DISCUSS: News on Future veterinary schools

[SV88]

My concern with churning out this many new veterinarians is going to be having adequate support staff for them. We already have a huge technician and assistant shortage, staffing is a problem in the majority of clinics, so now we want more veterinarians without addressing the fact that they won't have any staff to support them? This is a gigantic issue in our field, and has been for some time, and my worry is more veterinarians will just make the disparity more apparent. 100% agree with concerns for the for-profit models, the money hungry schools (Chamberlain.... PLEASE DONT. Come on now) and debt the students will go into, and will the long term supply and demand remain the same as now.

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[SV88]

omg how did they know that I chose vet med over human med because of my inherent need to have more time to do housework at the end of the day?!? I didn’t tell anyone that this whole career was really just a smart ploy to let me live out my dreams of vacuuming more!!

Heard they also liked Harrison Butker's commencement speech.

 

[WhtsThFrequency]

I think previously a lot less people got their dogs veterinary care the way they do now. Kind of like how having a kid is very expensive because expectations on quality of life and stuff have shifted. I definitely remember babies raising babies when I was younger, but now that is VERY frowned on. Same with pets. Now, people are expecting to spend for knee surgeries, chemo treatments, eye tests, etc. That 25 years ago were not really seen as necessary for the majority of the pet owning population. That made owning 5 dogs way cheaper. You tossed the grocery store kibble in their bowl and euthanized when they got old or just let them die on their own, no extras. The has definitely changed.

Eh, I disagree somewhat because it's extremely dependent on locale. Sure, in richer/more educated areas of the county, views on these two things have changed. But in areas with low socioeconomic status and/or subpar education (which is a LOT of America) they have not.

Additionally, I'm more interested in not taking the MCAT than avoiding residency. I really think there are better ways of evaluating applicants than a standardized test. Dont know what, but it feels like a failure of immagination at this point. I very much would like to be a neurologist, and that has a more challenging path in vet med than human med. Your human neuro resident isn't going to rock up to the hospital at 9pm to do surgery, because that's a separate field of neurosurgery. Your veterinary neuro resident will though because we don't have the difference.

While I completely agree that the complexity and difficulty of veterinary medicine is often overlooked by the general public, this statement is nonsense. I'll be the biggest defender of our field I can be, but sometimes I do feel like we DVMs slip into having a weird inferiority complex when we start saying things like "our" medicine is somehow more challenging than "their" medicine. Same reason I hate that stupid "real doctors treat more than one species" tagline - I know it's supposed to be cute or something, but really? Take it from someone who teaches at both a DVM and an MD school - it's apples and oranges, and you can't compare one to the other in terms of perceived "difficulty". We are trained for breadth, they are trained for depth.

 

[WhtsThFrequency]

Where are you going to find enough boarded veterinarians to teach at 12 new veterinary schools who do not have a teaching hospital? Make it make sense. Veterinarians are not flocking towards academia when they can make more money in private practice or consulting at a larger company if they want out of a client facing position. The current schools are struggling to retain their own faculty and staff, how do they think this is a good idea? There isn't a small animal veterinary shortage, its a large animal/rural area veterinarian shortage and the majority of students who potentially will go to those schools will end up in small animal and won't solve the issue.

I’m glad somebody said this - this is a major issue. Although there is the benefit of PSLF if you need/want it, and generally good benefits packages….pay in academia is middling, especially for new assistant professors no matter how many specialty certifications or additional degrees you have. Collegiate and clinical prof appointments are often pretty thankless positions too, and students only see the surface of what we have to do - we are all burned out. Badly. All the time. We’re juggling curriculum design, on the floor teaching, clinical performance and patients, having our jobs depend on student evaluations and publications, all our required committees and service, somehow trying to do research in between everything, jumping through flaming hoops for annual reviews, all the while forcing ourselves through the meat grinder of academic politics. This is why retention is in the crapper right now, and new grads aren’t exactly excited to go spend years specializing, and in some cases even more years doing a PhD, and then start at 90k as an assistant professor at the bottom of the totem pole.

I don’t know where they think they are going to find all these new faculty either. I love parts of my job, but there are enough other parts that, after finishing my 10 years of PSLF employment, pure diagnostics is starting to look pretty good (although I would miss teaching - the students are what keep me here for sure.)

 

[WhtsThFrequency]

I get that schools are expensive to run, but I don't think students should be a cash cow. Maybe we can take the money used for college athletics and put it into professional programs? (I think collegiate level athletics is insanely out of hand)

Oh god, I wish. Problem is, athletic profits (if any) are earmarked to go directly back into athletic programs at many institutions due to how university budgets operate. Which can be anything from facilities, marketing, equipment and travel expenses, to propping up all the non-profitable sports (which is basically anything other than football and basketball). Football profits allow the other areas like tennis, swimming, lacrosse, golf, baseball/softball, and all the intramural programs to still exist. I do agree it’s gotten wild though, and I could think of so many other areas that money could go :/

Tuition increases (and class size increases) aren’t just happening because of greed, it’s also due to necessity when it comes to public land grant institutions (and please don’t take this as me defending it - the whole situation makes me livid - just giving context). State funding used to be a huge income stream for public universities, but year after year state funding has been slashed, slashed, and slashed again. Raising tuition was the only way to cover the gap for keeping schools afloat. Is it in excuse? Hell no because this has been a progressive legislative failure. Thats where a lot of the anger should be directed - at state budget offices and the federal programs ahead of them. But it’s an explanation. Of course this doesn’t apply to the private ones charging up the wazoo - that is a whole ‘nother dumpster fire.

 

[EB73674]

Would these positions even be eligible for PSLF if they're at private universities?

 

[BlackCatsRuleTheWorld]

Would these positions even be eligible for PSLF if they're at private universities? Rowan is a private institution in NJ, although to their credit they are setting up a teaching hospital...

most likely yes, majority of universities (even private) are classified as 501c3 nonprofit organizations

 

[Rejected Med_Vet_Students]

Would these positions even be eligible for PSLF if they're at private universities? Rowan is a private institution in NJ, although to their credit they are setting up a teaching hospital...

Do you know how hard it is to set up a teaching hospital? I ask because I don’t understand why some vet schools don’t have one. I am sure that makes the clinical year tough.

 

[JaynaAli]

Do you know how hard it is to set up a teaching hospital? I ask because I don’t understand why some vet schools don’t have one. I am sure that makes the clinical year tough.

Facilities alone are a major initial financial investment, and even the established schools are having difficulty maintaining staffing, because specialists can make significantly more in private practice and not deal with academia bureaucracy. Why would a new school go to that trouble and expense when it’s not required anymore by the AVMA COE to get approval? They can send students off to partner practices and make them someone else’s responsibility. I absolutely think that having a hospital helps further a student’s education and is an important piece of training, but I can absolutely see why schools don’t bother when it’s not a requirement anymore. Saves them a ton of money in annual salaries to staff the hospital and that associated headache, even above the initial facilities investment. Sure, a hospital is going to bring in revenue, but probably not enough to pay for itself and truly be profitable. The issue is, the schools that are distributive don’t seem to be passing those “savings” on to students…the new no-VTH schools are still some of the most expensive, which is where my issue with them lies.

 

[Rejected Med_Vet_Students]

By partner practices, do you mean private vet practices or other schools with teaching hospitals?

 

[JaynaAli]

By partner practices, do you mean private vet practices or other schools with teaching hospitals?

That’s going to vary from school to school. Most of the US based distributive places (such as Western, LMU, etc) seem to mostly send students to private/corporate GP and specialty hospitals not affiliated with any universities. Sometimes students make arrangements for a rotation at another school. Some schools might make arrangements for their students to rotate through another school, similar to how Ross and St. George’s do it…I think Puerto Rico has stated they’re going to have a teaching hospital but also have partnerships with UF, Missouri, Kansas, Michigan, Oregon, and Purdue for their students to rotate there (source: Puerto Rican veterinary school will open this fall), but even with that, there is theoretically a limit on how many spaces a school can support. Meaning I don’t think there’s enough capacity at current vet schools to absorb all the new programs for clinical year so that can’t be an option for everyone.

