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NY Times article on vet med profession

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DVMDream

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This post demonstrates a fundamental lack of understanding of how the veterinarian client relationship actually functions.

Interesting... because that is exactly how I saw every vet talk with a client.. give the options for treatments, explain their effects, and prognoses, answer questions, give guidance, then produce treatment plans with the associated costs for the various treatments (of which as a tech I went over with the client).. if the client had any additional questions then the vet would answer them, guidance was provided but the ultimate decision as to what was done was that of the owner, not the vet in charge of the case and many times the owner did not choose what the vet would have considered the "best" option. The vet was simply a source of guidance and knowledge not a decision making factor (at least not to the point of the vet saying, "This is what we are going to do").
 

nyanko

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Allowing owners to dictate how you practice medicine is likely the single worst decision you will ever make. I'm thrilled that we have decided to add such an ineffective practitioner to the ranks of our profession.

I dunno you're talking to SOV here, he's probably made far worse decisions within the last 24 hours alone.

:smuggrin:
 

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Interesting... because that is exactly how I saw every vet talk with a client.. give the options for treatments, explain their effects, and prognoses, answer questions, give guidance, then produce treatment plans with the associated costs for the various treatments (of which as a tech I went over with the client).. if the client had any additional questions then the vet would answer them, guidance was provided but the ultimate decision as to what was done was that of the owner, not the vet in charge of the case and many times the owner did not choose what the vet would have considered the "best" option. The vet was simply a source of guidance and knowledge not a decision making factor (at least not to the point of the vet saying, "This is what we are going to do").

@julieDVM: I agree with this.

The vet I work for nearly had to have a client sign a release of liability because the client wanted to bring the animal home after a major oral surgery as opposed to doing what the vet recommended, which was have the animal stay overnight at one of the other local hospitals. The only reason the release ultimately did not have to be signed was because the owner's partner agreed with the vet and so the animal was brought for an overnight stay. The fact of the matter is, regardless of the vet's recommendation, and try she might to drive home how important it was that the cat be monitored (she explained the risks, the potential additional expenses, etc.), the owner did what the owner wanted to do in the end, and the vet couldn't sit there and rightly say, "sorry, I don't agree with that decision. Please do not come to collect your cat until I decide it's okay" had the owner's partner not been there to say so themself.

I am sure there are times, places and ways to say things, but I think that's an intuitive timing a lot of people lack. I had a veterinarian want to do extensive testing on my cat (this was when I was 12, but I remember this distinctly) when URI was a possibility for what was wrong. My mother asked if we could try a round of antibiotics, and if he didn't improve, we would go from there, as we had literally moved to our new home within the month and money was tight as a result of all the expenses we had incurred. We certainly did not plan for thousands that could be spent on veterinary testing! Lo and behold, my cat improved after a round of antibiotics and lived his remaining time with us very, very healthily. We never went back to that clinic, because when my mother asked about the antibiotics, the vet's response had been to shout and tell her she was condemning her daughter's cat to death and the cat's blood would be on my mother's hands, not hers. That's the least of the offenses she shouted, and I only wish my mother had reported her.

Veterinarians are not there to tell you what to do and then berate you when you don't do what they say. They are there to lay out all your options, answer as many questions as you have, and explain the various routes that you can take. Good veterinarians understand that clients are people, not just customers, that they have varying budgets, histories and experiences and that a veterinarian does not know enough about those experiences and budgets to demand that a client do x instead of y or z because x is the best option. That might be true, but sometimes you need a Plan B. SOV hit the nail on the head perfectly, as to what a good practioner should do and as to how a good practioner should conduct his or herself. Any veterinarian I know who has pushed treatments on their clients or made their clients feel poorly for not immediately going with Plan A has a very limited and/or unhappy client base based on the way they conduct themselves. The most popular clinicians in my area are clinicians that know how to work with a variety of people, because being a vet, as I'm sure you're well aware, is not all about working with the animals. It is about working with the people and knowing how to work with those people. That means providing guidance but also understanding that you won't be approaching each client with a cookie cutter model. You are there to provide guidance, to provide thorough explanations, to answer questions, and yes, to say "I strongly suggest" or "I would recommend" or "if it were my animal...", but you are not there to dictate decisions that ultimately come down to the person you don't know enough about to make those decisions in the first place.

My .02 and to build off DVMDream's and SOV's excellent points.
 
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kernel

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Interesting... because that is exactly how I saw every vet talk with a client.. give the options for treatments, explain their effects, and prognoses, answer questions, give guidance, then produce treatment plans with the associated costs for the various treatments (of which as a tech I went over with the client).. if the client had any additional questions then the vet would answer them, guidance was provided but the ultimate decision as to what was done was that of the owner, not the vet in charge of the case and many times the owner did not choose what the vet would have considered the "best" option. The vet was simply a source of guidance and knowledge not a decision making factor (at least not to the point of the vet saying, "This is what we are going to do").

Thinking back on it, I can't recall a single instance when I *didn't* see this happening while I had been shadowing or working.
 

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This post demonstrates a fundamental lack of understanding of how the veterinarian client relationship actually functions.

