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RESPONSE TO PAUL PION’s September 15 letter by AVMA CEO Ron DeHaven:

After reading the post from Dr. Paul Pion regarding AVMA COE accreditation, I am once again compelled to respond. I will do so in bullet point fashion, trying to keep this as brief as possible.

Historical Perspective

• AVMA was created 151 years ago for the primary purpose of improving veterinary education in the U.S.
• AVMA has been accrediting veterinary colleges for 92 years, with recognition by the US Dept. of Education (USDE) since 1952

AVMA COE Qualifications

• In addition to recognition by USDE, the AVMA COE is recognized by 2 independent accreditation associations that have even higher standards for recognizing professional accrediting org’s like AVMA:
  • Association of Specialized & Professional Accreditors (ASPA)
  • Council on Higher Education Accreditation (CHEA)

Conflict of Interest Concerns

• AVMA’s only interest is in maintaining high standards of veterinary education and, by doing so, protect the value of the DVM/VMD degree. Where’s the conflict?
• With 8 members of the COE selected by AAVMC and 8 members selected by AVMA, we ensure both academic rigor and the practitioners’ perspective are at the table when evaluating the colleges.
• Some have suggested an independent, LCME type model that is used to accredit (human) medical colleges. I feel that our system is better for the following reasons:
  • Except for the public member and the 2 students, LCME consists entirely of medical school deans. They are missing the practitioners’ point of view; this is critical in ensuring graduate will be successful in the marketplace.
  • The solid “firewall” between the AVMA Board (and any other entity) and the COE ensures that accreditation decisions are made independent of any influence outside the Council. There have been accusations of inappropriate influence by the AVMA Board but not a single case where such claims have been substantiated. It is very hard to prove a negative, i.e., prove what “never happened.”
  • The AVMA has the administrative infrastructure in place to support the logistical needs of the COE. Any move to make it totally separate from this logistical support would duplicate efforts and significantly increase costs at a time when we need to contain the cost of veterinary education.

Workforce Issues

• Some would like to use accreditation as a tool to control/limit the number of new graduates coming into the workforce. We live in a free market society and any such effort would not only be unethical, it would be illegal. Any organization that might assume the role of accrediting US veterinary colleges would be similarly restricted.

Distributive Model of Education

• There have been statements by some that the distributive model of education is inferior and that, by accrediting such schools, the COE is lowering educational standards in the US. Where’s the evidence? The NAVLE pass rate from Western University of Health Sciences approaches 100% and actually exceeds the 92% pass rate for all AVMA COE accredited colleges. (Pass rate for graduates of non-accredited schools is only 37%!)
• Many have also said that, due to the cost of veterinary education in the US, our traditional model of education is not sustainable. This suggests that the AVMA COE needs to allow for flexibility in meeting the standards in order to accommodate innovation.

USDE Recognition

Some have suggested that by not granting full recognition to the AVMA COE last year, (but rather granting provisional status until some procedural changes are implemented) that this is evidence the AVMA COE accreditation process is inferior. In reality, the required changes are due to changes in the regulations that came about during the last Higher Education Reauthorization Act. The AVMA COE, along with all but 2 of more than 40 programs being evaluated under the new rules, were similarly situated. We are confident that all of the required changes have been implemented.

Final Comments

From my biased but informed perspective, I still trying to determine what problem the AVMA COE critics are trying to fix by removing this function from AVMA. Their case seems to be based solely on opinion and innuendo - while the evidence supports leaving this activity with the AVMA COE.

I agree with Dr. Pion that this is becoming a divisive issue within our profession at a time when we need unity. That is truly unfortunate. Going forward, I hope we can form our individual opinions and base our actions on the evidence, not speculation. That’s what we do in veterinary medicine.

Ron DeHaven,
AVMA CEO

RESPONSE TO Ron DeHaven’s response by PAUL PION 

I have read Dr. Ron DeHaven’s response. Dr. DeHaven is an excellent administrator and AVMA spokesperson. But he doesn’t tell the whole story

I pondered at length how to raise this issue without unduly influencing others with my views.