 

[Rejected Med_Vet_Students]

I agree about there not being enough spaces. I know a school like Ross pays a premium for their student spaces which is passed on to the student with I bet a little surcharge since they are a for profit school. I have been told the AVMA COE limits how many Ross students can go to each school. Also I heard University of Illinois is no longer going to take Ross students.

 

[spayallday]

Rowan is public, not private. They are building a SA teaching hospital and using local partnerships and ambulatory services for large animal, exotics, etc.

 

[battie]

Sure, a hospital is going to bring in revenue, but probably not enough to pay for itself and truly be profitable.

The vast majority of teaching hospitals operate in the red. Back in 2018, my school held a town hall about VTH expansion coming in 2019. Illinois was one of 5 or 7 vet schools with profitable VTH where it paid for itself.

 

[SkiOtter]

Also I heard University of Illinois is no longer going to take Ross students.

Where’d you hear this from? Also only Ross, or all island students in general? I’m nosy

 

[Rejected Med_Vet_Students]

I heard this from Ross students. Are you an island student? If so, what school?

 

[SkiOtter]

I heard this from Ross students. Are you an island student? If so, what school?

I’m not. I’ve already graduated. I went to Illinois, so I was curious.

 

[Benjamin Scalera]

*cries in 1500/mo* but seriously we are the most expensive in town but honestly it's not even that bad (compared to cities). I also thankfully have a decent SA load to help support a nice salary compared to the $3.50/head bangs vaccination and $25 bull castrations. I definately have a significant load of I only have $20 to fix this doc plus the exam fee (if that!). So I get to try and guess what 1 drug I get to give the pet and hope it lives/gets better. (Don't get me wrong I love most of the aspects of my job even the hard $ cases but it can be challenging sometimes).

$51 office visits plus whatever. We are also the only clinic with in house labs and x-rays and US at this time.
TBH Idk how the girl down the street pays her loans. She's a 2023 grad. Their office visit is $30. They do a dental to include extractions for 270-they're giving away time and money! (granted they don't have dental x-ray. we charge for basic dental to include rads, extractions are extra). She just graduated but went home to practice with her dad so I'm sure she had money from before (shes a nontrad student)/her family is helping her.

Salaries are one problem. The on call life is definately another huge factor. Followed by living in BFE. There's alot of reasons TBH. I don't have any solutions that anyone seems to want to take seriously yet/my ideas probably require major govt involvement and lets be honest they don't care enough yet to make it happen.

A lot of these posts are funny to read, Im actually applying to vet school with the ambitions to help the rural/food animal field in any way I can

 

[supershorty]

A lot of these posts are funny to read

What's funny about them?

 

[Cowsrcool]

I heard this from Ross students. Are you an island student? If so, what school?

You seem to have a lot of info on Ross in general are u a current student/ know a current student?

 

[Rejected Med_Vet_Students]

I know current students. I don’t like how they are not upfront with all the information so I want to get the information out there as much as possible so students can make a good decision. Especially considering the amount of money the students are investing for a chance to become a vet.

 

[Cowsrcool]

I know current students. I don’t like how they are not upfront with all the information so I want to get the information out there as much as possible so students can make a good decision. Especially considering the amount of money the students are investing for a chance to become a vet.

Wasn’t criticizing was just curious to your connection! I appreciate knowing the information as well

 

[Rejected Med_Vet_Students]

Wasn’t criticizing was just curious to your connection! I appreciate knowing the information as well

No worries. I didn’t take it as you were criticizing me. 😁 The one thing I find interesting is the advisors I have talked to have never been to the island but act like they know about it. They definitely don’t like it when you call them out on it. Lol.

 

[katiemcat]

Do you know how hard it is to set up a teaching hospital? I ask because I don’t understand why some vet schools don’t have one. I am sure that makes the clinical year tough.

Well I’ve been told by multiple faculty our teaching hospital actually loses money so there’s that aspect if that’s true.

 

[TheDogFather]

With respect to finding faculty for the new (and existing) vet schools: a fair number of my instructors were not diplomates and I think they did a pretty good job of teaching the more practical aspects of the trade. The board-certified were far more likely to be the ones perpetuate the "only specialists will be performing this procedure, but you need to be exposed to it as it may come up on your licensing examination" aspects of the curriculum. I don't think instruction provided by experienced but non-boarded instructors would be quite the disaster some might believe it to be.

Regarding attracting and retaining support staff (at least at the GP level): as long as "there is no time in the curriculum" to better teach skills and procedures that might bring in more clinic revenue (TTAs, TPLOs. corneal and conjunctival surgeries,, fracture repair, ultrasound, more in-depth radiographic interpretation, for example) we're going to have a hard time "paying our support staff what they're worth". I think the ceiling to what we can charge for giving shots, squeezing anal sacs, and pushing preventatives and WSAVA approved diets has pretty much been reached.

 

[battie]

With respect to finding faculty for the new (and existing) vet schools: a fair number of my instructors were not diplomates and I think they did a pretty good job of teaching the more practical aspects of the trade. The board-certified were far more likely to be the ones perpetuate the "only specialists will be performing this procedure, but you need to be exposed to it as it may come up on your licensing examination" aspects of the curriculum. I don't think instruction provided by experienced but non-boarded instructors would be quite the disaster some might believe it to be.

Regarding attracting and retaining support staff (at least at the GP level): as long as "there is no time in the curriculum" to better teach skills and procedures that might bring in more clinic revenue (TTAs, TPLOs. corneal and conjunctival surgeries,, fracture repair, ultrasound, more in-depth radiographic interpretation, for example) we're going to have a hard time "paying our support staff what they're worth". I think the ceiling to what we can charge for giving shots, squeezing anal sacs, and pushing preventatives and WSAVA approved diets has pretty much been reached.

The caveat here is that the majority of the schools won't be able to retain the average DVM either. CSU was offering 90k for an ER doctor about a year ago that has clinical and teaching duties. Yeah, no. If I'm moving my family from Denver to FoCo, it's not for 90k.

More over, I don't understand where this perception that specialties say GPs can't do "advanced" procedures is coming from. I see this in VIN but don't actually see this in real life. I was taught the theory of all sorts of procedures from a variety of specialists. I just didn't get the surgical exposure because 1) I didn't go out of my way to get them and 2) COVID clinics really limited exposure in hospital to begin with. Follow that up with the majority of new vet schools following the distribution model, then it's really up in the air what the exposure is.

The vast majority of the specialists at my school emphasized that GPs could do a ton of what they refer. My vet school bestie did a TECA her first week on the job.

 

[MixedAnimals77]

With respect to finding faculty for the new (and existing) vet schools: a fair number of my instructors were not diplomates and I think they did a pretty good job of teaching the more practical aspects of the trade. The board-certified were far more likely to be the ones perpetuate the "only specialists will be performing this procedure, but you need to be exposed to it as it may come up on your licensing examination" aspects of the curriculum. I don't think instruction provided by experienced but non-boarded instructors would be quite the disaster some might believe it to be.

Just echoing bats that my board-certified instructors were awesome, I understand not everyone has the same experiences but I do think having board certified instructors is VERY important. Like sure there's certain things I will never do, but my internal med and many other instructors were great champions of learn this so it's 99% worked up before sending it to us and therefore you might not need to send to us because you can do xyz as a GP. As far as instruction I do think certain aspects NEED to be taught by board certified vets. I guarantee you don't want me teaching radiology, but why teach when they can remote work and make bank ya know. One thing I have noticed through distribtive models is some of those grads lack the ability to keep working things up basically up to the gold standard because they lacked exposure on what CAN be done because they're not getting the exposure to the speciality level like they should be. Not saying other grads don't also have those short falls but I find it more apparent with distributive models and less specialist exposure. I also have found that sometimes those students are more "cavalier" in doing something they probably shouldn't be doing that should have 100% been referral only and have seen the bad outcomes of those because that's how so and so did it at x practice.

The problem with saying experienced but non-boarded is who is defining what experienced means? Like my boss is more experienced than I, but I usually run circles around them regarding complex IM cases but I'm not "experienced" by many standards considering I'm only 2 years out. That's where board certification really sets the standard imo.

