Heads Up! Loose Horse!

Here we go again! California is trying to pass legislation that on the surface "appears" to be a good thing, but, in reality, will cause harm to our horses. It got through the Assembly without anyone in the horse industry knowing much about what was going on. If it passes the Senate, then it will be up to the governor to veto this poor piece of legislation that has serious commercial underpinnings.

California Assembly Bill 2842 will change the law to allow graduates of any veterinary school in the world--whether accredited through the American Veterinary Medical Association's programs or not--to take the California veterinary medicine licensing exam.

If this bill passes, and some insufficiently educated veterinarians become licensed in California, they could be granted reciprocity in other states and become licensed there. If this bill passes, there will be no way of knowing if a foreign practitioner is from an accredited vet school, or what training or competency testing has been completed to prepare that vet to work on horses in the United States.

Medical doctors have the same type of program to protect humans from insufficiently educated professionals, who also might or might not have enough command of the English language to pass the medical test, much less give critical, detailed medical instructions to patients and associates.

North America is known throughout the world as having high educational standards for its veterinarians. To that end, the AVMA does approve foreign veterinary schools, which in turn recognize our veterinarians for licensing testing overseas. To date, only three foreign veterinary colleges have requested and received approval by the AVMA's Council on Education for this reciprocal educational parity agreement. Those are the State University of Utrecht in The Netherlands, the Royal Veterinary College in London, England, and the University of Glasgow in Glasgow, Scotland. Preliminary site visits for the approval process by the AVMA are scheduled this year at Massey University in New Zealand and the Dick Veterinary School in Edinburgh, Scotland.

The World Health Organization lists more than 250 veterinary schools throughout the world. While we could expect some of these schools to produce veterinarians on par with those educated in North America, what are the guarantees that they have even heard of--much less used--some of the medications and treatment modalities that commonly are found here? Do Sri Lanka, Cuba, Bolivia, or Mexico (which has 31 "schools" to train veterinarians) educate veterinarians to work on horses in North America? The California legislature would have you believe that is true.

Would my view--which is held by many leading veterinary educators around the world--be considered protectionist?Absolutely!

If we don't protect our horses, who will? If we can't trust our government to ensure that the veterinarian who appears at our barn or in our clinic has been trained appropriately to care for our horses, then it will be an added burden on us before we let the "vet" touch our animals to decide whether he/she is competent.

I don't know about you, but I'd just as soon have the educational professionals decide what the basic educational needs are for a vet, then test for that before the person is legally able to touch my horse!

There is a very workable, reliable, and updated way that veterinarians trained in foreign countries can obtain the right to test for state licenses in North America. (Most states require that a "national" test be passed by all veterinarians before they are eligible for state licenses or to take individual state tests.)

The Education Commission on Foreign Veterinary Graduates (ECFVG) is responsible for getting foreign-trained veterinarians through the first phase of competency measurement and ready to test for licenses in North America. A graduate from a non-approved or non-accredited veterinary school (as deemed by the AVMA's Council on Education, which is sanctioned by the United States Department of Education to do so) has several criteria that must be met:

1) Proof of graduation.

2) Proof of fluency in English (either that the individual was educated in English or can pass a written and spoken English test).

3) Successful completion of the NAVLE (see below) required for all veterinarians.

4) Pass a clinical proficiency examination approved by ECFVG or complete a year of evaluated clinical experience at an AVMA-accredited or -approved college of veterinary medicine.

The North American Veterinary Licensing Examination (NAVLE) is a computer-based licensing examination. It is offered throughout North America at about 300 testing centers. Candidates are able to take the exam no sooner than six months prior to expected graduation.

All vets have to meet requirements in states where they want to practice. For foreign veterinarians, this ranges from Nebraska, which has no provision for licensure of graduates of foreign countries, to a few states that allow temporary practice permits to otherwise qualified veterinarians pending successfully passing the licensing examination.

Again, I want to stress that while these foreign veterinary graduates might be skilled in practicing medicine in their own countries, there are serious doubts in my mind that someone trained to care for livestock in South Africa or Mexico, for example, could also have the training to care for livestock (specifically horses) in North America. The diseases are different. The management is different. The licensed drugs are different. The commonly used diagnostics are different. And the owners' expectations are different.

In other words, as the AVMA so aptly put it on their web site: "The education of veterinarians differs extensively throughout the world. Educational programs are designed to produce the capabilities and skills needed by veterinarians in a particular country or region. Veterinarians in the United States are expected to be able to perform a wide range of professional tasks that are quite different than those required in many other countries...Licensing examinations intended to test individuals for professional practice in this country are testing for knowledge which is not provided in the educational programs of many of the veterinary colleges outside North America."

Also, Australia and the AVMA want to develop a reciprocal program for veterinarians. Word is, if we reduce our standards, they don't want our vets. How about that?

Opposing Viewpoint:

Change Is Needed!

By Wayne McIlwraith, BVSc, PhD, DACVS

I have read with interest the various emotional responses (pertaining to California licensing), first from Dr. Rick DeBowes, President of the American Association of Veterinary Clinicians, and most recently in your column (on page 11).