How does that relationship work in your experience? I'm not being sarcastic I'm actually asking. Working at a very large busy practice thats pretty much how I saw it go too....the vet presents the options and the pros/cons and what they think is the best, but ultimately the client has to make the decision and I think we as veterinarians have to respect that, even if its not what we think should be done
 

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Allowing owners to dictate how you practice medicine is likely the single worst decision you will ever make. I'm thrilled that we have decided to add such an ineffective practitioner to the ranks of our profession.

All I can think is that either you are ineffective in communicating what you are trying to say, or you live in a fantasy world.

I have been on both sides of this equation in both human and vet med. I have NEVER seen a case where the patient/client is not extensively involved in the decision making process, and where the client doesn't make the final call (except perhaps sometimes in emergency med). And in human med, where the doctors supposedly are much more knowledgeable (based on earlier comments), I guarantee you, I made the call when I had complicated problems, and it was a negotiation to do what I thought was the best choice, not some hot-headed doctor's view of whether or not I should undergo complicated surgery.

You are deluded if you think you can do whatever you want. It is a negotiation between the best medicine, the economic concerns (in human med insurance, in vet med the pocket book), the biases of the practitioner and the client, and reality, etc etc.

This discussion is meaningless. Either you are an autocrat, a know--it-all, or as I believe in this case, doing a poor job of making your point.

Re-read the comments. Everyone agrees the vet has an important role in the process, but in the end, you work for the client, not the other way around. You ADVOCATE for the animal.
 

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The ONLY times I have seen vets stipulate to clients "what will be done" are in extreme cases where, as humans, the only way we could have gone home and slept that night was if we euthansed the pets. For instance, we had a pet rabbit brought in to us that was so badly fly blown that it had an open abdominal cavity and one of its hindlegs was just about hanging off because so much tissue had been eaten away. The vet went immediately into the consult with a euthanasia consent form and didn't even give them any other option - she told them "the only way forward is euthanasia". There have been a few other similar circumstances where the same thing has been done, but it is extremely few and far between.

Aside from that, the good vets I've seen in practice are similar to what SOV etc said. That said, I think you need to make it very clear to the client what the best choice is because they can't always see that and you are the one with the education and training, but they should always be offered options.
 

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I think there are still pockets where it is much less a partnership than we'd like. Especially with older, low income or low education/low knowledge clients I encounter the 'You're the doctor, you know best' attitude. An expectation that the client will not be involved in the decision making process. But it really varies with practice, too. I've worked for a number of practices in the same general area, and found very different client expectations in each job.
I do agree letting clients dictate how we practice would be a bad idea; the client's budget may dictate what options they choose to accept, but it can't dictate what options we offer.
 

DVMDream

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I think there are still pockets where it is much less a partnership than we'd like. Especially with older, low income or low education/low knowledge clients I encounter the 'You're the doctor, you know best' attitude. An expectation that the client will not be involved in the decision making process. But it really varies with practice, too. I've worked for a number of practices in the same general area, and found very different client expectations in each job.
I do agree letting clients dictate how we practice would be a bad idea; the client's budget may dictate what options they choose to accept, but it can't dictate what options we offer.



I agree with this.... as a vet we still have to offer every viable treatment option... cdndvm made mention of not offering a specific treatment because even though it is a viable option you as the vet, don't think it is right to put the pet through that treatment.... that is something that we can not do. We can not pick and choose which treatments to offer or not offer because we simply would not do the same for our pets. I, personally, would never put an old dog with severe cancer through chemotherapy, but is it my call to tell someone else that they can not? No, it is my job to inform them of that option, give them the expected outcomes, prognosis, side effects, etc, etc and let the owner decide what they want to do.

We had a client tell the vet exactly how he was going to perform the surgery on his dog and the vet as gently as he could said, "I am going to do this surgery in a way that will make your dog heal as quickly as possible with hopefully little to no side effects or complications."

I don't think we should let clients dictate how we will perform a surgery, which medications to give or exactly how to perform our jobs but they do dictate which treatments we end up doing, no matter if we agree or not. Hopefully, we have given them enough guidance and our knowledge was good enough to allow them to choose the treatment that ends up being the best for that pet.
 

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Well, all I can say is I am thankful you have never been my vet.

A vets job is to inform and help GUIDE the decision. Ultimately it is the owner's, and short of abuse you have no right to withhold crucial treatment information.

You may think you know better, but that is the despot's answer in every single case. The ego to think only you know what is best for the animal is the ultimate hubris.

Do owner's make bad decisions? Absolutely, but they are theirs to make, not yours. And I guarantee, you must make some bad calls as well.

I absolutely believe in strongly advocating for the animal when necessary, but not to impose my own opinions on others as if I know better. As I said, you can believe you are doing what is right, and I can hope not to have you as a vet.

Interesting... because that is exactly how I saw every vet talk with a client.. give the options for treatments, explain their effects, and prognoses, answer questions, give guidance, then produce treatment plans with the associated costs for the various treatments (of which as a tech I went over with the client).. if the client had any additional questions then the vet would answer them, guidance was provided but the ultimate decision as to what was done was that of the owner, not the vet in charge of the case and many times the owner did not choose what the vet would have considered the "best" option. The vet was simply a source of guidance and knowledge not a decision making factor (at least not to the point of the vet saying, "This is what we are going to do").

:thumbup:

I have been reading this thread, but avoiding posting.... I usually only have sarcastic things to say on most days of the week....

but had to comment on this....