Unless we lengthen vet school, students will have to continue to pursue their interests for things like TPLO, TTA, etc outside of the standard curriculum. Just like MDs, they can't learn everything in 4 years, why else do they bascially require internship and residency? Vet med is moving in the same direction-not saying it's good or bad, just fact. I got alot of exposure to ultrasound during school because that was an interest so I still do alot of ultrasound in my daily practice, but I also know my limits and when a patient needs more. There's still alot of opportunities for advanced learning in school if one takes it-I can drive a scope and was doing a few advanced surgeries day 1 due to time I spent in my skills lab, but I chose to develop those skills.

 

[MixedAnimals77]

The caveat here is that the majority of the schools won't be able to retain the average DVM either. CSU was offering 90k for an ER doctor about a year ago that has clinical and teaching duties. Yeah, no. If I'm moving my family from Denver to FoCo, it's not for 90k.

This is crazy to me that their ER doc was posted for that...like I make more in podunk town in mixed GP and my living costs are a fraction of FoCo... Out of curiosity I looked at WSU and their large animal surgery/equine lecturer salary is 80-120k, onco&IM positions were 145-190k and it's cheaper to live in Pullman than FoCo. I hope they increased it when they got 0 applicants to be more on par with their other speciality salaries and even have a chance of attracting and retaining someone in the ER field.

 

[EB73674]

Rowan is public, not private. They are building a SA teaching hospital and using local partnerships and ambulatory services for large animal, exotics, etc.

Learn something new every day, I grew up near campus & my mom got her teaching degree there, I always thought it was private! Will update my post to reflect.

 

[TheDogFather]

Just echoing bats that my board-certified instructors were awesome, I understand not everyone has the same experiences but I do think having board certified instructors is VERY important. Like sure there's certain things I will never do, but my internal med and many other instructors were great champions of learn this so it's 99% worked up before sending it to us and therefore you might not need to send to us because you can do xyz as a GP. As far as instruction I do think certain aspects NEED to be taught by board certified vets. I guarantee you don't want me teaching radiology, but why teach when they can remote work and make bank ya know. One thing I have noticed through distribtive models is some of those grads lack the ability to keep working things up basically up to the gold standard because they lacked exposure on what CAN be done because they're not getting the exposure to the speciality level like they should be. Not saying other grads don't also have those short falls but I find it more apparent with distributive models and less specialist exposure. I also have found that sometimes those students are more "cavalier" in doing something they probably shouldn't be doing that should have 100% been referral only and have seen the bad outcomes of those because that's how so and so did it at x practice.

The problem with saying experienced but non-boarded is who is defining what experienced means? Like my boss is more experienced than I, but I usually run circles around them regarding complex IM cases but I'm not "experienced" by many standards considering I'm only 2 years out. That's where board certification really sets the standard imo.

Unless we lengthen vet school, students will have to continue to pursue their interests for things like TPLO, TTA, etc outside of the standard curriculum. Just like MDs, they can't learn everything in 4 years, why else do they bascially require internship and residency? Vet med is moving in the same direction-not saying it's good or bad, just fact. I got alot of exposure to ultrasound during school because that was an interest so I still do alot of ultrasound in my daily practice, but I also know my limits and when a patient needs more. There's still alot of opportunities for advanced learning in school if one takes it-I can drive a scope and was doing a few advanced surgeries day 1 due to time I spent in my skills lab, but I chose to develop those skills.

Yes, everyone will have different experiences, and maybe in some programs things have changed since I graduated 14 years ago. And yes, in a number of cases board certified instructors can be important. Radiology, with its countless variations on normal and all but infinite very subtle abnormalities is one of them. The same with ultrasound. For that reason, radiology is one of the core skills that should be emphasized for all four years. Not just a year, a rotation, and maybe a handful of FAST examinations. Ditto for surgery. There is plenty of room in four years to teach the TPLO, TTA, and so on. It's just not a priority. Somehow the various organizations such as AO, Viticus Center, the NAVC Institute, Sound, WAVE, Sonopath and so on convey a huge amount of practical information in a matter of days. Yes, I know that none of these programs make one a diplomate overnight. No need to tell me that. No one has to buy what I think, but I believe that 90% of our clients would be better served by more focused training in a few areas--reinforced over four years--than by cramming a bunch of the quickly-forgotten, non-clinical trivia conveyed in most of the "-ologies" and being forced into courses in large animal medicine (or, obviously, vice-versa for the large-animal types). For sure those courses are available post-graduation, but they cost thousands to attend and that leaves out lost clinic revenue during your attendance.

More later. Time to head off to the clinic.

 

[battie]

This is crazy to me that their ER doc was posted for that...like I make more in podunk town in mixed GP and my living costs are a fraction of FoCo... Out of curiosity I looked at WSU and their large animal surgery/equine lecturer salary is 80-120k, onco&IM positions were 145-190k and it's cheaper to live in Pullman than FoCo. I hope they increased it when they got 0 applicants to be more on par with their other speciality salaries and even have a chance of attracting and retaining someone in the ER field.

That was the increased rate, sadly. I saw it last year on the DVM moms Facebook page. The clinician advertising it on the page convinced the school their original amount wasn't adequate. Don't know what happened later.

 

[WhtsThFrequency]

Sounds unfortunately about right. Coming in as an assistant professor with specialty certification AND a PhD I started at about 115k. I know people with my credentials started at vet schools at even lower. Compared to a colleague of mine who went industry started at 160.

 

[KCgophervet]

Sounds unfortunately about right. Coming in as an assistant professor with specialty certification AND a PhD I started at about 115k. I know people with my credentials started at vet schools at even lower. Compared to a colleague of mine who went industry started at 160.

Yep. When I started (residency-trained but not yet boarded) I started at 100K. Passing boards got me a 6% raise. Resident-mate who went into industry started at 140K (pre-boards). Academia is not where to land for high salaries, need to find the silver linings (benefits, PSLF, etc)

 

[SV88]

The caveat here is that the majority of the schools won't be able to retain the average DVM either. CSU was offering 90k for an ER doctor about a year ago that has clinical and teaching duties. Yeah, no. If I'm moving my family from Denver to FoCo, it's not for 90k.

More over, I don't understand where this perception that specialties say GPs can't do "advanced" procedures is coming from. I see this in VIN but don't actually see this in real life. I was taught the theory of all sorts of procedures from a variety of specialists. I just didn't get the surgical exposure because 1) I didn't go out of my way to get them and 2) COVID clinics really limited exposure in hospital to begin with. Follow that up with the majority of new vet schools following the distribution model, then it's really up in the air what the exposure is.

The vast majority of the specialists at my school emphasized that GPs could do a ton of what they refer. My vet school bestie did a TECA her first week on the job.

I think part of the restriction of GPs doing more advanced surgeries is the facility supporting it. You need a hospital that's prepared (think instrumentation, blood in case of transfusion for a TECA, staff for post op care, etc). If you're corporate, you can't spend hours doing a procedure you aren't proficient in if you could do 3 COHATs during that time. You also have to have skilled support staff that can scrub in/assist/not contaminate things, especially for ortho, which creates a learning curve and adds more time to the overall procedure. For example, an average 25kg TPLO I can induce, radiograph, prep, move to the OR and be ready for the surgeon to cut in about 40 minutes without complications (epidural space, lookin' at you). I spent 7 years getting quick, and it could be quicker. If you had seen me when I started prepping TPLOs, that was my shave time alone. So that just slows down the whole conveyor belt of the procedure, plus that added time increases anesthetic risk. It's not that GP staff isn't necessarily capable of learning, it's finding the time to build that into a GP schedule that's already hectic. I think that creates a bottleneck between what a general practice vet and team COULD do, and what they realistically CAN do in the time they're given.

 

[JaynaAli]

I think part of the restriction of GPs doing more advanced surgeries is the facility supporting it. You need a hospital that's prepared (think instrumentation, blood in case of transfusion for a TECA, staff for post op care, etc). If you're corporate, you can't spend hours doing a procedure you aren't proficient in if you could do 3 COHATs during that time. You also have to have skilled support staff that can scrub in/assist/not contaminate things, especially for ortho, which creates a learning curve and adds more time to the overall procedure. For example, an average 25kg TPLO I can induce, radiograph, prep, move to the OR and be ready for the surgeon to cut in about 40 minutes without complications (epidural space, lookin' at you). I spent 7 years getting quick, and it could be quicker. If you had seen me when I started prepping TPLOs, that was my shave time alone. So that just slows down the whole conveyor belt of the procedure, plus that added time increases anesthetic risk. It's not that GP staff isn't necessarily capable of learning, it's finding the time to build that into a GP schedule that's already hectic. I think that creates a bottleneck between what a general practice vet and team COULD do, and what they realistically CAN do in the time they're given.

