Reconsidering the Role of Veterinary Medical Education in Public Health

1. Reconsidering the Role of Veterinary Medical Educationin Public Health

2. Contention: There is a pressing national need for veterinarians to fulfill the role of public health professionals in the years to come, and to manage diseases in animal populations that can have profound health and economic consequences in animal and human populations. In Veritas, human and animal population health are inextricably, inevitably, and inexorably linked:

3. Petting Zoos and Hemorrhagic E. coli

4. Emergency Preparedness and Disaster Relief

5. Rabies:A Pandemic Disease • Globally, in terms of human disease, dogs represent the most important reservoir: dog rabies accounts for 99% of all rabies deaths. • It is estimated that each year 50,000 - 70,000 people worldwide die from rabies. • Children aged 5–15 years are at particular risk. • More than 99% of all human deaths from rabies occur in Africa, Asia and South America; India alone reports 30,000 deaths annually.

6. New Variant Creutzfeldt-Jakob Disease

7. A Home-Grown Prion Disease: Is This an Unrecognized Danger??? • Chronic Wasting Disease (CWD) is a prion disease of elk and deer, both free range and in captivity.  • CWD is endemic in areas of Colorado, Wyoming, and Nebraska, but new foci of this disease have been detected in Nebraska, South Dakota, New Mexico, Wisconsin, Mississippi Kansas, Oklahoma, Minnesota, Montana, and Canada. • Since there are an estimated 22 million elk and deer in the USA and a large number of hunters who consume elk and deer meat, there is the possibility that CWD can be transmitted from elk and deer to humans.  As of November 2004, the NPDPSC has examined 26 hunters with a suspected prion disease.  However, all of them appeared to have either typical sporadic or familial forms of the disease.

8. Biosecurity

9. Zoonotic Diseases

10. West Nile Virus Transmission

11. Avian Influenza

12. Epidemic of renal failure from consumption of dog and cat food – 2007 • Melamine in wheat gluten? • National cooperation of veterinary diagnostic laboratories • Potentially thousands of dogs and cats affected

13. National Research Council: • “There are insufficient (veterinary medical) graduates to meet the needs in a number of major and distinct fields of veterinary medicine dealing with various species of food-animals, rural practice (mixed domestic animals), ecosystem health, public health, the many dimensions of the food system, and biomedical science. Too few veterinary students are choosing to specialize in basic biomedical science or pathology.”

14. National Research Council: • “The USDA, state animal health agencies, the AVMA, and colleges and schools of veterinary medicine and departments of animal science should develop a national animal health education plan focusing on education and training of individuals from all sectors involved in disease prevention and early detection through day-to-day oversight of animals.”

15. National Research Council: • “The majority of students who obtain a DVM do not go on to pursue the PhD and postdoctoral training needed to become a researcher. • “The shortage is due partially to declining interests in research among veterinary students, many of whom have little exposure to basic science and hands-on research. • “Other factors also play a role in discouraging students, such as the substantial cost and time commitment to obtain research training and a lack of available financial support.”

16. National Research Council: • To meet the nation’s needs for research expertise in veterinary science, changes in recruitment and programming for graduate and veterinary students will be required. • Changes recommended … include enhancing research cultures in veterinary colleges and strengthening summer research programs, combined DVM/PhD degree paths, and the integration of basic science into clinical curricula.

17. The Exodus of Veterinarians From Graduate School

18. Veterinary Public Health Workforce Expansion Act (S. 746 and H.R. 1232) Congress makes the following findings [redacted]: • Veterinary medicine is an integral and indispensable component of the Nation's public health system. • Veterinarians are essential for early detection and response to unusual disease events that could be linked to newly emerging infectious diseases… • There is a need to build national capacity in research and training in the prevention, surveillance, diagnosis, and control of newly emerging and re-emerging infectious diseases. • Veterinarians are uniquely qualified to address these high priority public health issues because of their extensive professional training in basic biomedical sciences, population medicine, and broad, multi-species, comparative medical approach to disease prevention and control. • There is a shortage of veterinarians working in public health practice. • The Bureau of Labor Statistics expects there to be 28,000 job openings in the veterinary medical profession by 2012 due to growth and net replacements, a turnover of nearly 38 percent. • The Nation's veterinary medical colleges do not have the capacity to satisfy the current and future demand for veterinarians and veterinary expertise that is vital to maintain public health preparedness.

19. Vet Schools to the Rescue! • 28 vet schools committed to graduating 10 public health veterinarians per year for the next 4 years = 1,120 new public health veterinarians by 2012. • This will go a long way to filling the “28,000 job openings in the veterinary medical profession by 2012”

20. UC Davis 2005-2006Graduation Statistics • Master's (MA, MS) degrees: 560 • Doctor of Philosophy (PhD) degrees: 312 • Doctor of Veterinary Medicine degrees: 124

21. We have a “mind shaft gap”between research-oriented students and practice-oriented students

22. We hold these truths to be self-evident … • Most incoming veterinary students want to be practitioners. • Most graduating veterinarians want to be practitioners. • Few graduating veterinarians intend to go into careers in veterinary public practice or health. • It is unrealistic to think that we can solve the problem of a shortage in this field by changing the mind-set of veterinary medical students or by changing our admissions policies (e.g., targeted admissions).

