Vet School vs. Vet Students

When staffing shortages affect patient care, it's the students who suffer.

“Power tends to corrupt and absolute power corrupts absolutely.”

John Emerich Edward Dalberg Lord Acton letter to Bishop Mandell Creighton, 1887. Lectures on Modern History. Kindle Edition.

Being a veterinary student isn’t the cushiest gig in the world. Long hours are expected, the coursework is fairly demanding, and you almost certainly occupy the lowest position in any permutation of organizational hierarchy. On the upside, vet school is both optional and temporary.

I bring up the Lord Acton because I believe that there is always the risk of what has been called “the fatal poison of irresponsible power.” Lord Acton wrote to the Bishop the about nature of leadership, liberty, and how to maintain individual freedoms while ensuring moral governance. There is risk of exploitation and even dehumanization when there is a marked imbalance of power, or when a leader finds it easier to exercise their authority than to honor their responsibility.

Somewhat unhelpfully, the federal government of our United States has decided that you can more or less be put to work for free as part of your studies. The relationship between a student and the educational institution can amount to little more than exploitation, and there’s some case law to back it up.

The Fair Labor Standards Act of 1938 hasn’t always held up when challenged by students put to work for the financial gain of their educators.

• It didn’t hold up in Benjamin v. B&H Education Inc. before the Ninth Circuit in 2017, when it was ruled that the educational benefits made the cosmetology students the primary beneficiaries despite working in for-profit nail salons.

• It didn’t hold up in Schumann et all v. Collier Anesthesia, P.A. before the 11th Circuit in 2015, when it was ruled that interns mandated to complete internships were not employees and were the primary beneficiaries of the unpaid work due to the educational result.

• It didn’t hold up for Solis v. Laurelbrook Sanitarium & School Inc. before the Sixth Circuit in 2011, when it was ruled that the educational and vocational aspects of the work made the students the primary beneficiaries of the work. This suit was brought by Hilda Solis during her tenure as Secretary of Labor.

• It didn’t hold up in Walling v. Portland Terminal Co. before the United States Supreme Court all the way back in 1947, where it was ruled that training was not employment under certain circumstances.

There isn’t a legislative federal mandate protecting students from exploitation and overwork.

But there are moral and ethical ones.

Burning the midnight oil

Clinical Signs

If it makes you uncomfortable reading that educational institutions, even private ones, can mandate students work for no pay, that’s only because you have sufficient conscience to be troubled by indentured servitude. That’s just your humanity chafing.

An outsider might hope that the hard-working, high-achieving, soon-to-be doctors who enter veterinary school wouldn’t be subjected to this kind of abuse. Especially from an institution charging them $61,000 a year in tuition, with an enormous operating budget - more than $30M of that budget coming from state taxpayers.

As a veterinarian, I’d expect that one of the world’s premier veterinary schools wouldn’t use this troubling history of borderline exploitation to justify working its students for more than 100 hours per week.

But we’d both be wrong.

The University of Pennsylvania School of Veterinary Medicine received a letter signed by 65 students - roughly half of a full class - stating that the students had consistently been working more than 100 hours per week. The letter went on to state that the students are being used to compensate for a nursing shortage.

Brady Beale, VMD, Chief Medical Officer of Penn’s Ryan Veterinary Hospital, stated that students hadn’t been called in to cover nursing shifts because of a shortage but rather, “We’ve just been hit with an unusual, a really, really unusual number of illnesses and injuries.” Whether the illnesses and injuries are to the staff or to the patients is not clear but irrelevant,¹ as in either circumstance there were too few veterinary technicians to do the work required. Dr. Beale seems to be noting a distinction without a difference.

Dr. Beale went on to note that the veterinary industry is experiencing a shortage of both doctors and technicians. The industry as a whole, but not the University of Pennsylvania. Incidentally and undoubtedly unrelated to anything approaching a nursing shortage, the University of Pennsylvania School of Veterinary Medicine is hiring for a number of veterinary technician positions. Twenty-seven animal care positions are listed at the time of this writing.

In a more recent article, Dr. Beale further said that the Philadelphia Inquirer’s reporting was outdated and changes had been implemented. As we nod along to the promises from the Chief Medical Officer, it’s hard to resist a sidelong look toward the 27 animal care positions listed on the Penn Vet website.

Students, who wisely remained anonymous, said that it was “business as usual.” And “that it’s hard to care anymore.” Also, “Yes, we have honestly given up.” Just the kind of thing you want to hear from the future of a profession leading the league in suicide rate and responsible for the care of patients.

Changes take time to implement, but the words from Dr. Beale seem a barely polite brush off of real concerns for student safety and well-being. I’m not altogether a grouchy jerk, pointing out problems without offering solutions. There is a simple solution: Ryan Vet Hospital can do what every other veterinary hospital I’ve ever worked at or heard of has done and divert cases elsewhere when they exceed the capacity of their present staff.

The Greater Philadelphia Area has a tremendous number of tertiary care facilities on par with Penn’s level of care. It would not be difficult to help clients find an alternative when you find yourself short on paid animal caretakers. Working anyone 100 hours per week is abusive and irresponsible, compromising both the duty of a leader and that of a doctor. The moral and ethical failures are even worse when the workload is both unpaid and mandatory.