Eh, I agree and disagree. I do agree with your main point that corporate production demands and profitability do influence what people can and are able/willing to do, but where I disagree is that you need lots of special equipment. Sure, bells and whistles are nice and help efficiency, but not strictly necessary when it really comes down to it. I live in a very rural area and my vet friends here do a lot of “advanced” procedures by themselves out of necessity. I’m sure the splenectomy or amputation would be tons easier with cautery but instead they tie off vessels. The only “blood products” they have on hand is the vets own dog who may get grabbed to donate whole blood after the procedure if desperate. Once as a pre-vet I scrubbed in to pinch off the gut manually because the Doyen forceps were broken but the foreign body couldn’t wait. A dedicated anesthesia is almost a luxury at some practices. My best friend’s clinic is just her and a receptionist every day, though for really complicated stuff the clinic owner DVM also comes in to help. But they do these procedures because there is no emergency clinic within two hours and most people can’t afford referral anyway. So they McGuyver through it (after informed consent), because the only options are try or euthanize. But you’re right that a lot of people are not given time to do these things… it’s easy for practices in urban and suburban areas to just pass the patient down the line and maximize profitability and not do these procedures if they (they meaning both clinic and the vets) don’t want to because they don’t have to. Luckily there are still privately owned clinics that may be more open to it than corporate.

 

[battie]

I think part of the restriction of GPs doing more advanced surgeries is the facility supporting it. You need a hospital that's prepared (think instrumentation, blood in case of transfusion for a TECA, staff for post op care, etc). If you're corporate, you can't spend hours doing a procedure you aren't proficient in if you could do 3 COHATs during that time. You also have to have skilled support staff that can scrub in/assist/not contaminate things, especially for ortho, which creates a learning curve and adds more time to the overall procedure. For example, an average 25kg TPLO I can induce, radiograph, prep, move to the OR and be ready for the surgeon to cut in about 40 minutes without complications (epidural space, lookin' at you). I spent 7 years getting quick, and it could be quicker. If you had seen me when I started prepping TPLOs, that was my shave time alone. So that just slows down the whole conveyor belt of the procedure, plus that added time increases anesthetic risk. It's not that GP staff isn't necessarily capable of learning, it's finding the time to build that into a GP schedule that's already hectic. I think that creates a bottleneck between what a general practice vet and team COULD do, and what they realistically CAN do in the time they're given.

In my area (Denver), there are tons of GPs doing these procedures without issue. Hence why I don't understand this perception that GPs are being purposely taught they shouldn't be doing these procedures. That's just not the reality. I can name several GPs in Denver I refer clients to from my ER if specialty isn't an option (my ER is stand-alone, not attached to a referral center). A TPLO is worth 2.5-3.5x the average COHAT and definitely doesn't take 2.5-3.5x as long with a proficient surgeon and team, which most of these folks are.

Your points have merits. It just so happens that there are a ton of GPs that do these procedures already because they like surgery and put forth the time and money to learn these skills along with their teams.

I'll also add that learning these skills and getting the equipment is definitely sellable to corporate entities. Again, if a TPLO is worth 3.5x what a COHAT is and takes 1.5 COHAT amount of time, it pays for itself eventually. Just like any other CE and equipment expense (ultrasound being a great example)

 

[SV88]

Eh, I agree and disagree. I do agree with your main point that corporate production demands and profitability do influence what people can and are able/willing to do, but where I disagree is that you need lots of special equipment. Sure, bells and whistles are nice and help efficiency, but not strictly necessary when it really comes down to it. I live in a very rural area and my vet friends here do a lot of “advanced” procedures by themselves out of necessity. I’m sure the splenectomy or amputation would be tons easier with cautery but instead they tie off vessels. The only “blood products” they have on hand is the vets own dog who may get grabbed to donate whole blood after the procedure if desperate. Once as a pre-vet I scrubbed in to pinch off the gut manually because the Doyen forceps were broken but the foreign body couldn’t wait. A dedicated anesthesia is almost a luxury at some practices. My best friend’s clinic is just her and a receptionist every day, though for really complicated stuff the clinic owner DVM also comes in to help. But they do these procedures because there is no emergency clinic within two hours and most people can’t afford referral anyway. So they McGuyver through it (after informed consent), because the only options are try or euthanize. But you’re right that a lot of people are not given time to do these things… it’s easy for practices in urban and suburban areas to just pass the patient down the line and maximize profitability and not do these procedures if they (they meaning both clinic and the vets) don’t want to because they don’t have to. Luckily there are still privately owned clinics that may be more open to it than corporate.

I think the rural communities are a different ballgame, and I wish more training was done for veterinary students on what other options you have with procedures or even diagnostics. Yes, it's ideal to have the Doyens and yes it's ideal to have blood, which some GPs can access or will have available. But other practices, including in low income areas of cities, don't have that. My instrumentation comment was more towards orthopedics procedures (TPLOs, TTAs, etc) where you need very specific tools that are costly, nitrogen gas vs power tools, it's still a decent up front cost. And then cost of a range of implants can be giant, for example what if you think you can use a 3.5 regular when you plan, but in reality you need a 3.5 mini TPLO plate?

 

[SV88]

In my area (Denver), there are tons of GPs doing these procedures without issue. Hence why I don't understand this perception that GPs are being purposely taught they shouldn't be doing these procedures. That's just not the reality. I can name several GPs in Denver I refer clients to from my ER if specialty isn't an option (my ER is stand-alone, not attached to a referral center). A TPLO is worth 2.5-3.5x the average COHAT and definitely doesn't take 2.5-3.5x as long with a proficient surgeon and team, which most of these folks are.

Your points have merits. It just so happens that there are a ton of GPs that do these procedures already because they like surgery and put forth the time and money to learn these skills along with their teams.

I'll also add that learning these skills and getting the equipment is definitely sellable to corporate entities. Again, if a TPLO is worth 3.5x what a COHAT is and takes 1.5 COHAT amount of time, it pays for itself eventually. Just like any other CE and equipment expense (ultrasound being a great example)

I'm not saying they're unable to do it. I'm just saying doing procedures like this in GP require more than just the veterinarian's willingness to perform or to learn the procedures. I've worked in various GP settings, some privately owned, and while you have more leeway there with advancing skills it's still a big picture situation. It's not just the DVM, it's the whole team, and if you have a green team it will take longer up front to train them. If you're in a corporation, gooooood luck. I worked at a Banfield once where the DVM got crap from the PM because a dental that ended up as half the mouth needing extractions took all morning and she couldn't see patients. They defined success as pet count, not income or patient care. I think a DVM will have a harder time advancing skills in corporate settings, but honestly if you want to do procedures like that you probably won't seek out a big corporation for long term anyway. It's the same Banfield that she had to put up a strong argument to get hydromorphone, so it might have been a one off (it's the only Banfield I've worked at).

 

[battie]

I'm not saying they're unable to do it. I'm just saying doing procedures like this in GP require more than just the veterinarian's willingness to perform or to learn the procedures. I've worked in various GP settings, some privately owned, and while you have more leeway there with advancing skills it's still a big picture situation. It's not just the DVM, it's the whole team, and if you have a green team it will take longer up front to train them. If you're in a corporation, gooooood luck. I worked at a Banfield once where the DVM got crap from the PM because a dental that ended up as half the mouth needing extractions took all morning and she couldn't see patients. They defined success as pet count, not income or patient care. I think a DVM will have a harder time advancing skills in corporate settings, but honestly if you want to do procedures like that you probably won't seek out a big corporation for long term anyway. It's the same Banfield that she had to put up a strong argument to get hydromorphone, so it might have been a one off (it's the only Banfield I've worked at).

Banfield specifically as a corporate has a very specific model to be profitable while also relatively inexpensive. Folks like NVA and VCA don't function the same and are more hands off in my experience when it comes to day to day functions. Banfield is quite likely the most restricted. Your local and regional management makes all the difference in the world as well. My friend who did a TECA her first week after graduation did so at a NVA hospital.

