Commentary The veterinary profession and precarious values Paul J. Hollier, DVM, MPH; Robert L. Fathke, MS, MPH; Corrie C. Brown, DVM, PhD
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s well-articulated in our shared oath, the veterinary profession is founded on the idea of using scientific knowledge and skills for the benefit of society, and our profession has long served society through the provision of both private (eg, clinical services for privately owned livestock and companion animals) and public (eg, developing policies and building systems to prevent diseases that threaten human and animal health) services. The public services the profession provides are especially relevant today, given our globalized society. However, as a result of current market forces, they have been overshadowed by veterinary policies, standards, and educational initiatives that focus on the provision of private services. The failure to preserve professional values that have broader societal benefits may leave the profession vulnerable to defaulting on its obligations and drifting from its foundational principles.
Professionalism, Autonomy, and Precarious Values Gorman and Sandifur1 describe professionalism as having 4 basic attributes: expert knowledge, technical autonomy, a normative orientation to the service of others, and high status, high income, and other rewards. Individual and organizational autonomy in a profession provides members the independence necessary to practice their craft without interruption2 but carries with it some responsibilities. In particular, autonomy requires that members of the profession identify the precarious values of the profession—those values essential to the mission and identity of the profession that are in danger of being overwhelmed by other priorities or corrupted by forces external to the profession—and determine what safeguards should be imposed to insulate and maintain those values.2 For the veterinary profession, the precarious values are those values for which erosion by external forces could lead to a downgrading or alteration in the profession’s original purpose of working for the benefit of society. We argue that for the veterinary profession in the United States, market forces have caused the profession to become too focused on the human-animal bond and its associated economic opportunities, with resulting sidelining of the original societal values.3 From the Army Fellows Program, Rand Arroyo Center, Santa Monica, CA 90407 (Hollier); the Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech, Blacksburg, VA 24061 (Fathke); and the Department of Pathology, College of Veterinary Medicine, University of Georgia, Athens, GA 30602 (Brown). Address correspondence to Dr. Hollier ([email protected]). 1130
Views: Commentary
Ted Leighton wrote a decade ago that if “the Titanic of our collective human enterprise runs into an iceberg of some unanticipated and severe difficulty,” those in society’s essential professions—the food producers, health-care workers, engineers, and educators—would all be given a place in the lifeboats, but most of the veterinary profession “would be left standing at the rail with the jewelers and fashion designers, watching the lifeboats pull away.”4 Similarly, we question whether society currently views the veterinary profession as necessary and relevant outside the realm of companion animal practice. In part because of the psychological benefits of the human-animal bond, clinical practice has become the focus of our professional associations, and food safety, food security, public health, research, protection from transboundary animal diseases, and maintenance of ecosystem health, are not generally recognized as professional veterinary values. As a result, these precarious values, so essential to the origin of the veterinary profession and to the profession’s societal value, have become substantially eroded. Any review of veterinary college curricula would demonstrate that they are dominated by companion animal medicine. Although this is largely appropriate, considering the professional openings available to veterinary graduates, it also illustrates how academic institutions have been swayed by the same market forces that have eroded the profession’s precarious values. As Richard H. Kohn,5 a professor of history at the University of North Carolina, Chapel Hill, said, “Professions that cannot change themselves from within, cannot respond to the needs of their clients, and cannot enforce standards of behavior so as to maintain the confidence of their constituencies while also inspiring the admiration and loyalty of their own members are in trouble.” Professional Organizational Structure and Relationship to Precarious Values Most scholars agree that a profession consists of a professional association, a standardized body of knowledge gained through institutionalized training, a system for licensing, a large degree of work autonomy, a code of ethics, and a system for colleague control.6 All professions have various checks and balances necessary to recruit, train, and regulate their members. These checks and balances can generally be grouped into three categories: policies and standards, training and education, and licensure and certification. These 3 function together as 3 legs of a stool. JAVMA, Vol 244, No. 10, May 15, 2014
