Straight talk about veterinary workforce issues

As AVMA President, Dr. Lori Teller delivered a presentation and participated in a panel on July 13 on the topics of the veterinary workforce, proposed midlevel position (MLP), and importance of the in-person veterinarian-client-patient relationship (VCPR). Her remarks, delivered in Denver during a meeting of industry leaders, are summarized here.

The last few years have presented the nation, and the world–veterinary medicine definitely included–with a crisis unlike any that most of us have lived through. A worldwide pandemic that made carrying out the tasks of everyday life, much less fulfilling our oaths and roles as veterinarians, a significant challenge. But we have persevered and emerged, I believe, stronger as a profession and as individuals.

Unfortunately, a great deal of misinformation has circulated widely over the past few years. Some of this may be inevitable in a climate of crisis and uncertainty. But as clinicians and scientists, we can never allow faulty information to serve as the foundation for our planning or decisions. The AVMA has been working exhaustively on research and modeling to ensure that we have accurate data to inform decisions that will affect generations of veterinarians, patients, and clients. As my term as president comes to close, I want to share some of our insights into the best path forward to help our beloved profession thrive.

Estimating future workforce needs

The profession is still recovering from the impacts of COVID, but the pandemic was an outlier, not a benchmark, for long-term planning. Across society, not just in veterinary medicine, we have seen workforce challenges emerge. We have and definitely need to continue to address current concerns, but we must not make hasty, kneejerk decisions about long-term workforce needs based primarily on our COVID experiences. We are seeing the number of clinic visits, new patients, and new clients returning to pre-pandemic levels. This suggests a normalization of demand. With this in mind, we need to be careful that proposed “fixes” don’t derail the future health of our profession. We know there’s a short-term problem, but we want the right long-term solutions.

Some circulating estimates for workforce needs substantially overestimate demand and underestimate supply. These numbers, which are being used to support claims of a future shortage of companion animal veterinarians, are based on faulty math. Worse, these erroneous numbers are being used to justify proposed long-term changes to the profession that place profits ahead of animal health and safety. These proposals include introducing an unnecessary midlevel position, inappropriately expanding the scope of practice of non-veterinarians, and dangerously relaxing VCPR requirements under the guise of expanding access to care.

AVMA data do not support the projected companion animal veterinarian shortage that has been reported. Instead, between 2022 and 2030, the number of veterinarians providing services for companion animals will grow by more than 20%, from about 80,000 to more than 98,000. The anticipated 20% increase in companion animal practitioners reflects historical increases in class sizes, as well as the three new veterinary schools graduating their first classes in 2023, 2024, and 2025. This should help address the capacity crunch being felt across the profession. What that 20% projected increase doesn’t include, however, are seats being added to existing programs that are substantively beyond historical increases. And, looking even further ahead, there are 10 new veterinary schools that are in various stages of development.

This said, addressing veterinary workforce needs isn’t just a numbers game—it’s much more nuanced than that. Veterinarians’ changing preferences for the number of hours they work, how they work, and the emergence of new service models all need to be considered. There are also shortages in rural America and in certain segments of veterinary medicine, such as food animal, equine, academia, shelters, emergency practices, specialties, and public health, that are caused and affected by factors unique to each of these segments. Future planning and solutions need to be targeted and directly address these factors. Retaining the individuals currently working in the profession is key, as is identifying what attracts veterinarians to the profession’s various roles in the first place. Simply increasing the number of veterinarians, creating a midlevel position, and/or relaxing the VCPR isn’t the answer.

Speaking of retention, some have pointed to the number of advertisements placed for veterinarians on job sites as evidence of a shortage. What hasn’t been shared is that those ads often reflect challenges with retention. Retention is a serious issue for both veterinarian employees and employers. Factors affecting retention include hours worked, salary, practice culture, support of work-life integration, and comfort with community lifestyle. It doesn’t do us any good to graduate more veterinarians if they don’t stay in their jobs or, worse, leave the profession.

