A Changing World and a Changing Profession Challenge Veterinary Medical Education
William R. Pritchard, DVM, PhD, JD
From the Pew National Veterinary Education Program,
School of Veterinary Medicine, University of California, Davis, CA 95616.
Formal veterinary education began in the Western world in the 1760s in Lyon and Alfort in France with the establishment of the first Western veterinary colleges (1). These institutions were established in an effort to reduce the severe economic impact of animal diseases, particularly, rinderpest. The French colleges had high standards for producing well-educated veterinarians who quickly addressed important animal health problems of the day and the new profession flourished. The first anglophone college was established in London in 1791 (2). Although founded on high principles, it early adopted low standards resulting in a profession with limited competence and low public esteem. The first successful colleges in North America were private institutions modeled after British veterinary colleges. The New York Veterinary College established in 1857 and the Ontario Veterinary College in 1862 (3). Private colleges, generally with low standards, dominated veterinary education in North America until their demise following World War I.
Between the World Wars, veterinary education in the United States was consolidated in the land-grant colleges. The land-grant tradition of teaching, research, and public service was adopted by veterinary colleges. Veterinary education, however, was poorly supported during this period, which reflected the lack of public concern for the profession.
World War II was a turning point, ushering in a "Golden Age" for veterinary education and veterinary medicine. Veterinary colleges adopted high standards and were strongly supported. Well-educated veterinarians provided for a wide variety of human needs. The profession flourished as never before and gained a high level of public acceptance.
Review and Renewal
During the early 1980s, rumblings of concern about the future began to be heard within the profession. Practitioners, particularly those in small animal practice, believed that there were too many veterinarians. An American Veterinary Medical Association (AVMA) commissioned a manpower study that lent some support to that belief (4). The profession also was having difficulty serving some of its traditional constituencies, such as the food animal industries, and the public sector.
These concerns led to a Symposium on Veterinary Medical Education, the ninth in a series sponsored by the AVMA and the Association of American Veterinary Medical Colleges (AAVMC). The purpose of the Symposium was to plan for the 21st century. Participants identified the growing discordance between veterinary medical education and the needs of the profession and society (5). The Symposium articulated many problems confronting veterinary education and identified possible courses of action to correct some of them (6).
The Pew National Veterinary Education Program (PNVEP)
The PNVEP was conceived at the same time the 9th Symposium was being planned (7). It was designed to support efforts of educators to make changes in veterinary medical education, many of which had been identified by the 9th Symposium, and to further define the needed changes.
The goal of the PNVEP was to strengthen and institutionalize the ability of the profession to adapt to changes in society, i.e., support the processes of change. It was not designed to achieve any particular change. The project was constructed on 3 basic premises:
- The social, economic, technologic, and political changes that are occurring in society today will shape the world in which veterinarians function in the future and determine the kinds of veterinary services needed.
- The welfare of the profession and of individual veterinarians is determined by how well the profession serves society in those tasks and functions for which veterinarians have a comparative advantage over other professions, disciplines, and businesses. Therefore, the profession must be responsive to societal change and continually adapt services to changing needs.
- Veterinary education is a key leverage point for change in the profession.
The project consisted of 4 related phases: A strategic analysis of veterinary medicine and veterinary education from a national perspective was conducted by a panel of experts drawn from the profession, none of whom were active educators (one now is a dean and another an associate dean). The analysis was structured to provide an integrated and coherent perspective of the profession, its strengths, weaknesses, its modern role in society, the threats and opportunities facing it, and insight into the nature of the forces that will shape veterinary medicine in the years ahead. The report Future Directions for Veterinary Medicine(8) identified directions the profession might take to strategically position itself for the changing world of the future.
Leadership training, particularly in skills to initiate and manage change, was provided to deans and key veterinary college leaders from all colleges. Year-long strategic planning efforts were conducted at all 31 United States and Canadian veterinary medical schools. Finally, educational innovations with implications to veterinary medical education in general were supported. The primary tools of PNVEP were analysis and debate of major issues. The program was designed to structure, provide venues for, and focus debate on veterinary education on both the national and college levels. National debate of issues occurred at one national review session and three AVMA/AAVMC/PNVEP sponsored symposiums on veterinary education. Debate at the college level was structured through the strategic planning processes, and led to college decisions on specific changes.
