11/11/13 Meeting

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Pre-vet club Mon Nov 11, 2013

Dr. Bartlett

Pre-vet clubMonday Nov 11, 2013 Dr. Paul Bartlett"Government and Corporate Vet Practice, Student Debt and the Future of Food Animal Medicine"

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Introduction

• Paul C. Bartlett DVM, MPH, PhD– BA – Zoology. U. of Wisconsin

– Madison

– Masters of Public Health (Epidemiology)• U. of Minnesota – Mpls.

– DVM – U. of Missouri

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Introduction– Epidemic Intelligence Service – Centers for Disease control

and Prevention– Board certifications

• Am. Col. Vet. Prev. Med.• Am. Co.. Vet Prev. Med. – Epidemiology Specialty

– PhD – Ohio State U. – Columbus• Contact information:

– 171 Food Safety Building 884-2016 Office– [email protected]

• Email is the best method of contact

• Research:– Antimicrobial resistance, dairy epidemiology,

foodborne outbreaks, surveillance programs, norovirus, C. difficile, Vancomycin-resistant Enterococci, MRSA, food safety, Shiga Toxin E. coli, bovine leukemia virus, others.

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Introduction• Teaching

– Veterinary Public Health, Zoonotic Diseases, Epidemiology, foodborne disease control, outbreak investigation, surveillance programs,

– DVM Students• VM 544 (this course)• VM 533 (Vet Epi)• VM 532 - VIPS• LCS 678 – Gov and Corp Vet Practice Clerkship (The field trips)• LCS 690 – Vet Public Health Practice Clerkship• LCS 691 – Vet Public Health Research Clerkship• LCS 613 – Special Problems Clerkship

– MS in Food Safety• VM 830, VM 831, VM 832, VM 821, VM 817

– Masters of Public Health program at MSU• HM 803, HM64 – Epidemiology and Public Health

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Some disjointed observations first – then discussion

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High Debt and Falling Demand Trap New Vets NY Times Feb 23, 2013

• http://www.nytimes.com/2013/02/24/business/high-debt-and-falling-demand-trap-new-veterinarians.html?pagewanted=all&_r=0

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http://www.nytimes.com/interactive/2013/02/24/business/Veterinarian-Squeeze.html?ref=business

Associated Graphic:

Decreasing visits to the veterinarianDecreasing number of U.S. petsIncreasing number of new veterinarians each yearIncreasing avg. debt load per vetDecreasing avg vet starting salary

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Executive summary of the 2013 US Veterinary Workforce Study

• JAVMA 242 (11):1507 June 1, 2013

• http://avmajournals.avma.org/doi/pdf/10.2460/javma.242.11.1507

“The recent National Research Council report found little evidence of workforce shortages in most fields of veterinary medicine and expressed concern that the profession is confronted with an unsustainable economic future owing to the large number of veterinarians being trained and the high debt levels of new graduates.”

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Study IDs Excess Capacity in Veterinary Workforce

• JAVMA June 1, 2013• 11 to 14% underutilization projected

through 2025• “The demand for veterinary service in 2012

was sufficient to fully employ just 78,950 of the 90,200 currently working in clinical and nonclinical settings.”

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But . . .

• Are other professions hit just as hard?– Lawyers? Physicians? Professors?

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Some thoughts about food animal vet practice

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Consolidating Food Industry• The old agrarian agricultural system is disappearing.• Today: Industrial Model (2009)

– The top ten food retailers sell > 75% of food– The top four beef packers process >80% of beef– The top ten chicken companies produce 79% of the chicken– The top 50 dairy cooperatives produce 79% of the milk– The top 60 egg companies produce 85% of the eggs.– The top 20 pork producers produce 50% of the pork

• 2% of producers produce more than 80% Source: Charlie Arnot - What food producers really want. International Conference on the Use of Antimicrobials

in Cattle Production. May 27 - 29, 2009 Kansas State University.