Having worked in a ER/ICU as a tech, I saw many cases brought in that were treatable with a few different good options, but because of the clients pocketbook ended up being euthanised (which was not the best option in those cases), but the client's finances dictated. We also had parvo puppies who would come in that needed to be hospitalised and the vets would lay out all treatment plans, but in the end due to either the client not having the funds or not wanting to spend the funds to treat the dog in hospital, the dog was then sent home with fluids for care.

In every situation in ER/ICU as well as in the regular vet practice I worked in, the veterinarian would lay out all of the treatment options - the potential risks, benefits, costs, etc - but in the end the client had the final call. The vets would make a recommendation for the best course of action, but the client would always get the final say. And it has always been the same in human medicine as well (except perhaps in the ER when the patient is unconscious). Every time I have gone in for a procedure or an appointment they need my consent to do anything. And I decide the treatment plan I follow or whether I have surgery. The doctor always makes their recommendation, but the client can refuse or ask for other suggestions based on finances or personal reasons.

And the veterinarian is not always right (nor is the MD) - and I don't think a vet or an MD should think they are infallible as that can get you into real trouble. We all make mistakes or errors in judgement - such is the act of being human.

I had an instance being the owner having to say to the vet caring for my dog that they were wrong and I was taking my dog home. It is a long story which I will not delve into here, but he was hospitalized for a few days for a bout of pancreatitis and was getting worse which he does away from me (yes I know a lot of owners will say this - but amazingly for my dog it is true - the vets here agree now). From the stress he had started seizing (he has epilepsy), so they called me down as they wanted me to consider euthanisia. I spent some time with him and he showed marked improvement - I knew he was not ready. So I signed a release. The intern said to me that the meds she was giving me would be more than I would need (assuming he would die or be PTS prior) - poor bedside manner. Anyhow he completely recovered at home and has been been going strong ever since - about a year. So.... sometimes you have to put your ego aside and listen to the owner.

tl; dr.... no worries... but you catch my drift....
 

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I think this is a really important point. The emotional devastation of losing a pet for many people is no different than a child, and as for a parent/friend is often much worse because of people's less complicated, purer love for animals. There is no debate on this. Ask any psychologist about it.

Society still frowns on people being excessively emotional over the loss of a pet, but that doesn't stop people from having those emotions.

I personally do not understand the reasoning in this argument at all, and it depends a lot on the doctor and owner/patients involved.

Basically, society still values a human doctor way higher, they have a lot more funding, having more research/drugs/procedures available, but practicing medicine is practicing medicine. I would say that we are probably 3 or 4 decades behind. We probably practice medicine on animals similarly to the way it was done in the 70s in human med. Were those doctors not the same as current doctors? I don't buy it.
Out of curiosity, why do you think that vet med is 3-4 decades behind human medicine? I seen some amazing equipment being used in vet clinics (MRI, ultrasounds, ECG etc) that are similar to being used at a human hospital. One clinic even measures the blood pressure of the animals (no clue how accurate that is). Of course I am not saying that you are wrong or trying to be confrontational about this, but am truly curious.
 

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Out of curiosity, why do you think that vet med is 3-4 decades behind human medicine? I seen some amazing equipment being used in vet clinics (MRI, ultrasounds, ECG etc) that are similar to being used at a human hospital. One clinic even measures the blood pressure of the animals (no clue how accurate that is). Of course I am not saying that you are wrong or trying to be confrontational about this, but am truly curious.

MRI, u/s and ECG are considered fairly basic, run of the mill diagnostics/treatments in human medicine that are done every day (maybe a little less for MRI but still done all the time for a lot of different orthopedic, etc problems. And blood pressure is one of the first things that gets done when you walk into the doctors office, and its becoming more common in vet med but human med there are SO many different imaging options, diagnostics, laboratory tests, treatments, surgeries drugs etc that veterinary medicine doesn't have access to (yet). I would venture to guess that we may even more behind human med than 3-4 decades, actually but that's purely opinion
 

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MRI, u/s and ECG are considered fairly basic, run of the mill diagnostics/treatments in human medicine that are done every day (maybe a little less for MRI but still done all the time for a lot of different orthopedic, etc problems. And blood pressure is one of the first things that gets done when you walk into the doctors office, and its becoming more common in vet med but human med there are SO many different imaging options, diagnostics, laboratory tests, treatments, surgeries drugs etc that veterinary medicine doesn't have access to (yet). I would venture to guess that we may even more behind human med than 3-4 decades, actually but that's purely opinion

yeah, but I would argue that for most patients, an in hospital blood pressure won't tell you much. So while it may be behind, when a dog or cat is scared out of its mind, you're going to read high. The other diagnostic tests ARE behind but I do believe that most of it has to do with cost. Most of the items that are being discussed are cost prohibitive. Or the studies haven't been done on those drugs yet.
 
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krist

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yeah, but I would argue that for most patients, an in hospital blood pressure won't tell you much. So while it may be behind, when a dog or cat is scared out of its mind, you're going to read high. The other diagnostic tests ARE behind but I do believe that most of it has to do with cost. Most of the items that are being discussed are cost prohibitive. Or the studies haven't been done on those drugs yet.

Totally agree...I was just saying that veterinary medicine is definitely way behind human med, and the tests like BP, MRI, US are common practice in human medicine and there are way more advanced procedures and tests that human med uses and vet med does not, due to cost or necessity, ethics etc.
 