All but one of the GPs I know doing these procedures are all in VCA, NVA, etc. corporate clinics/hospitals. The private practices in my area are really no worse or better based on my interviews with them. One was my worst offer; 85k in Denver with no benefits and the old doc retiring in 6 months. The new owner was a tech with no business experience whatsoever.

According to a local newspaper (just googled it cause I'm home sick with the stomach flu), 80% of the clinics in the Denver Metro Area are corporate. That number doesn't shock me at all. Nationwide, it's around 10% for GPs and 40% for referral practices, which is lower than I anticipated based on the freak out over the corporatization of vet med. The AVMA article is pretty interesting, actually. Goes into detail on why certain private practices are picked to be purchased. 1.2mil in revenue seems to be the sweet spot.

I agree overall that there are a lot of hurdles to a GP getting started with advanced procedures/diagnostics. I just disagree that corporations are adverse to setting up based on working in corporate hospitals with these set ups.

 

[SV88]

Banfield specifically as a corporate has a very specific model to be profitable while also relatively inexpensive. Folks like NVA and VCA don't function the same and are more hands off in my experience when it comes to day to day functions. Banfield is quite likely the most restricted. Your local and regional management makes all the difference in the world as well. My friend who did a TECA her first week after graduation did so at a NVA hospital.

All but one of the GPs I know doing these procedures are all in VCA, NVA, etc. corporate clinics/hospitals. The private practices in my area are really no worse or better based on my interviews with them. One was my worst offer; 85k in Denver with no benefits and the old doc retiring in 6 months. The new owner was a tech with no business experience whatsoever.

According to a local newspaper (just googled it cause I'm home sick with the stomach flu), 80% of the clinics in the Denver Metro Area are corporate. That number doesn't shock me at all. Nationwide, it's around 10% for GPs and 40% for referral practices, which is lower than I anticipated based on the freak out over the corporatization of vet med. The AVMA article is pretty interesting, actually. Goes into detail on why certain private practices are picked to be purchased. 1.2mil in revenue seems to be the sweet spot.

I agree overall that there are a lot of hurdles to a GP getting started with advanced procedures/diagnostics. I just disagree that corporations are adverse to setting up based on working in corporate hospitals with these set ups.

Not disagreeing with you in any way, just my own perspectives and experiences. 100% agree that the local and regional management is the biggest factor in what a DVM can or can't pursue. I'm of the mind that if my dogs need a surgery, they're going to a specialist. But I'm in a large metro area and have been in the field for 17 years, so I know that specialty medicine exists and it's my personal preference. In rural areas of my state, there isn't a specialist available within a 5 hour drive. Other families can't afford it. There's definitely a market for GPs doing some advanced procedures, and a financial benefit to the hospital if the DVM is proficient doing them. But I think if a GP is going to do surgery on a specialty level, they should be taught by boarded surgeons (as they are if they go to a course at Arthrex or attend a lab at ACVS).

 

[battie]

I'm of the mind that if my dogs need a surgery, they're going to a specialist.

Same. My Pittie needed bilateral TPLOs last summer. I drove down to Colorado Springs for a specialist there to do it, skipping every single GP up here that does them. I've only seen bad work from one of these GPs on a regular basis by being his nearby ER. The other folks are great. But I was spending thousands over the course of the summer; I wanted my biggest risk to her being the development of osteosarc at a surgery site in 5 years rather than a malunion or failed plate.

But I think if a GP is going to do surgery on a specialty level, they should be taught by boarded surgeons (as they are if they go to a course at Arthrex or attend a lab at ACVS).

I think this is reasonable too, tbh. There's a thread on VIN right now discussing what sort of training a GP can do as far as advanced procedures. The OP is a very recent grad with a lot of enthusiasm, but unrealistic parameters; he wanted to learn hemilams via videos and textbooks essentially. He was overwhelmingly told across the board (fellow GPs and boarded folks alike) that if he wants to do that level of surgery, he should go the residency route.

 

[SV88]

Same. My Pittie needed bilateral TPLOs last summer. I drove down to Colorado Springs for a specialist there to do it, skipping every single GP up here that does them. I've only seen bad work from one of these GPs on a regular basis by being his nearby ER. The other folks are great. But I was spending thousands over the course of the summer; I wanted my biggest risk to her being the development of osteosarc at a surgery site in 5 years rather than a malunion or failed plate.

I think this is reasonable too, tbh. There's a thread on VIN right now discussing what sort of training a GP can do as far as advanced procedures. The OP is a very recent grad with a lot of enthusiasm, but unrealistic parameters; he wanted to learn hemilams via videos and textbooks essentially. He was overwhelmingly told across the board (fellow GPs and boarded folks alike) that if he wants to do that level of surgery, he should go the residency route.

I hope your pup did well! We have two little senior dogs with cardiac disease, and my 16 year old has exclusively been managed by cardiologists since she was diagnosed. I just wish specialty care was more accessible to people (both with physical and financial barriers).

I think that's the tricky part, harnessing the enthusiasm but also instilling a sense of "this needs to be referred." First do no harm....

 

[TheDogFather]

Just echoing bats that my board-certified instructors were awesome, I understand not everyone has the same experiences but I do think having board certified instructors is VERY important. Like sure there's certain things I will never do, but my internal med and many other instructors were great champions of learn this so it's 99% worked up before sending it to us and therefore you might not need to send to us because you can do xyz as a GP. As far as instruction I do think certain aspects NEED to be taught by board certified vets. I guarantee you don't want me teaching radiology, but why teach when they can remote work and make bank ya know. One thing I have noticed through distribtive models is some of those grads lack the ability to keep working things up basically up to the gold standard because they lacked exposure on what CAN be done because they're not getting the exposure to the speciality level like they should be. Not saying other grads don't also have those short falls but I find it more apparent with distributive models and less specialist exposure. I also have found that sometimes those students are more "cavalier" in doing something they probably shouldn't be doing that should have 100% been referral only and have seen the bad outcomes of those because that's how so and so did it at x practice.

The problem with saying experienced but non-boarded is who is defining what experienced means? Like my boss is more experienced than I, but I usually run circles around them regarding complex IM cases but I'm not "experienced" by many standards considering I'm only 2 years out. That's where board certification really sets the standard imo.

Unless we lengthen vet school, students will have to continue to pursue their interests for things like TPLO, TTA, etc outside of the standard curriculum. Just like MDs, they can't learn everything in 4 years, why else do they bascially require internship and residency? Vet med is moving in the same direction-not saying it's good or bad, just fact. I got alot of exposure to ultrasound during school because that was an interest so I still do alot of ultrasound in my daily practice, but I also know my limits and when a patient needs more. There's still alot of opportunities for advanced learning in school if one takes it-I can drive a scope and was doing a few advanced surgeries day 1 due to time I spent in my skills lab, but I chose to develop those skills.

Now, where were we? I took me a few days to reply because an older, established local vet suddenly retired due to health problems and we have been snowed under with his former clients.

Right, certain topics will benefit from being taught by diplomates. Radiology, internal medicine, clinical pathology, a couple others. Since surgery experience is so limited in vet school (spays/neuters, abdominal exploratoriums, maybe a resection and anastomosis if a school is still doing terminal surgeries (I opted out of those)) I don't think you'd have to search high and low to find a competent vet who wants to pocket a few dollars teach those. As far as spay/neuters--I'll bet some of the HQHVSN programs would jump at the chance to bring their efficiencies and enthusiasm for the procedures to the schools. Then there is distance instruction. Can't find boarded radiologists to fill your slots? Perhaps, if the price was right, a handful of DACVRs (retired, looking for something new, etc.) could lecture from home. Radiology is not very hands-on (until you get to the interventional stuff). Then, you place high-definition cameras in every dark room and have students watch every interpretation done by a freshly-scrubbed, apple-cheeked first year resident on up to the instructors. Ditto for cytology. No room in the curriculum? You chuck a lot of the brute-force memorization "-ologies" and the large (or small) animal requirements. With all due respect for the anatomical pathologists on board (in my wildest veterinary dreams I cannot conceive of digesting the vast amount of material you all do) learning about "the disease process" and staring at decades-old professionally prepared slides hardly pays off clinically.