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U.S. Dairy Farms & Cows(1992-2003)

020,00040,00060,00080,000

100,000120,000140,000

Year

Co

ws (

x100

) &

Herd

s

020406080100120140

Avera

ge H

erd

Siz

e

(Cow

s)

Cows (x100) Herds Herd Size

Source: USDA-NASS, AFBF, FASS

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Idaho dairy vets vs. Wisconsin dairy vets

• Sorry – I can’t find the reference• Idaho dairies were much bigger than

Wisconsin dairies, and had many more cows per vets than did Wisconsin.

• Idaho (not Wisconsin) represents the future of the industry.

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Biosecurity

Food safety

Animal welfare

In the future, veterinary expertise will be needed for issues important to the “public good”. But not easily charged to an individual farm.

Food security (supply)

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What role will future veterinarians play in food animal medicine? – Bartlett’s opinion

It may be very different from the private practice situation that we now see.

As the food industry consolidates and becomes more vertically integrated, veterinarians may need skills in food safety issues to enable them to work up and down the food chain rather than only being involved at the production unit (farm). “Food Systems Approach”

Food animal veterinarians may more likely be employed by a large company or by a regulatory agency – rather than working in private practice.

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Physical hazards of food animal vet practice

• My Dad’s classmates

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“Like most veterinary students, Doreen breezes through Chapter 9.”

(Larson, The far side)

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What is Preventive Medicine?

• Preventive not “preventative” medicine – And there are no “preventative drugs” to give to

animals so they won’t get sick.

• What is “preventive medicine”?

-Objective of clinical medicine = “cure the sick individual animal or person”

-Objective of preventive medicine “solve the disease problem”

- The River Story

Veterinarians in Public Practice• Public practice is corporate or government practice.• It is unlikely that public health veterinarians will saturate the

public health “market”.• Historically there have been plenty of jobs given:

– the relative sizes of the two professions– The rapid and successful movement of veterinarians into

the interdisciplinary areas.• The MDCH has about 9 DVMs and only about 2 MDs.

• But - Public employment may be considerably reduced in future years if government continues to shrink.– However, private practice may be tough too.

Public HealthEngineering

Microbiology

Others

Vet Medicine

Human Medicine

Interdisciplinary Territory

Public HealthEngineering

Microbiology

Others

Vet Medicine

Interdisciplinary Territory

Human Medicine

Public HealthEngineering

Microbiology

Others

Vet Medicine

Human Medicine

Interdisciplinary Territory

Veterinarians in Public Health• Why do DVMs fare so well in public health ?

– Excellent public health and epi courses?

• Our students learn Medicine– Basic medical sciences (Pharm, Tox, Anatomy, Physiol,

Micro, Path, etc.) – They are fluent in the language of “Medicine”.

• Can understand a (human) patient’s chart. – Disease diagnosis and treatment– Aseptic technique/hygiene

• Mostly learned in surgery– Disease transmission and disease control– Vets are taught a population perspective.

• More so than are physicians.– Disease surveillance, outbreak investigation, etc.

• We are taught to be problem solving generalists.

Why the Increased interest of students wanting to specialize in public practice?

• Recent news events– BSE, FMD, Bovine TB, E. coli, SARS, Monkey Pox, H5N1

Avian influenza, 2009 – H1N1, foreign animal disease, Salmonella, frequent food recalls.

– Biodefense (most ‘Priority pathogens” are zoonotic).• Life Style

– 40 hr wks, not “on call”, stable salary, no business responsibilities, less economic risk, vacation days, sick leave, holidays, health plan, etc. Salaries have improved relative to private practice.

• Job opportunities– U.S.is/was re-building our public health infrastructure after

about 50 years of disrepair.– Maybe private practice has become less attractive. (Corporate

practices, student debt, disappearing middle class, diminishing disposable income for pets, etc.)

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Examples of Vet Public Practice Jobs• Public health departments (federal, state or local)• USDA (Vet Services, Food Safety Insp. Serv., Animal Care, Fish

and Wildlife)• FDA, DHS, EPA, CDC, NIH, USPHS• Local Animal Control• Uniformed Services (US Army, USAF, USPHS)• International organizations • Private industry (pharmaceutical, vaccine, animal feed, food

industries, medical device)• Specialties: Risk commun., food safety, zoonosis control,

disaster preparedness, occupational health, teaching & research, epidemiology, environmental health, animal control

• Note: Many public practice vets do some private practice on the side.