As a result I didn’t share the depth of my opinion as to how off the mark AVMA-COE has come and how this has inadvertently damaged the profession.

I couldn’t remain silent, so I presented a message that encouraged awareness and unification. I pointed out how I feel AVMA’s involvement in accreditation has caused division within the profession and has damaged AVMA’s relationship with its membership and profession at large.

I have received feedback from AVMA Executive Board and House of Delegates members who appreciated the approach I took. 

I hope together we can help make AVMA better for the profession and membership.  I don’t have the answer to the many issues our profession faces. I do firmly believe that in order for healing to begin and for faith to be restored, AVMA needs to distance itself from divisive issues like accreditation.

Dr. DeHaven is correct in saying that AVMA accreditation activities in the mid-20^th century improved veterinary education. But that should not prevent us from questioning AVMA’s practices with regard to veterinary school accreditation in recent years and suggesting a new path.

Dr. DeHaven cites AVMA-COE’s recognition by the Association of Specialized & Professional Accreditors (ASPA) and the Council on Higher Education Accreditation (CHEA) as evidence of COE being on-track and held to a “higher standard.” My understanding is these organizations represent and lobby for accrediting bodies like AVMA-COE as AVMA and AAHA do for their membership. A fee is paid, certain minimal standards are met and membership is granted.

Dr. DeHaven states, and asks, “AVMA’s only interest is in maintaining high standards of veterinary education and, by doing so, protect the value of the DVM/VMD degree.  Where’s the conflict?”

This excellent question speaks to the core of the issue. This is the reason I believe AVMA needs to step back from involvement in accreditation. As CHEA and ASPA exist to represent and advocate for accrediting agencies, I believe that most AVMA members wish for AVMA to focus upon representing and advocating for them and their colleagues.

Facts:

• In 1973 there were 18^[1] accredited veterinary schools when the first foreign veterinary school was recognized (Utrecht).
• In the ensuing years, ten^[1] more domestic schools were accredited with no foreign accreditation activities.
• In 1998, by the direction of the AVMA Executive Board, a focus on accrediting foreign schools was initiated.
• Since 1998, 12 foreign and two^[2] more domestic veterinary schools have been accredited, with two, and soon three, new programs opening with letters of assurance. Four additional foreign schools have submitted letters of intent to pursue AVMA accreditation.^[8,9]
• Concurrent with this, as reported by the AAVMC^[3], the number of veterinary students graduating from AVMA-COE accredited schools per year, who are expected to enter the US market, has increased from 2,170 to 4,460.
• 25% of these will have graduated from foreign institutions accredited since 1997.^[3]

Let me clarify that I have great respect for these foreign schools and the colleagues who teach and attend them.

However, the number of U.S. citizen applicants to veterinary school seeking seats at domestic and foreign accredited schools has not kept pace with the number of seats. Although the data is imperfect, I now calculate that the approximate ratio of applicants per seat has hit an all-time low of <1.5 applicants per seat. When this number was reported to be 2.1 in 2011^[5], JAVMA news asked, “Will veterinary education hit a tipping point?

For several decades, AVMA studies have predicted an excess of veterinarians compared to demand, yet at every turn, AVMA has ignored that data and pronounced a need for up to 20,000 more veterinarians in the next decade. Recently AVMA economist Dr. Mike Dicks and the AVMA Economics Committee reported that there is a 12.5%^[6] excess capacity within the profession.

Most reading this have observed and experienced the plight of our profession, especially our young graduates who have felt the impact of these realities. Though, most find employment, I think we must consider the quality of the employment. While student debt has risen at a near constant 7% per year, salaries have risen at about 3%^[7] per year and stagnated over the past several years. This is not sustainable. This is not how we, who have enjoyed the fruits of this wonderful profession, should be nurturing its future.

I agree with Dr. DeHaven that accreditation should not be used as a tool to control/limit the number of new graduates coming into the workforce. But one must remember that AVMA decided to pursue accrediting foreign schools. The US Department of Education did not request, require, or oversee these activities. As the above statistics depict, this decision has added significantly to the excess capacity of colleagues we face today.

