Can we grow more rural veterinarians?
By Alan Newport

Ideas to reverse the decline of rural veterinary care.

This spring when Dr. Chuck Dake started looking for another veterinarian to work in his rural clinic, he knew it would be a challenge.

Dake has shared the practice with his father in their clinic near Mount Vernon, Mo., since he graduated from vet school. However his father recently won a seat in the Missouri House of Representatives. The problem Dake now faces in replacing his father is that it’s a rare young veterinarian these days who wants to treat farm animals.

Instead, new-crop vets usually prefer nights and weekends off and labor in a warm dry office instead of cold, muddy corrals or sweltering hot barns. Most also prefer not to be kicked and stomped by their patients. Hence, most new veterinarians—the kind Dake needs to hire—aren’t interested in working with him.

Dake’s experience is the same many other rural veterinarians face. Three months after he began advertising and looking for an associate veterinarian for his mixed-animal practice, he was still shopping. He found a young woman from Iowa State University willing to do mixed-animal work, but she really wanted to stay in Iowa. Another veterinary graduate whom Dake recently interviewed didn’t really want to do large-animal work but said she would consider it.

From the stories veterinarians tell almost anywhere in the nation, Chuck Dake may be lucky to find even one qualified veterinarian to work in his type of practice. The crux of the problem is this: America is facing a national shortage of veterinarians willing to doctor farm animals.

More and less

There is no shortage of veterinarians—just large-animal vets.

A 2002 report released by the Texas Higher Education Coordinating Board said applications to all U.S. veterinary schools have increased 56 percent since 1991. Applications to Texas A&M’s veterinary college have increased 164 percent. Yet livestock-rich Texas faces one of the worst shortages of large-animal vets, the report said.

“Mizzou had 61 graduates last year and only five that wanted to do large-animal work,” said Dr. Kent Haden, a veterinarian and vice president of Livestock Operations for MFA Incorporated.

A 2004 survey by the American Veterinary Medical Association found only 25 percent of graduating veterinary students were willing to devote at least part time to large animals. That is down from 36 percent a decade earlier.

In contrast, the overall number of vets dealing with large animals actually rose over the last 20 years—from 14,725 to 15,903. But only 12 percent of those practicing last year spent most or all of their time treating large animals.

In fact, the shortage of large-animal vets is serious enough even the federal government has become concerned. There are not enough veterinarians with large-animal practice and experience to serve public health needs such as slaughter and livestock inspection. Further, the feds say additional large-animal veterinarians will be needed in the coming years to guard against bio-terrorism launched through livestock diseases, such as brucellosis and anthrax, which can be passed from animals to humans.

Cash and effect

It isn’t just a matter of money, although small-town vets are at some disadvantage because of lower rural wages and agriculturally suppressed prices. Certainly the reputation of large-animal practice is one of lower pay, but statistics say the difference is relatively small. A 2002 study by the AVMA found vets with a mixed clientele, a common arrangement in rural areas, earned about $11,000 less than the specialists. On the other hand, the average pay of specialists in any type practice was about $84,000 a year.

“Starting wages for new veterinarians are going up and it’s hard to pay $60,000 to match what they earn in the cities,” said Dr. Rachel Goehl, who practices with her husband, Dan, in Canton, Mo. Add to starting salary the price of a truck and supplies and it’s almost as expensive as starting a satellite office, she added.

“I think if you went and talked to my accountant, he would tell me to sell the truck and just take care of the cats and dogs,” Dake said. “And believe me, there’s plenty of work just taking care of cats and dogs. But I can’t really do that. The large-animal practice is part of this practice and the community expects it to be here.”

However, all veterinarians realize the expensive and intensive training they undergo isn’t well rewarded, especially compared with those who practice human medicine. That seems to be a beef for some vets.

The average starting salary for new vets in private practice was about $40,000 to $50,000 last year, and veterinarians now finish school with an average debt of $88,000. Their obligation is comparable to the $100,000 average debt medical doctors face upon graduation. It would be easier to repay such debt with a higher income, vets say, and doctors typically have higher incomes once their practices are running. Compare the $50,000 to $75,000 rural veterinarians earn to the $120,000 to $150,000 average salaries family care doctors report.

By appearance, at least, the financial disincentive encourages many vets to specialize or settle in urban practices, thereby earning higher pay.

Yet the qualifications for admittance into vet school are similar to those for medical doctors—often a minimum 3.6 grade point average in undergraduate school.

“I have a son who’s weighing the difference in med school and vet school,” Haden said.

“Veterinary medicine has been good to me, but I told him to think hard about it. I told him if he’s going to study just as hard to become a veterinarian as a doctor and pile up debt going to college he might be better off becoming a medical doctor,” Haden said.

Normally, such pent-up demand as now exists for veterinarians would solve itself through market forces. Perhaps since prices in agriculture are perennially suppressed by oversupply and tradition, no such solution has emerged.

A rough sport

Besides the money, the outdoor conditions and the demanding hours, there may be another important cause for the decline of the rural veterinarian. No matter how careful the vets are, large farm-reared patients can be dangerous.

“Large-animal work is physically demanding,” Haden said. “Several years ago I took a young woman veterinarian out to make calls. She was fairly athletic and quite able to do the work. I got run over in an alleyway by a cow and she said to me, ‘You can’t do this when you’re pregnant.’”