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Careers in Vet. Prev. Med.

• 75% of all veterinarians are employed in private practice– They relate to public practice veterinarians for

disease control programs, regulations and disease reporting.

– They prevent zoonotic disease among their clients.• Consider PubH with every Dx and every Tx

• 25% of veterinarians are in public practice (not privately employed)– But perhaps actually quite a bit higher.

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Veterinary Preventive Medicine• Where public practice veterinarians are employed:

– 27% Federal– 37% University– 20% Industry– 9% State and Local Government– 7% Armed Forces

• Predictions for Vet Med: Biggest growth areas are expected in population medicine, preventive medicine and other kinds of public practice.

• 9/11 has spurred our nation to rebuild it’s public health and regulatory institutions.– Means more jobs for preventive medicine veterinarians.

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Current Professional Activity of U.S.

Veterinarians – based on AVMA membership

70000

2500250

45001800

3500 1500

Clinical PracticeFederal GovernmentState GovernmentAcademiaIndustryRetiredOther

But – AVMA membership is much lower among DVMs that have moved away from traditional veterinary clinical practice.

High dues. Membership not needed if you don’t need the practice insurance. Professional orientation shifts to specialty organizations.

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Public Health Veterinarians in the Federal Gov’t

82 8597

1043

637

30

6

407

105

26

220

15 11HHS-CDC

HHS-NIH

HHS-FDA

USDA-FSIS

USDA-APHIS

USDA-ARS

Coop State Research, Ed,ExtDOD-Army

DOD-Air Force

Environmental ProtectionAgencyDOI-USGS

DOI-Fish and Wildlife

DOI-National Park Service

DO Commerce

DOS/USAID

Total: ~2,400

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Veterinarians at CDCAs of September 2003

611

6

7

36

4

18

3State Health Departments

Reproductive Health

Health Statistics

Occupational Safety &Health

AIDS/STD

Emerging InfectiousDiseases

Immunizations

Environmental Health

Global Health, Lab Safety,Terrorism Preparedness

Total: ~82

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• Federal public service loan repayment plan http://www.finaid.org/loans/publicservice.phtml

• "The College Cost Reduction and Access Act of 2007 established a new public service loan forgiveness program. This program discharges any remaining debt after 10 years of full-time employment in public service. The borrower must have made 120 payments as part of the Direct Loan program in order to obtain this benefit. This is for federal stafford (subsidized and unsubsidized) loans.

• The 10 years must be in local, state or federal government (or some NGOs)

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Federal Loan Forgiveness• Diane Batten [email protected], MSU Financial Aid• The 10 years do not need to be consecutive. • Pay 10% of your salary for 10 years and you are

done! No taxes on the amount forgiven.– So the total amount you owe becomes irrelevant. This

encourages some students to go ahead and get a second (dual) degree.

• But will they cut the program in the future?

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Veterinary Preventive Medicine• Career limitations for DVMs are largely self imposed:

– The human medicine community welcomes us as part of the preventive medicine team.

• Summary:– Keep an open mind about public practice.

• Never say “never”.– If you are interested in public practice, plan your clerkship

years of vet school wisely. – Make an appt to talk to me sometime.

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The Public Awakens to Links Between Animal and Human Health

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The Public Awakens to Links Between Animal and Human Health

Beef recall hits record 1.2 million pounds                          USDA questions delay in recall of E. coli-tainted meatAugust 15, 1997

WASHINGTON (CNN)

Bio and Agro Terrorism

Avian & swine Influenza - H5N1 2009 H1N1

Category Bacteria, Rickettisia, Toxins

Viruses Total (% Zoonotic)

A

Anthrax; Botulism; Plague; Tularemia

Smallpox Viral Hemorrhagic Fevers

6 (83%)

B

Brucellosis; Epsilon toxin of C. perfringens; Glanders; Staphylococcus, enterotoxin B; Q Fever

5 (80%)

C

Multidrug-resistant tuberculosis

Hantaviruses; Nipah virus; Tickborne encephalitis viruses; Yellow Fever

4 (80%)

NIH Priority Pathogens

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The Future looks good for Applied Veterinary Public Health Research and Disease Control of Emerging

Infectious Diseases

Public Health, Food Safety and Food Animal Medicine

• Where will veterinarians fit in?