We live in a free market society, but I find it disingenuous for Dr. DeHaven to claim that it would be unethical to use accreditation to manage the market when that is exactly what AVMA did. They substantially contributed to saturating the market through accreditation.

In addition, there is significant case law and precedent suggesting that AVMA does not need to treat foreign schools as they treat domestic schools.

What’s done is done. It may, according to AVMA’s Dr. Mike Dicks, take decades for the market to correct the situation we face. Anything we choose to do today will likely have little impact for years.

We can put a dent in the issue by increasing demand for veterinary services – in practice and beyond. We have been working at that for decades and have not succeeded substantially. That doesn’t mean we shouldn’t continue trying.

We need a focused and strong national organization to help lead us through these times.

This issue is not going away. Some state associations have taken a stand against AVMA continuing in its current accreditation role. Many members are concerned and voicing discontent.

Yes, I believe AVMA can weather this storm and continue to do as it has been doing. But is it worth it?

AVMA has opened the door for foreign schools to welcome our students, and the US Federal student loan dollars that come with them. AVMA claims to be raising the bar of education. Looking at the list of foreign accredited schools, do any of us truly believe that the UK and Australian schools, for example, are elevated by AVMA accreditation? Yes, they can learn from us; as we can learn from them.

However, I view it as an insult to them to suggest that they were not and would not be as excellent if it were not for AVMA accreditation. Speak to colleagues at these schools. They will, in private, tell you, as they have told me, they jump through the hoops of AVMA accreditation for one purpose: the dollars that come with US students.

AVMA has opened the door for profiteers to operate veterinary schools at low cost by weakening the standards and allowing schools to open with no significant research program and no VMTH. I am sure these schools can train adequate practitioners. But can they stimulate the thought leaders and generate the ideas we need to move forward as a profession? Only time will tell.

We can’t close the door that has already been opened. But we can ask our AVMA to abandon its march to accredit the world and instead focus on its membership.

There is need for diverse representation on the COE, but it needs to be selected via a non-political process that the profession and public can support and trust.

With no disrespect to current COE members, the current process and direction are clouded by distrust. The recent dismissal of Dr. Mary Beth Leininger – the first female president of the AVMA – from the council for asking a question about COE’s direction/practices in an AVMA reference committee meeting speaks volumes as to the environment in which the COE operates.

Why should COE members who actively support foreign accreditation be allowed to serve, but a colleague who asks a question about the council’s direction is summarily dismissed?

I love this profession, as I know all reading this do. I believe we share an obligation to leave to the next generation a profession that is as vibrant and rewarding as the one we inherited from those who came before us.

As with all big initiatives, this will take incremental changes, making many choices over time, which we believe will improve the situation. We are not going to get there with the status quo.

As Margaret Mead said, “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has.”

We should not change just for the sake of change, but we also should not fear trying something different when the facts before us suggest that we are on the wrong path. AVMA-COE has been on the wrong path for over a decade and we need to rethink the direction it has taken.

Thanks for giving due consideration to the issue and I hope you will make your feelings known to your colleagues, the AVMA and the USDE NACIQI.

I wish you well.

Sincerely,
>>>Paul<<<
Paul D. Pion, DVM, DipACVIM (Cardiology)
Davis, CA

1. The lost history of American veterinary medicine: the need for preservation
   J Med Libr Assoc. Jan 2011; 99(1): 8–14.
   http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3016659/
2. Vet Schools Debut In Arizona, Tennessee
   http://www.veterinarypracticenews.com/Two-New-Vet-Schools-Debut-In-US/
3. Oct. 7 Application Deadline for New AAVMC Public Policy Faculty Fellows Program
   http://aavmc.org/VetMedEducator13.aspx#Enrollment
4. Speaking different languages - Foreign veterinary school accreditation stirs debate
   https://www.avma.org/News/JAVMANews/Pages/100515a.aspx
5. Will veterinary education hit a tipping point?- Veterinary school applicant-to-seat ratio trending downward
   https://www.avma.org/News/JAVMANews/Pages/110201a.aspx
6. 2013 AVMA Veterinary Workforce Report Confirms Excess Capacity in U.S. Veterinary Profession
   https://www.avma.org/news/pressroom/pages/2013-AVMA-Veterinary-Workforce-Report-Confirms.aspx
7. Employment, starting salaries, and educational indebtedness of year-2013 graduates of US veterinary medical colleges. Journal of the American Veterinary Medical Association, October 1, 2013, Vol. 243, No. 7 , 983-987.
8. International interest in COE accreditation grows
   https://www.avma.org/ProfessionalDevelopment/Education/Accreditation/Colleges/Pages/coe-standard-newsletter-fall2009-international-interest.aspx
9. Upcoming Council on Education (COE) Site Visits
   https://www.avma.org/professionaldevelopment/education/accreditation/colleges/pages/coe-upcoming-site-visits.aspx