I myself thought the "island students" (there were no distributive programs when I was a fourth year) were a lot more practical and "can-do" than we stateside folks. I recall during one review or another, one of the few positive things the instructor was able to say about me (and she probably had to really reach to find it!) was that no faculty member ever had to worry about trying to attempt something I had no business doing. That lead me to think that there were those among us that were less clever than their GPAs and evaluations lead them to believe. As far as 100% referral cases--I think that will vary from vet to vet.

The DVM vs. MD training? To me they are so different that it is pointless to address the supposed pros/cons. Obviously you cannot be taught everything in four years, but lengthening the school year? No. You prioritize what ails our patients the most. Lameness, skin problems. ophthalmic concerns, dental disease and work through those. To stick with the TPLO procedure, for example, you start early on integrating stifle disease with anatomy. Teach one or two of the various lateral suture procedures, then the TTA, then the TPLO. Then, you have groups of students right there in the surgery suite--not standing behind a six-foot tall resident--but right there at the edge of the table watching every move they make, see the complications they encounter, and hear every swear word they utter. Bring in a sonographer to teach the basics of ultrasound. You don't need a diplomate for that.

It would be interesting to hear how you are outperforming a more experience vet. Not that it can't be done. It seems to me that after a year or two we are all pretty much at the same level unless you take a particular interest in dentistry, orthopedics, whatever. Are you doing more diagnostics that perhaps experience has taught the other doc are more than likely unnecessary? Our clinic has an entry-level slit lamp biomicroscope. I am somewhat handy with it but still have a lot to learn. Just because I have one and no other clinic in town seems to, am I leaving other local vets in the dust?

You also mentioned doing some more advanced surgeries on Day 1, after learning some skills in the lab. Is that consistent with how you feel about the necessity of an internship and a residency?

 

[TheDogFather]

In my area (Denver), there are tons of GPs doing these procedures without issue. Hence why I don't understand this perception that GPs are being purposely taught they shouldn't be doing these procedures. That's just not the reality. I can name several GPs in Denver I refer clients to from my ER if specialty isn't an option (my ER is stand-alone, not attached to a referral center). A TPLO is worth 2.5-3.5x the average COHAT and definitely doesn't take 2.5-3.5x as long with a proficient surgeon and team, which most of these folks are.

Your points have merits. It just so happens that there are a ton of GPs that do these procedures already because they like surgery and put forth the time and money to learn these skills along with their teams.

You are 100% right. No one is explicitly telling GPs that they cannot perform these procedures. However, GPs are implicitly discouraged from doing so because these surgeries receive scant attention in the typical curriculum. Sure, they get batted around a lot as being the (and I choke as I type this) "gold standard" for stifle repair. Maybe they are, and maybe your training was more hands-on than mine but the extent of my exposure to the TPLO was maybe a fifteen minute drive-by during a more broad series of three or four lectures on orthopedics. And yes, it got the "specialist only" asterisk. I do recall watching two residents prepare for one by messing about with some planning software but that was it. We did observe a single TPLO but we did so behind the residents, interns, and assisting technicians. All I remember is the clever design of the screwdriver that allowed the surgeon to pick up the screws from the screw rack.

I went on to pursue a good amount of training in orthopedics. Tackling the TPLO is next. It hasn't been cheap. Whenever I travel to a continuing education event (and these are not the mega-conventions where you register for $500-$600, hit 30 or 40 fifty-minute lectures, maybe run a 5K or participate in a golf outing (I am neither a Tiger Woods wannabe or an Ethiopian goat herder so I just sit by the pool) and listen to some B- or C-list celebrity prattle on about how they wanted to be a vet but couldn't do what we do so they went Hollywood) it costs me from $2,500 to $5,000 all before travel/lodging and the clinic revenue is lost during my absence. Sure you can make it back in time but it is significant hit. It would have been nice if my tuition dollars had gone toward this training rather than sitting through canned lectures on bacteria and viruses.

I just came back from some concentrated training at the NAVC institute in Orlando. Back in October I attended the Veterinary Dental Forum in Louisville. The number of younger vets at both of these events who wondered aloud "where was this when I was in school?" was telling. At the dental forum, the most heavily attended lab sessions were those on extractions--at which any vet should be proficient given the supposed prevalence of dental disease in dogs and cats. When you get into the marginally more advanced topics, you are almost always softly warned that "if you attempt these procedures be aware that you could be judged the same way a specialist would." I get that but it hardly encourages one to even think about trying to bring better care to more pet owners. The older vets bemoan the lack of interest they see in younger doctors in pursuing more advanced training. Feel free to label that sentiment as old men yelling at the clouds, but it is coming from somewhere. Fear of having "THE BOARD" come down on you, getting a bad online review, or "losing your license" seems pretty pervasive.

Clients seem to take a lot of grief for shortcomings in our training. Their expectations are too high? Why wouldn't they be when they are regularly read that it is harder to get into vet school than med school and we have to learn about so many species vs. MDs and their lone charges. Like another poster above, I know that the "Real Doctors Treat More Than One Species" t-shirt is a cutesy novelty but when that cliche becomes a mainstay in defending our prices and skill levels, its hardly surprising that a significant number of pet owners might buy into it.

 

[JaynaAli]

Right, certain topics will benefit from being taught by diplomates. Radiology, internal medicine, clinical pathology, a couple others.?

These are the exact specialties that are ALREADY struggling to fill positions in academia, even without adding 14 new programs into the mix. There are several schools without radiologists (or at least there were fairly recently). Schools that used to have 3-4 clinical pathologist positions have often downsized to one or two. We had a whole discussion panel at ACVP conference in October literally titled “The Exodus of Pathologists from Academia”…let’s just say the discussion was pretty bleak and even aside from pay issues, the rampant mental and sexual abise, and lack of respect are also consistently mentioned “pain points”. Probably a more immediate issue we talked about at the panel was who is going to train residents in these specialties if there isn’t anyone left in academia, but who is going to teach students is the natural step after that.

You raise fair points about remote instruction and honestly that’s probably going to be a realistic thing places have consider. But also, the “old retired folk” are extremely knowledgeable, but I’ve interacted with some that seem to stop reading new literature and don’t keep up on the new knowledge, so that also isn’t always good. I still respect them as doctors and for their contributions, but I wouldn’t necessarily want them being the only educator for large groups of people.

 

[DVMDream]

I think part of the restriction of GPs doing more advanced surgeries is the facility supporting it. You need a hospital that's prepared (think instrumentation, blood in case of transfusion for a TECA, staff for post op care, etc). If you're corporate, you can't spend hours doing a procedure you aren't proficient in if you could do 3 COHATs during that time. You also have to have skilled support staff that can scrub in/assist/not contaminate things, especially for ortho, which creates a learning curve and adds more time to the overall procedure. For example, an average 25kg TPLO I can induce, radiograph, prep, move to the OR and be ready for the surgeon to cut in about 40 minutes without complications (epidural space, lookin' at you). I spent 7 years getting quick, and it could be quicker. If you had seen me when I started prepping TPLOs, that was my shave time alone. So that just slows down the whole conveyor belt of the procedure, plus that added time increases anesthetic risk. It's not that GP staff isn't necessarily capable of learning, it's finding the time to build that into a GP schedule that's already hectic. I think that creates a bottleneck between what a general practice vet and team COULD do, and what they realistically CAN do in the time they're given.

I think the bigger restriction to GPs doing a wide variety of more specialized procedures is the potential for a board complaint. There are numerous stories of a GP agreeing to try a procedure they don't do, haven't done, etc because the owner can't afford referral. The GP has warned the owner 5,000 different ways that they will try but aren't proficient, a-z may go wrong, have had the owner sign off on this information and despite all of that, they are still disciplined by the board for proceeding forward with the procedure.

 

[battie]

I hope your pup did well! We have two little senior dogs with cardiac disease, and my 16 year old has exclusively been managed by cardiologists since she was diagnosed. I just wish specialty care was more accessible to people (both with physical and financial barriers).

I think that's the tricky part, harnessing the enthusiasm but also instilling a sense of "this needs to be referred." First do no harm....