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Corporate and Government Veterinary Practice Clerkship (LCS 678)

• “The Field Trip” Clerkship– Field trips every day (except for one).

• It is the “sampler plate” of veterinary public practice.

• Offered in spring 5 of your 3rd or 4th year.• Addresses the breadth of the veterinary

profession.

• It is experiential learning. – No nasty quizzes or exams. – Lets you walk around in someone else’s shoes for a

while to:• Learn about their job, and • See if you could imagine yourself in their job.

– You will meet about 60 veterinarians employed in many aspects of veterinary public practice

Corporate and Government Veterinary Practice Clerkship (LCS 678)

• Gets you out of the ivory tower and into the real world.

• Transportation provided (MSU motor pool mini-vans).

• Designed for students: – Students heading into public practice – undecided about their career path and looking

for ideas.

Corporate and Government Veterinary Practice Clerkship (LCS 678)

Day at the Detroit Zoo One or more of the zoo vets also join our tour to tell about their work.

Dr. Kurt Hammel lead a USDA Animal Care Inspection of the Detroit Zoo. You get to see the “backstage” as well as the “front stage”.

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Zoetis Animal Health, Kalamazoo, MI

• Pathology Tour• Toxicology• Clinical Research• Clinical Support – customer support• New Animal Drug Development• Tour of their lab and farm animal research

facilities

Wright-Patterson Air Force Base – Meeting with lots of Army and Air Force Veterinarians

A visit to the Air Force Museum before heading back to MSU

Wright-Patterson Air Force Base – Pathology, Lab Animals, Public Health, Clinical Medicine, Military Working Dog Demo.

USDA:APHIS:VS

Get to meet about 7 Vet Services veterinarians and hear about their jobs.

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• Great tour• Pathology and Clinical Pathology• Laboratory Development• Toxicology• Microbiology• Research Design, Animal Studies

MPI – Contract Research Laboratory (Just E. of Kalamazoo)

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• Conference calls with Power Points slides and lots of questions.– With three clerkship alumni who now work for

CDC

CDC and DHS

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Detroit Border Inspection• USDA:APHIS:VS – Ambassador Bridge

International Port (Import/Export work)• Detroit Metro Airport

– CDC Quarantine Station– USDA inspection procedures

• Beagle Brigade demonstration• X-ray surveillance of luggage for food items• View confiscated materials

– Wildlife prohibited substances• Ivory, hunting trophies, etc.

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Dow Chemical

• Pathology tour• Occupational and environmental

epidemiology tour• Aquatic laboratory tour• Laboratory Animal• Toxicology tour

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FDA – Detroit Office• Meet 3 or 4 FDA veterinarians• Food Safety• Animal and human drugs• Antimicrobial resistance field work

Inspect Detroit Animal Control while we are downtown.

Michigan Department of Agriculture Veterinarians

- Inspect Sundance Riding Stables.

Also inspect Capital Area Humane Society.

Dairy Processing Plant

Beef Feedlot

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Michigan Department of Community Health

• Meet with about seven MDCH veterinarians at the Office of Public Health Preparedness (OPHP) incident command center.– Avian Influenza– Communicable Disease Surveillance– Chronic Disease– Environmental Health

• Tour the MDCH laboratories

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Packerland and Michigan Turkey Producers

USDA:FSIS Meat Inspection

• Maybe your last chance to see where meat comes from.FSIS-led tour of a turkey plant and a beef plant

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• The one day “at home”• A role-playing table-top exercise regarding

international animal disease control.• International Veterinary Medicine

Opportunities.

International Veterinary Medicine

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Summary of Corporate and Government Veterinary Practice Clerkship (LCS 678)

• See the real world and learn about possible specializations!

• Meet about 60 public practice veterinarians– Contacts for future clerkships, summer jobs, etc.

• Good experience for if you are applying for a public practice job someday.

• Always lots of fun!• Spring 5 in your 3rd or 4th year.

