Evolution of Veterinary Medicine in the United States

In the evolution of Schools of Veterinary Medicine in the U.S., between 1852 (The Veterinary College of Philadelphia) and 1938, 41 independent (proprietary) schools were started. Thirty-two were in the North and Midwest, seven in the South (including KY and W V), and two in California. By the turn of the 20th Century, 20 were closed, merged, or suspended, fourteen more closed by the end of World War I (1920), six more by 1933, and the last one in 1947. By World War II, the demand for graduate, licensed veterinarians incentivized establishment of new schools. In the depths of the Great Depression (1932) Auburn had only three graduates and 84 students. By 1936, the ranks had swelled to 188 students and 24 graduates. In 1946, only ten years later, there were 223 students from 14 states and Puerto Rico. The distribution extended to New England and the Midwest. Between 1944 and 1957, the eleven schools in 1944 grew to eighteen. Between 1967 and 1979, nine more were added. The addition of the Western University in Pomona, Calif., in 1998 brought the number to 28 schools by the turn of the 21st century. Since then, new schools at Lincoln Memorial University in Harrogate, Tenn., and Midwestern University in Glendale, Ariz., were provisionally accredited by the AVMA in 2015, bringing the total to 30 schools in 27 states in the U.S. In addition, there are five in Canada or 35 accredited schools in North America. Not included are four schools in the West Indies. So, after a history of 92 years (1852-1944), in the space of the next 54 years (1944-1998), the eleven U.S. schools at the end of World War II (1945), more than doubled to 28 schools before the turn of the century. Counting the five Canadian schools and the next two U.S. schools, in the space of 70 years (1945 to 2015), the number of North American schools had grown from thirteen to thirty five, nearly triple. This progress was dwarfed, however, by the growth of the specialties. Prior to mid-twentieth century, the great preponderance of veterinarians were in mixed practice—large and small animals. The other occupations—state and federal regulatory veterinarians, academic medicine, the military, and commercial (pharmaceutics and feed manufacturers)—accounted for important but small numbers. Not unexpectedly though, these smaller numbers accounted for the first specialties.

On February 10, 1950, the A.V.M.A. Board of Directors entertained a request for recognition of the American College of Veterinary Pathologists, and on July 31 of the same year, a similar proposal from the American Board of Veterinary Public Health. After review by the A.V.M.A. Council on Education (C.O.E.) and the Association of Deans of American Veterinary Colleges, in 1951, the A.V.M.A. House of Representatives gave their approval and established criteria for recognition of future veterinary specialty organizations. Responsibility for review of such was to be the C.O.E. and the A.V.M.A. Board of Directors. After several iterations in 1992, the final version was named the American Board of Veterinary Specialties. A list of nine rules, standards, and procedures was updated and approved by the A.V.M.A. Board of Directors in 2015. At present, there are 22 AVMA-recognized veterinary specialty organizations comprising 41 distinct specialties established between 1951 and 2010:

Chronology

1. 1951—The American College of Veterinary Pathologists- Anatomic & Clinical
2. 1951—The American Board of Veterinary Public Health, changed in 1978 to the American College of Veterinary Preventative Medicine & Epidemiology
3. 1957—The American College of Laboratory Animal Medicine
4. 1962—The American College of Veterinary Radiology and Radiation Oncology
5. 1967—The American College of Veterinary Surgeons
6. 1967—The American Board of Veterinary Toxicology
7. 1971—The American College of Veterinary Microbiologists
8. 1971—The American College of Veterinary Ophthalmologists
9. 1971—The American College of Veterinary Theriogenologists
10. 1972—The American College of Veterinary Internal Medicine (5 Divisions: Cardiology, Large Animal, Small Animal, Neurology, and Oncolog y)
11. 1975—The American College of Veterinary Anesthesiologists
12. 1978—The American College of Veterinary Practitioners (8 Divisions: Avian, Beef Cattle, Dairy Cattle, Canine & Feline, Feline, Equine, Food Animal, and Swine)
13. 1982—The American College of Veterinary Dermatology
14. 1983—The American College of Veterinary Zoological Medicine15.
15. 1988—The American Veterinary Dental College
16. 1988—The American College of Veterinary Nutrition
17. 1989—The American College of Veterinary Emergency & Critical Care
18. 1990—The American College of Veterinary Clinical Pharmacology
19. 1991—The American College of Veterinary Poultry Veterinarians
20. 1993—The American College of Veterinary Behaviorists (Animal Psychology)
21. 2006—The American College of Animal Welfare
22. 2010—The American College of Sports Medicine & Rehabilitation

Additionally, there are 31 associations and academies based on either discipline or species. There are 57 societies, conferences, associations, symposia, corps, operators, missions, etc. based on activities, ethnicity, gender, social orientation, and other interests. There are 402 associations based on state and regional location. These are all listed in the A.V.M.A. directory with full titles and addresses. Surely, no one in this profession ever needs to feel isolated.

This, then, is what we look like today, and that poses a monumental problem which confronts both academic and organizational veterinary medicine. Should we even attempt to represent all these interests or just let them go their own way? And perhaps more perplexing, how can academic veterinary medicine best provide a curriculum to prepare graduates for the myriad of opportunities that confront them? Given the spiraling cost of a college education today and the time commitment, especially if graduate school, residency training, and board certification in a specialty are considered, what practical courses of action are there? For employers of these graduates, starting salary packages often include expec-tation of health care benefits as well as other amenities. Nor do these concerns address the growing gap between small animal practice and food animal practice, the diminishing supply of young candidates with a rural background and an appreciation for animal agriculture.