In the United States, these checks and balances are largely provided for the veterinary profession by three organizations, each representing 1 leg of the stool: the AVMA, Association of American Veterinary Medical Colleges (AAVMC), and National Board of Veterinary Medical Examiners (NBVME). The AVMA, as the umbrella organization for the profession, creates policies and standards and develops criteria for professional education through the Council on Education, which accredits colleges of veterinary medicine. The AAVMC is the coordinating organization for educational institutions involved in the training of veterinary professionals, and in recent months, has assumed an important role on the AVMA Council on Education. The NBVME, in conjunction with the individual state boards of veterinary medicine, plays a critical role in the licensure of veterinary professionals, in that graduates of veterinary colleges are typically required to pass the North American Veterinary Licensing Examination, administered by the NBVME, to be licensed by the state boards. Through these 3 organizations, the veterinary profession in the United States is remarkably well organized and interconnected. But, this system has structural characteristics that expose the profession’s precarious values to erosion and sequential subtle modifications that endanger those values. Policy and Standards (AVMA) The stated mission of the AVMA is “to improve animal and human health and advance the veterinary medical profession,” and the association strives to serve as the professional organization for all veterinarians. However, AVMA membership does not include all veterinarians in the United States. Although the actual number isn’t known, approximately 100,000 veterinarians are estimated to be working in the United States currently,7 whereas the AVMA membership is approximately 84,000.8 Most AVMA members are in private clinical practice, partly because AVMA membership provides certain benefits for private practitioners, such as health and liability insurance, which are less relevant for those outside of clinical practice. But having a predominantly clinically focused membership could skew the views of the association, limiting the focus on professional activities that have a broader scope and influencing the competencies that drive veterinary school accreditation. One of the recommendations of the AVMA Workforce Advisory Group in response to the 2013 US Veterinary Workforce Study was that “[t]he AVMA should identify and implement strategies to increase the demand for veterinarians and veterinary services.”9 To expand into new areas outside private clinical practice, however, will require input from the entire profession, and many of those who could provide valuable input are not members of the AVMA. Training and Education (AAVMC) Veterinary educational institutions develop curricula and train veterinarians on the basis of standards established by the AVMA Council on Education. The JAVMA, Vol 244, No. 10, May 15, 2014
AAVMC is the coordinating association for higher education institutions involved in training veterinary professionals and, in some cases, postgraduate training of those professionals. It is an association that brings together academic institutions to speak with a common voice. Individually, however, these institutions are competing for funding, faculty, recognition, and students, raising concerns about whether this competition could act to further erode the profession’s precarious values. In addition, the AAVMC board of directors is made up of individuals who work for these higher education institutions. Competing priorities of professional membership with employer expectations complicates the decisionmaking process, with conflicting short-term priorities of an employer and long-term goals of a profession. Multiple institutions are experiencing rising tuition and expanding student bodies to the benefit of the institutions but of debatable benefit for the profession.9,10 Licensure and Certification (NBVME) The third leg of the stool, professional licensure and certification, is designed to ensure that individuals working in the profession possess some minimum level of competency. The North American Veterinary Licensing Examination is specifically designed to determine whether veterinary college graduates have attained the baseline knowledge needed for private clinical practice. This demonstration of clinical competency is required for state licensure to practice clinical medicine but does not imply mastery of those competencies applicable to employment sectors embodied in the veterinary profession’s precarious values. Testing a narrow band of veterinary competencies could itself help further erode the profession’s precarious values and could influence professional policies and educational curricula that define what it is to be a veterinarian. Conclusions The current structure of the veterinary profession in the United States presents challenges to the promotion and preservation of the profession’s precarious values. Market forces have driven the AVMA to focus more on companion animal practice, monetary pressures have forced veterinary college administrators to make decisions based on finances, and the licensure process has always been clinically focused. As a result, the profession’s role in providing public services of greater benefit to society writ large has been minimized. Clinical practice has focused on the value of the human-animal bond, a golden egg that came from our professional goose. We enjoyed it for our financial and communal success for many years, without paying enough attention to the overall health and diversity of the goose. Society has forgotten that we had other golden eggs that promoted overall well-being. Restoration and preservation of our precarious values will require a monumental effort by veterinary professional organizations to make changes that will insulate and safeguard those values. Important in this will be strategic communication to change the public perception of the veterinary profession from a group of individuals who are primarily caregivers for companViews: Commentary
1131
ion animals to one that protects and serves society in a broader sense. This will set the stage for changes in employment, training, and funding opportunities and put the veterinary profession on the long path back to the foundational idea of using scientific knowledge and skills for the benefit of society. References 1. 2. 3. 4.
