Filling the rural veterinarian gap

While the number of companion animal veterinarians steadily increased by 22% over the last decade, the number of mixed animal and food animal veterinarians decreased by 15%. Compared with a robust 68,400 veterinarians in companion animal medicine, there were just slightly more than 8,100 veterinarians working in a food animal or mixed animal practice in 2023, according to AVMA data.

Multipronged efforts to increase the number of rural and food animal veterinarians include state and federal loan repayment programs, veterinary colleges developing programs to attract students, and specialized workshops. These programs have generally been successful at what they've been designed to do. However, none of them were intended or designed to fix the lack of veterinarians in rural areas in a comprehensive manner. That's difficult to accomplish, because while finances are an important component, that is not all of what is challenging about attracting and retaining veterinarians to rural areas.

Participating in the U.S. Department of Agriculture's (USDA) National Institute of Food and Agriculture's (NIFA) Veterinary Medicine Loan Repayment Program assists veterinarians in providing essential private and public health services to their communities and state, which impacts animal agriculture at a national level. This year, NIFA designated 240 veterinary services shortage areas across 47 states.

Dr. K. Fred Gingrich II, executive director of the American Association of Bovine Practitioners (AABP), says, "It is up to every individual practice owner in a rural community to understand what the next generation wants versus trying to force what we want to be done onto the next generation, which is unsuccessful."

The salary impact

Around 175 to 200 veterinary graduates join the AABP each year and enter bovine practice, according to Dr. Gingrich.

The association offers externship and education grants, scholarships, and partnerships with the National Milk Producers Federation and the Wisconsin Rural Opportunities Foundation to help recruit veterinary students interested in rural medicine. He says that's not the issue.

"We have plenty of new graduates who enter cattle practice. The problem is that half of them leave," Dr. Gingrich said.

Based on AABP data, the cost of education and repaying educational debt is one of the most significant challenges identified for being successful as a food animal veterinarian.

The lowest mean salary in 2024 among all private practice types was for mixed animal and equine associate veterinarian, coming in around $100,000, according to AVMA data. Alternatively, the mean salary for a companion animal exclusive associate veterinarian was $133,000.

AABP exit surveys show that most veterinarians who leave cattle practice transition to companion animal medicine

The American Association of Equine Practitioners (AAEP) faces similar issues. After surveying members, the organization found that approximately half of those who enter equine practice after veterinary school leave within the first five years of their career.

The AAEP Compensation Subcommittee conducted a salary survey, released in October 2022. Results from the 2022 Equine Medicine Salary & Lifestyle Survey showed that the mean salary for a recent graduate in equine practice, not including internship positions, was $89,000 a year.

Federal level assistance

The U.S. Department of Agriculture (USDA) has designated nearly every U.S. state as having one or more rural or livestock production areas with an unmet need for veterinary services.

The USDA's National Institute of Food and Agriculture (NIFA) launched the Veterinary Medicine Loan Repayment Program (VMLRP) in 2010. It offers educational loan repayment to veterinarians in exchange for working in one of these shortage areas for up to three years.

The VMLRP statutory authority does not allow NIFA to track VMLRP awardees after their award closes out, said Dr. Robert Smith, national program leader for animal health at NIFA. However, the program put together a summary that looked at data from 2010-22.

"With the recognition that we need to have sustainable rural practice models, I'm hopeful that many practices will be able to meet that challenge so we can continue to improve retention," says Dr. K. Fred Gingrich II, executive director of the American Association of Bovine Practitioners. (Courtesy of AABP)

The largest numbers of shortage areas were nominated in the Midwest and West as well as Georgia, and beef cattle has consistently been the species identified as having the greatest need.

From 2010-22, the VMLRP received 2,061 applications and entered into agreements with 795 awardees. The states with the largest number of applicants have been in the West and Midwest, and the largest number of awards have been made to veterinarians in Iowa, Kansas, and Nebraska.

Slightly more than half of the awards have been made to veterinarians who are six to 10 years post-graduation (49.9%) followed by those one to five years postgraduation (43.8%).