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Totally agree...I was just saying that veterinary medicine is definitely way behind human med, and the tests like BP, MRI, US are common practice in human medicine and there are way more advanced procedures and tests that human med uses and vet med does not, due to cost or necessity, ethics etc.
What are some examples of the way more advanced procedures and tests commonly done in human med but not in vet out of curiosity? My knowledge of human med is very limited and is based on heath exams maybe once every two years (crappy insurance). My basic physical and the annual exams that my pet gets seems sort of similar...
 

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What are some examples of the way more advanced procedures and tests commonly done in human med but not in vet out of curiosity? My knowledge of human med is very limited and is based on heath exams maybe once every two years (crappy insurance). My basic physical and the annual exams that my pet gets seems sort of similar...

I'm not even sure where to start......

Do not use your basic health exam as something representative of the extent of human medicine. That is akin to saying well hey, i only see my vet giving my puppy vaccines, that must be all they do, right?

I'm in pathology - basically, we are vet school on steroids. Take everything you learned in vet school, every disease in every single species and add in all the genetic, molecular, and cellular changes that take place. Trust me, we are WAY behind humans even at this level.

I mean, just as one example, they have genes identified for countless neoplasms and inherited conditions, extremely advanced molecular signature detection/genetic analysis and immunohistochemical techniques....us, we slap a CD3/CD4 on a suspected lymphoma and call it lymphoma...they look at flow cytometry, genetic alterations, categorize it according to dozens of different lymphoma types in humans.....
 

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I'm not even sure where to start......

Do not use your basic health exam as something representative of the extent of human medicine. That is akin to saying well hey, i only see my vet giving my puppy vaccines, that must be all they do, right?

I'm in pathology - basically, we are vet school on steroids. Take everything you learned in vet school, every disease in every single species and add in all the genetic, molecular, and cellular changes that take place. Trust me, we are WAY behind humans even at this level.

I mean, just as one example, they have genes identified for countless neoplasms and inherited conditions, extremely advanced molecular signature detection/genetic analysis and immunohistochemical techniques....us, we slap a CD3/CD4 on a suspected lymphoma and call it lymphoma...they look at flow cytometry, genetic alterations, categorize it according to dozens of different lymphoma types in humans.....
Of course! I only used that example to highlight my vast ignorance of the medical field :) Thanks for the response as well. It will be interesting to see what will come to the vet field from human medicine over time!
 

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Of course! I only used that example to highlight my vast ignorance of the medical field :) Thanks for the response as well. It will be interesting to see what will come to the vet field from human medicine over time!

And vice versa :) A lot of human medicine comes from animal studies. Unfortunately in vet med, we often don't have the funds to refine the cutting-edge technology that we may have initially contributed to, and as researchers and clinicians in human medicine do.
 

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And vice versa :) A lot of human medicine comes from animal studies. Unfortunately in vet med, we often don't have the funds to refine the cutting-edge technology that we may have initially contributed to, and as researchers and clinicians in human medicine do.
What do you guys think will be some of the advances that come to human/vet medicine from each other? Genetic testing for pets for problems? Something else entirely?
 

WhtsThFrequency

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What do you guys think will be some of the advances that come to human/vet medicine from each other? Genetic testing for pets for problems? Something else entirely?

A lot of it depends on owner financing and all that.....we could have the fanciest technology in the world but it may be unaffordable.

We have so many animal models of diseases which are very helpful. Heck, a researcher at my alma mater is using WNV to treat prostate cancer by modifying the virus to attack PSA-secreting cells (or something like that).

We have a few genetic tests for pets in general (or at least we have identified genes), but not many.
 

psilovethomas

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So, in the long run, no the international schools are not going to be the big problem... the problem needs to be dealt with at its core.... which is inside the US... US students can still go to international schools and go back to the US to practice even without the AVMA COE accrediting them .... yes, it is harder and more expensive... but people were still doing it. If you want to take care of the problem, there needs to be a cap on class size for all schools accredited by the AVMA COE (including international ones)... and even this isn't going to help much at all.

What about Ross, SGU, and SMU that can graduate 2-3 classes/year? That WILL have a large impact and DOES propose a big problem.
 

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What about Ross, SGU, and SMU that can graduate 2-3 classes/year? That WILL have a large impact and DOES propose a big problem.

Yeah putting out 270 grads/year vs most US schools at avg 120 or whatever it is is a HUGE difference.
 
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I mean, just as one example, they have genes identified for countless neoplasms and inherited conditions, extremely advanced molecular signature detection/genetic analysis and immunohistochemical techniques...

YES! All of this and way way more on top of the NORMAL sequence of the genes in question, which is super essential to a vast majority of research studies necessary for medical advancements.

On the other hand... there's barely been one cat's genome (as in one individual abyssinian cat) sequenced back in 2007. And it's not very reliable at all... Better than nothing I guess, but super super frustrating to work with. We're kind of in the dark ages when it comes to that type of work, which is very much standard in human medicine.
 

psilovethomas

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So...I looked up the numbers for the big international schools (Dick Vet, RVC, Glasgow, Dublin, Onatrio, AVC) and got a total of 256 seats. If I were to say roughly half of those went to US students, which I am sure is a gross underestimate, that is 128 students- bigger than the class size at my school. The number of US students entering SGU alone in one academic year is 145. Couldn't find the numbers for Ross. But those numbers combined (271) equals to 2-3 veterinary schools in the US (again, on the very conservative end).
 