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Gorman EH, Sandifur RL. “Golden age,” quiescence, and revival: how the sociology of professions became the study of knowledge-based work. Work Occup 2011;38:275–302. Selznick P. Leadership in administration: a social interpretation. Berkley, Calif: University of California Press, 1984. Reinisch AI. The human-animal bond: a benefit or threat to the integrity of the veterinary profession? Can Vet J 2009;50:713– 718. Leighton FA.Veterinary medicine and the lifeboat test: a perspective on the social relevance of the veterinary profession in the 21st century. Can Vet J 2004;45:259–263.
Views: Commentary
5.
Kohn R. Tarnished brass: is the U.S. military profession in decline? World Affairs 2009;171:73–83. 6. Larson MS. The rise of professionalism: a sociological analysis. Berkeley, Calif: University of California Press, 1977. 7. AVMA. Market research statistics—U.S. veterinarians—2013. Available at: https://www.avma.org/KB/Resources/Statistics/Pages/ Market-research-statistics-US-veterinarians.aspx. Accessed Jan 16, 2014. 8. AVMA. Member center. Available at: https://www.avma.org/ Members/Pages/default.aspx. Accessed Jan 16, 2014. 9. AVMA Workforce Advisory Group. Implications of the 2013 Veterinary Workforce Study and recommendations for future actions. J Am Vet Med Assoc 2013;242:1516–1521. 10. Segal D. High debt and falling demand trap new vets. New York Times, 2013;Feb 23:BU1.
For all commentaries, views expressed are those of the authors and do not necessarily reflect the official policy of the AVMA.
JAVMA, Vol 244, No. 10, May 15, 2014
A
s well-articulated in our shared oath, the veterinary profession is founded on the idea of using scientific knowledge and skills for the benefit of society, and our profession has long served society through the provision of both private (eg, clinical services for privately owned livestock and companion animals) and public (eg, developing policies and building systems to prevent diseases that threaten human and animal health) services. The public services the profession provides are especially relevant today, given our globalized society. However, as a result of current market forces, they have been overshadowed by veterinary policies, standards, and educational initiatives that focus on the provision of private services. The failure to preserve professional values that have broader societal benefits may leave the profession vulnerable to defaulting on its obligations and drifting from its foundational principles.
Professionalism, Autonomy, and Precarious Values Gorman and Sandifur1 describe professionalism as having 4 basic attributes: expert knowledge, technical autonomy, a normative orientation to the service of others, and high status, high income, and other rewards. Individual and organizational autonomy in a profession provides members the independence necessary to practice their craft without interruption2 but carries with it some responsibilities. In particular, autonomy requires that members of the profession identify the precarious values of the profession—those values essential to the mission and identity of the profession that are in danger of being overwhelmed by other priorities or corrupted by forces external to the profession—and determine what safeguards should be imposed to insulate and maintain those values.2 For the veterinary profession, the precarious values are those values for which erosion by external forces could lead to a downgrading or alteration in the profession’s original purpose of working for the benefit of society. We argue that for the veterinary profession in the United States, market forces have caused the profession to become too focused on the human-animal bond and its associated economic opportunities, with resulting sidelining of the original societal values.3 From the Army Fellows Program, Rand Arroyo Center, Santa Monica, CA 90407 (Hollier); the Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech, Blacksburg, VA 24061 (Fathke); and the Department of Pathology, College of Veterinary Medicine, University of Georgia, Athens, GA 30602 (Brown). Address correspondence to Dr. Hollier ([email protected]). 1130
Views: Commentary