The VMLRP is a "very helpful and useful program to help alleviate some of the salary discrepancies between rural and urban practice," Dr. Gingrich said. "It certainly has a tremendous impact on the people who receive those awards. Although it's very appreciated, the level of funding is far less than what's needed to have a wide impact."

Though federal appropriations for the VMLRP program have increased from less than $5 million in 2011 to $10 million in 2023, the award amount has remained the same since the program's inception: $25,000 per year for a three-year service agreement. Awardees may apply for a renewal award at the end of their three-year period if they have remaining educational debt. At the same time, the average amount of debt in 2011 was $109,000, rising to $147,000 in 2022, an increase of 35%.

State programs

Twenty-five states have created their own debt repayment programs and scholarships that seek to ensure recipients stay in a rural area to work specifically in mixed or food animal practice, according to the AVMA.

Colorado's Veterinary Education Loan Repayment Program (VELRP) provides educational loan repayment for veterinarians willing to practice food animal medicine in underserved areas of the state. Thanks to the revised Colorado Senate Bill 23-044 this spring, the VELRP will now pay up to $90,000 over four years to help licensed veterinarians in the state pay off their student debt.

Both veterinarians who have completed the four-year program remain in their practices.

States such as Colorado, Kansas, Georgia, and Nebraska have programs to assist veterinary students and encourage them to remain and practice in rural areas. Beyond retention as a measure of success, Colorado's program collects reports from community members to gauge the effectiveness of an awardee's service before awarding each year's loan repayment over the four-year program.

This year, the program is launching its second cohort of participants, and the state has accommodated six more veterinarians.

"I believe this program should be expanded to every state," said Dr. Kayla Henderson, Colorado VMA president-elect and vice chair for the VELRP Committee. "The federal VMLRP is an amazing program-I was awarded it in 2013, and it completely changed my life-but one of its shortcomings is that it doesn't allow for nuances."

For example, the VMLRP mandates specific hours that are closely audited, which can sometimes be difficult for a rural mixed animal practitioner to fill depending on the season, Dr. Henderson said.

"Our VELRP does not have specified hours, but we do ask for annual reports illustrating the amount of food animal work they do as well as how much it has increased from year to year," she said.

Neighboring Kansas has its Veterinary Training Program for Rural Kansas (VTPRK), which provides for up to seven veterinary students to receive a $25,000 loan annually for four years to help cover tuition and other school-related expenses.

After graduation, for each year that the new veterinarian works full-time in a veterinary practice in a Kansas county with fewer than 40,000 residents, or in a full-time veterinary practice if food animal patients make up at least 50% of the practice, a year of loan is forgiven.

In addition to loan forgiveness, the VTPRK provides industry tours, business management and development training, and fosters relationships with practicing veterinarians so participants are prepared for future success. After four years of the program, 94% of recipients are still practicing in a qualifying county and 77% remain in their initial practice.

Species group efforts

Food animal and equine species groups such as the AABP and AAEP have also stepped in to help. They have been greatly assisted by the Veterinary Services Grant Program (VSGP). Like the VMLRP, it is overseen by NIFA and targets rural areas that lack adequate veterinary services for food animal care and public health. The VSGP specifically addresses veterinary workforce gaps through grants to private practices, nonprofits, and veterinary schools. It also grants money to veterinarians for equipment, such as a truck or ultrasound machine.

AABP's Veterinary Practice Sustainability Committee received a total of four of VSGP grants to fund Building Excellence in Rural Veterinary Practices workshops. They are for practicing veterinarians with at least 10% of revenue from food animal species. Priority points are assigned to veterinarians who are owners, have access to practice financial data, and work in USDA-designated shortage areas.

The program includes two, two-and-a-half-day workshops one year apart with three follow-up teleconferences between the two workshops. The workshops focus on strategic planning, understanding and improving practice finances, moving into or being a part of ownership, and refining human resources competencies.

Participants in the American Association of Swine Veterinarians' (AASV) Participant-led Early Career Development Program engage in group activities focused on identifying communication preferences and practicing new skills. (Courtesy of AASV)

Participants have said the workshops equipped them with tools they can take back to their practices while connecting them with peers who can support them in that process.