Veterinary medical education in the United States and Canada has become sensitized to the need for change as a result of all these activities and many changes are being implemented.
What About the Future?
What can we expect for veterinary medicine in the future? Insight to the future of the profession can be gained by examining the social, technologic, economic, and political trends that affect the need and demand for veterinary services, and the potential impacts of these changes on veterinary medicine. I will briefly review a few of the environmental changes identified in Future Directions for Veterinary Medicine, which are particularly important to veterinary medicine.
Changing Status of Animals
The social and legal status of animals, once mere chattels to be used and exploited at will by owners, is changing rapidly. For a variety of reasons including a rapidly growing world population, increasing urbanization, and mounting concern about environmental deterioration, most classes of animals, both domestic and wild, are becoming more important to people. As society assigns higher values to animals, it places higher social value on veterinary medicine and increased economic value on veterinary services. The changing status of animals is having a profound effect on the veterinary medical profession.
Focus on Health, Not Disease
Veterinary medicine in the United States and Canada has been successful in controlling most infectious diseases of animals, and has reduced losses from many diseases of nutritional, toxic, metabolic, and genetic origins. Increasingly the public looks to veterinarians for information and services that will keep animals healthy, productive, and useful. The increasing emphasis on health and productivity/utility is creating a fundamental change in the tasks and functions of the profession.
Expectations of High Quality Services
The public increasingly expects services of ever-higher quality, specificity, and predictability from veterinarians working in all facets of the profession. Higher expectations result in part from widespread publicity in the media of advances in science, agriculture, and in human and veterinary medicine. They also are an expression of a trend among consumers worldwide to demand higher quality products and services. The expectations of consumers of veterinary services will fuel efforts of the profession to constantly improve the quality of veterinary services rendered and the effectiveness of the animal health delivery system.
A large body of knowledge relevant to veterinary medicine currently exists and we are enlarging it at an ever-accelerating rate. Without information management systems, the quantity of relevant knowledge is far beyond human capacity to cope.
Advances in Science and Technology
Breathtaking advances are being made in science and technology, particularly at the molecular level, which are revolutionizing our understanding of life processes, disease and its control, and increasing the power and specificity of all kinds of veterinary technology. The ability of veterinarians to deal decisively with health and disease in all classes of animals will be greatly and progressively enhanced in the coming years.
The revolution in computers, data collection, management and use, is as spectacular and important as the advances in science and technology. Information and information-based services are the chief stocks in trade of the veterinary profession. The development of information management systems for general veterinary use will in time revolutionize veterinary practice. Information systems also provide unprecedented opportunities for veterinary medical colleges to interact and share human resources.
The long-term cumulative effect of human activity is having a devastating effect on the natural environment. There is a growing belief that arresting progressive environmental deterioration must become North America's number one priority. Veterinary medicine has an important role in this task.
The population of the world is growing rapidly. It now is 5.5 billion and expected to reach 6.2 billion in 2000 and 8.2 billion in 2025. Over 90% of the growth will occur in developing countries with important implications for food production, environmental deterioration, and migration patterns to developed countries. In the U.S. and Canada, growing middle-aged and elderly populations, changes in household structure, and urbanization all will have profound effects on the demand for and nature of veterinary services in the years ahead. The growing proportion of the population with low incomes will negatively impact companion animal practice.
Changes in Animal Agriculture
Far-reaching structural and technological changes are occurring in animal agriculture that are having a profound effect on the ability of veterinarians to provide needed health services to the livestock industries. The total number of farms is decreasing but the proportion of both large and small farms is increasing. New strategies for servicing the animal health needs of both the very large and the very small farms are needed and are being developed.
The United States and Canada are becoming more involved in the social, political, and economic affairs of the world, which will directly affect veterinary medicine in the future. The North American Free Trade Agreement will increase interactions with Mexico and the rest of Latin America.
What Do These Changes Portend?
Most of these major trends will enhance the importance of the veterinary profession and increase the demand for veterinary services. For nearly a half century the profession has attracted some of the most intelligent and motivated young people in the United States and Canada. Veterinary educational institutions have enjoyed 45 years of growth and development. The profession at large is competent, and well-respected. From almost any perspective the potential future for veterinary medicine in the United States and Canada is bright. What actually happens, however, will depend upon how well the profession adjusts to the changing needs of society.
