Better business and communication skills will be a must for tomorrow’s veterinarian, says AVMA chief executive officer

Tomorrow’s veterinarians will be better prepared for the business challenges facing them than their predecessors, and they’ll probably also have better communication skills. They will possess outstanding technical competence, though they may receive their schooling in ways that differ from today’s practitioners.
But they’ll also face heavy school debt loads, as well as the threat of onerous government regulation of their practices. As more of them veer toward specialization, they may face a public increasingly unable to afford their services, despite the rise of pet insurance. They will have to adjust to competition from online pharmacies, and they may struggle to maintain their traditional strengths in wellness and preventive medicine.
Meanwhile, rural areas will continue to face a shortage of professional expertise, while society at large will be forced to come to grips with the fact that human and animal health are inextricably linked.
All of these trends are on the mind of Ron DeHaven, DVM, MBA, chief executive officer of the American Veterinary Medical Association. DeHaven, who joined AVMA in 2007, recently spoke with Vet-Advantage about the present and future of veterinary medicine and those who practice it.

Twenty years with APHIS
Prior to joining AVMA, DeHaven spent more than 20 years with the Animal Plant Health Inspection Service. As APHIS administrator, he was ultimately responsible for the protection of U.S. agriculture and natural resources from exotic pests and diseases, administering the Animal Welfare Act, and carrying out wildlife damage management activities. Prior to serving as APHIS administrator, he served as deputy administrator for the agency’s Veterinary Services program. He served as acting associate administrator of APHIS from October 2001 through April 2002, and from 1996 to 2001, he was the deputy administrator for the Animal Care Unit of APHIS, administering the Animal Welfare Act and the Horse Protection Act. Before assuming the deputy administrator’s position, he was the Animal Care Unit’s western regional director in Sacramento, Calif., for seven years.
Prior to starting work at APHIS, DeHaven was commissioned into the U.S. Army Veterinary Corps and served in the U.S. Army Reserves and National Guard. He obtained his Doctor of Veterinary Medicine degree from Purdue University in 1975 and a master’s degree in business administration from Millsaps College in 1989.

Business smarts
Given the fact that DeHaven has an MBA, it’s not surprising that he appreciates the importance of business knowledge for veterinarians. ÒWe have historically graduated technically competent veterinarians,Ó he says. ÒBut technical competency is only one of three critical skills they need,Ó the other two being good communication skills across the exam table or feedlot, and business smarts. ÒFor those individuals who fail in practice, I would suspect poor communication or business skills are responsible, more than lack of technical expertise.Ó
The good news is that virtually all veterinary schools are incorporating some business education into their curricula, he says. Some schools offer a dual DVM/MBA program. Meanwhile, veterinary students have formed the Veterinary Business Management Association, a student-led effort to educate themselves on the business aspects of running a practice, points out DeHaven.

Debt load a problem
Regardless of their business acumen, however, young graduates of veterinary school face an overwhelming financial challenge – student debt.
“It is a huge issue,” says DeHaven. “Student debt used to be roughly 1 to 1 with starting salaries; so you would graduate with a debt load roughly equivalent to your starting salary,” he says. “Now it has grown to 2 to 1.” AVMA data shows that in 2009, the average student debt was $130,000, while the average starting salary of those not going to an internship was $65,000. “You only have to go back to 2008, when the average debt load was $120,000 and starting salary $62,000. So, it’s getting worse.”
Young doctors, who are four or five years out of school and eager to start their own practice, find it difficult to do so because of the huge debt loads they face, says DeHaven.
“Couple that with some of the critical shortages we have in the profession,” he says, referring to rural food animal and mixed-animal practitioners, public health doctors and those involved in laboratory animal medicine. Of biggest concern, he says, are food animal doctors, particularly those who treat individual animals on the farm. “Production agriculture will make sure they have adequate veterinary care,” he says. “But who’s taking care of the small animal farm with 40 cows, or the small dairy farm, or the small swine operation? That’s where the biggest shortage and greatest demand is.”
Efforts are being made to help, he points out. The U.S. Department of Agriculture’s Veterinary Medicine Loan Repayment Program provides up to $25,000 of student loan debt relief per year for a minimum of three years service in a designated shortage area in the United States. And in March 2010, the AVMA and its charitable arm, the American Veterinary Medical Foundation, with funding from several industry partners, announced its intention to provide financial incentives in the form of student loan debt forgiveness for veterinarians who commit to four years of employment in food animal veterinary medicine.