23. Consider an alternative degree program that allows students to … • Acquire broad knowledge of veterinary public health practice, research, and theory. • Analyze issues and problems in veterinary public health using critical evaluation, applied research methodology and statistical methods. • Understanding of veterinary public health policies and practices through the study of how programs are implemented in institutions and society. • Develop a vision and philosophy for professional leadership in veterinary public health.

24. You’ve got to ask yourself one question: Is it really necessary for such veterinary public health practitioners to be trained to be clinical practitioners as well?

25. To help solve this problem, the prescient school or college of veterinary medicine will have to be willing to think of new career paradigms. California has a tradition of thinking “outside the box” when it comes to developing new careers …

26. Doctor of Public Health (DrPH) • Such a degree program already exists in Schools of Public Health throughout the US – except it is for practitioners of human health. • These individuals do NOT obtain MD degrees, thus they are NOT licensed to practice human medicine. • It thus represents an advanced field for students who do not want too go to (or cannot get into) (human) medical school.

27. Doctor of Public Health (DrPH) • The degree shares similarities with the PhD degree, though with specific philosophical differences: • DrPH is a professional practice degree, while PhD is an academic research degree. • DrPH is designed for those intending to work as public health professionals, its training program and dissertation focusing on public health practice.

28. Future Plans for UC Davis • A School of Public Health is in the developmental stages at UC Davis as a joint venture between the Schools of Medicine and Veterinary Medicine. • An alternative career pathway offering a Doctor of Veterinary Public Health degree is both realistic and feasible.

29. Doctor of Veterinary Public Health (DVPH) • For students who are interested in a career in the allied health sciences, but who do not want to go to vet or med school. • For students who are interested in animal-related careers, but who do not want to become clinicians. • For highly-motivated students, entrance into the program could occur prior to B.S. degree (like our current admissions policy).

30. Doctor of Veterinary Public Health (DVPH) • The program need not be restricted to California residents. • The program could offer, for example, a curriculum similar to the first two years of vet school (basic and pre-clinical sciences), and then diverge away from clinical practice courses and towards veterinary and human public health courses. • The program would not lead to licensure. • The program could co-exist with or supercede the MPVM degree program.

31. Sample Curriculum: Years 1 and 2 • Cell and tissue and function • Cellular mechanisms of disease, injury, repair, and healing • Organ system form, function, and disease • Infectious disease • The “…ologies” • Ecosystem health • Critical thinking and reasoning • Ethics and jurisprudence

32. Sample Curriculum: Year 3 • Epidemiology • Food safety • Food animal medicine • Foreign animal disease • Zoonotic disease • Public health • Biostatistics • Veterinary medicine electives

33. Sample Curriculum: Year 4 • Food animal in-house and ambulatory medicine • Advanced coursework leading to joint MPVM or MPH degree • Analytic epidemiology • Statistics and biostatistics • Entomology • Nutrition • Ecology • Public health agency (counties, California Department of Health Services, USDA, FDA, CDC, etc.) externships • Thesis based on senior year project

34. Doctor of Veterinary Public Health (DVPH) This is predicated on the assumption that: • there are a larger number of students who would like a veterinary public health career without the clinical training … • than there are veterinary medical students who are getting clinical training who want veterinary public health careers

35. Not a Devaluation of Veterinarians! • DrPH and MD graduates work together in complementary ways in public health • Physician Assistant and Family Nurse Practitioner and MD graduates work together in complementary ways in public health • DVPH and DVM graduates can also work together in complementary ways.

36. Diversity • The veterinary profession has historically had a difficult time making itself more diverse (except for gender), and current demographic changes in California are outpacing our School • Public health, on the other hand, is a much more diverse field (e.g., 31% minority at UC Berkeley School of Public Health). • It is plausible that veterinary public health - because of its natural interface with human public health - could attract students of diversity that veterinary medicine cannot.

37. Doctor of Veterinary Public Health (DVPH) • If this is an initiative that the School’s administration and faculty decide to pursue further, then it will be done contemporaneously with the planning for a School of Public Health at UC Davis and in anticipation of funding from the passage of the Veterinary Workforce Expansion Act.

38. Summary • The nation's veterinary medical colleges do not have the capacity to satisfy the current and future demand for veterinarians and veterinary expertise that is vital to maintain public health preparedness

39. Summary • Reconsideration of public health practitioner objectives and national interests (food safety, public health, biosecurity) will inevitably lead prescient and futuristic-thinking veterinary schools/colleges to offer an alternative professional degree pathway to help redress the shortage of veterinary medical public health professionals