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LCS 690 and 691LCS 690 – Public Health Field ExperienceLCS 691 – Public Health Research Experience

• LCS 691 requires a summary paper.

Can do any of about 100 different things with these clerkships.

A graded “Public Health Field Experience” looks better on your transcripts than does a pass/fail “Externship”.

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LCS 690 and 691

• Provides you the flexibility you need to get the education you want.

• Usually about 20 students per year enroll, all at different times.

• Can take LCS 690 twice and LCS 691 once.• Students working on an MPH or MS in Food

Safety can count this as their practicum.

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Most Popular Uses for LCS 690/691 • Centers for Disease Control Senior Epidemiology Elective• USDA:APHIS:VS veterinarians in Michigan• Animal control offices, humane soc. or spay/neuter programs like

CSnip• Michigan Department of Community Health• USDA:FSIS food safety inspection• U.S. Army or Air Force; FDA, DHS, other agencies• Michigan Department of Agriculture, Animal Industries

Veterinarians• Mich. DNR or various wildlife programs• Other state’s agriculture or health departments• International programs• Plus many more (Dr. Bartlett can send you a complete list of

possibilities)• Industries: Zoetis, Dow Chem., MPI, other

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LCS 690 and 691• You set up these experiences yourself (with my help as

needed).– That’s part of the whole experience. You can’t just show

up on the first day and ask where you are supposed to go! (That’s only happened once!)

– You can sign up for these clerkships before your plans are solidified as to what specifically you will do.

– Complete and sign Bartlett’s 1-page form • It very much helps your job application to an agency if you

can demonstrate that you know what the job entails. LCS 690 is how you get that experience!

• Essentially no min or max, and I’ll always let you drop or add.

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Dual Degrees (General): DVM, MPH or DVM, MS in Food Safety

• Never have to take DVM and masters courses in the same semester– but some students do this to save money via block

tuition.

• Admission and courses are generally easier than vet school.

• Get at least a start on the 2nd degree early when it does the most good for job applications

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It’s all about “Double Dipping” • Starting your masters now can mean about 1/3 off MPH

or 1/3 off MS in Food Safety.• If you stay in public practice, you’ll probably want a

master’s eventually. • Get your field experience/practicum project done when

you are a CVM student. – It is harder to do a practicum when you are working full time.– As a ckerkship or as part of summer Food Animal Fellow or

NIH program (Drs. Grooms and Vilma Yuzbasiyan-Gurkan)

• Public vet practice is getting more competitive, and a masters degree helps you compete early in your career.

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But – you might want to wait

• You may fall in love with private practice– You may want to wait on a masters until you

are sure you want to move into public practice.

• You may want to concentrate on one degree at a time to “get your money’s worth”.

• You may need your summers to recover your sanity.

• And it is expensive on top of the DVM.

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MSU’s MPH program: • http://publichealth.msu.edu/pph/ • 42 credits. All online. No out-of-state tuition for anyone. 9

credits transfer from your CVM courses. • If you take public health field experience (LCS 690 & 691)

clerkships and sign up for the 4 cr of MPH practicum (HM 891 and 892) at the same time, then you will save your time, but will not save any money.

• Double dipping: If you take HM 803 (Epi) and HM 864 (Intersect of An. and Hu. Health) before 3rd sem of vet school, then you won’t have to take VM 533 (Epi) or VM (544) in your 3rd semester of vet school, thereby freeing up time in 3rd semester to take MPH courses for free under block tuition.

• Savings: 15cr / 42cr = 35% off ($660. per credit)

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MPH at MSU• Most students apply for the MPH program during

their 1st year of vet school.• Dr. Melinda Wilkins [email protected] works

for the MPH program and is the advisor to virtually all of the DVM/MPH students.

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What if you are not accepted into vet school on your first attempt?

• An MPH degree can be a good move– It gives you a chance to pull up your GPA.– It strengthens your application to vet school– It adds value to your DVM if you eventually

get one.– It leads to a viable career if you never get your

DVM.• It is not a dead end like taking courses outside of a

degree program. “Life-long education”

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MS in Food Safety • http://www.online.foodsafety.msu.edu/ • 30 credits, of which 9 can transfer from vet school. • Students mostly are working for Food Companies

(75%) and food regulatory (25%). • Good for students with a strong interest in food

animal medicine • Do practicum in summer or during clerkships. • See Dr. Julie Funk who is the program’s director.