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psilovethomas

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Yes, agree... that is why I suggested the cap on class size across the board at all schools.

But even if we cap them. that's still a huge number of incoming veterinarians from a foreign school. Capping it won't solve the problem.
 

DVMDream

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So...I looked up the numbers for the big international schools (Dick Vet, RVC, Glasgow, Dublin, Onatrio, AVC) and got a total of 256 seats. If I were to say roughly half over those went to US students, which I am sure is a gross underestimate, that is 128 students- bigger than the class size at my school. The number of US students entering SGU alone in one academic year is 145. Couldn't find the numbers for Ross. But those numbers combined (271) equals to 2-3 veterinary schools in the US (again, on the very conservative end).

So 7 international schools are producing the amount of graduates that only 2-3 US schools produce...... ok. Not sure where the problem is... that is like having 7 US schools with only 40ish seats... (SGU and Ross being exceptions here).

I know in my class there are probably around 40-50 US students that will graduate from here.... I think your numbers are probably close but may be a bit of an underestimate... I would say it is more like 7 international schools producing the same as 4-5 US schools, but still not anywhere near the same capacity as the US schools. I think the bigger problem are still the vet schools that are going to be opening their doors here soon (supposedly the one in AZ should be open for 2014)..... I also think there needs to be a cap on class size because a bigger class size does have a negative impact on teaching and education, but that is just my opinion....

And I need to get back to studying exam in 9 hours....
 

psilovethomas

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So 7 international schools are producing the amount of graduates that only 2-3 US schools produce...... ok. Not sure where the problem is... that is like having 7 US schools with only 40ish seats... (SGU and Ross being exceptions here).

I know in my class there are probably around 40-50 US students that will graduate from here.... I think your numbers are probably close but may be a bit of an underestimate... I would say it is more like 7 international schools producing the same as 4-5 US schools, but still not anywhere near the same capacity as the US schools. I think the bigger problem are still the vet schools that are going to be opening their doors here soon (supposedly the one in AZ should be open for 2014)..... I also think there needs to be a cap on class size because a bigger class size does have a negative impact on teaching and education, but that is just my opinion....

And I need to get back to studying exam in 9 hours....

I guess what I am trying to say about the international seats being equivalent to 2-3 US vet schools is: We do not need more vet schools. We do not need veterinarians to be trained overseas. There is no market demand for more veterinarians. There is no market demand for foreign trained veterinarians. The majority of US students go to international schools because they did not get accepted to a US school. Until foreign schools became accredited, the number of US seats acted like a check point system for the number of US vets. Now that foreign schools got the OK, the check point system is out the window. Granted, increases in class sizes have not helped, but they do not equal the equivalent of 2-3 new vet schools.

This has been modeled in dentistry and law. Why can't vet med just learn from that?

What do people think about shutting some schools down? This was how the dental field coped. Not saying it's the best way, or even feasible. Just wondering.
 
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DVMDream

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But even if we cap them. that's still a huge number of incoming veterinarians from a foreign school. Capping it won't solve the problem.

Even if there are quite a few incoming vets from international schools, it is not anywhere near close to the number of seats/school in the US... as you showed it is essentially half, so 1 international school= 1/2 of a US school in terms of numbers. Yes, I do think capping will help; I do not think it will solve the issue but I don't think there will be any easy solve to the problem.

You also have to realize this: the international schools often have a hard time filling seats (as I have said before, at least here at Edinburgh), probably due to the cost, possibly due to some people not even knowing that is an option, possibly due to people just not wanting to move out of the country. Increase in the size of classes in the US is going to prove a bigger issue because those seats will be filled with US students (more likely than not)... the international seats at international schools are not just for US students... we have Canadians, Australians, etc, etc....

The international schools have been around for a long time, US students have been attending them for awhile and coming back to the states.... this isn't a new thing and the numbers have remained static... what has not remained static? The number of graduates that the US schools have been producing.
 

psilovethomas

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Even if there are quite a few incoming vets from international schools, it is not anywhere near close to the number of seats/school in the US... as you showed it is essentially half, so 1 international school= 1/2 of a US school in terms of numbers. Yes, I do think capping will help; I do not think it will solve the issue but I don't think there will be any easy solve to the problem.

You also have to realize this: the international schools often have a hard time filling seats (as I have said before, at least here at Edinburgh), probably due to the cost, possibly due to some people not even knowing that is an option, possibly due to people just not wanting to move out of the country. Increase in the size of classes in the US is going to prove a bigger issue because those seats will be filled with US students (more likely than not)... the international seats at international schools are not just for US students... we have Canadians, Australians, etc, etc....

The international schools have been around for a long time, US students have been attending them for awhile and coming back to the states.... this isn't a new thing and the numbers have remained static... what has not remained static? The number of graduates that the US schools have been producing.

Yes, long term, capping will work.
What is the average class increase/year/school? MSU has only raised it by 4 in the past 10 years. I know some schools recently bumped it up to +20. But, these schools are probably maxed out now. If a cap is made for each school and if the average school increases their class size by 10 seats in the next 10 years to meet that cap, that's 280 extra vets/year. That's a big number, but we do not need the extra 280 from international schools on top of that...is what I am trying to get at.
 