Midlevel position

The idea of a midlevel position (MLP) is an answer in search of a problem. There are more expedient and sustainable solutions to the workforce challenges that veterinary teams are facing. Human medicine is often suggested as a model for the MLP, but while the first nurse practitioner program was established nearly 60 years ago, human medicine is still struggling with the issues created by moving forward without standardized education, credentialing, and licensure, including some educational programs that do not prepare students appropriately and put patients at risk.

We should not go down the same path. There are no accurate data supporting the need for a midlevel position, and advocates of a midlevel position are either woefully misinformed or are, unfortunately, prioritizing profits above patient care. There’s no standard curriculum, no programmatic accreditation, and no national test to deliver and assess knowledge and skills. From a practical standpoint, creating a midlevel position with the necessary accredited educational programs, state and federal practice authorities, national testing, and licensure would likely take decades.

Creating a midlevel position would be a disaster, and a significant risk for our profession. The enormous expenditure of time and resources that would go into creating an MLP would be much better spent on programs and tools that fully engage veterinary technicians and veterinary technician specialists as part of a veterinarian-led team, and that allow them to practice to the top of their degrees and training, while respecting the training and purview of the veterinarian when it comes to diagnosis, prognosis, and treatment, including prescribing and performing surgery.

Telemedicine

Telemedicine is something that veterinarians have been doing for a long, long time. However, it’s important to do it with a VCPR that has been established in person. That in-person visit provides the veterinarian with information about the patient and the client. Knowledge about both allows veterinarians to deliver an effective treatment plan that the owner is able to follow.

Some people say some care is better than no care, but that’s not true if you have the wrong diagnosis and the wrong treatment plan. An accurate diagnosis and a good treatment plan from the start reduces the number of veterinary visits an animal ultimately will need and reduces costs for the owner. Frankly, the “some care” that most animals need is vaccinations and other tailored preventive care that cannot be delivered by telemedicine. Furthermore, animals—be they pets or otherwise—with gaps in seeing a veterinarian are more likely to have acute and complex problems that the ability to create an electronic VCPR isn’t going to solve. For these animals, initiating diagnosis and treatment through an electronic VCPR means costs are incurred for at least two visits (telemedicine and in-person) to get to the heart of the issue, rather than one in-person visit with appropriate follow up.

So, how does telehealth play a role in reducing barriers to care without opening the VCPR? Teleadvice provides owners with basic information and education around preventive care. No VCPR is required. Teletriage enables determination of urgency (i.e., whether the animal needs to be immediately seen by a veterinarian or not). No VCPR is required. Telemedicine can be very useful once the VCPR has been established through an in-person examination or premise visit to facilitate progress checks and owner compliance with treatment plans. Using telemedicine in this way can result in substantive time and cost savings. Emergency clauses present in many state practice acts allow treatment in the case where immediate intervention is required and/or address the unique needs of those states (e.g., geography) for additional accommodation while maintaining the integrity of the VCPR.

Moving forward with confidence

As we settle into the new post-pandemic normal, it’s important to consider other ways of meeting demand that may provide more immediate and more sustainable gains, no matter how markets are behav­ing. One way is to improve practice efficiency. As a recent JAVMA article noted, “An improvement in technical efficiency could lessen the need for more veterinarians and other veterinary team members, allow more patients to be seen by staff on hand each day and translate to higher revenues and profits and greater employee engagement and wellbeing.”

And, while the AVMA is sharing information about steps that practices can take right now to address current challenges, we’re also taking a careful, data-based look at what veterinary medicine and its workforce are likely to look like 10, 20, and even 30 years from now. That includes consideration of changes in practice models (e.g., acute care clinics, mobile services); the impact of emerging technologies, including but certainly not limited to telehealth; the number of hours that practitioners want to work and how they want to work (e.g., increase in relief services); and more.

No one cares more about ensuring there is an adequate workforce of qualified veterinarians now and in the future than the AVMA. Our current veterinarians, including experienced and recent graduates alike, and our veterinary students deserve nothing less than a very careful look at what is needed to help them secure their futures and stay in a profession and career they love. Our patients and clients and our industry partners similarly expect and deserve our due diligence.

And that is what the AVMA will continue to deliver.