Where Have All the Horse Doctors Gone?
Preserving the equine veterinary profession
By Lucile Vigouroux, MSc
Sponsored by:
PHOTO: Courtesy Dr. Ann Lynch
Rigorous academic programs that generate astronomical student debt. Highly selective veterinary school admissions processes. The public perception of veterinarians as “less than” human doctors. Personal sacrifices made to pursue extended, tedious schooling during a time when many individuals start families. And to top it off, being accused of “only doing it for the money” when clients’ financial limitations get in the way of patient care.
These are just a few of the many challenges all veterinarians can face, regardless of their specialization. For the mere 5.8% of veterinary students who choose to pursue a career in equine practice after graduation—says American Association of Equine Practitioners (AAEP) immediate past president Dr. Emma Read—the obstacles pile on. The first order of business, for many, has been a yearlong intensive internship, accompanied by a salary sometimes insufficient to cover basic necessities. And whether practitioners enter private practice or pursue a residency post-internship, life doesn’t get much easier. These credentialed, licensed equine doctors have had to accept considerably lower salaries and longer, less predictable work hours than their small-animal colleagues, making boundaries and a healthy work-life balance difficult to enforce and achieve.
Given these working conditions, it is no surprise our industry faces a growing shortage of horse doctors. Equine veterinarians have been leaving the profession at staggering rates, with 2019 data from the AAEP revealing just 11.2% of veterinarians stay in equine practice past 15 years, and only one out of 100 equine practitioners remains beyond two decades post-graduation.
While these numbers might make the prospect of pursuing a career in equine medicine look bleak, there is hope. The industry is changing for the better, advocating for a more sustainable version of the equine veterinary profession. Difficult conversations are taking place to define what this redesigned career looks like in practice, and incentives and programs to support veterinarians and veterinary students are flourishing. The small number of passionate graduates who continue to choose to pursue a career in equine medicine despite all these barriers to entry must be protected, supported, and appropriately compensated. We must act now, collectively, to preserve the equine veterinary profession.
The Problem
The Current Crisis: Equine Practice Is Unsustainable.
If you ask your horse’s veterinarian why they chose their career path, chances are they will say it was a calling driven by their love of the horse and passion for medicine. Most knew before age 10 they wanted to be a horse doctor (2019 AAEP Equine Economic Survey Report). Realistically, however, veterinarians need more than love and passion for a childhood dream job to make equine practice a realistic career. At the bare minimum, a chosen profession should pay for itself, meaning the income must be sufficient to cover the cost of education (student loans) and the individual’s bills (rent or mortgage, groceries, transportation, health care, etc.). This bare minimum is not always met for equine veterinarians, whose financial stability is further compromised by current high interest rates and skyrocketing inflation (see “The Numbers Speak for Themselves” sidebar).
Mental Health Challenges
“Not only does debt create a debilitating financial situation for the young practitioner, but it can also significantly strain the individual’s emotional well-being,” says Dr. Jorge Colón, associate professor of practice in financial and organizational management at the Cornell University College of Veterinary Medicine’s Center for Veterinary Business and Entrepreneurship. “Compounded with the demanding work schedule required by equine practice, this creates the perfect storm for mental unwellness and burnout.”
Compassion fatigue: A state of mental and physical distress that occurs when caregivers are chronically exposed to the suffering of others.
Mental health is a serious problem in the veterinary profession. Veterinarians succumb to suicide at more than three times the rate of human medical professionals and four times the rate of the general population (Stoewen, 2015). Stress, anxiety, and depression are rampant among both veterinary students and veterinarians (Nahar et al., 2019; Bartram et al., 2009), who face an additional challenge specific to medical professionals: compassion fatigue.
Jorge Colón, DVM, MBA
is an associate professor of practice in financial and organizational management at the Cornell University College of Veterinary Medicine’s Center for Veterinary Business and Entrepreneurship, in Ithaca, New York. He spent 25 years in clinical practice in Lexington, Kentucky, as an equine ambulatory practitioner, also working as a private business consultant and educator since 2014.