New education model needed
Student debt is just one of the signs that today’s veterinary education model needs to be updated, says DeHaven. That model has remained essentially unchanged since he graduated from Purdue in 1975, he says.
Identifying new models is the intent of the North American Veterinary Medical Education Consortium, to which AVMA has lent its support. Spearheaded by the Association of American Veterinary Medical Colleges, the Consortium has brought together more than 200 stakeholders to take a close look at educational models, accreditation and licensing. Its goal is to “create a workforce of next-generation veterinarians who are ready to address some of society’s greatest needs.”
Such a reassessment is long overdue, says DeHaven. One indicator is the fact that the number of young people interested in the veterinary profession has leveled off, at a time when demand for veterinary services is increasing. What’s more, the applicant pool is not very diversified ethnically, he says.
Another thing that needs examining are the criteria used to admit students into veterinary programs, he says. “We have largely [admitted] those with the highest grade point average, with a lot of emphasis on whether the applicant has had experience working with veterinarians. Maybe that’s the wrong criteria. Maybe we should be looking for students with the right personality traits; those who have been in a successful business; or those with interpersonal skills and entrepreneurship in their background. We can teach them the technical side.” NAVMEC will be exploring such options.
What’s more, today, 28 colleges of veterinary medicine are trying to provide education in 20 different specialties, “at a time when specialty practices are popping up all over,” DeHaven points out. Meanwhile, some faculty members are starting their own specialty practices, and some urban veterinary colleges are trimming their curricula in farm animal medicine. To make matters worse, schools are compensating for dips in state funding by raising tuition, exacerbating the debt load for graduates.
Rather than all 28 colleges providing instruction in all specialties, perhaps the industry should form centers of emphasis, suggests DeHaven. In that scenario, swine medicine might be the focus of one college, dairy might be the focus of another, etc. And perhaps the industry should reconsider the current regimen of four years pre-vet studies followed by four years of vet school, he adds. “I don’t think the data would show any greater success in practice between those who did two years pre-vet and those who did four years.”

Growth of specialists
The growth of specialization is another area of interest and concern for DeHaven.
Recent AVMA data shows that veterinarians are increasingly seeking board certification as specialists, a trend that is in direct response to a demand for a higher level of care by pet owners, according to the association. Statistics from specialty colleges show that there were 9,826 active board-certified diplomates in 2009, a 15.46 percent increase in veterinary specialists from 2006. Even more striking, the number of specialists in the internal medicine specialty went up by more than 11 percent in just one year, from 2008 to 2009, according to AVMA.
Young veterinarians are attracted to specialization for a couple of reasons, points out DeHaven. “First and foremost, by going into a specialty, you can, on average, command a better salary.
“Second, our veterinary teaching hospitals have become tertiary care facilities,” he adds. “They’re referral practices.” Unless schools force students to get primary-care experience, perhaps by providing care at a local humane shelter, students will leave school having been exposed primarily to specialists. “That drives specialization, because the faculty become the role model.”
Yes, specialization leads to higher levels of care, but it’s not without its own set of challenges, says DeHaven. “The level of care is becoming increasingly sophisticated. There’s virtually nothing done in human medicine that can’t also be done in veterinary medicine. But there’s a cost that goes with that, and not everybody can afford that level of care.”
In veterinary medicine, unlike human medicine, veterinarians and animal owners recognize that treatment options will be affected – at least to some extent – by the person’s ability to pay. “Without general practitioners, will that lesser expensive option exist?” he asks.

Pet insurance
Indeed, the cost of patient care is climbing, and that’s a driving force for the pet insurance industry. “It’s here to stay, and we support it,” says DeHaven, speaking about insurance. That said, AVMA wants to make sure that pet insurance doesn’t follow the same path as human health insurance. “We get concerned when the pet insurance companies try to dictate what the veterinarian’s services are worth. We want to make a distinction between defraying the cost [of veterinary care] and dictating its value.”
AVMA believes that the pet owner – not the veterinarian – should be the primary contact with the pet insurance company, says DeHaven. In other words, AVMA frowns on insurance companies setting up networks or fee schedules. AVMA’s vision for insurance is similar to that of the dental industry, where the patient pays the dentist the agreed-on fee, then collects from the insurance company.
The association has codified its stance toward pet insurance in its “Guidelines on pet health insurance and other third party animal health plans,” published on its website.

Some clouds on the horizon
Indeed, veterinarians face some big challenges, says DeHaven. Attracting young veterinarians to rural practices is one of them. And economics is only part of the challenge. “The other part is the rural lifestyle. It’s hard to take a kid out of the city or ’burbs and make them comfortable in a rural environment,” he says. “We need to interest more [young people] with farm-animal backgrounds in veterinary medicine.” Debt-relief programs will help.
Another challenge for the profession will be managing zoonotic disease. At the time of his departure from APHIS, DeHaven wrote this memo to staff: “We are facing a future where the intersection of animal health and public health, and food supply veterinary medicine, is becoming critical to meeting the needs of a global society.”
“At the time, we had just successfully gone through the Bovine Spongiform Encephalopathy issue, and we were still facing what we thought was a huge threat from H5N1,” he explains. “Those are just a couple of examples to bring home the fact that human and animal health are inextricably linked. There was a recognition that diseases emerging in animals are likely to have huge implications for public health and food safety.”
This recognition was – and is – occurring just as the demand for animal protein globally is exploding. “It has been estimated by the United Nations that by the year 2050, we will have to double the amount of food we get from animals,” says DeHaven. It was largely through the work of AVMA Past President Roger Mahr, DVM, that the One Health Commission was established in June 2009 to spotlight the connections between human, animal, and environmental health, as well as the benefits of proactive and collaborative approaches toward better health for all. Mahr serves as One Health’s chief executive officer.
“There is one component to One Health that we’re missing, and that we as a profession need to highlight, and that is the health benefits to people of pet ownership,” says DeHaven. Data suggests that pet owners are at lower risk for diseases such as high blood pressure, heart disease, diabetes and obesity, he says. “By taking care of pets and promoting the human/animal bond, we’re actually contributing to public health.”