Ted Leighton wrote a decade ago that if “the Titanic of our collective human enterprise runs into an iceberg of some unanticipated and severe difficulty,” those in society’s essential professions—the food producers, health-care workers, engineers, and educators—would all be given a place in the lifeboats, but most of the veterinary profession “would be left standing at the rail with the jewelers and fashion designers, watching the lifeboats pull away.”4 Similarly, we question whether society currently views the veterinary profession as necessary and relevant outside the realm of companion animal practice. In part because of the psychological benefits of the human-animal bond, clinical practice has become the focus of our professional associations, and food safety, food security, public health, research, protection from transboundary animal diseases, and maintenance of ecosystem health, are not generally recognized as professional veterinary values. As a result, these precarious values, so essential to the origin of the veterinary profession and to the profession’s societal value, have become substantially eroded. Any review of veterinary college curricula would demonstrate that they are dominated by companion animal medicine. Although this is largely appropriate, considering the professional openings available to veterinary graduates, it also illustrates how academic institutions have been swayed by the same market forces that have eroded the profession’s precarious values. As Richard H. Kohn,5 a professor of history at the University of North Carolina, Chapel Hill, said, “Professions that cannot change themselves from within, cannot respond to the needs of their clients, and cannot enforce standards of behavior so as to maintain the confidence of their constituencies while also inspiring the admiration and loyalty of their own members are in trouble.” Professional Organizational Structure and Relationship to Precarious Values Most scholars agree that a profession consists of a professional association, a standardized body of knowledge gained through institutionalized training, a system for licensing, a large degree of work autonomy, a code of ethics, and a system for colleague control.6 All professions have various checks and balances necessary to recruit, train, and regulate their members. These checks and balances can generally be grouped into three categories: policies and standards, training and education, and licensure and certification. These 3 function together as 3 legs of a stool. JAVMA, Vol 244, No. 10, May 15, 2014
In the United States, these checks and balances are largely provided for the veterinary profession by three organizations, each representing 1 leg of the stool: the AVMA, Association of American Veterinary Medical Colleges (AAVMC), and National Board of Veterinary Medical Examiners (NBVME). The AVMA, as the umbrella organization for the profession, creates policies and standards and develops criteria for professional education through the Council on Education, which accredits colleges of veterinary medicine. The AAVMC is the coordinating organization for educational institutions involved in the training of veterinary professionals, and in recent months, has assumed an important role on the AVMA Council on Education. The NBVME, in conjunction with the individual state boards of veterinary medicine, plays a critical role in the licensure of veterinary professionals, in that graduates of veterinary colleges are typically required to pass the North American Veterinary Licensing Examination, administered by the NBVME, to be licensed by the state boards. Through these 3 organizations, the veterinary profession in the United States is remarkably well organized and interconnected. But, this system has structural characteristics that expose the profession’s precarious values to erosion and sequential subtle modifications that endanger those values. Policy and Standards (AVMA) The stated mission of the AVMA is “to improve animal and human health and advance the veterinary medical profession,” and the association strives to serve as the professional organization for all veterinarians. However, AVMA membership does not include all veterinarians in the United States. Although the actual number isn’t known, approximately 100,000 veterinarians are estimated to be working in the United States currently,7 whereas the AVMA membership is approximately 84,000.8 Most AVMA members are in private clinical practice, partly because AVMA membership provides certain benefits for private practitioners, such as health and liability insurance, which are less relevant for those outside of clinical practice. But having a predominantly clinically focused membership could skew the views of the association, limiting the focus on professional activities that have a broader scope and influencing the competencies that drive veterinary school accreditation. One of the recommendations of the AVMA Workforce Advisory Group in response to the 2013 US Veterinary Workforce Study was that “[t]he AVMA should identify and implement strategies to increase the demand for veterinarians and veterinary services.”9 To expand into new areas outside private clinical practice, however, will require input from the entire profession, and many of those who could provide valuable input are not members of the AVMA. Training and Education (AAVMC) Veterinary educational institutions develop curricula and train veterinarians on the basis of standards established by the AVMA Council on Education. The JAVMA, Vol 244, No. 10, May 15, 2014
