other veterinary industry pursuits) immediately, while the other half pursue advanced training through post-graduate internships and residencies. Post-graduate training opportunities do not pay well—average salaries for interns or residents range from $26,000 to $34,000. Such low wages coupled with educational debt makes these opportunities untenable for many. In 2019, only 28% of veterinary students pursued post-graduate internships—this was the lowest number of interns since 2009.

Companion animal medicine comprises three-quarters of internships. Equine internships make up about 25% and exotic animal internships 1%. For 2020, the total number of intern trainees is 420; the number of resident trainees is 1,228.

A new bill—the VET MED Act (Veterinary Education and Training Minimizes Educational Debt)—proposed in March 2020 by Reps. Kurt Schrader (D-Ore) and Ted Yoho (R-Fla), can help residents, interns or those in PhD programs to receive a pause in student loan repayment and interest accumulation while they pursue advanced and specialized training. In addition, the Coronavirus Aid, Relief and Economic Security Act (CARES Act) suspended payment and interest on federal student loans through September 30, 2020.

Faculty at veterinary schools has remained relatively constant since 2010, with about 3,800 to 4,500 positions that do not include residents and interns. Of these totals, 18% are tenure or tenure-track faculty, 12.5% are research faculty and 12.8% are administrators.

Gatekeeper aka QPR Training

Despite a lack of previous training in mental health, programs exist for veterinarians and veterinary students to help address the increasing rate of suicides in veterinary medicine, both of students and of practitioners. While availability of professional mental health assistance is ideal, QPR (question, persuade and refer) training can help as a “gatekeeper” to save lives from suicide.

AVMA, AVMA LIFE and AVMA PLIT have implemented an hour-long, online training program for veterinarians and veterinary students. There is no cost for this program, but only a limited number of QPR training licenses are offered on a first-come, first-served basis for AVMA and SAVMA members.

Tuition

First-year, in-state resident tuition and fees at U.S. DVM programs range from $20,000 to nearly $70,000 per year, with an average annual cost around $35,000. For non-residents, the cost averages $53,000 (a range of $38,000 to nearly $80,000) for the first-year DVM program. Private veterinary schools are markedly more expensive than state schools, with average costs per year of tuition and fees over $50,000.

Since 2005, tuition and fees have doubled. Within the past decade, in-state tuition has increased by 60%. The AAVMC has posted a website that provides financial cost information for each U.S. veterinary school and for 11 international schools. Go to aavmc.org and search for “cost of veterinary medical education” for a tool to compare vet schools.

DVM students at several U.S. colleges of veterinary medicine are allowed to establish residency during their first year so that their new residency status enables them to pay in-state tuition for the remaining three years in the professional program. Students applying for residency reclassification must be independent and not receive family support. The schools allowing early residency admission are Washington, California at Davis, North Carolina, Ohio State, Missouri and Illinois.

Debt

There is no way to discuss veterinary school without addressing the “elephant in the industry”—student loan debt. In 2019, the median student debt for veterinary school was estimated around $174,000 at the time of graduation, with a mean starting salary around $70,000. By 2025, student debt is expected to reach $200,000. This kind of debt load also accrues interest over the course of the loan, which can range from $27,000- $40,000 on top of the loan repayment.

Currently, only 18-20% of veterinary students are able to graduate without debt, which is a figure that has increased in the past few years compared to earlier in the decade. Still, more than 80% of students will incur student debt by the time of graduation from a DVM program. The debt load for veterinary school graduates has increased three-fold from 2001 to 2018. To pay for veterinary school, about 60% of applicants for the class of 2024 rely on student loans, 18% on family support, 10% will work, and 7% will spend personal savings. Approximately one-third of students borrow $50,000-$100,000 while 61% borrow up to $50,000. Nearly 11% of 2019 graduates have amassed $300,000 in student loans, and nearly 1% took loans exceeding a staggering $400,000.

According to the AAEP, in 2005, those interested in pursuing equine practice numbered 5% of veterinary students; today it is only 1%. A presentation at the 2019 AAEP Annual Convention described a survey that examined why the number of those pursuing equine practice has diminished. Some of this could be attributable to debt versus salary opportunities; some could be due to the on-call lifestyle of equine practitioners or the physical demands of equine practice; some could be based on more urban experiences of veterinary applicants with no focus on large animals.

In 2019, the AAEP surveyed nearly 1,800 veterinarians as to their interest in equine practice. Only 44% (789) said equine practice was their desired career, but of those, 55% (441) said they left, did not pursue or wished to leave exclusive equine practice primarily because of student debt and financial reasons. Graduates reported that 41% are only able to address interest payments on loans with nothing paid toward the principal. A big problem is that repayment rates of loans far exceed the salaries paid to an associate equine practitioner; small animal practitioners are paid considerably more. In the survey, 82% said that their student debt affects their quality of life.

A Texas Higher Education Coordinating Board report pointed out: “To pay off student loans, veterinarians are more likely to gravitate to higher-paying practices dealing with companion animals than they are to lower-paying practices in rural areas of the state.”

It seems that there might be a shift from students who must incur student debt to more applicants with other sources of financial support. The AAVMC reported that only about 30% entering for the class of 2024 have debt, with a median debt of $24,500. Of applicants for the class of 2024 that have limited or no undergraduate debt, nearly 60% have financial support from family, about 48% earn money working full or part-time; and a similar number receive merit-based scholarships. About 25% are awarded need-based scholarships, and fewer than 5% receive military benefits.

Some possible resolutions for this debt crisis exist. For example, the AVMA Council on Education has accredited several international five and six-year veterinary degrees, and some U.S. veterinary colleges (such as Iowa State University and Purdue) are accepting students after only two years of undergraduate education instead of the standard four-year pre-veterinary education programs. The new veterinary school at the University of Arizona in Tucson is offering a three-year program that runs continuously from the time of start to graduation to enable students to reduce costs of living while in school and also to enter the job (and salary) market sooner than their peers at four-year programs.

The United States Department of Agriculture (USDA) created the Veterinary Medicine Loan Repayment Program (VMLRP), which matches veterinarians willing to work in rural areas with regions identified as high-priority veterinary shortage areas. A veterinarian who services the rural area for three years earns repayment by VMLRP of up to $25,000 annually of the DVM program loans. For fiscal year 2020, Congress funded $8 million to this program.

Another option is the Public Service Loan Forgiveness program, which forgives any remaining student debt after 120 on-time payments have been made in conjunction with 10 years of employment at a government entity or non-profit, especially one that provides a public service.

Paychecks

Embarking on a first job is an exciting adventure for a new graduate. Yet mounting student debt looms as a daily concern. In 2019, the mean starting full-time salary was around $78,000 across practitioners of all species. The COVID-19 crisis of 2020 (and possibly beyond) could radically alter not only salaries, but also the number of available veterinarian positions.

Women are still receiving less pay for the same work as their male colleagues, but the gender income gap has dropped from 4% to 3%, which is an improvement.

The Bottom Line

Veterinary education is continually evolving to meet the challenges of the time. Still, time spent with live horses in real-life settings cannot be replaced by simulation in clinical training labs. Additionally, what students see in equine rotations in veterinary school is often dependent on the time of year of the rotation, as much of equine work is seasonal.

Externships become extremely important as a means to supplement experience and knowledge. Some veterinary schools turn students over to private practices for their fourth-year clinical rotations so they can glean real-life experience—not just caring for the animals, but also dealing with clients and to gain an understanding of how veterinary business works in a private facility or ambulatory practice. Mentoring by experienced practitioners provides an invaluable means of offering veterinary students a broader foundation and practical clinical knowledge. 

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