She did do great! Can't even tell she has the new knees with how crazy she is in the backyard. 🤣

The balance of referral vs trying is definitely difficult. My home hospital is in the middle of a divergence of well to do and straight homeless folks. On any given overnight, I could do an enucleation for a lawyer and then a parvo puppy from a homeless encampment. Kinda wild compared to the two other hospitals in our group tbh. I always verbally and document the offer for referral. Whether or not they take it is up to them. Sometimes they do (incidental splenic mass found looking for rocks) vs they don't (donated euthanasias my hospital pays for out of pocket).

You are 100% right. No one is explicitly telling GPs that they cannot perform these procedures. However, GPs are implicitly discouraged from doing so because these surgeries receive scant attention in the typical curriculum. Sure, they get batted around a lot as being the (and I choke as I type this) "gold standard" for stifle repair. Maybe they are, and maybe your training was more hands-on than mine but the extent of my exposure to the TPLO was maybe a fifteen minute drive-by during a more broad series of three or four lectures on orthopedics. And yes, it got the "specialist only" asterisk. I do recall watching two residents prepare for one by messing about with some planning software but that was it. We did observe a single TPLO but we did so behind the residents, interns, and assisting technicians. All I remember is the clever design of the screwdriver that allowed the surgeon to pick up the screws from the screw rack.

I went on to pursue a good amount of training in orthopedics. Tackling the TPLO is next. It hasn't been cheap. Whenever I travel to a continuing education event (and these are not the mega-conventions where you register for $500-$600, hit 30 or 40 fifty-minute lectures, maybe run a 5K or participate in a golf outing (I am neither a Tiger Woods wannabe or an Ethiopian goat herder so I just sit by the pool) and listen to some B- or C-list celebrity prattle on about how they wanted to be a vet but couldn't do what we do so they went Hollywood) it costs me from $2,500 to $5,000 all before travel/lodging and the clinic revenue is lost during my absence. Sure you can make it back in time but it is significant hit. It would have been nice if my tuition dollars had gone toward this training rather than sitting through canned lectures on bacteria and viruses.

I just came back from some concentrated training at the NAVC institute in Orlando. Back in October I attended the Veterinary Dental Forum in Louisville. The number of younger vets at both of these events who wondered aloud "where was this when I was in school?" was telling. At the dental forum, the most heavily attended lab sessions were those on extractions--at which any vet should be proficient given the supposed prevalence of dental disease in dogs and cats. When you get into the marginally more advanced topics, you are almost always softly warned that "if you attempt these procedures be aware that you could be judged the same way a specialist would." I get that but it hardly encourages one to even think about trying to bring better care to more pet owners. The older vets bemoan the lack of interest they see in younger doctors in pursuing more advanced training. Feel free to label that sentiment as old men yelling at the clouds, but it is coming from somewhere. Fear of having "THE BOARD" come down on you, getting a bad online review, or "losing your license" seems pretty pervasive.

Clients seem to take a lot of grief for shortcomings in our training. Their expectations are too high? Why wouldn't they be when they are regularly read that it is harder to get into vet school than med school and we have to learn about so many species vs. MDs and their lone charges. Like another poster above, I know that the "Real Doctors Treat More Than One Species" t-shirt is a cutesy novelty but when that cliche becomes a mainstay in defending our prices and skill levels, its hardly surprising that a significant number of pet owners might buy into it.

While I see where you're coming from, I don't necessarily agree on the practicality or the feasibility.

Do I think there needs to be curricula remodeling? Absolutely. I think the 3 years didactic and 1 year of clinics is outdated. Human med schools do 2 years each and Mizzou and Mississippi follow those tracts now. Having more clinical exposure in the curriculum where you actually get something out of it would be better. I went to Illinois where we have the 8 week quarters, one of which is spent in clinics during 1st and 2nd year. Nope, wasn't worth it. The didactic portion was accelerated as a result anyways. Just put those clinical weeks through third year.

Should everyone still rotate through everything at least once? Yes. The main premise as to why we don't have separate licensing is the "what if" we have a disease outbreak or bioterrorist attack that affects the majority of a production species. There aren't enough large/mixed animal vets between the private and public sectors to be able to handle that kind of scenario. So they would pull from the small animal pool like they did for mad cow in the UK. I'm not a proponent of split/separate licensing mainly for that kind of scenario. Likewise, having split licensing prevents people from easily going from one species to another if necessary.

I'm not here to compare the MD vs DVM route per se (depth vs breadth basically, which I think we can all agree on). But the reason human cardiologists can. Run laps around a human gastroenterologist (and vice versa) is because of the "-ologies". They are the experts in the diseases and pathophysiology of their specific areas and they specifically treat these cases so well because they have such an indepth understanding. There's a discussion over on the human ER side of SDN where there's a concern human med students going into residency aren't as good as they can be because they're missing the -ologies part of their education for whatever reason. By not understanding the pathophys of a disease process, you're just utilizing pattern recognition; you're not actually doctoring. Sure, it works 60-70% of the time (grade 2/3 lameness for a dog, 2 weeks rest and some carprofen, here you go). But the other 30-40% of the cases, you're missing something, and your patients are worse off for it.

Finally, getting people to teach. Unless someone is actually in academia, I don't think we truly understand how hard it is to get someone to go to a school to teach, even a GP teaching a GI surgery lab. The vet schools have an average class size of 100 (some as low as 70 or 80, others as high as 160; we're not even going to touch on the island schools). Ideally, youd have 2-4 students per GP per cadaver. That's 25-50 GPs with 25-50 cadavers for one lab in an ideal circumstance. Obviously you would do as many procedures as possible (gastrostomy, enterotomy, RnA, splenectomy, biopsies, maybe a nephrectomy if you have time, and spay/neuter cause why not). This is going to be hours of lab time both from the perspective of prep and execution. Even though it sounds like a pretty doable proposition, it's really not. Good luck getting 25-50 cadavers for one lab; I'm not kidding. Both financially and logistically, it's a struggle for schools to get cadavers for anything due to changes in perceptions of the students (terminal surgeries out the window, purchasing live animals just to be cadavers, etc.), the cost of supplies, etc. The majority of our cadavers were donated animals from clients. And so labs were limited to 15-20 people. And then it's getting 25-50 GPs to come in and teach, which maybe the most doable part. Maybe. Even if it's two local GPs that come in once a week for the whole school year, that's a stretch for some people (gives you 64 total labs though) due to personal schedules. Most vet schools are in small cities where there are 10 or fewer other clinics. Then do this for every other surgery type (orthopedics, lacerations and wound management, etc.).

Getting people to teach full time is a whole other ball game as well. Even if it's distance learning (radiologist, clin path), the income isn't going to be worth it for a ton of people, not when private practice is so much better. Likewise, there's not a lot of ways to fix this without forcing schools to open their books and show how money is being spent and where. And in student town halls, deans are very cagey on answering that question. Until students start to say enough is enough in regards to what it costs to become a vet, the schools won't have that incentive.

 

[MixedAnimals77]

Now, where were we? I took me a few days to reply because an older, established local vet suddenly retired due to health problems and we have been snowed under with his former clients.

Right, certain topics will benefit from being taught by diplomates. Radiology, internal medicine, clinical pathology, a couple others. Since surgery experience is so limited in vet school (spays/neuters, abdominal exploratoriums, maybe a resection and anastomosis if a school is still doing terminal surgeries (I opted out of those)) I don't think you'd have to search high and low to find a competent vet who wants to pocket a few dollars teach those. As far as spay/neuters--I'll bet some of the HQHVSN programs would jump at the chance to bring their efficiencies and enthusiasm for the procedures to the schools. Then there is distance instruction. Can't find boarded radiologists to fill your slots? Perhaps, if the price was right, a handful of DACVRs (retired, looking for something new, etc.) could lecture from home. Radiology is not very hands-on (until you get to the interventional stuff). Then, you place high-definition cameras in every dark room and have students watch every interpretation done by a freshly-scrubbed, apple-cheeked first year resident on up to the instructors. Ditto for cytology. No room in the curriculum? You chuck a lot of the brute-force memorization "-ologies" and the large (or small) animal requirements. With all due respect for the anatomical pathologists on board (in my wildest veterinary dreams I cannot conceive of digesting the vast amount of material you all do) learning about "the disease process" and staring at decades-old professionally prepared slides hardly pays off clinically.

