Limited licensure ignites debate

National organizations, regulators explore options
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Apr 01, 2008


On the fence: The idea of limited licensure weighs heavily on Dr. Leon Pielstick. "It breaks my heart, but it's a direction I think we need to go," he says.
National Report — Some call it evolutionary. Others consider it a mistake. No matter how it's defined, limiting the licenses of veterinarians is stirring national debate, from college classrooms to the American Veterinary Medical Association (AVMA).

The outcome could mean licensure limitations much like those in engineering and human medicine, experts say. Proponents consider narrowing the scope of licensure via species a fix for manpower shortages in food-animal and other deficient sectors by possibly reducing the duration and cost of earning a DVM degree. Critics counter it will erode veterinary medicine's broad education — a professional strength. Yet at the argument's core exists one fundamental question: Has medicine become so complex that students can't graduate within four years and be competent in all species?

It's a polarizing topic dividing DVMs on both sides of the debate with state regulators and national organizations now entering the fray. In 1989, a Pew report titled "Future Directions in Veterinary Medicine" mapped a need for colleges to create "centers of excellence" to facilitate a limited-licensure education system with multiple re-entry points. It also made a startling revelation: Not all veterinary colleges need to teach all species.

The concept was revived with last year's Foresight Report — issued by the Association of American Veterinary Medical Colleges (AAVMC) — which considered implementing species-specific education and licensure restrictions within a decade. While much of the profession clings to the "all creatures great and small" tradition, influential pockets of change supporters are emerging, looking at ways to transform the current education model into one that effectively feeds more than small-animal medicine, but public health, research and starving food-animal sectors. Proponents argue that without limited licensure, veterinary medicine's exploding knowledge base requires additional schooling, which would further tax a student body already drowning in educational debt.

If limited licensure is to succeed, it must be supported by education, licensure and accreditation sectors, AAVMC Executive Director Dr. Marguerite Pappaioanou says. By all accounts, implementation represents an enormous task, and critics defending the current system note that such broad training fosters experts in recognizing emerging infectious diseases.

"This issue is so big and fundamental to the profession that it's hard to get your arms around," Pappaioanou contends. "I think a lot of this has to do with the belief that the profession is at a crossroads. There are all kinds of pressures out there to keep this from happening. That said, there's growing movement to implement change, and many people are excited about this."

Talks ensue

Dr. Leon Pielstick is torn. As a mixed-animal practitioner, he's been served by his inter-species education. Yet the Oregon Veterinary Medical Examining Board member is charged with drafting a legislative concept concerning limiting veterinarians' licenses to practice. Regulators plan to meet on the topic this month.

"I have James Herriot in my blood, so in some ways, I'm still sitting on the fence," he says. "At the same time, limited licensure seems to be a logical step. You can't cram all that education into four years anymore. We're taking a serious look at this."

The Council on Education (COE), AVMA's accrediting arm, also is exploring the issue, with plans to recommend creating a task force to study the Foresight Report and propose AVMA positions. The issue of limited licensure appears so contentious that AVMA leaders shunned three weeks' worth of DVM Newsmagazine interview requests to talk on the topic, apart from confirming that the Executive Board will consider the COE recommendation during its April 10-12 meeting.

In the meantime, AVMA's Board of Governors and the American Animal Hospital Association (AAHA) Executive Committee were scheduled to discuss limited licensure in Tampa.

"There are a lot of naysayers, and there are a lot of very clear-thinking people who agree with this idea," explains Dr. John Albers, AAHA executive director. "Limited licensure makes sense with a caveat that the veterinary education system must have multiple re-entry points. If someone followed an equine track and at some point decided to go back to companion animals, they could re-enter the veterinary curriculum at some point in the system."