How Will the Profession Change in the Future?
Most of the changes in the future will be a continuation of changes that are occurring today.
- The world is growing more complex, and knowledge of science, animals, animal production, and animal health is expanding rapidly. Consequently, people expect more and more from the profession. The veterinary profession must become capable of routinely delivering higher and higher levels of services to all the classes of animals important to people and to achieve ever-higher levels of competence in all veterinary activities. It is not enough to provide services just to livestock and companion animals. All classes of animals are considered by the public to deserve high quality veterinary services.
- Veterinary medical practice will focus more and more on the care, health, welfare, utility, and productivity of animals rather than mainly on diseases and their control. This changing focus is happening more rapidly with food, laboratory, aquatic and wild animals than it is with companion animals.
- With increasing public concern about food safety, a growing understanding of the importance of companion animals to human health and well being, and continuing importance of animals and zoonoses to human health, practicing veterinarians, whether they recognize it or not, are becoming more actively involved in the human health delivery system.
- The profession will continue to differentiate, i.e., limit the scope of professional responsibility of individual veterinarians in order to maintain needed levels of competency. In 1992, 67% of all practicing veterinarians limited their professional efforts exclusively to a class of animals or species, and 92% predominantly to a class or species (9). Differentiation will be followed by more disciplinary specialization.
- The profession will develop information banks and practical systems of organizing and using information so that practitioners, both public and private, will be able to more easily and routinely use the vast store of knowledge that exists on health, disease, drugs, and management.
- Major improvements will be made in the veterinary delivery system to improve services, increase the productivity of veterinarians, and to keep the costs of services affordable.
- Veterinary technology will markedly advance, i.e., drugs, vaccines, diagnostic tests, etc., thereby greatly increasing the effectiveness of veterinary interventions.
- The veterinary profession in the U.S. and Canada will become more cosmopolitan and better prepared to cope with animal health issues within a more global context.
Changes in Veterinary Education
Changes are required in veterinary education to better equip the profession to provide for a changing role in a changing world.
In this regard, Future Directions for Veterinary Medicine recommended that:
- Strengthen the undergraduate education so that all veterinarians have a strong (baccalaureate level) general college education by the time they receive the DVM degree.
- Structure the professional curriculum to emphasize a core of instruction about the biomedical and veterinary sciences, and the principles of clinical veterinary medicine in populations and individual animals in general, and an in-depth clinical experience in a practice theme either in the public or private sectors.
- Strengthen instruction relating to health and productivity/utility for all classes of animals.
- Devise programs to adequately educate veterinarians within the DVM/VMD program for public sector roles that are growing in complexity.
- Focus professional education process on the ability to find and use information rather than on the accumulation and instant recall of facts.
- Move veterinary education toward a North American strategy in which colleges focus their programs to enhance their quality and effectiveness, and cooperate with other veterinary medical colleges to ensure that all of society's needs are covered.
The Pew Health Professions Commission in Healthy America: Practitioners for 2005, made one additional recommendation that was embedded in, but not highlighted by Future Directions for Veterinary Medicine(10): Veterinarians are more knowledgeable about the impact of animals and their diseases on human health and the role and use of animals in the improvement of health and well-being than any other health professional in most communities. Thus, veterinarians should be more directly available to human health providers for consultation on these subjects. If veterinarians are to play a larger role in human health delivery, veterinary education should equip them to do it.
Veterinary colleges in the United States and Canada are being confronted by some important institutional issues. As veterinary practice is becoming ever-more complex and the public is demanding more from veterinarians and increasing the demands on veterinary colleges, higher education is confronted with diminishing resources. Veterinary colleges are being forced to operate with funding levels that, in the light of previous experience, are thought to be inadequate. There is every reason to believe that lower levels of funding will continue for some time. Lower levels of funding do not necessarily mean that a school's program must be of lower quality, but it does mean that it will be different.