PAUL PION's original letter

Several state associations and individuals have deemed the accreditation of veterinary schools of “urgent, national importance to the veterinary medical profession.“ I urge you to become involved in the dialogue, and to take action as outlined below.

I believe all colleagues should understand AVMA’s role in veterinary school accreditation and make their opinions known to the only organization that can make an impact: the U.S. Department of Education’s National Advisory Committee on Institutional Quality and Integrity (NACIQI).

This issue will come to a head this December when NACIQI reviews AVMA’s role in accreditation.

The Department of Education is currently accepting public comments on the issue. The deadline for written comments is less than a week away – September 22, 2014.

If you do nothing else, I urge you to send a letter to NACIQI stating your support or lack of support for the way in which the AVMA Council on Education has applied the 11 standards for accreditation of veterinary schools.

WHAT CAN YOU DO?

1. Spend a few moments educating yourself by reviewing the 11 standards and perusing background information and information and links that instruct and help you send feedback to NACIQI: http://beta.vin.com/Link.plx?ID=6446322.
2. Make your voice heard – in favor of, against, or with recommendation on how to change the role of the AVMA Council on Education (AVMA-COE) in accrediting veterinary schools.

WHAT DO I THINK?

On the surface, this is a complex issue. However, what I believe we need to move forward and find peace within our profession is not that complicated. The AVMA Council on Education should be spun off from AVMA and reformed as an independent body, similar to how accreditation operates for human medical schools.

I believe a Veterinary Council on Education that is independent of AVMA and AAVMC (American Association of Veterinary Medical Colleges) politics and direct influence will best serve our profession in the same way that the NAVLE (National Board Examination) has gained credibility and wide support within our profession since being spun off from AVMA.

The current Council on Education has in place much of what is needed. I believe it needs to be provided with the resources to set its own independent path, and budget, as well as independent legal counsel, and a selection process that insulates it from being largely staffed by the same individuals who serve year after year in AVMA and AAVMC leadership positions.

I urge you to make your voice heard on the role of the AVMA Council on Education (AVMA-COE) in accrediting veterinary schools.

My personal feelings on the topic are driven by my concern for the future of our profession, the future of veterinary education, and the impact upon our colleagues – young and old, associates and practice owners.

I have hesitated to reach out in a communication like this because I view VIN’s role and my role in the profession as promoting education and building a unified community – not a political entity. I am sending this letter because I believe veterinary school accreditation has created an increasingly large divide within our profession. It has placed AVMA at odds with its members, our veterinary schools at odds with its students and alumni, and colleagues at odds with colleagues.

This divide is growing at a time when our profession needs to unify. We need to find ways to put aside our differences and stand together with our schools and local, state and national organizations in order to support each other and give a unified message to the public.

A strong AVMA with a focus upon its members is critical to the future of our profession, especially our young colleagues. AVMA’s continued direct involvement in veterinary school accreditation is a major conflict of interest and distraction that keeps AVMA from maintaining focus upon its members’ well-being and the well-being of the profession overall.

We need to put the accreditation issue to rest and get on with the business of advocating for and supporting each other and our profession. This is critical if we are to be a strong profession, focused on advancing and providing the best care for our patients, clients, and society-at-large.

I am happy to discuss this one-on-one or in a rounds discussion. Please don’t hesitate to reach out to me – or join some of the ongoing discussions related to this issue on the message boards.

Thanks!

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