The Numbers Speak for Themselves: Most Can’t Afford to Become Horse Doctors
Dr. Jorge Colón, associate professor of practice in financial and organizational management at the Cornell University College of Veterinary Medicine’s Center for Veterinary Business and Entrepreneurship, presents a financial breakdown of veterinary students’ debt burden: “Veterinary graduates with anywhere between $150,000 and $200,000 worth of veterinary school student loan debt is not an uncommon scenario, with the average being $186,430. At an assumed average annual percentage rate (APR) of 6% (direct unsubsidized graduate student loans had a 6.54% APR for the 2022-2023 academic year), a student with $185,000 worth of student debt would owe a $2,054 monthly loan payment if they were to repay their student loan under a normal 10-year repayment scenario. Equine practice income for new graduates does not financially support that reality.
While it is not uncommon to see small animal general practice starting salaries hovering around $120,000-$140,000, evaluation of multiple prominent equine internship programs shows internship salaries in the $30,000 to $40,000 range. Post-internship, veterinary graduates entering private equine practice have an expected gross income of around $75,000, which grows to around $90,000 after two to five years in practice. Based on current U.S. poverty guidelines and discretionary income calculations, a graduate earning $35,000 in internship salary would have $109/month in discretionary income to pay off the $2,054/month student loans, while a five-year graduate earning $90,000 would have $568 per month to do the same. The math is simple, $109 and $568 per month do not even cover the interest portion of the monthly student loan repayment schedule.”
Work Schedules and Emergency Duties
In his experience as university faculty mentoring students as they select their career paths, Colón commonly observes another major factor that steers veterinary students away from equine practice and toward a small animal specialization instead: work schedules.
“Graduating students entering small animal general practice are consistently seeing four-day work weeks and weekends off,” he says. “These veterinarians are off duty on their days off—as they should be—and have the opportunity to build a life outside of veterinary medicine. While some equine practices have moved away from the seven-day workweek schedule, I have personally yet to see an equine practice with a constant four-day workweek.”
Indeed, the days are long in equine medicine, but on-call emergency work is also a major pain point for many horse doctors—and students thinking about becoming one. During the six-month Thoroughbred breeding season in Central Kentucky, for instance, veterinarians have reported it’s not uncommon to see even the senior, board-certified theriogenologists work seven days a week and attend to overnight emergencies. Each doctor has his or her own client base of several hundred broodmares and foals they solely care for day and night, for months on end.
Being on call means equine veterinarians are never really “off.” This makes it difficult to plan a life or make commitments outside of work. Family plans are geographically restricted and constantly interrupted by work, says Colón.
The standards for emergency coverage are very different in human and small animal medicine. If a dog owner has an emergency at 8 p.m. on a Saturday, they rush their pet to the nearest 24/7 emergency clinic and see the doctor on staff that night. Similarly, when a parent wakes up to a sick child in the middle of the night, the thought of calling their regular pediatrician probably doesn’t even cross their mind: They head straight to the ER.
Why is this different for horse owners? The short answer is horse people have long been accustomed to the convenience of always having “their” equine veterinarians at their fingertips. “Most (equine) clients have their veterinarian’s personal cell phone number,” says Colón. “They expect this individual to serve as the initial line of defense for all emergencies, even when the horse needs to be taken to an emergency hospital.”
He says he’s seeing firsthand the result of this cocktail of unfavorable employment conditions. One of his equine student mentees expressed recently: “If I want to have time for my horse and be able to afford him, I will need to switch to small animal,” which she did.
How Did We Get Here, and Is This a Global Problem?
“Though equine practice sustainability is at the forefront of current conversations, this is not, in my opinion, a new problem,” says Colón. “I remember the percentage of graduating veterinarians going into equine practice already being low when I graduated almost 30 years ago.”