If veterinary education is to continue to provide support and leadership for the continued growth and development of the profession, new and innovative ways must be found to increase the efficiency of education processes, i.e., the productivity of veterinary schools. Increased efficiency could (among many possibilities) include:
- The development of new relationships within the university in which veterinary colleges use university academic units for components of professional education, or contribute to teaching or research in other units, providing economies for the university as a whole. Promising areas for consideration are programs in animal science, biomedical sciences, and human medicine.
- Cooperative efforts ("strategic alliances") between veterinary medical colleges and with other colleges permitting individual colleges to focus resources on fewer programs to maintain or enhance quality, while depending upon cooperative efforts with other institutions for needed breadth. Advances in electronics are making this strategy more and more attractive. The Swedish government currently is considering this strategy for all universities and research institutions (11).
- Adoption of new teaching modes to increase the efficiency and effectiveness of teaching/learning processes and the productivity of faculty. This could include new uses of electronics and sharing of human resources among veterinary medical colleges.
- Veterinary colleges must learn to function more like the graduate professional colleges that they have become, giving more responsibility to students for their education than has been traditional in United States and Canadian veterinary medical colleges.
- Veterinary medical colleges must establish new relationships with the practicing community to take advantage of the opportunities for teaching afforded by the high quality of contemporary veterinary practice. The gap between the quality of private practices and the quality of veterinary college hospitals which once existed, has now narrowed to the point where colleges might more cost-effectively use private practice for part of their clinical teaching needs. Teaching hospitals, staffed by specialists, who work mainly with referred cases and have expanded public service responsibilities, are having increasing difficulty in teaching primary care.
The overall cost of veterinary education (to the public and to students) requires a critical evaluation of every element in the preveterinary and veterinary program, and an openness to changes that will decrease costs without diminishing effectiveness.
The veterinary profession in the United States and Canada is strong and enjoys a higher level of public acceptance than at any other time in its history. Veterinary medical education has become a vital force in higher education in these two countries and is adjusting to numerous social, economic, technologic, and political changes that are occurring in its environment. Some far-reaching institutional changes will be required, however, if U.S. and Canadian veterinary medical colleges are to meet the challenges of the future. A question of paramount importance is: How will veterinary education structure itself so that it can support the needs of a rapidly developing profession with static or diminishing resources?
Hunter Rawlings III, President of the University of Iowa, has good advice for all of higher education (12).
- "If we spend less time fretting about ourselves, our funding and perks and
- privileges, and more time thinking creatively about what we can do for a nation
- that needs us, we will accomplish more of lasting value--and our public image
- will take care of itself."
- privileges, and more time thinking creatively about what we can do for a nation
We must think creatively about the future of veterinary education.
References and Endnotes
1. Smithcors JF: The Evolution of the Veterinary Art. Kansas City: Vet Med Pub Co., 1957.
2. Pattison I: The British Veterinary Profession 1791-1948. London: JA Allen, 1983.
3. Smithcors JF: The American Veterinary Profession. Ames: The Iowa State University Press, 1963.
4. Wise JK, Kushman JE: U.S. veterinary manpower study: Demand and supply 1980 to 2000. Schaumburg, Il: Am Vet Med Assoc., 1985.
5. Morgan HC: Symposia revisited 1964-1990. J Vet Med Educ 17: Special Issue, 5-10, 1990.
6. Proceedings 9th Symposium on Veterinary Education. J Vet Med Educ 14:66-97, 1987.
7. O'Neil E, Pritchard WR: The Pew National Veterinary Education Program. J Vet Med Educ 14:99, 1987.
8. Pritchard WR, (Ed.): Future Directions for Veterinary Medicine. Durham, NC: Pew National Veterinary Education Program, Duke University, 1989.
9. AVMA Membership Directory and Resource Manual, 42nd ed, Schaumburg, Il: Am Vet Med Assoc, 1993, pp 22-26.
10. Pritchard WR, Stone EA: Healthy America: Practitioners for 2005, A Beginning Dialogue for US Schools of Veterinary Medicine, Durham, NC: The Pew Health Professions Commission, 1991, p 1.
11. Aldhous P: More elitism, encouraged with a shot of hard cash. Science 260:1751-1752, 1993.
12. Rawlings III, H: Quoted in Chronicle of Higher Education, May 5, 1993;39: No. 35, p B2.