Many Midwestern communities suffer from veterinary clinic shortages
This is the first in a four-part series, “On Call: Vets Under Stress”, that explores the pressures and overwhelming challenges facing those who choose a career in providing care for our animals.
Veterinary experts say Midwestern states are suffering from shortages of veterinary professionals in their rural communities.
On a national level, according to the US Department of Agriculture, over 500 counties in 44 states had vet shortages in 2019, many of them rural areas. And beyond that, independent clinics are starting to go away, instead turning into corporate clinics with satellite offices. Many rural vets report having to drive multiple hours one way just to get to a client.
While Waupun Veterinary Service is not considered a small practice, the clinic's staff of 10 veterinarians often travel an hour or more to service clients in outlying areas.
"The further you have to drive, the quality deteriorates from an emergency perspective," said Al Martens who has worked as a veterinarian for the past 43 years.
That makes life difficult for both veterinarians and farmers alike. The veterinary profession is among one of the highest-stress careers among graduate professionals, and farmers are having to do more and more of the basic veterinary care themselves because the vet can only come out for emergencies – and even then, a long drive could affect the outcome.
Russ Daly, an extension veterinarian and professor at South Dakota State University, said many clinics are actually spending a lot of time trying to recruit new hires in rural areas, but it's hard to incentivize vets to live in rural areas because of a lower average annual income and small amount of clients for a large area. What's more, only 6.5% of vets practice large animal and livestock care according to the American Veterinary Medical Association.
"You look at western South Dakota, and if you put a pin on the map of where the veterinarians are, there's a huge, vast expanse of the state where there's just not very many veterinarians," Daly said. "Those producers in those areas are still accessing veterinary care, but it's coming from farther away. It's coming from practices that are multi-veterinarian in nature, so a four or five doctor practice instead of the one doctor, hometown kind of practice."
Since the vet might be a hundred miles away at any given time, some farmers have learned how to do stitches themselves, though Daly said he believes it's best left to a professional. Daly said that sometimes vets will simply decline to do a service for a client because their practice is understaffed and they don't have time to fit it in. Some large animal practices may simply decide to stop working on a certain animal if they've had problems with them or just don't like working on them.
Daly said it's also getting harder and harder to find vet students with a background in agriculture or even just being from a rural community. While anyone can go into large animal services, few students who don't come from those backgrounds go down that path, and those that do have a big learning curve during their time in school.
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"We've been really fortunate here in South Dakota ... to have a good cadre of students who have that farming background, or some sort of ag background," Daly said. "What we find is, if students aren't comfortable or associated with that kind of background, that's not a kind of practice they're going to want to seek out once they get into vet school."
Martens, who did not grow up on a farm, said fewer and fewer vet students hail from an ag background.
"We like to have some farm background, but what's more important in the field today is if they can communicate, are personable and have a strong work ethic," he said. "Attitude goes a long ways."
There's also many reasons why a vet grad might move from a rural to urban area, or even stop practicing in that profession altogether. Daly cited high stress, large amounts of debt and work-life balance as being factors in some people moving out of the career field. He said it's become a little more common these days, but he believes the people who left the profession "never entered it in the first place."
Farm consolidation has also affected the income rural large animal practices bring in, Daly said. While the amount of livestock stays the same or increases, those larger farms can afford to do more of their own labor with their animals and can even order veterinary items and prescriptions over the internet without the need of a local vet.
Martens' colleague, veterinarian Ralph Stowell says many veterinarians are finding ways to make their services "value added" on large farms, from creating health protocols for calves and heifers and performing pre-emptive care.
"These larger dairies are doing more of the health care services themselves that veterinarians used to do years ago. In a few years, us even doing pregnancy checks may be a thing of the past," said Stowell.
With livestock owners becoming more and more consolidated in recent years, the practices lose those clients, and if that happens in a large area, it could lead to a practice shutting down entirely.
"It's big cattle country, but those cattle are under the management of fewer and fewer people," Daly said. "You might have a lot of cattle out in your area, but if they only get worked once or twice a year, and you get the occasional emergency call, it takes quite a few of those herds to really make it economically viable."
Nigel Cook, chair of the Department of Medical Sciences at University of Wisconsin-Madison's School of Veterinary Medicine, said starting salaries are actually more similar than you'd expect between urban and rural vets. But there's a problem – with the consolidation of clinics, independent clinics are dying out as they can't afford to pay a competitive salary, and they may only have one or a few vets working there.
"You'll see five to 10 person clinics a lot more ... and much fewer one or two person practices, which may well have really struggled to produce a competitive salary for new graduates," Cook said. "I think those larger clinics have much more sound financial policies."
Overall, an increase of 32% in the veterinary profession between 2007 and 2017 led to lower overall starting salaries due to the increased competition, while student debt rose, making life more difficult to afford. Cook said that a university taskforce focusing on the problem of rural vet shortages several years ago found that a big problem is the lack of business in an area, lacking incentivization for new practices to open up in those areas.