Dr. Jamie Pribyl, a professional services veterinarian at Boehringer Ingelheim, agrees. “The overall well-being of equine veterinarians has been a concern in our industry for many years now,” she says. Pribyl left clinical practice after 14 years due to a combination of factors, including well-being.
Across the pond, the British Equine Veterinary Association’s (BEVA) former president and current veterinary projects officer Dr. Lucy Grieve echoes many of our struggles in America. “Here in the U.K., we have seen a similar trend, with employers reporting difficulty recruiting equine veterinarians,” she says. “Students appear to be increasingly choosing small animal practice over equine. The most commonly cited reasons for not entering equine practice or (for) leaving it are lower salaries, longer hours, more hours on call, the unpredictability of work schedules, poor work-life balance, and poor management.”
According to 2022 BEVA survey results, 81% of respondents reported a retention problem for equine vets.
A 2022 BEVA survey of equine veterinarians revealed statistics similar to those in the U.S., with 81% of respondents reporting a retention problem and 92% of equine veterinary practice owners reporting difficulty in recruiting an experienced veterinarian.
While the crisis seems to transcend borders, where the U.S. differs from the U.K.—and from most of Europe as well—is in the cost of veterinary education. “Unlike in the U.S., where veterinary medicine is a graduate-level course—meaning a four-year undergraduate bachelor’s degree is a prerequisite—U.K. veterinary degrees start straight out of high school and take five to six years total,” explains Grieve. “Tuition in the U.K. is capped at £9,250 (approximately $11,875) per year.”
The amounts of student debt accumulated by U.K. versus U.S. equine veterinarians are very different but arguably proportional to their salaries and their countries’ respective economies. In the U.S., salaries are higher, but so is the cost of education and living. Therefore, Grieve warns that drawing direct comparisons between countries can be misleading.
Jamie Pribyl, DVM
is a professional services veterinarian at
Boehringer Ingelheim. Previously, she had a 14-year career as an equine practitioner and was a partner at a large animal clinic in Buffalo, Minnesota.
Lucy Grieve, MA, VetMB, MRCVS
is the veterinary projects officer and former president of the British Equine Veterinary Association (BEVA). Previously, Grieve was an equine practitioner in ambulatory practice for 14 years in Newmarket, England.
The Solutions
Based on the available data and our sources’ input, the current equine veterinarian shortage crisis has no easy fix or overnight solution. No one person or organization has the power to remedy it. Change is needed at all levels, in all parts of the industry, from academia to clinical practice. Let’s dive in.
Starting at the Root: Veterinary School
“Graduating veterinarians are entering a rapidly changing and increasingly complex business environment,” explains Colón. To equip their cohorts with the skills necessary to succeed as doctors and future practice managers, the Cornell Center for Veterinary Business and Entrepreneurship recently established a certificate in veterinary business and management. The program provides training in financial literacy, professional development, financial and organizational management, and entrepreneurship. “Preliminary data suggest that possessing these skills is helping our graduates stand out and rapidly advance through their first years of employment.”
A Redesigned Vet School Experience
Lincoln Memorial University (LMU), in Harrogate, Tennessee, is launching its Equine Veterinary Education Program this fall, the first of its kind among the 30 other U.S.-based veterinary schools. The program will consist of a two-and-a-half-year undergraduate program, followed by a four-year doctor of veterinary medicine program with a strong emphasis on equine medicine. “We believe the addition of this program … will offer students an opportunity to achieve their dream to become equine veterinarians at a lower cost and with a much more targeted (equine) focus,” says LMU College of Veterinary Medicine dean Dr. Stacy Anderson. “Just as important will be the goal of providing qualified equine veterinarians to a horse industry sorely in need of these professionals.”