A look ahead
DeHaven voices concern about onerous government regulation. For example, the so-called “red flag rule,” which would require all businesses that extend any kind of credit to their customers to have procedures in place to protect the identity of their clients. “We’re working with our counterparts from the AMA, the ADA and other organizations to try to exempt small medical professional practices from somewhat onerous requirements, where, in most cases, we’re accepting credit card payment.”
AVMA also wants to make sure that the Obama administration understands production agriculture and the growing demand for animal protein. “If we make the regulatory climate so hostile that we drive production to other countries, it’s likely to go to developing countries, which have little or no concern about animal welfare or environmental damage,” he says. “It won’t be a single piece of legislation, but rather, a collective effect from many pieces of legislation affecting many different areas, and much of it likely at the state level.”
DeHaven fears that veterinarians are losing their focus on wellness and preventive medicine. “We have developed a human health system based on treating disease and injury, as opposed to promoting wellness. I see veterinary medicine going down the same path.” But it doesn’t have to be that way. “There’s a huge unmet potential for focusing on pet wellness,” he says. “It’s been estimated that over 60 percent of dogs leave the veterinary clinic without the benefit of heartworm prevention. And 25 percent of pets don’t go to the veterinarian at all.”
Veterinarians need to make one more change as well, he says. “They historically have depended on the sale of products for profit margin, as opposed to the sale of their professional services and expertise. We’re seeing Internet pharmacies pop up, and products formerly sold only by veterinarians now are available at Walmart.” It’s difficult to compete on price with the big retailers, he says. “Those practitioners who don’t [shift away from products to services] will have trouble maintaining their client base.”

The successful veterinarian
The successful veterinarian of the future will bear several characteristics, said DeHaven.
First, there’s a good chance that the veterinarian will be a woman. That’s simply because the profession is seeing a huge increase in the number of women in it. (The tipping point came in 2009, when, according to the AVMA, female veterinarians surpassed the number of male veterinarians, 44,802 to 43,196.)
The successful veterinarian will also stay current in terms of his or her knowledge of the profession, technology, techniques, etc. He or she will also have a better handle on what makes his practice profitable. And he or she will make better use of technicians, much like their counterparts in dentistry. “The average credentialed veterinary technician will add $93,000 to the bottom line of the practice,” says DeHaven.
And distributors can play a role in helping their customers be successful, he adds. “Distributors can play a valuable role in bridging the gap between the individual practitioner and organized veterinary medicine. With the field force that the distributors have, if we can get information in their hands and get that face-to-face contact, that’s an important line of communication that we heretofore haven’t tapped into.“

Sidebar:

AVMA guidelines on pet health insurance and other third-party animal health plans

The American Veterinary Medical Association endorses the concept of pet health insurance that provides coverage to help defray the cost of veterinary medical care.
The AVMA recognizes that viable pet health insurance programs will be important to the future of the veterinary profession’s ability to continue to provide high quality and up-to-date veterinary service. These programs should comply with the following guidelines.

Pet health insurance programs should:
Require a veterinarian/client/patient relationship in which the veterinarian monitors health maintenance of the animal.

Be acceptable to organized veterinary associations, individual veterinarians, insurance providers, the animal owning public, and others interested and involved in promoting the welfare and well being of animals.?

Have clearly specified protection for the animal owner. The animal insurance provider should disclose to the consumer the coverage provided which may be of most benefit in reducing the financial burdens resulting from medical problems requiring extensive veterinary medical care, as well as the option for coverage for routine and/or wellness health care.?

Allow animal owners the freedom to select a veterinarian of their choice, and allow for referrals.?

Meet the rules and regulations of the insurance commission of the state in which the insurance is sold, be readily available to the public, and provide coverage using ethical standards that are approved by the insurance industry.?

Be consistent with the principles of veterinary medical ethics.?

Allow each veterinary facility to establish its own fee structure.?

Reimburse the animal owner, in a timely manner, for fees previously paid to the veterinarian.?

Commit to assure that animal owners are aware of how the terms and conditions of their policy will impact their coverage and reimbursement. This includes the type and amount of monetary coverage and concurrent financial obligations such as co-pay, deductible, and other risk-management charges (e.g. surcharges, exclusions) that are integral components of the insurance contract.

Source: American Veterinary Medical Association