The Canadian Veterinary Summit brings together the leadership of organized veterinary medicine in Canada to discuss issues of national interest to the profession. Last year, delegates were consulted by the CVMA Task Force on Education, Licensing, and the Expanding Scope of Veterinary Practice, commissioned to explore whether the current veterinary educational and licensing system limits the profession's development. Task Force chair and CVMA president Dr. Jeanne Lofstedt outlined the concerns: the system may hinder participation in the breadth of available career opportunities; graduates may not have the competence to keep pace with the increasing client-driven demand for specialization.
The objectives for the 2003 Summit, held in Winnipeg in July, were to review the problems and find “smart resolutions.”
What are the problems?
As Dr. Duane Landals, incoming CVMA president, pointed out, millions of dollars have been spent studying the profession's problems over the last 15 years, and the same problems are consistently identified: the “whine list” (excessive workload, low compensation, and workplace and lifestyle issues) and changing demographics. But do we know whether veterinarians are doing what the public expects and needs for assurance of safe food? “Are we doing our job?”
“Since 9/11 there has been a greater demand for veterinarians to work in the public health sector,” said Dr. Joe Howell, president of the American Veterinary Medical Association (AVMA). In his view, education is the biggest issue for the profession and public perception is second. But if we solve the economic problems, the postgraduate education needed in order to change specialty will become more feasible.
Several speakers, reviewing recent demographic studies, confirmed the shortage or looming shortage of large-animal veterinarians in some areas of the country. The proportion of female veterinarians is climbing, and women tend to choose small or mixed animal practice.
“One finds essentially the same problems throughout the world,” said Dr. Herbert Schneider, president of the World Veterinary Association. He reported that 28 000 “paravets” are called “Doctor” in the Horn of Africa. Why isn't the veterinary profession reacting? We will be challenged by issues of animal welfare and bio security in the next decade. We don't have the training yet. “Let's get into it before others do!”
Proactive solutions
The Western College of Veterinary Medicine has added business and ethics courses, along with opportunities to spend summers in large-animal practices. At the Ontario Veterinary College, certificate programs, including an MBA component, are being developed, as well as a student leadership program. The Faculté de médecine vétérinaire at the Université de Montréal has revamped its curriculum and introduced new media to help in teaching. With student mentoring, conference exposure, and bovine and swine club activities, more students are going into the final-year large-animal rotation. At the Atlantic Veterinary College (AVC) final-year rotations are being done in communications, animal welfare, and practice management. The AVC has a busy continuing education program, with a fall conference, individual programs, retraining and upgrading opportunities, and skills programs of 1 or 2 weeks. The AVC's Vet Camp exposes students in grades 7 to 9 to veterinary medicine.
Initiatives in other countries were described; notably, the AVMA's mentoring program model, aimed at those interested in public health and food animal practice; and the Royal College of Veterinary Surgeons' retooling of the educational and licensing system in Britain.
Smart resolutions?
Delegates had lively small-group discussions on 4 possible major changes in veterinary education and licensing. Their mission: determine the pros and cons, and offer suggestions for the future.
1. Provisional licensure after a generalized undergraduate education, followed by full licensure only after a recognized professional training phase in an identified practice type.
This system would help to deal with the new graduate's possible lack of competence and confidence; it also might protect the public while the new graduate acquires greater competence, and would enhance public confidence. However, a new, complicated and sophisticated level of bureaucracy would be needed to identify and monitor training practices, and to evaluate the new graduate at the end of the professional training phase; regulatory changes would have to be made, and there might be further economic stress on new graduates. Licensing by practice type was suggested for the future.
2. A system of certificates and diplomas to advance the training of veterinarians in specific fields.
Such a system would provide a recognized method of retraining, enable rejuvenation and diversification, allow practitioners to keep pace with technology, and enhance the veterinarian's public image. However, retraining costs the trainee money and time, and the resources of most veterinary colleges are stretched to the limit. International recognition might be a problem. Current diplomas might be devalued, and those with certificates might promote themselves inappropriately as specialists. Although most veterinarians have a thirst for knowledge, some with established practices might be resistant, and others would not have access to the technology.
Delegates suggested that the CVMA and the colleges first develop 1 or 2 certificates in popular areas and explore distance learning.
3. Renewed competency evaluation: requiring veterinarians to reestablish their credentials for licensure from time to time.
This system would provide an objective measure of competence, allow deficiencies to be identified earlier in one's career, force maintenance of competence, enhance public perception, validate the profession's ability to self-regulate, and increase service. On the other hand, the infrastructure could be complicated, requiring very good definitions, an evaluation model, continuing education, and legislative and regulatory changes. There could be mobility problems. How would we deal with different levels of evaluation and experience, with subspecific areas, and with those who did not pass the new evaluation? Wouldn't this be a lot of work to weed out the few practitioners who are not sufficiently competent?
4. In the context of limited licensure, should paraprofessionals be recognized and employed within a limited scope of veterinary practice?
Licensing and regulating paraprofessionals, in a defined relationship with veterinarians, would be a major step forward. Currently, lay people are doing some procedures and veterinarians others. Would such a system infringe on their respective livelihoods? Would veterinarians be moving to a more managerial role? There are limited training opportunities. The paraprofessional's licence would have to be explicit to prevent complaints and working at cross-purposes.
Suggested future steps included ensuring proper education of paraprofessionals, setting national standards for their work within a clearly defined scope of practice, developing some form of recognition of their competence, and finding ways to clearly distinguish paraprofessionals from veterinarians in the eyes of the public.
In summary
Dr. Deb Stark, assistant deputy minister of Research and Corporate Services Division at the Ontario Ministry of Agriculture, Food and Rural Affairs, summed up the day's discussions. Some of the profession's problems may not really exist or may not be as bad as one thinks: graduates are competent; large-animal practice is growing in some regions; and, although we may not have enough large-animal practitioners in some regions, we also have fewer farms and fewer production animals. She reminded delegates that the changing demographics, the shortage of knowledgeable workers, and the change in lifestyle preferences are not unique to veterinary medicine.
Any of the possible new approaches to education and licensure might increase practitioner and public confidence, as well as new-graduate competence; but maybe not, and they would be difficult, complicated, and expensive.
Economics and education are driving change, and there is good work in both areas. Provincial efforts are beginning to pay off, as is benchmarking. The deans showed how proactive the veterinary schools are. We can be proud of that work. But gaps remain. We need to build on the provincial funding for colleges. We need to get to young people early to encourage interest in underserviced areas, and we need to show clients why veterinarians are worth more. “Our message has to get out more clearly.”
As Drs. Lofstedt and Landals had urged in welcoming delegates to the Summit, veterinarians need to speak as one voice, if they are going to advance as a profession and reach the peak.