"What AABP feels is one of the ways to make rural practice sustainable is to make it a place where you can earn a good living. The workshops have done a great job at teaching that," Dr. Gingrich said.

The American Association of Swine Veterinarians (AASV) has its Participant-led Early Career Development Program funded by the VSGP.

Currently, 18 of the 25 participants in the program serve in federally designated shortage areas. The goal of the program is to provide participants with resources needed to encourage and ensure successful, lifelong careers as swine veterinarians and to cultivate new leaders in swine veterinary medicine.

The AASV also offers two debt-relief grants to early career veterinarians, though a partnership with MentorVet. The MentorVet Leap program is a six-month, virtual mentorship and professional development program that aims to promote wellbeing and decrease burnout in the transition into veterinary practice.

"MentorVet helped me grow as a person and a doctor in all the areas vet school doesn't prepare you for," said Dr. Monica Strawn, a 2024 AASV MentorVet Leap program participant. "The soft skills I have learned over the last six months have helped me navigate as a new veterinarian and will benefit me for the rest of my career.".

The AAEP's Commission Equine Veterinary Sustainability and its subcommittees are focused on topics such as compensation, emergency coverage, internships, students, and practice culture.

Already the tide appears to be turning for equine salaries, as average offers for veterinary graduates entering equine practice have jumped from $65,000 in 2021 to $95,000 in 2023. Of course, compensation is not the only factor. Providing emergency services and long hours on-call are other reasons large animal and rural medicine can be challenging. Surveyed equine practitioners reported working an average of 104 on-call weeknights and 22 on-call weekends in 2021.

The AAEP's Emergency Coverage Subcommittee created a comprehensive toolkit, "Emergency Coverage 2.0: Innovative Strategies to Revolutionize After-Hours Care" that describes various successful models of emergency coverage.

Meanwhile, the AAEP Practice Culture Subcommittee identified seven pillars that contribute to a positive workplace culture, which has been shown to reduce employee turnover, enhance workplace environment, and improve profitability.

For each pillar, the subcommittee developed a variety of resources for practices and staff members, including a practice owner handbook, and a culture transformation toolkit, "Building a Thriving Equine Veterinary Practice: A Culture Transformation Toolkit."

Other considerations

While changes are being made to remedy low salaries and stressful emergency care demands, other, more intangible factors also play a role in veterinarians choosing to stay in food animal or rural medicine.

White, male veterinarians still make up a large portion of bovine practitioners, especially when compared with the overall number of U.S veterinarians by race and gender. Rural veterinarians, particularly if they are nonwhite and female, may face discrimination from their clients.

In bovine practice, instances of gender bias often occur, particularly in recently graduated woman veterinarians, according to a 2021 study published in The Bovine Practitioner.

Dr. Jenna Funk, a clinical assistant professor at the Texas A&M University College of Veterinary Medicine & Biomedical Sciences, recalls working in environments as a new graduate where she was made to feel unwelcome by the community because of her gender. She suggests that instead of asking why there aren't more white men working as veterinarians, communities need to figure out how to accept and better utilize the workforce they are provided.

"As a producer, you're going to have to come to the realization that your options are often female and your options are often minority," Dr. Funk said.

For veterinary practices in these rural communities, the more students they bring through, the more their clients will understand this is what the profession is turning into, she said.

Then there are considerations for family members. Some veterinarians have concerns about finding sufficient child care options or high-quality public schools in a rural community.

She continued, "Either you're in animal agriculture or you're not, and then you have to think about, what's your spouse going to do? Can both people in that marriage find sufficient work and satisfaction in their careers in a small community like that?"

Veterinary students and new graduates have different expectations for the field than past generations, Dr. Gingrich said, and it's important to value their ideas.

"It's our fault as older veterinarians that we've created a practice model that's not attractive to our customer base," he explained. "Every generation wants something different, there's absolutely nothing wrong with that. What we need to do is find out how to adapt our practice models so this isn't even a consideration anymore. So those people are clamoring to be working at rural practices."

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