As a graduate from a non-AVMA accredited veterinary school (Massey University, New Zealand, 1970), I first take issue with your statement that "there is a very workable, reliable, and updated way that veterinarians trained in foreign countries can obtain the right to test for state licenses in North America." I presume you mean the Education Commission on Foreign Veterinary Graduates (ECFVG). I will use my experience as an example.

I have an ECFVG certificate (July 1977). After obtaining this, I took the National Board and State Board Exams in Indiana and became licensed in that state. When I moved to Colorado, I had to retake the National Board exam because of time limitations (a score of over three years old), which I passed again, then did the Colorado State Board and passed that.

A few years ago, I applied to take the California State Board Examination and at that time there was a policy where veterinarians licensed in the State of Colorado for more than five years and in good standing could through reciprocity arrangement just have to take the clinical competency exam (something I was willing to do). Imagine my surprise when I found that because I was not an American DVM, I was informed that I had to take "everything" again, including National Board and the complete California State Board examination.

I had personal communications with a member of the California state board, who checked it out and reaffirmed that yes, I did have to do everything again because I obtained my ECFVG certificate by a year's probationary experience (after taking the National Board) and now there was a comprehensive examination. In other words, despite my ECFVG certificate, I was still treated differently. Apparently someone had decided in California that an ECFVG certificate in 1977 did not carry the same supervisory implications that it did in 1999.

So the system has not been consistent and therefore people will attempt to change it.

The ECFVG is not a gold standard because the states can manipulate it any way they want to (you acknowledge that Nebraska doesn't even accept foreign graduates. I guess it is just fortunate for me that I have never wanted to practice in Nebraska!) So you don't have a "workable, reliable, and updated way that veterinarians trained in foreign countries can obtain the right to test for state licenses in North America" because I was denied that right in California (or at least under the same terms as an AVMA accredited veterinarian with a Colorado license). Until there is a system that is equitable and fair to everybody, then something needs to change.

I have been in practice (both academia and private consulting practice) for more than 20 years in the United States. I have always considered the open-mindedness of Americans and the fact that they judge you on what you can do rather than on your pedigree to be a great strength in this country.

The National and State Board licensing fiasco is a contradiction to what has made America successful. It smacks of protectionism and politics, and I am quite delighted that someone has "upset the apple cart."

As President-Elect of the American Association of Equine Practitioners, I will quickly acknowledge that I am as interested as anybody in high-quality practice. However, you won't get it by setting yourself up as being elite. The process of the AVMA approving foreign veterinary schools also could be construed as somewhat political. From what I can gather, if a school requests an AVMA delegation of inspection and pays for it, there is a good chance it may well get accredited. All the schools so far are worthy of accreditation, and as far as I know, would have equal standards to those in North America. Believe it or not, there are countries that give veterinary training equal to or better than that in America.

I would also warn against picking instances such as South Africa to voice your serious doubts in your mind that they would have the training to care for horses. Standards in South Africa are high. I have been at the veterinary school in Onderstepoort twice. The intellect and capabilities are quite comparable to ours. Also, your comments about different drugs, etc., are petty arguments that will only inflame and confuse horse owners. We all learn new things every day.

Last but not least, it is not as though these inadequate foreign graduates are going to walk in, slap down their money, and get a license. I note that they need to successfully complete a year of experience in practice supervised by a licensed California veterinarian before they could be eligible to receive a permanent license. What is so scary about that? Don't you trust your AVMA accredited veterinarians to evaluate the ability of these suspect veterinarians?

In his initial commentary, Dr. DeBowes expressed concern that this bill would make mandatory rather than permissive the Boards' determination of the qualifications of a nonaccredited school graduate, etc. I say to that, "About time!" Up to now, it has been permissive and therefore capricious and biased.

Here's A Solution

1. Require ECFVG qualification for a foreign veterinary graduate. Agree on the best system of testing. (I favor 12 months supervised training rather than a simple exam as people can study for those rather than demonstrate competency.)

2. Throw out state licensing examinations except for proof of knowledge of individual state regulations.

3. Accept the fact that the current system is not perfect--in the instances I have been asked to consult on questions of malpractice and competency by attorneys and insurance companies, the veterinarians involved have been graduates of AVMA accredited schools.

4. Get global and realize that competent veterinary training programs exist outside the U.S. Yes, there is a lot of variation, but that can easily be sorted out with a controlled year's ECFVG practice evaluation.

Some of my statements are somewhat "tongue-in-cheek," but my experiences with the "system" certainly lead to some degree of cynicism. As Past-President of the American College of Veterinary Surgeons and President-Elect of AAEP, I am well aware of the need for standards, but let's have one consistent standard and leave it at that.

As long as you have 50 different state standards, you have a nonworkable situation. I think if you threw out National and state licensing examinations, nothing would change.

Get people within the system, and discipline the profession fairly and equally.

About the Author

Kimberly S. Brown

Kimberly S. Brown was the Publisher/Editor of The Horse: Your Guide To Equine Health Care from June 2008 to March 2010, and she served in various positions at Blood-Horse Publications since 1980.

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