Systemic Afflictions

The federal government won’t protect students from exploitation, but could anyone else?

I think so. The American Medical Veterinary Association’s Council of Education is the accreditation body for veterinary schools. If you want to be a veterinarian in the United States, it’s a much easier path if you graduate from an AVMA-accredited school.

Among the numerous, varied, and rigorous standards of AVMA accreditation is a mandate that mental health services be available to the students. The AVMA standards include the modifiers “adequate” and “readily” in the language, emphasizing the importance of access

If a veterinary student is consistently working 100 hours per week, healthcare and mental health resources are not actually available to them. A workload averaging more than 14 hours per day, seven days a week, does not allow for the use of mental health services, rendering them effectively unavailable to the students.

And it’s a good thing, too, because one of the three counselors on Penn Vet’s Veterinary Wellness Resources website is available only from 3pm to 7pm on Tuesdays and Wednesdays. Estimating that Penn has 125 students per class, that’s 500 veterinary students. The counselor is available fewer hours per year than Penn has students.² And that’s to say nothing of how many veterinary technicians and veterinarians (specialists, residents, and interns) work at the University of Pennsylvania and where they will turn should they need the support of a mental health professional.

I believe the AVMA COE has an opportunity to protect veterinary students in a meaningful way by protecting the students’ access to mental health services. Aside from being the right thing to do, it’s easy to imagine the powerful, positive impact such protection would have on the profession.

Pathology and Treatment

Veterinarians aren’t always great at boundaries. Lots of clients have my cell phone number. Rarely does the weekend pass when I don’t hear from a few of them. I don’t mind, mostly. I’m happy to put someone’s mind at ease about their pet’s bloodwork results on a Sunday. I’m not so happy when I get nasty voicemails during a blizzard-induced power outage demanding that I go to the hospital to fill a prescription for a mild illness. I try to balance those things and it’s a work in progress.

Veterinarians are often hard-working, ambitious folks, but the pull that comes with the practice of medicine is deeper than a high-tension character trait. It’s no small thing to aspire to be a veterinarian and then to do the job. You want to help and, as a veterinarian, you know that you often can. It’s satisfying. It’s fulfilling. It’s fun. You don’t say “no” as often as you should because you just don’t want to. You want to be there to help.

It’s passion not pathology, vocation rather than addiction.

In veterinary school, it’s even harder to say no. The environment often fosters a masochistic competitive martyrdom. And there’s the threat of losing it all for saying no to a professor,³ resident,⁴ or intern.⁵ In many circumstances, you’re just not allowed to set even reasonable boundaries. Such circumstances all but ensure abusive treatment of one another. I relate some of my own stories in the footnotes, but there’s not a student or veterinarian who doesn’t have a dozen or more memories like those. If not for the decency of some, the indecency of others would win out to the great detriment of the profession.

It’s the responsibility of people like Dr. Brady Beale to use their power to do more for the profession and for the student than set medical standards and hospital protocols. The duty of a Chief Medical Officer at a teaching institution is greater than that of a medical director in a non-academic setting. There is a responsibility to the people who are powerless to refuse you, not the least of which is that you must protect those people from an environment that is abusive or exploitative.

I hope the words from Dr. Beale and others represent frustration with the situation rather than a dismissive attitude toward resolving it. And, for the sake of my student colleagues and their patients, I hope it is resolved soon.

Author’s update 3/4/2024: I have removed some critical comments because the authors opted to remain anonymous. I offered to keep the comments if the authors would provide their identity, but none did so. I welcome meaningful criticism, but I will not tolerate anonymous trolling. It’s important to me that we are responsible for what we write.

It’s come to my attention that students at Penn Vet received an email this week encouraging them to participate in a workload monitoring program so that the university can avoid a student workload approaching or exceeding 80 hours per week.

It’s to the leadership’s credit that they sent such an email. While Dr. Beale was not the sender of the email, I would find it hard to believe that she had nothing to do with this effort to resolve the problem. Kudos to Dr. Beale and the rest of those involved for trying to make things better. I hope they see it through.

1. It is irrelevant to the greater workload imparted to the students. It is, of course, relevant to those who suffered said afflictions.

2. I doubt that it’s any fault of the counselor that her workload exceeds her realistic capacity. I’m a veterinarian; I certainly sympathize with that situation. The fault lies with the leadership at the University of Pennsylvania for allowing it to persist.

3. I was once threatened with a failing mark on a rotation because I did not attend an “optional” lecture. “But you said it was optional,” I protested. “It was optional, but you had to attend to pass,” came the explanation. “That makes it mandatory!” Even though I passed, the incident still rankles.

4. The most abusive treatment I received in veterinary school came at the hands of a surgery resident. While he was permitted to humiliate and harass me, he was prevented from further harm to my education or career by the kindness and decency of the attending surgeon. He lost his license for a year for stealing narcotics from patients for his own personal abuse. Is it still schadenfreude if the person’s misfortune is self-inflicted?

5. A favorite anecdote about the ridiculous environment that is veterinary school was provided by a newly minted intern who asked me to do something for her. I forget why I questioned the instructions, and I don’t think either of us behaved unprofessionally, but I recall her saying, “that’s just how I practice medicine.” I chuckle at the memory because she’d been “practicing medicine” for a little less than two full days at the time of the conversation.