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Yes, long term, capping will work.
What is the average class increase/year/school? MSU has only raised it by 4 in the past 10 years. I know some schools recently bumped it up to +20. But, these schools are probably maxed out now. If a cap is made for each school and if the average school increases their class size by 10 seats in the next 10 years to meet that cap, that's 280 extra vets/year. That's a big number, but we do not need the extra 280 from international schools on top of that...is what I am trying to get at.

You are missing the point.....

Cap all schools at one spot... say 120 (some of them are currently above this so they will have to adjust this by their next review from the AVMA COE), keep it at that... stop creating new schools (no new vet schools allowed).... The "280 extra from international schools" is NOT extra there is nothing extra about it... that has been there for the past 10+ years and is nothing new, so not sure how you are getting that there is not a "need for the 280 extra from international schools" because it is not an extra...

The first thing that people do in the US when there is a problem within the US is try to find something outside of the US that is "causing" the problem instead of growing balls and dealing with the issue internally.

Do you really want to solve the problem? Get rid of OOS seats at US schools... there you go... they are for the most part: 1. more expensive for the student (so bigger debt load for them, yes there are exceptions). 2. where the class sizes tend to be increasing at. 3. A big amount of seats at some of the schools. It would have a much bigger impact than anything you do with international schools... the problem is NOT in the international schools that have remained unchanged in the past many, many years... the problem has arisen much more recently and people need to realize that.... getting rid of the international schools will have little impact, you need to get rid of the of what caused the problem not some outside arbitrary issue... that is like slapping a band-aid on bullet wound and hoping there is no internal damage.
 
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Do you really want to solve the problem? Get rid of OOS seats at US schools... there you go... they are for the most part: 1. more expensive for the student (so bigger debt load for them, yes there are exceptions). 2. where the class sizes tend to be increasing at. 3. A big amount of seats at some of the schools. It would have a much bigger impact than anything you do with international schools... the problem is NOT in the international schools that have remained unchanged in the past many, many years... the problem has arisen much more recently and people need to realize that.... getting rid of the international schools will have little impact, you need to get rid of the of what caused the problem not some outside arbitrary issue... that is like slapping a band-aid on bullet wound and hoping there is no internal damage.

And if you're from Rhode Island, or New Jersey, or Maine, etc., what then? Not really fair to those students to make them have to move states in order to establish residency somewhere or go out of the country which is going to be more expensive (considering air fare, exchange rate, etc.).
States aren't going to be able to find it in their budgets to add contract seats. Even those with contract seats don't always guarantee that funding for years into the future (see Connecticut's dealings with Iowa State every year).
Yes, doing so might solve problems, but it's not practical.


And when we say "international schools" in terms of discussing class sizes, I think it's worth separating the UK/Ireland schools from the Carribean Island schools, since we've pretty much established that the US student relationship with these schools is very different.
 

psilovethomas

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The first thing that people do in the US when there is a problem within the US is try to find something outside of the US that is "causing" the problem instead of growing balls and dealing with the issue internally.

I think we are looking at this in different ways and butting heads.
The way I see it: Remove the extra 280 seats from international means 280 less veterinarians/year looking for work in the US=potential for better job prospective, balance supply/demand, potential for increase in salary for US vets. Again, keep in mind that 280 is a very low end estimate. This number could easily be 400 when Ross is calculated in.

Capping will help a lot to control the market.

Getting rid of SOME out of state seats could work, but would just be filled with IS states, so we will still have the same problem of too many vets. It is important to keep OOS available because different schools offer different programs and opportunities that will train the vet work force in different areas.
 

psilovethomas

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And when we say "international schools" in terms of discussing class sizes, I think it's worth separating the UK/Ireland schools from the Carribean Island schools, since we've pretty much established that the US student relationship with these schools is very different.

UK was 234 international. If half are US students= 117
 

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And if you're from Rhode Island, or New Jersey, or Maine, etc., what then? Not really fair to those students to make them have to move states in order to establish residency somewhere or go out of the country which is going to be more expensive (considering air fare, exchange rate, etc.).
States aren't going to be able to find it in their budgets to add contract seats. Even those with contract seats don't always guarantee that funding for years into the future (see Connecticut's dealings with Iowa State every year).
Yes, doing so might solve problems, but it's not practical.


And when we say "international schools" in terms of discussing class sizes, I think it's worth separating the UK/Ireland schools from the Carribean Island schools, since we've pretty much established that the US student relationship with these schools is very different.

Life isn't fair... and I am from AZ originally so I know what not having an in state vet school is like. And no, WICHE, sucks... so don't mention it.

Going out of the country was actually cheaper than OOS for me or very close to the exact same price...

And the last point I bolded goes the same for the international schools, getting rid of those may make a small dent but it not practical and will not solve the problem.
 

DVMDream

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I think we are looking at this in different ways and butting heads.
The way I see it: Remove the extra 280 seats from international means 280 less veterinarians/year looking for work in the US=potential for better job prospective, balance supply/demand, potential for increase in salary for US vets. Again, keep in mind that 280 is a very low end estimate. This number could easily be 400 when Ross is calculated in.

Capping will help a lot to control the market.

