|Volume 21, Number 2||Fall, 1994|
Post-DVM clinical training programs are considered to have had a very positive effect upon the quality of teaching, clinical service and research in teaching hospitals and upon the veterinary services available in private specialty practices. In spite of this, there is increasing concern with at least three major issues.
- The lack of satisfactory career opportunities for clinical specialists in some disciplines.
- The increasing cost of training clinical specialists and the cost to trainees in lost salary and increased educational debt.
- The need for different training/educational models for different clinical disciplines.
The goal of post-DVM clinical training/educational programs should be to prepare veterinary specialists for professional services needed in the private and public sectors. Other goals or forces may operate to sustain residency programs in some institutions. For example, because of their relatively low salaries, residents often provide excellent, high quality and affordable support for clinical service, teaching and/or research activities. In areas with large numbers of clinical cases, interns and residents provide a high monetary return to the institution by providing veterinary services at a relatively low cost to the institution. In return, residents expect to receive advanced clinical training which will enable them to successfully pass the examinations necessary to becoming a diplomate in a specialty college, and thereafter, earn a much higher income (and of course, enjoy providing a highly sophisticated service to their clientele). This model has worked well for most specialties, but is becoming increasingly untenable for those specialties in which the market is becoming saturated. In addition to the problem of insufficient career opportunities for the new diplomates, some institutions with residency programs find it increasingly difficult to attract the number of cases needed to train residents (or veterinary students) in a satisfactory manner because, in part, there are abundant specialists available in their region who compete for the cases that once "automatically" came to the tertiary, referral institution.
The costs of sustaining a residency program fall into three categories: 1) those associated with the residents, 2) those related to the qualified faculty, and 3) cost of resources deemed to be necessary for residency training/education. The costs directly related to the support of the residents are usually relatively small and are offset by the value of the services they provide the institution. However, the amount of support provided the resident or new faculty members to underwrite their preparation for, and completion of, their specialty boards is a matter of concern to some institutions.
Veterinary clinical specialists (diplomates) must be available to train/educate residents. The residents require a portion of the diplomates' time which might otherwise be spent with veterinary students, clinical service, research or other activities of importance to the institution. Further, the diplomates are expected to take on responsibilities on behalf of their specialty colleges. These activities, which include professional time and travel, are often largely funded by the diplomates' institution. These costs are, of course, not a net loss to the institution. Because of the diplomates' advanced clinical training, they provide a high level of service for the institution, and as stated earlier, the residents usually provide an affordable (profitable) service for the institution.
The cost of nonpersonnel resources deemed to be necessary for residency training include:
- Increased numbers of "non-essential" laboratory tests for residents' education and case-reports;
- More sophisticated equipment;
- More complex cases, many of whose care must be underwritten by the institution;
- Training protocols that require residents to have access to a number of different specialties either from within or outside of the institution.
To be affordable for the resident, it is likely that their training program will have to be underwritten by private or public institutions. This is more likely to occur if the training program benefits the institution such as supporting its teaching, research or clinical service programs. It seems unlikely that government funding for the training program per se will be forthcoming, and only a few segments of private industry will see it to be in their interest to invest in post-DVM education. In periods of severely restricted funding, the value of the symbiosis between the resident program and the institution's goals will be evaluated in terms of the cost of the program relative to its monetary return to the institution. The outcome of these assessments will be, no doubt, different among the various clinical specialties. Eliminating programs will be difficult. If residency programs are eliminated in some areas (disciplines) within an institution, it is likely to cause stress between the "haves" and the "have nots," because most residency programs are seen as improving the clinical environment for specialists.
In the future, the model and domain for post-DVM training/education may vary among the disciplines. For example, those trainees who aspire to enter the private sector as a clinical specialist may pursue all or part of their post-DVM clinical training in a sophisticated private practice; those who wish to pursue an industrial or government position may pursue part of their training in an academic setting and part in an industrial or government setting; those who aspire to enter academics may pursue their training in a veterinary or human-medical teaching hospital as a postdoctoral research fellow.
Five Models for Future Post-DVM Clinical Training/education Programs
- Clinical residency without the goal of Specialty Board Certification.
It is conceivable that individual institutions or groups of institutions may develop advanced clinical training programs in some disciplines without specialty college certification. Instead the institution may develop its own certifying system. The quality of the training and the market will determine the success of these programs.
- Clinical residency with the goal of Specialty Board Certification.
More and more of the strictly advanced clinical training may occur in private specialty practices. If this occurs, two questions arise: 1) will this model of training adversely affect clinical research and the advancement of clinical veterinary medicine?; and 2) how well will the quality of these programs be monitored/ controlled and by whom?
- Clinical residency with MS degree.
Some see the synergism between clinical training and MS-degree education which is to benefit the residents in their careers in a variety of settings. This model has worked well in several clinical specialties, and may continue to be a good model for some.
- Clinical residency with a PhD degree.
Increasingly, some academic and industrial units will have positions in certain disciplines for those with both advanced clinical and research training. One example is clinical epidemiology in which well trained researchers are needed for clinical research, and the discipline requires a high level of sophistication in clinical medicine and in research. Others with few employment opportunities in their discipline may choose to improve their career opportunities by preparing for a research career with a PhD degree.
- Clinical residency followed by post-doctoral fellowship with emphasis on clinical research and/or advanced clinical technology.
A model that might fit both the post-DVM trainee's and the institution's goals would be advanced clinical training followed by an intense and sophisticated postdoctoral fellowship in a large, high-quality, medical institute. The postdoctoral training should be designed to prepare the trainee to do high-quality, focused clinical research required by industry, academia and governmental agencies.