AAVMC is the coordinating association for higher education institutions involved in training veterinary professionals and, in some cases, postgraduate training of those professionals. It is an association that brings together academic institutions to speak with a common voice. Individually, however, these institutions are competing for funding, faculty, recognition, and students, raising concerns about whether this competition could act to further erode the profession’s precarious values. In addition, the AAVMC board of directors is made up of individuals who work for these higher education institutions. Competing priorities of professional membership with employer expectations complicates the decisionmaking process, with conflicting short-term priorities of an employer and long-term goals of a profession. Multiple institutions are experiencing rising tuition and expanding student bodies to the benefit of the institutions but of debatable benefit for the profession.9,10 Licensure and Certification (NBVME) The third leg of the stool, professional licensure and certification, is designed to ensure that individuals working in the profession possess some minimum level of competency. The North American Veterinary Licensing Examination is specifically designed to determine whether veterinary college graduates have attained the baseline knowledge needed for private clinical practice. This demonstration of clinical competency is required for state licensure to practice clinical medicine but does not imply mastery of those competencies applicable to employment sectors embodied in the veterinary profession’s precarious values. Testing a narrow band of veterinary competencies could itself help further erode the profession’s precarious values and could influence professional policies and educational curricula that define what it is to be a veterinarian. Conclusions The current structure of the veterinary profession in the United States presents challenges to the promotion and preservation of the profession’s precarious values. Market forces have driven the AVMA to focus more on companion animal practice, monetary pressures have forced veterinary college administrators to make decisions based on finances, and the licensure process has always been clinically focused. As a result, the profession’s role in providing public services of greater benefit to society writ large has been minimized. Clinical practice has focused on the value of the human-animal bond, a golden egg that came from our professional goose. We enjoyed it for our financial and communal success for many years, without paying enough attention to the overall health and diversity of the goose. Society has forgotten that we had other golden eggs that promoted overall well-being. Restoration and preservation of our precarious values will require a monumental effort by veterinary professional organizations to make changes that will insulate and safeguard those values. Important in this will be strategic communication to change the public perception of the veterinary profession from a group of individuals who are primarily caregivers for companViews: Commentary
1131
ion animals to one that protects and serves society in a broader sense. This will set the stage for changes in employment, training, and funding opportunities and put the veterinary profession on the long path back to the foundational idea of using scientific knowledge and skills for the benefit of society. References 1. 2. 3. 4.
1132
Gorman EH, Sandifur RL. “Golden age,” quiescence, and revival: how the sociology of professions became the study of knowledge-based work. Work Occup 2011;38:275–302. Selznick P. Leadership in administration: a social interpretation. Berkley, Calif: University of California Press, 1984. Reinisch AI. The human-animal bond: a benefit or threat to the integrity of the veterinary profession? Can Vet J 2009;50:713– 718. Leighton FA.Veterinary medicine and the lifeboat test: a perspective on the social relevance of the veterinary profession in the 21st century. Can Vet J 2004;45:259–263.
Views: Commentary
5.
Kohn R. Tarnished brass: is the U.S. military profession in decline? World Affairs 2009;171:73–83. 6. Larson MS. The rise of professionalism: a sociological analysis. Berkeley, Calif: University of California Press, 1977. 7. AVMA. Market research statistics—U.S. veterinarians—2013. Available at: https://www.avma.org/KB/Resources/Statistics/Pages/ Market-research-statistics-US-veterinarians.aspx. Accessed Jan 16, 2014. 8. AVMA. Member center. Available at: https://www.avma.org/ Members/Pages/default.aspx. Accessed Jan 16, 2014. 9. AVMA Workforce Advisory Group. Implications of the 2013 Veterinary Workforce Study and recommendations for future actions. J Am Vet Med Assoc 2013;242:1516–1521. 10. Segal D. High debt and falling demand trap new vets. New York Times, 2013;Feb 23:BU1.
For all commentaries, views expressed are those of the authors and do not necessarily reflect the official policy of the AVMA.
JAVMA, Vol 244, No. 10, May 15, 2014
