Dr. Bill Wagner
Opinion: Veterinary Medical Schools Are Failing New Graduates
Veterinary medicine has reached an inflection point, with the likelihood that the profession’s business model will continue to dramatically shift in the coming years. Some of that change has been good (rising associate compensation, increased focus on work-life balance, rising standards of care) but much of it has not (skyrocketing student loan debt, growing non-veterinary corporate ownership). Veterinary medical school is the crucible for veterinarians that ultimately shapes how our profession operates. Right now veterinary schools are failing many new graduates in their duty to prepare them for professionally and financially rewarding careers. Veterinary medical schools are currently failing in three important pillars: readiness for practice, financial literacy, and debt to income ratio.
Readiness for practice:
If we had to boil down the job of a veterinary medical school into one statement, it would be this: Their job is to produce graduates who are prepared to practice medicine. Unfortunately, we’ve been seeing a trend in the wrong direction of clinical preparedness of veterinary graduates. This doesn’t appear to be a failure by schools to impart “book knowledge” in lecture format, but rather an erosion of the hands-on clinical component of veterinary education that typically occurs in the final year of vet med school.
This seems to be mostly due to a rise of a “worst of both worlds” application of the specialty-focused human healthcare education model. In human healthcare, internships and residencies are a mandatory part of becoming a practicing clinician and most of the hands-on portion of a student’s education happens during those internships and residencies which are preparing students for their eventual specialty. In veterinary medicine, internships and residencies are not a mandatory part of becoming a practicing clinician although they are becoming more popular. The rise in popularity of internships, residency, and specialization has led to veterinary teaching hospitals looking more like human teaching hospitals where most hands-on clinical learning opportunities are given to residents and interns. Fourth year vet med students are mostly resigned to watching procedures rather than participating (supervised, of course) as used to be the case. This is leading to a rise in new graduates who have largely made it through their veterinary education without ever having performed many of the duties themselves that they’re going to be expected to perform in practice, particularly in the area of surgery. This has unfairly shifted the burden of teaching new graduates how to be functioning doctors rather than walking collections of “book knowledge” onto their first employers. There has always been an expectation of mentorship when hiring a younger veterinarian, but it was always meant to be a fine-tuning process rather than teaching large amounts of knowledge from scratch.
Having a career as a veterinarian means not just being a clinician, but also being an employee and for many veterinarians also an employer. Having a rewarding career as a veterinarian means understanding how to advocate for yourself as an employee (particularly on matters of compensation and working conditions), knowing how your compensation needs to appropriately match with your debt level, and most importantly having the financial literacy to be an effective business owner should you choose to pursue practice ownership. If I could go back in time and swap my “wasted” (not in terms of quality but should have been reserved for residents on track for specialty) lectures on the physics of radiation oncology, hemodialysis protocols, and other specialty-level topics that turned into space-occupiers in my GP brain for lectures on financial literacy I think that I’d be a much better veterinarian for it.
Debt to income ratio:
The median cost of getting a veterinary education now surpasses $200,000 and total debt to income ratio for new graduates is typically greater than 2:1. This is a massive, nearly existential threat to the profession which has many veterinarians feeling as though their student loan debt will become a permanent fixture of their professional lives. If this trend continues, veterinary medicine runs the risk of being unable to attract the kind of top academic talent that it has long enjoyed. We already see excessive debt to income ratio causing a crisis of a lack of diversity. Our profession will suffer if we allow a veterinary degree to become a privilege only available to those who either come from wealthy enough means to avoid debt entirely or those who are willing to commit to a state of permanent debt. A manageable amount of debt is not necessarily an unfair expectation for entry into a sought-after career, but the current state of veterinary debt has grown entirely unmanageable and has become fundamentally mismatched with the earning power of the average veterinary graduate.
The cost of a veterinary medical degree has risen at an astronomical pace over the last few decades, paralleling a similar trend in undergraduate education and driven in part by a ballooning proportion of administrative expense at veterinary medical schools. Student loan debt is easy to acquire, even imprudent amounts, so there is no market pressure to cost correct this trend as students simply get approved to take on more debt with each passing year to fund the exponential trajectory of tuition cost. Administration in academia has grown heavy, and the entire profession is being forced to carry the weight.
What can we do about it?
Readiness for practice: Veterinary medical schools need renewed focus on securing hands-on clinical opportunities for clinical year students in order to ensure they’re properly prepared for clinical practice without “passing the buck” by recommending internships for under-prepared graduates. Some schools have found successful outside-the-box solutions like opening teaching clinics in under-served communities that provide significantly subsidized veterinary care and provide clinical year students with a chance to get truly hands-on with patients without needing to worry about losing out to residents and interns.
Financial literacy: Robust curriculum on topics of financial literacy, both in terms of personal finances and basic business skills, needs to become a standardized part of veterinary medical curriculum.
Debt to income ratio: An education is only as good as its ability to set a graduate up for a rewarding career. Paying more for the same education effectively means getting less value. The rising cost of tuition isn’t just a cost issue but also a quality issue and therefore should be an accreditation concern. It is this author’s opinion that cost mitigation requirements including limits on administrative costs should be part of accreditation criteria, and schools that are unable or unwilling to provide their graduates with a path to sustainable debt to income ratio upon graduation should lose their accreditation status.
How AVP is trying to help:
Practice ownership is the best available path to paying down student loan debt for veterinarians and achieving a more financially rewarding career, since owners of well-run veterinary practices significantly out-earn associate veterinarians. However, excessive student loan debt, lack of financial literacy, and concerns about work-life balance make the idea of practice ownership very intimidating to many veterinarians. The idea of taking on more debt to finance purchase of a practice, working more hours, and trying to run a small business by themselves with no formal training in business management is understandably frightening. AVP has recently been working to partner with great clinicians who are interested in the financial upside of ownership and the clinical autonomy of overseeing medicine at their own clinic, but don’t want to take the leap into practice ownership by themselves and without support. AVP can bring much of the required financing for purchasing a practice and is able to run the business side of the hospital while our co-owning clinician can focus on running the clinical side. This symbiotic business partnership ensures that everyone is focused on what they do best. Our co-owner partners share in the financial upside of the business on equal terms but enjoy far fewer headaches and much better work-life balance than is typical for practice owners because they have a motivated business partner taking care of most administrative duties.
For any veterinarians who are interested in learning more about co-ownership opportunities, please don’t hesitate to reach out to me at firstname.lastname@example.org