The Sustainability of Equine Internships
When looking at aspects of the equine veterinary career path where compensation and work-life balance need an upgrade, the equine internship is at the forefront of conversations. In 2022 Morello et al. reported 32% of equine veterinary interns have a negative income surplus, meaning their salary is lower than the average cost of living in their area and, therefore, insufficient to meet basic needs.
But times are changing. Many efforts are underway to revamp the experience of interns, who overwhelmingly continue to value this yearlong experience as an indispensable “stepping stone” to equine private practice. The AAEP has conducted an internal satisfaction survey for its members and is actively working to create an AAEP-branded internship experience. This redesigned program will prioritize education and mentorship and provide opportunities for structured feedback.
32% of equine veterinary interns had a negative income surplus in 2022.
The AAEP’s Sustainability Commission’s Internship and Student subcommittee reported in a May 2023 AAEP Practice Life podcast episode that currently, 70% of equine veterinarians would still recommend their particular internship program to others in spite of the challenges. The subcommittee’s ambition is to bring this number up to 100%.
Entering the Real World: Private Practice
The first waves of Gen-Z veterinarians (born 1997-2012) are now entering the workforce. Surveys reveal nearly 75% of all Gen-Z professionals consider workplace flexibility the single most important employee benefit.
“Veterinary medicine has also become increasingly feminized as a career, inevitably leading to a greater proportion of practitioners pausing or leaving their careers to have children,” says Grieve. The 2022 American Veterinary Medical Association (AVMA) Census revealed the current veterinarian population is 65.7% female and 34.2% male (see Figure 2) compared to a decade ago, when vets were 44.4% male and 55.4% female. These changing statistics highlight the need for flexibility and sustainable work schedules, she says, to meet the needs of the women and younger professionals braving the barriers to entry and choosing to become horse doctors.
Changing Expectations Regarding Access to Equine Veterinarians
A major contributor to burnout among equine veterinarians is the need to constantly be in “work mode,” whether because they are on call for emergencies or because clients expect them to answer texts and calls at all hours of the day and night. But our sources say emergency coverage in equine medicine is showing promising change. Neighboring practices are teaming up with each other and rotating emergency coverage duties among their doctors through a concept called emergency cooperatives. These incentives allow more practitioners to share on-call duties, thus reducing the time each individual must commit to being on call without compromising the availability of emergency care.
Some practices are taking it further and eliminating their associates’ on-call duties altogether by partnering with exclusively emergency practices. For example, practitioners founded Bluegrass Equine Emergency Service in Central Kentucky with the purpose of handling after-hours emergencies in the region. At the university level, North Carolina University’s College of Veterinary Medicine has recently brought two equine ambulatory practitioners whose sole role is to attend to after-hours emergencies. Some equine veterinarians thrive in emergency settings, and providing them with opportunities to make a full-time career out of emergency coverage is a win-win for everyone involved.
Furthermore, setting healthy boundaries is a fundamental step in moving the profession forward. “Protect yourself by learning to say no,” John Townsend, PhD, author of the book Boundaries, said during his presentation at the 2022 AAEP Convention, in San Antonio, Texas. “There are good reasons why veterinarians’ work makes saying no difficult. Many have financial concerns and fear the consequences of disappointing a client or a boss. But without some parity between our resources (energy, time, support, kindness, money) and our responsibilities, the risk of burnout rises sharply.”
He highlighted the importance of having clear rules in writing for client accessibility. “These rules would include when you are reachable and when you are not, and what options you will provide when you are not available.”
Is There a Bright Side to This Crisis?
A shortage of equine veterinarians is detrimental to our horse industry, posing big problems to everyone from practice owners and associate practitioners to horse owners and the horses themselves. The silver lining of the current crisis is that from a purely economic standpoint, it’s arguably a fantastic time to be an equine veterinarian. The high demand for their skills and comparatively low supply gives practitioners leverage when it comes to negotiating salaries, benefits, and work schedules. Because of the difficulty in hiring staff across many industries, employers nationwide are recognizing that offering enticing benefits is essential to attracting and retaining talent. A major component of addressing the equine veterinary shortage crisis is offering higher salaries to horse doctors, starting their internship year and continuing into their private practice career.