I myself thought the "island students" (there were no distributive programs when I was a fourth year) were a lot more practical and "can-do" than we stateside folks. I recall during one review or another, one of the few positive things the instructor was able to say about me (and she probably had to really reach to find it!) was that no faculty member ever had to worry about trying to attempt something I had no business doing. That lead me to think that there were those among us that were less clever than their GPAs and evaluations lead them to believe. As far as 100% referral cases--I think that will vary from vet to vet.

The DVM vs. MD training? To me they are so different that it is pointless to address the supposed pros/cons. Obviously you cannot be taught everything in four years, but lengthening the school year? No. You prioritize what ails our patients the most. Lameness, skin problems. ophthalmic concerns, dental disease and work through those. To stick with the TPLO procedure, for example, you start early on integrating stifle disease with anatomy. Teach one or two of the various lateral suture procedures, then the TTA, then the TPLO. Then, you have groups of students right there in the surgery suite--not standing behind a six-foot tall resident--but right there at the edge of the table watching every move they make, see the complications they encounter, and hear every swear word they utter. Bring in a sonographer to teach the basics of ultrasound. You don't need a diplomate for that.

It would be interesting to hear how you are outperforming a more experience vet. Not that it can't be done. It seems to me that after a year or two we are all pretty much at the same level unless you take a particular interest in dentistry, orthopedics, whatever. Are you doing more diagnostics that perhaps experience has taught the other doc are more than likely unnecessary? Our clinic has an entry-level slit lamp biomicroscope. I am somewhat handy with it but still have a lot to learn. Just because I have one and no other clinic in town seems to, am I leaving other local vets in the dust?

You also mentioned doing some more advanced surgeries on Day 1, after learning some skills in the lab. Is that consistent with how you feel about the necessity of an internship and a residency?

I think several others have already addressed alot of this in one form or another. I mean for sure MD and DVM training cannot be 100% equivelated and sure structure could use change, but as Bats stated I do think there is something to be said for exposure to all the fields and what can and can't be done.

As far as "outperforming" it comes down to skill set and strengths/where intersts lie and keeping up on CE . I was very specific to say running circles around them regarding IM cases for a reason. Hence defining what qualifies as experienced and quality enough to teach and keeping things to a certain standard. For example they are great with orthopedics, they do extracapsular procedures, pins, and such. I'm not one that cares much for orthopedics. TBH having to learn TPLOs is not my definition of fun and I'm glad I can work them up then refer those out or to them for sx. Meanwhile their IM skills haven't quite kept up as much. At this point they mainly only do surgery and covers appointments only when they have to. hardly recommending confirmatory hypothyroid testing vs just starting, missing 4dx testing on an adr with a hx of travel to AZ and KS, and they don't feel comfortable with advanced things that you can do in house such as liver aspirates and some focal US, those skills just aren't in their wheel house. That being said, I would trust them to treat my animals if needed, compared to many people because while there are some gaps they do a good job and who doesnt have knowledge gaps. Meanwhile you can also take the practitioner that's down the road that probably shouldn't even have a license at this point that treats everything with steroids, vit B complex, and baytril, but you could argue they're more experienced because they've been out of school forever. My point being is to maintainin that level of standardization as best we can because not every GP is qualified to be teaching, and the question becomes how do you to that. However, yes things like S/N area already taught in alot of places by HQHVSN people. I'm not against some GPs helping teach certain subjects, but there needs to be a way to maintain standards depending what position you're planning on putting them in and your original statement did not define which subjects would be gp vs specialist. However, finding GPs to teach is still a challenge in itself-$, dealing with the bureacy, and let alone sometimes dealing with the students themselves. I had the opportunity to teach an assistant couse at the local community college and said hard pass for all the reasons above.

I don't quite understand your last question...I'm saying GP day 1 can be doing things like cherry eye replacement,GDV, traumatic DH repair, spleenectomy, RnA, gastropexy, apendage amputation, enucleation, cystotomy all learned extra on my own via me putting myself in those learning positions. Alot of job applicants we are getting that are new grads, we are lucky if they have done 1 spay or 1 neuter before graduating. As far as the necessity of internship and residency, 100% for those that want to specialize and should be required, I am never going to be doing hemis or cataract sx. If you're talking about for a GP position I don't think it's necessarily 100% necessary the way things are currently structured, but could some people benefit from it,100%.

As for distance learning, sure it's for some, but I personally felt my learning lacked during distance learning and many classmates felt the same. IF Navle scores are any reflection of forced distance learning, then it is certainly inferior, but correlation is still tbd on that front

 

[battie]

Going to add here:

ll learned extra on my own via me putting myself in those learning positions. Alot of job applicants we are getting that are new grads, we are lucky if they have done 1 spay or 1 neuter before graduating.

I originally had zero intention of doing any surgery or dentistry. I was going into a GP/ER clinic with 7 other doctors, 3 of which loves dentistry (including a boarded dentist) and 5 of which loved surgery (including 2 dudes with multiple internships, one of which is now in surgery residency). I really didn't have an interest in surgery as a student or a new grad. So I never went out of my way to learn these skills in school.

Now I do surgery to be helpful, not because I enjoy it. And I'm really only comfortable with gastrotomy and enterotomy. I'm not even really comfy with spays any more. Id do a GDV because that's truly an emergent situation of you do it or it dies. Our head assistant has saved me a 90lb intact dog to practice with my next overnight at that hospital. I'll essentially be teaching myself RnA, a spay, and splenectomy that night.

If you're talking about for a GP position I don't think it's necessarily 100% necessary the way things are currently structured, but could some people benefit from it,100%.

Yeah, until internships pay the same as GP out the gate, absolutely should not and cannot be a requirement.

but I personally felt my learning lacked during distance learning and many classmates felt the same.

I feel like there was a significant bump in students who did internships due to COVID clinics. Something like a third of my class did an internship and fewer than a third of them went on for further education. It was purely due to distance learning.

F Navle scores are any reflection of forced distance learning, then it is certainly inferior, but correlation is still tbd on that front

This will be interesting to see. I honestly feel the NAVLE is disconnected from real life now (why are the radiographs still film?!?!?!) despite input from currently practicing doctors. Blows my mind. Unlike human med, I don't think we have any data on how people do in school compared to their NAVLE score, whereas MD/DO programs do for their step scores. And are the students doing poorly on NAVLE the same students who had lower undergrad parameters? I know I fit all those boxes: 3.3cgpa for undergrad, last person in my class, score ~450 in NAVLE. Obviously isn't about individuals but population data, but would be interesting to know.

There are plenty of doctors on VIN that deplore that incoming students don't have real world experience in vet med, when all of us here know that's pretty inaccurate. Likewise, if we're going to prioritize more subjective parameters (hours, essays, letters, etc.) other factors become less important (grades). Have schools swung too far one way and it's showing up down the road in NAVLE scores? Who knows. I think the attrition rates of schools shows that better.

 

[SV88]

There are plenty of doctors on VIN that deplore that incoming students don't have real world experience in vet med, when all of us here know that's pretty inaccurate. Likewise, if we're going to prioritize more subjective parameters (hours, essays, letters, etc.) other factors become less important (grades). Have schools swung too far one way and it's showing up down the road in NAVLE scores? Who knows. I think the attrition rates of schools shows that better.

I am of the camp where incoming students do not have enough experience, but for me it's the mental health side of things. If vet schools keep accepting 50% or more of the class still in/straight from undergrad with 100 hours of experience and a 4.0, you're ensuring that student will get through your program but you're not ensuring that student is fully understanding the realities of the job they're signing their life away for (debt-wise). It makes me nuts, because yes clinical rotations are super helpful but they also are not the reality for 80% of those students. I just wish more incoming students did have experiences, in the real world, with difficult clients and crappy cases. It's been a long time since I worked in GP (except a short stint at a Banfield in 2018), but I also felt the shadowing students were shielded from some of the struggles that the DVMs were dealing with (Dr. Smith, Tony Green called about his 18 year old laterally recumbent cat for the third time today and berated the CSR because he didn't want to bring it in). From client situations to cases that the owner elected to euthanize after refusing to surrender it (8 month old puppy femur fracture that the owner "didn't want anyone else owning her"). I just think that aspect of the job is missing for people until they're already in practice, and that sucks for the veterinarian.