Getting rid of SOME out of state seats could work, but would just be filled with IS states, so we will still have the same problem of too many vets. It is important to keep OOS available because different schools offer different programs and opportunities that will train the vet work force in different areas.

Will it? Will removing those seats really lead to that big of a decrease?... I bet it won't... because those students can still come back to the US (those that want to anyway), accreditation is not needed... just have to take an extra test... it won't do anything... and so what you get rid of 280 seats at international schools and within the next 5 years (possibly less) you will have those seats appear within the US via the schools being produced and increased class sizes.... again putting the band aid on the bullet wound and praying nothing else is wrong is not the answer. Why stop the already established, accredited schools that are producing good veterinarians? Why not put the cap on class size and prevent new schools from being produced? You are still removing that "extra" in the market... just in a different and more productive way.

And why does getting rid of OOS seats mean they have to be filled with an IS student? The whole point of getting rid of the seats is to GET RID OF THEM.. completely... gone, no more... bye bye... adios....
 

psilovethomas

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Will it? Will removing those seats really lead to that big of a decrease?... I bet it won't... because those students can still come back to the US (those that want to anyway), accreditation is not needed... just have to take an extra test... it won't do anything... and so what you get rid of 280 seats at international schools and within the next 5 years (possibly less) you will have those seats appear within the US via the schools being produced and increased class sizes.... again putting the band aid on the bullet wound and praying nothing else is wrong is not the answer. Why stop the already established, accredited schools that are producing good veterinarians? Why not put the cap on class size and prevent new schools from being produced? You are still removing that "extra" in the market... just in a different and more productive way.

And why does getting rid of OOS seats mean they have to be filled with an IS student? The whole point of getting rid of the seats is to GET RID OF THEM.. completely... gone, no more... bye bye... adios....

Why? Because something needs to be done. Because I want a job when I graduate. Because I want to be able to make a salary that isn't 1/2 (up to 1/6th for some) of my debt.
Unfortunately, those OOS seats will probably need to be filled by IS so the school can afford to train and educate veterinarians.
Clearly there are many solutions. Something needs to be done- I am just throwing out ideas, not trying to offend anyone.
 

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Why? Because something needs to be done. Because I want a job when I graduate. Because I want to be able to make a salary that isn't 1/2 (up to 1/6th for some) of my debt.
Unfortunately, those OOS seats will probably need to be filled by IS so the school can afford to train and educate veterinarians.
Clearly there are many solutions. Something needs to be done- I am just throwing out ideas, not trying to offend anyone.

probably not going to be filled by IS since those students don't make the school money that OOS makes. More likely get rid of all subsidized seats and make everyone OOS - that solves the problem of incomes for the schools.
 

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Why? Because something needs to be done. Because I want a job when I graduate. Because I want to be able to make a salary that isn't 1/2 (up to 1/6th for some) of my debt.
Unfortunately, those OOS seats will probably need to be filled by IS so the school can afford to train and educate veterinarians.
Clearly there are many solutions. Something needs to be done- I am just throwing out ideas, not trying to offend anyone.

And I don't want a job? I agree, something needs to be done... but the solution is not with the international schools... something needs to be done in the US... and halting the opening of new schools and putting a cap on class size is probably a good start.... and since you are hung up on the international schools... there are a number of them that are above the cap I mentioned...they would be subject to that cap as well.
 

NStarz

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I think the European/Australian schools are fine. The real issue I am seeing now is with the accreditation of the Caribbean schools. They graduate 3x the classes of most other vet schools, and now US students are not deterred from going there because of potential licensing issues.
 

psilovethomas

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probably not going to be filled by IS since those students don't make the school money that OOS makes. More likely get rid of all subsidized seats and make everyone OOS - that solves the problem of incomes for the schools.

Well that would be awful.
 

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And I don't want a job? I agree, something needs to be done... but the solution is not with the international schools... something needs to be done in the US... and halting the opening of new schools and putting a cap on class size is probably a good start.... and since you are hung up on the international schools... there are a number of them that are above the cap I mentioned...they would be subject to that cap as well.

I don't think anyone is disagreeing with your cap idea. But why can't we focus on decreasing veterinary students from international schools AND capping US schools. That would make the most sense.
 

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I think the European/Australian schools are fine. The real issue I am seeing now is with the accreditation of the Caribbean schools. They graduate 3x the classes of most other vet schools, and now US students are not deterred from going there because of potential licensing issues.

I completely agree. Not to mention that a lot of people go there because they COULD NOT get into a US school. I know some pretty lazy unmotivated people who are in the caribbean right now going to vet school. Its frustrating when I sacrificed everything in undergrad and worked my butt off to get into vet school thinking that I will be a better candidate for a DVM then the dude who was too drunk to go to class. Now drunkie frat dude is competing with me for jobs. I am not saying this is the case all the time, but it seems like anyone can get into vet school nowadays because of the caribbean schools and it makes the quality of applicants go down.
 
E

Escalla

I'm just going to throw my thoughts out here and try and meet in the middle between revoking accreditation of international schools and focusing solely on the U.S. I don't know how much of a battle it would be to revoke accreditation of a school that meets the standards of the AVMA, but I don't imagine it would be anything less than messy. I do think that cutting off the increasing number of schools in the U.S. is the bare minimum that needs to be met. I think we can all agree that more schools being built is something that should not be happening.

