Dr. Bill Wagner
Where Have All the Veterinarians Gone? Part 1 of 2: The Problems
There is an acute and growing crisis of access to veterinary care in the United States. This access crisis is being driven in large part due to a shortage of providers (veterinarians), although we will also discuss in this article how a parallel shortage of nursing care (credentialed veterinary technicians) is compounding this issue.
The Bureau of Labor Statistics projects that the veterinary profession will need to increase the size of the veterinary workforce by just shy of 15,000 veterinarians in order to meet rising demand, which would require graduating approximately 4,400 veterinarians per year in order to accomplish.
Accredited veterinary medical schools currently only graduate about 2,400 to 2,600 veterinarians per year. Clearly, the math doesn’t look good. This means that our profession is not only drastically unprepared to meet rising demand but is poorly positioned to even maintain the workforce that is currently in place.
Just like any system, the “ins” and “outs” need to match to maintain the workforce that we have, and a mismatch will lead to a change in size of the workforce.
Ins: Demand for veterinary services has risen faster than class sizes.
The number of households with pets continues to increase by leaps and bounds, with the 2021-2022 APPA National Pet Owners Survey reporting that the number of U.S. households that own a pet has increased from 67 to 70 percent over the last two years, or nearly 4 million new pet-owning households. All relevant financial metrics for veterinary hospitals are up: Total pet ownership, visits per pet per year, and spending per pet per year.
The overall pet industry exceeded $100 billion in sales for the first time in 2020. On average most veterinary hospitals are oversaturated with demand for their services but struggling to find enough skilled labor to rise to meet that demand – particularly veterinarians and credentialed technicians. While this feels like a “good problem to have” from an industry standpoint, as rising demand and workforce shortages are driving wages up across veterinary medicine, the reality of working through this workforce shortage has been anything but good for the clinical teams on the front lines of this crisis.
Outs: The veterinary profession already needed to adjust for the retirement wave of the Boomer generation, but now faces additional new pressures.
Burnout and other mental health concerns, poor debt-to-income ratios, and dissatisfaction with corporate owners are factors driving many vets into relief work, non-clinical roles, or out of the profession entirely. While it may be possible to convince some of these veterinarians to eventually return to traditional clinical practice by addressing their concerns with the systemic issues of our profession, these are deeply rooted issues that cannot be fixed overnight.
Utilization also matters: the number of veterinarians required to perform the same amount of work will change based on how well those veterinarians are utilized.
There is a strong push for improved work-life balance in veterinary medicine. This is a very good thing and long overdue in this author’s opinion, but improved work-life balance is not without cost. Vets working a healthier workload with fewer hours is a good thing, but it means we need more vets to accomplish this desirable goal while still serving the same number of patients as a profession. Nursing leverage for clinicians is critical in improving productivity-per-DVM in order to compensate for fewer hours worked, but a shortage of CVTs exacerbates this challenge. “Leverage your vets better” is hollow advice if there aren’t enough qualified people available to hire to leverage them with.
Rural communities will continue to be the most heavily affected by the shortage of veterinarians and technicians until it is addressed.
Due to a variety of factors, rural veterinary medicine is being hit harder by the labor shortage of veterinarians than suburban and urban areas. Rural America is already deep into a veterinary healthcare access crisis which is poised to worsen deeply over the next few years as the Boomer-generation veterinarians who anchor much of the current rural veterinary healthcare access leave the workforce. This is a complicated topic which deserved its own separate article, which you can find here.
Many have suggested the creation of a paraprofessional job class in veterinary medicine, akin to the Physician Assistant role in human healthcare.
In this author’s opinion, that is not the answer medically or financially to the current crisis. As we’ve heard echoed throughout our careers, “dogs are not little humans, and cats are not little dogs”. Veterinary medicine is not human medicine, and the aspects that make our profession unique are those that also make the creation of a mid-level provider position so potentially harmful. Veterinarians are expected to assess, diagnose, and treat a multitude of species, none of whom can self-advocate. Put bluntly: veterinary medicine is very hard, and the level of competency required to do the work of a veterinarian cannot be adequately taught in a shorter 2-3 year program with significantly abbreviated hands-on clinical training. As discussed in one of my previous articles, traditional 4-year DVM programs are already falling short in their goal of training veterinarians who are fully prepared for practice.
The vocal push by some of the largest veterinary corporate groups for the creation of a paraprofessional job class is a thinly veiled effort by those companies to leverage down the cost of provider-only work by flooding the market with underqualified non-veterinarian providers who they can pay less than veterinarians.
Importantly, many of the proposed functions of a paraprofessional job class already fall within the scope of a CVT practicing at the top of their degree. Creating paths for career advancement for CVTs with additional certifications is admirable, but the best path forward is to support them (and pay them) as true nursing professionals rather than trying to convert them into under-trained “para-veterinarians”. The evidence is clear that veterinarians are significantly more productive and efficient when they are supported by credentialed technicians and this needs to be at the forefront of our profession’s vision: Credentialed technicians fill the critical nursing role in delivery of veterinary healthcare and currently are not being properly valued, as such, leading to a massive loss of talent as good vet techs often leave the industry to seek better-paid professions. Nearly half of credentialed veterinary technicians leave the profession within 5 years. The answer to a shortage of veterinarians and technicians is not to create a new, third role which is a poor substitute for the two existing direct care roles that are bleeding talent. Instead, we need to address the systemic issues within our profession that are causing good veterinarians and technicians to leave veterinary medicine earlier than retirement age.
Tune in for the next AVP blog post where I will discuss possible solutions for the veterinary workforce crisis, all the way from industry-wide initiatives to practice-level efficiency hacks.
At AVP we are committed not only to building excellent careers for the teams at our partner practices, but also to being a positive change agent in the broader community of veterinary medicine.