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The History of Preventive Medicine

How do we usually measure the “Success” of an animal species?

Population

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Graph of the Human Population Over Time• Two inflection points:

– At the time of the Agricultural revolution

– At the time of the Industrial revolution

• Due to improvements in nutrition, disease control practices and sanitation– All of which are key

elements of preventive medicine.

– Clinical medicine was pretty ineffectual in the ancient world.

Estimated Global Population

0

1

2

3

4

5

6

7

-10,000 -2000 -500 0

Years ago

Po

p in

Bill

ion

s

http://www.census.gov/main/www/popclock.html

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Antibiotics

Infectious Disease Mortality

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Preventive Medicine• The major health improvements in our civilization

were made before the advent of antibiotics or much effectiveness of individual (curative) clinical medicine.

• Epidemic disease has largely been controlled through preventive medicine by:– Sanitation and hygiene (food hygiene, pest control,

vector control, reservoir control, etc.)– Good nutrition (food animal medicine helps makes

food plentiful and affordable)– Disease control measures (education, food safety,

isolation/quarantine, vaccination, eradication, control of animal disease reservoirs.)

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Summary - Preventive Medicine

• The increase in the human lifespan is mainly due to preventive medicine.– Perhaps your garbage collector contributes

more to your health than your physician.• The natural state of mankind is disease and

squalor. – It is preventive medicine that freed us from this

desperate situation.– Epidemic disease quickly returns when

preventive medicine infrastructure breaks down.

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Wisconsin Death Trip by Michael Lesy

Life in the “good old days” was not that good. Uncontrolled infectious disease greatly diminished the quality of life.

• Life was very stressful.– Quarantine signs on doors of houses.– Limited movement (public gatherings rare, meat

purchased cautiously, restaurants rare)• Stress is when your children die,

– not when you can’t find a parking place at the mall.• Last 100 years in the U.S. is an aberration from the

normal stressful human existence of desperate poverty and squalor.

• True stress is not having any choices.

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Wisconsin Death Trip by Michael Lesy

High Infant Mortality Rate

Suicide

Insanity

Religious dementia

Poverty

Untreated Depression

The “Good Old Days”

The “Good Old Days”?

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One more word about stress

• I’m not saying we don’t have stress now days.

• I’m saying we should have incredible respect for the stresses endured by our ancestors– And be inspired by their perseverance – And encouraged that our bodies and minds

were made to survive stressful situations.

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U.S Infant Mortality Rate

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Source: https://www.cia.gov/library/publications/the-world-factbook//rankorder/2091rank.html?countryName=Norway&countryCode=no&regionCode=eu&rank=212#no

The Sanitary Hypothesis

Rankcountry (deaths/1,000 live births)1 Afghanistan 121.632 Niger 109.983 Mali 109.084 Somalia 103.72 . . . . 218 Sweden 2.74219 Singapore 2.65220 Bermuda 2.47221 Japan 2.21222 Monaco 1.80

Infant mortality rateThe number of deaths of infants under one year old in a given year per 1,000 live births in the same year;

68-fold difference between highest and lowest, i.e. 68 times more dead children.

Yes – you get healthier adults – if they survive, but look at the cost!

United States is 174th 5.98

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Disease and Squalor has been controlled by: “Public Health Infrastructure”

Sewers, clean water, garbage disposal, pest control (dog pounds), health department disease control, dairy and meat inspection, pharmaceutical licensure, vector control, reservoir control, etc.

Veterinarians participate in all these activities.

In Conclusion

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I hope I didn’t “oversell” my message.• You can still be a good person even if you decide to specialize in

something other than public health.• Keep in mind that all veterinarians practice public health in some

aspects of their work.• There are many worthwhile specialties in veterinary medicine.• Each professor states their best case to get you interested in their

specialty.– But we all realize that veterinarians are needed in many

different areas.

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Paul Bartlett, DVM, MPH, PhD

Professor

College of Veterinary Medicine

[email protected]