There Is Help: Programs for Equine Veterinarians
- Not One More Vet (NOMV) is an organization founded to combat the high suicide rate among veterinarians. The nonprofit provides a plethora of resources to support the well-being of veterinarians, including trained advocates, ambassador programs, a workplace wellness certification program, and a peer-based “Lifeboat” mentorship program.
- Decade One, and its branch Starting Gate, are incentives started by Drs. Amy Grice and Andy Clark to help equine practitioners thrive early in their careers and stay in equine practice. The results speak for themselves: Decade One members have an average 93% retention rate in the past eight years, significantly higher than the 50% retention rate within the first five years of the general equine practitioner population.
- Opportunities in Equine Practice Seminar (OEPS) is returning in September 2023 to provide third-year veterinary students with information about various avenues and disciplines of equine practice, financial remuneration, employment, practice ownership, and marketing.
- The American Association of Equine Practitioners (AAEP) established the Commission on Equine Veterinary Sustainability in July 2022 with five subcommittees focused on separate topics: compensation, strategies for effective emergency coverage, veterinary practice culture, internships, and supporting the growth and development of the equine veterinary student. The AAEP has additional resources for anyone interested in business solutions for equine practitioners, including the AAEP Practice Life Podcast, and members receive our sister publication, EquiManagement Magazine.
- Boehringer Ingelheim’s “The Stable Life” wellness initiative (see below).
Looking Ahead to a Sustainable Future for Our Horse Doctors
As we’ve described throughout this article, sustainability is a keyword in the multifaceted solution to the current crisis. Sustainable salaries, work hours, emergency coverage duties, and boundaries are the changes needed to keep veterinarians in equine practice long term. The work has already begun.
“The AAEP, along with the AVMA, individual veterinarians, and industry leaders, have made improving the well-being of veterinarians a priority and are working hard to develop solutions,” says Pribyl.
Many practices are creating schedules, cultures, and financial solutions that support staff welfare. Individual veterinarians can work to create professional boundaries that support their values and well-being. Veterinary schools can provide education in life skills such as boundary-setting, resilience, financial planning, leadership, and more to better prepare students for a life in equine practice.
“These are all difficult tasks,” says Pribyl. “But we need to make the day-to-day experience of equine practice better if we hope to have enough veterinarians to meet the health care needs of horses in the future.”
The Stable Life
In November 2021 Boehringer Ingelheim launched The Stable Life, a wellness initiative dedicated to transforming the future of equine medicine, helping practitioners find the balance to live and work their best. Throughout the United States, Boehringer Ingelheim is hosting and facilitating webinars, meetings, roundtable discussions, and presentations on topics that will support the overall well-being of veterinarians and veterinary staff. Some of the past offerings have included:
- 12 Steps to Transforming Your Equine Practice.
- Rockstar Resilience for the Equine Veterinarian.
- 5 Simple Ways to Increase Profitability.
- The Neuroscience of Difficult Conversations.
- Creating a Sustainable Life in Equine Practice.
bi-animalhealth.com/equine/initiatives/the-stable-life.
©2023 Boehringer Ingelheim Animal Health USA, Inc., Duluth, GA. All rights reserved. US-EQU-0288-2023
Credits
Lucile Vigouroux, MSc, holds a master’s degree in equine performance, health, and welfare from Nottingham Trent University (in the U.K.) and an equine veterinary assistant certification from AAEVT. She is a New-York-based freelance author with a passion for equine health and veterinary care. Vigouroux also manages a small team of professionals who provide wellness modalities, including PEMF and kinesiology taping, to equine athletes. Her lifelong love of horses motivated her to adopt her college care horse, Claire, upon graduation.
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