Now I realize this has been mentioned previously, but I think it's important to still consider. How are students able to study abroad? I think money is the root of the problem. I don't think that revoking accreditation in order to try to stop U.S. students from studying abroad is at all feasible and like I said before, accreditation matters to places outside the U.S. as well. Besides that, there are ways around it as DVMD mentioned and only serves as an inconvenience. If unlimited funds weren't available for a student to hang themselves with in regards to debt, there would be fewer people struggling in today's economy with such low salaries and mountains of debt still owing.

I realize that what works in some countries won't work in others, but the lack of government support is the reason that there are not more Canadian students studying abroad. We do not have access to COA loans and this prevents anyone without very well-off parents from attending school outside of Canada. Therefore, the supply has been controlled quite well here and we're not facing the same issues. I don't think we would be as well off if the government financially supported students to attend school outside the country.

Of course this means "government meddling", which I know isn't take at all lightly, my American friends. ;) But I do think it's a viable option which allows those that have the means to study abroad to do so while giving others pause before signing up. It's too easy to get that much money and I think that is something that should be addressed before accreditation.
 
E

Escalla

I completely agree. Not to mention that a lot of people go there because they COULD NOT get into a US school. I know some pretty lazy unmotivated people who are in the caribbean right now going to vet school. Its frustrating when I sacrificed everything in undergrad and worked my butt off to get into vet school thinking that I will be a better candidate for a DVM then the dude who was too drunk to go to class. Now drunkie frat dude is competing with me for jobs. I am not saying this is the case all the time, but it seems like anyone can get into vet school nowadays because of the caribbean schools and it makes the quality of applicants go down.

While I agree that it does make it easier to get into vet school, they still have to survive and pass the NAVLE. So I don't think that anyone that graduates from those schools isn't hard-working or deserving of the degree.
 

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This continues to be one of the best, most thorough and on point discussions of the supply issue I have seen yet.

A few points to consider:
1) The Caribbean schools are >90% US students who go there from the US and return to the US to practice. It has always been that way. Accrediting those schools in no way changed the total number of people hitting the market every year.

2) Last year 3879 new bodies hit the NA veterinary job market. US schools contributed 2686. Non US accredited grads were 967; this includes approximately 300 from Canadian schools. Non accredited schools were responsible for 226. Based on the number enrolled Fall 2012, US schools will produce 2940 in 2016.

3) Restricting access to non US schools will not help control supply unless similar restrictions are placed on access to US schools. In this era when schools offset decreasing state allocations by increasing enrollment and tuition, restricting access to non US schools without restricting expansion of US schools would just drive those increases even harder and faster. Accreditation makes little difference- US students will, as they always have, return to the US to practice via ECFVG and PAVE. PLUS we will have permanently increased production capacity and cost in the US.

4) The dental and medical schools didn't 'recognize' or 'handle' the same problem. Dental schools were closed by their parent universities because application numbers dropped; law schools are cutting class sizes for the same reason. As far as we can tell in vet med that hasn't happened yet. BUT we really can't tell because there is no comprehensive database of applicants (20 COE accredited, AAVMC member schools don't even use VMCAS)-

5) Vet med is a good field- if you can get through school with little to no debt, live like a pauper for 10-15 years when you get out and cement yourself into a position that builds long term equity: become either a clinic owner, a boarded specialist, a tenured faulty member or a spouse to someone with no debt and good pay. Better yet if you can become more than one of these.
 
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I don't think I agree that vet med is 3-4 decades behind human med. In some fields, certainly, but not all. Take the recent jaw repair tech that's been used in 12 dogs so far - it uses a new material to encourage bone to eventually regrow in the correct shape. From what I've heard, there's nothing like that in human med yet, and if this works in more dogs and other animals, it will start to go into trials for humans, reducing the need for bone grafts from other parts of a patient's body. Another example: the internal med/oncology vet I shadowed last summer told me that in oncology specifially vet med and human med are about the same, and for certain specific cancers vet med is more advanced simply because it's easier to do trials on animals in some cases than on people. Granted, that vet may have been mistaken, but she reads all the major human oncology journals. I'm sure I could dig up other examples, just as I could dig up examples of human med being way ahead of vet med.

I do think that what you see at the average GP vet clinic is 3-4 decades (at least) behind what you see at the average human med hospital/clinic. But I don't think that should be what we look at when we assess how advanced vet med is compared to human med.
 

psilovethomas

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2) Last year 3879 new bodies hit the NA veterinary job market. US schools contributed 2686. Non US accredited grads were 967; this includes approximately 300 from Canadian schools. Non accredited schools were responsible for 226. Based on the number enrolled Fall 2012, US schools will produce 2940 in 2016.

3) Restricting access to non US schools will not help control supply unless similar restrictions are placed on access to US schools. In this era when schools offset decreasing state allocations by increasing enrollment and tuition, restricting access to non US schools without restricting expansion of US schools would just drive those increases even harder and faster. Accreditation makes little difference- US students will, as they always have, return to the US to practice via ECFVG and PAVE. PLUS we will have permanently increased production capacity and cost in the US.

What about not offering federal loans to students wishing to travel abroad? That would significantly reduce the number of students able/willing to go to a foreign school.

So, cap US schools, reduce the number of foreign trained graduates...I just don't see why you think that would drive up the number of vets produced in the US.
 
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