An alternative to undergraduate streaming and limited licensure

Radostits and Prescott (1) have done an excellent job of diagnosing what ails the veterinary profession; however, their treatment recommendation is unlikely to cure the patient and could result in complications.

They, and other pundits, have correctly observed that the consumers of veterinary services in today's marketplace are demanding higher levels of expertise from more specialized practitioners. They lament the fact that veterinary colleges continue to graduate generalists who are ill-equipped to meet these needs. We respectfully submit that the proposal to stream undergraduates and then provide them with a limited license would not adequately address the problem.

Their plan ignores the recently signed agreement granting nationwide reciprocity based on the national examination and certificate of qualification and would pose problems for streamed graduates who decide to cross the 49th parallel.

Undergraduate students need all available time (and more) to acquire a general knowledge base and to begin to master basic medical and technical skills. Few would dispute the fact that veterinary colleges are inefficient places for undergraduates to gain some of these skills, which is why the debate over externship programs has raged loud and long. The basic education in “becoming a veterinarian,” including medical and technical skills development, client relations, and business skills, continues after graduation.

Where the profession has fallen down is in the development and promotion of specialists after graduation. When graduates enter practice, spend time developing their skills, and then choose to specialize, no avenue exists for pursuing the necessary training. The existing system of American-based specialty boards is completely inadequate for addressing this problem in Canada. Young adults (and some not so young) with educational debt, families, mortgages, and practice commitments may be unable to pursue a residency, even if enough programs were available. Moreover, many would be unable or unwilling to commit to the 5th year mentioned by Radostits and Prescott. Currently, it takes, on average, almost 8 years at university to earn the professional degree, which has been blamed for some of the profession's present problems.

Veterinary colleges, the CVMA, and provincial associations need to cooperate on developing a program of postgraduation study, testing, and certification to provide the specialized training the marketplace is demanding. The template for such a program already exists in the United Kingdom, where the Royal College of Veterinary Surgeons offers certificate and diploma programs in numerous specialty areas. Candidates pursue independent study with the direction of a mentor, must write a number of case reports, and successfully pass an examination. This provides the private practice veterinarian a certificate in a specialty, such as dairy nutrition or small animal dermatology. The diploma level has been compared to the current North American board certification, but is attainable in private practice.

Such a program would provide not only more skilled practitioners but also a source of renewed interest for those worn down by the tedious aspects of private practice. Included in this approach could be provision for short periods, perhaps a few weeks at a time, of more intensive study at a veterinary college.

It is unfortunate that reactions from some in academe to this type of proposal have not always been enthusiastic. Those who view the production of more “specialists” as an intrusion on their turf and caseload need to be assured that the intent is not to replace the board-certified specialist or to produce “cheap imitations.” Those who would balk at playing a mentor role in such a program or in spending time with a visiting practitioner during a short study period need to consider the positive impact the interactions between the practitioner, students, and faculty would have on the profession. Each would have something to teach the other.

In addition, revenue may be generated for cash-starved veterinary colleges. The Atlantic Veterinary College currently has a “visiting practitioner” program that is a first step down this road. A national program of specialty training, examination, and certification would provide objective standards by which colleagues and the public could recognize practitioners with special skills and training. This would effectively remove the need for “limited licensure.” Indeed, limited licensure without such a program implies specialty expertise that may not exist. Our physician colleagues seem content with a standard license, despite the fact that they are more specialized than our profession will ever be. They recognize that to be a neurologist and to begin delivering babies would not be acceptable under their disciplinary rules. Potential disciplinary considerations govern veterinarians in every provincial jurisdiction.

Give the veterinary colleges their due, they are doing an excellent job of providing a solid basic veterinary education at the undergraduate level. To think that they can gather the qualified faculty necessary to effectively stream every student in the myriad of veterinary specialties and animal species is overly optimistic. Consider administering a program where members of one class request streaming in each of the 9 taxonomic species' divisions referred to by Karg (2), while a few choose the generalist stream, and one or two others request extra classes in epidemiology, food safety, public health, animal behavior, or alternative medicine.

The colleges can and should play a key role in developing “specialists” and “experts,” once their primary product has had time to experience private practice and make more well-researched, long-term career decisions.

Thus far, this debate has been characterized by a “chicken and egg” impasse between the CVMA, the provincial veterinary associations, and the colleges. The colleges have told the licensing bodies that they are waiting for fair warning that limited licensure is coming down the line before altering curricula. The provincial veterinary associations have said they would only consider limited licensure in response to curriculum revisions aimed at undergraduate streaming. Around and around we go! Under the program we propose, the CVMA and the National Examining Board would take the lead. We challenge these groups to initiate discussions aimed at developing program criteria and specialty examinations. Obviously, the colleges would have extensive input and would be a major source of mentors. Provincial veterinary associations would then be in a position to determine acceptable ways for their members to have such training recognized by their colleagues and the public.

An ambitious undertaking? Unquestionably! But possible, practical, and long overdue!