“When you go to AVMA meetings,” Haden added, “it always seems like the large-animal vets are in one room comparing battle scars and the small-animal clinicians are in another area comparing their golf games.”

Certainly large-animal work is physically demanding, said Dr. Kim Ehlers, a mixed-animal practice vet at Mountain Grove, Mo. But having grown up on the farm she was accustomed to the work and the hours.

At one time this small-town girl said she considered the big city and small-animal medicine. Yet the call of rural life for her family, especially her children, made moving home and working in a mixed-animal practice more appealing. Today she treats mostly dairy and beef cattle. She has a small, but growing small-animal practice, she said.

Limited family time is another issue. Working hours for rural vets are like they were for the old country medical doctors. They’re on call—and often-called—24 hours every day.

It's demographic

All these things contribute to the lack of rural veterinarians, but the more systemic problem may be purely symptomatic. Hoards of people have been moving from the farm to the city since before World War II. Should we expect different results?

After all, country vets have historically been country boys, or in recent times more have been country girls. Some 75 to 80 percent of veterinary students are currently women. The flip side to all this is women in urban settings can work part time as veterinarians and be paid quite well.

“It’s actually just demographics,” said Dr. Jeff Tyler. Tyler is food animal section head of Missouri’s veterinary teaching hospital. “Less than 1 percent of the people in this country are directly involved in agriculture, so less than 1 percent of people entering college have livestock perspective,” Tyler said.

That situation leads to other problems besides shortages, he added. First, many city-reared youngsters aren’t well-suited to the old-style country life. They may not tolerate cold and heat, discomfort and long hours as readily as someone from a rural background .

Second, “bedside manner” and empathy are prized in most veterinary schools, but not so much in the country. The farm wife’s Yorkshire terrier may be like a child to the family, but the prolapsed cow is not.

“Kids from the suburbs don’t really get it,” Tyler said. “A cow is like a dog is like a human to them.”

He tells how recently while he was administering a proficiency examination one prospective veterinarian decided the most important need of a sick cow was a bath. In the rush to clean, the person overlooked several “overt clinical diseases.”

“Empathy for animals isn’t a negative characteristic if it’s part of a larger philosophical context which also includes concern for a client’s economic well-being,” Tyler added.

This bent toward anthropomorphism may further explain why it has become common for young beginning veterinarians to start out in rural clinics and then return to small-

animal practice in the city as soon as they have logged some experience.

What solutions?

Ideas for solutions to the problem are as numerous as the people making the recommendations.

To correct the imbalance, a recent report by the National Research Council calls for more government support, new educational opportunities and financial incentives. The council said this would increase the number of veterinarians practicing public health and large-animal work. The NRC said at least 500 graduates every year must enter these fields just to meet current demand.

The University of Minnesota veterinary college graduates about 72 students each year and said only about 15 percent (about 11 students) then pursue careers as large animal veterinarians. Those numbers are typical, maybe even high, and considering there are only 27 veterinary colleges in the U.S., that means about 350 new large-animal vets enter the national workplace every year.

Congress tried to address the issue in 2003 with legislation called the Veterinary Medical Services Act. It was designed to provide college loan forgiveness for new veterinarians willing to work in underserved disciplines such as large animal care. However, that federal program wasn’t funded.

Some states have debt relief programs for vets, including Pennsylvania and Texas. Kansas is considering similar legislation. South Dakota has no vet school, but offers tuition assistance for residents who earn veterinary degrees at Iowa State University and return home to practice.

Yet these repair attempts don’t entirely address the issue, according to Missouri University’s Tyler. He and Dr. Robert Larson, the university’s director of veterinary extension, have authored a paper calling for better large-animal training of vets. Too many of the nation’s vet schools, they say, no longer treat farm animals nor have adequate curriculum to teach such treatment and theory.

Tyler and Larson even suggest the development of an alternative programmatic review process for colleges to push them to better train their veterinary students for large-animal practice. This would counter the many years of “companion animal” bias by the colleges, they say.

With a near absence of large-animal teaching in some vet colleges and a limited curriculum in others, many students are arguably unprepared for large-animal practice.

Changing veterinary college accreditation to require more large-animal experience would at least address the issues of proficiency and attitude. But that may not be enough to counter current trends.

Closer to home

Dan and Rachel Goehl are trying a grow-your-own replacement system to get an associate for their Canton, Mo., clinic. They have tried to hire an associate clinician for the past 2 years with no success, and so they have a contractual agreement with a vet student from their area to help with vet school. He has worked for them since he was 16 years old and wants to come back to their practice.

“Our idea was to bring someone from this area back to the area,” Dan pointed out.

Rachel also thinks grouping vets into rural clinics may be a solution to the struggles with long hours. She said in one rural clinic she knows of, five veterinarians share the load. Together, they reduce the burdens of long hours and lost family time.

Ultimately, the question of how to recruit rural veterinarians may come down to paying them more money.

“Agriculture may just have to pay more to get veterinarians,” Ehlers suggested. But higher fees aren’t the only possible incentive.

Residents of rural towns also may find they can recruit vets by helping them repay college loans or by paying an incentive to come and stay. This is the same method some rural towns in Alaska and other remote locales use to get medical doctors.