To give you an idea of the concern of officialdom, a quick perusal of literature since the turn of the 21st century yielded the following: In the J.A.V.M.A., May, 1999- The Current and Future Market for Veterinarians and Veterinary Medical Services in the U.S. (conducted by the A.V.M.A. and A.A.V.M.C.)

1. Veterinarians’ income lags behind similar professions, including student debt.
2. The growing number of women—70% of students, expected to peak at 78% by 2015; 36% of practitioners, expected to peak at 67% by 2015. Women’s income lags behind men partly due to lack of interest in practice ownership. Other differences included less interest in food animal and agricultural fields.
3. The global demand for all categories of veterinary services, particularly in nontraditional and nonprivate areas such as food safety, environment, and animal welfare.
4. Delivery systems may suffer due to excess capacity and supply: demand imbalance. Other examples were health insurance, credit payment plans, and collection services.
5. Skills, knowledge, aptitude, and attitude of graduates, noting the varying levels at time of graduation. Also, concerns over lifestyle, income, benefits, and amenities, resulting from cultural differences.
6. Also, public expectations, for example, more litigations than in the past. From 1996 to 2009, I served as a trustee to the AVMA PLIT. Before that, I was on the clinic floor from 1955 to 1988. In that span of time, Professional Liability has gone “through the roof.” What once was considered as the cost of doing business or the understandable risks of ownership of livestock and forgivable mistakes, now seeks retribution through litigation, and little old Alabama was once known as a “tort hell.” Punitive trial lawyers have become a distinct species, well-characterized by popular author John Grisham with some 29 books to his credit. And Malpractice Law has become an industry. Remember, one candidate for president in 2004 and 2008 had made his fortune in suing doctors for malpractice.

Between 1983 and 1995, there were:

• Increase in small animal practice income – 15.7%
• Decrease in large animal practice income – 27.5%
• Increase in mixed animal practice income – 44.4%
• Decrease in equine practice income – 21.2%

In the A.A.V.M.C. Strategic Plan of June, 2009, the six goals and objectives were:

1. Improve education
2. Increase research
3. Improve recruitment of students
4. Diversify the population and the fields of study
5. Provide leadership training (as well as personnel and business management skills)
6. Strengthen the A.A.V.M.C.

In July, 2015, the North American Veterinary Medical Education Consortium released its Roadmap for Veterinary Medical Education in the 21st Century- Responsive, Collaborative, and Flexible. Briefly, the executive summary expressed concern over the reduced support of state legislatures in college funding, the increases in tuition, enrollments, and student debt load. Emphasis was placed on research and attention paid to global food production, safe and secure food supplies, emerging zoonotic diseases, wildlife health conservation, and veterinary public health. Also, graduate career-ready veterinarians proficient and confident in core areas, and shared resources in collaborative, biomedical fields.

A good example of Auburn’s commitment to these recommendations is its participation in a U.S.D.A. grant to strengthen veterinary services to designated under-served rural populations in Kentucky in partnership with Kentucky veterinarians. Another example of Auburn’s response to the challenges sounded by these “calls to arms” is the college’s Scott-R itchey Research Center collaboration with the Gene Therapy Center at the University of Massachusetts Medical School. Using their work with GM1 gangliosidosis, a naturally occurring disease in cats, and the comparable disease in humans, Dr. Doug Martin and his team of research scientists at Scott-Ritchey have developed a potential cure for the fatal disease affecting infants and early childhood. Dr. Martin is part of the team of researchers in the Tay-Sachs Gene Therapy Consortium, an international group; they are developing protocols for preclinical studies to be presented to the National Institutes of Health perhaps as early as 2018.

Not generally known is Auburn’s role in development of the defibrillating cardiac pacemaker and study of mitral valve prolapse. In the news recently was the story of a miniature dog brought to Auburn from Seattle, Wash., for surgical correction of a patent ductus arteriosus. And then, as previously reported, an independent survey of academic teaching hospitals in the U.S. rates Auburn’s as number one.

Already upon us is the Veterinary Feed Directive (VFD) implementing new policies and rules for the use of medically important antibiotics in food animal species that are administered in food or drinking water. Dictated by the U.S. Food and Drug Administration (FDA) and encouraged by the World Health Organization (WHO), the regulations took effect January 1, 2017. Many of the European countries had already banned the unrestricted use of antibiotics commonly used for nonspecific, i.e. nonmedical, purposes in food animals.

In the space of little more than two generations, a profession that was comprised of basically general practitioners with a fringe of teachers, veterinarians in government and military, and in the feed and drug industries, has become a complex that draws comparison to what happened to the Protestant Church in the 500 years (16th to 21st Century) since the Reformation. And although division into specialties may have peaked, other responsibilities and opportunities continue to mount on a global scale.

Given the explosion of medical science, consider the following:

1. Artificial intelligence
2. Nanotechnology
3. Miniaturization
4. Noninvasive surgery
5. Laser surgery
6. Imaging technology
7. Realtime biochemistry
8. Sensor technology
9. Stem-cell technology
10. Advanced vaccinology
11. Genetic engineering
12. Viral vectors in treatment of cancer and as previously illustrated in treatment of genetic disorders
13. Robotics

Whether these examples spawn additional specialties or subdivisions of existing ones, one cannot deny a horizon that extends beyond the current boundaries.

One thing is certain. Regardless of the number of branches, they must all emanate from the same trunk. Nothing will ever compromise the need for a basic foundation, and the higher the superstructure, the deeper must be the footing. Nothing so teaches an appreciation for physiology and pathobiology than the practice of clinical medicine, or for anatomy than the practice of surgery. Obstetrics begins with genetics and embryology, and all disease processes start at the molecular level.

Respectfully,

Yr humbl and obdt svt,

JTV