Cook also said the industry is undergoing a significant changing of hands as many Baby Boomer generation practice owners begin to retire and either pass their practice on to someone else or close it entirely. One thing Cook recommends to all vet grads looking to open a practice in a rural area is to ensure you're a mixed animal practice rather than a large animal only practice because the business isn't sustainable otherwise.
"Long term, those areas can't sustain a veterinary practice because of the low density of the animal population in those areas," Cook said. "The reality of those rural communities is the veterinarians actually need to be really good mixed animal veterinarians, and not just food animal, because to sustain their practice, they need to be seeing the cats, the dogs, the horses ... as well as the farm animals."
In population centers like Plymouth and Green Bay, corporate clinics have set up shop and built satellite clinics in the far reaches of the suburbs, allowing them to cover a wide geographical range. Cook said those same clinics also put an emphasis on offering externships and training opportunities to vet grads as a way of recruiting new hires.
Cook also mentioned that the waves in the agriculture industry and its livestock sectors also affect a veterinarian's business. With hundreds of dairy farms shutting their farm gates across Wisconsin in recent years, it's caused vet practices to dry up too, even if they aren't just working on dairy cows.
"If you're the only dairy in a 100-mile radius with 30 cows, it's going to be awfully difficult to have access to a skilled dairy veterinarian on a daily basis. Those farms are going to continue to struggle to get access to those veterinarians," Cook said. "They can certainly access them as consultants have infrequent visits from potentially far away, but that's the challenge of the moment."
Some states have begun to combat the shortages by instituting recruitment programs to get vet grads in rural areas in exchange for loan forgiveness. While the USDA has a federal program for it, it's much more selective than state programs, making them a more viable alternative to many grads. The USDA program, called the Veterinary Medicine Loan Repayment Program, will pay up to $75,000 in student loans over three years for vet students who practice in designated areas of need.
USDA also offers some grants, like the Rural Enhancement Program funding as part of the Veterinary Services Grant Program, that help struggling clinics to stay open and establish new clinics in underserved areas.
Bob Larson, a professor of veterinary medicine at Kansas State University, said Kansas has such a program – the Veterinary Training Program for Rural Kansas. Annually, five students are given the opportunity to have up to $80,000 in student loans forgiven if they practice in an underserved area for at least five years after graduating. Twelve other states have similar programs, though not always focused on rural areas and not always offering total loan repayment. A handful of other states have these programs but they are not currently funded.
"That program has been pretty successful in that most of those students not only fulfill that five year commitment, but then they stay in those communities much longer than that as well," Larson said. "(The) idea is recognizing the need for student debt management, and the need to pull some veterinarians into some underserved areas that lacks (them)."
For 20 years, Larson said the lack of vet students coming from ag and rural backgrounds has also been a problem. While he said it's "not documentable," he estimated that a sharp decrease in enrollment figures from those backgrounds happened about two decades ago, but enrollment has held steady for several years now at a much lower rate.
Larson also said that yes, Kansas does have a veterinary shortage, but many only know about it if they're living in a shortage area. If you ask people in larger cities and communities, he said they wouldn't think there's a shortage issue. It's also not a uniform issue across the state.
"If you talk to a lot of mixed animal veterinarians, you'll get different opinions on how critical a shortage is. Some would say there's not a shortage ... because it seems to be a local issue," Larson said. "If your local area has a shortage, it's a critically important issue. Or, in fact, if the veterinarians see it as too much competition, then they'll see it in a different light."
Veterinarian Meg Mueller who is a partner in a mixed animal practice in one of the state's underserved areas says her Oseeo-Augusta-area firm has four full-time veterinarians and could use a fifth veterinarian.
"We were lucky to hire a fourth veterinarian," Mueller said. "We've had several years in the past six years where we've been understaffed and down to just three doctors."
Some communities try to bring new vets to their area using business packages and incentives through local vendors and chambers of commerce. Some vets who establish much-needed practices could get financing help from local government or business organizations, like favorable payment schedules or delayed principle payments, Larson said. Some even receive land at a discount or for free, he added.
What does help, Larson said, is that every state in the Midwest has at least one reputable veterinary school, which can help with keeping vet grads in the state after finishing school if there are good opportunities (like these incentive programs).
"The federal program is available for all veterinarians in the United States ... so every rural community could benefit from that program. And then, if your state also has a program, then that's an additional kind of legislative help," Larson said. "In some ways, it certainly helps to have a veterinary college in your state, both attracting students into the profession and keeping them around."
Rural communities have already realized that vet shortages are part of a systemic problem that these incentive programs try to solve, Larson said. And there's still more ideas to come to continue combatting the problem, like addressing ballooning student debt, decreasing clinic workloads and introducing veterinary school as a career path to high school kids.
"Students tend to like to go back to the they grew up in or a community like that. So it goes back to those communities," Larson said. "Do you have students in your community that you would like to encourage to come back home – students that are good at science and math and may be interested in livestock production or veterinary medicine? Are there ways to encourage them while they're in high school and ... continue to look at that as a career path?"
Colleen Kottke of the Wisconsin State Farmer contributed to this report.