The 24th Grade: How to make a veterinarian

September 24, 2010

I sometimes wish we could take the information here and disperse it to a much wider audience. Don’t get me wrong — I love our tight-knit group of die-hard animal lovers but a lot of the information presented here is already known to the general audience of PetConnection.  Telling thinking individuals with a conscience and a heart stuff they already know is fun, but less satisfying than really opening the eyes of someone operating under misguided perceptions of how things run.

As an example, I will throw out one of the most common question asked of veterinarians (which I am sure will come as a surprise to most of you): Do you have to go to school to be a veterinarian?

I wish I were joking.

I have personally been asked this one, as have many folks I work with. Usually the person doing the asking is either chemically impaired, wearing a baseball hat backwards or missing teeth (or in some cases all three – a phenomenon I call the dumbass trifecta). But it still gets asked enough that I thought I would provide some insight into the training process and the steps involved in making a veterinarian in the United States – both a general practitioner and a specialist.

So the next time some glue-huffing, gap-toothed Derwood with a backwards baseball cap axes you this, just print this out and smack him on the head with it (best if it is wrapped in a brick beforehand).

Both GPs and specialist veterinarians have to undergo a rigorous and lengthy (not to mention expensive; the average debt load for a new grad veterinarian is now well over $100,000) training process. By the time I finished my residency and was able to take the board exam in emergency medicine I figured out that I had just completed the 24th grade –  and no damn recess for years, either.

The process usually starts in high school, or even before then for some driven and committed folks. As high school graduation nears, counselors and students start looking at schools that offer good pre-veterinary programs, and perhaps even have a veterinary school to transition to after college. Pre-vet classload is heavy on science (physics, organic chemistry, biology and the like) and the schools tend to be the larger land-grant or agricultural colleges. There are a few exceptions to this, but most schools that veterinarians attended as undergrads had ‘State’ somewhere in the name.  A few vet schools will accept students after a rigorous 2-year immersive pre-vet program, but most require a 4-year bachelor’s degree (mine was in zoology).

By the time they are ready for veterinary school, most people have attained the 16th grade.

Once someone has made the decision to apply for veterinary school, they have a mere 28 schools to choose from in the United States – and if they happen to reside in a state that already has a veterinary school, getting into another one is near impossible (and certainly more expensive for out-of-state tuition).  There are a few schools in the Caribbean that some folks can choose from as well.

The application and interview process is a mind-numbing blur for most folks I know who have gone through it – only afterward do they dimly remember some interviews, some travel, some cheap hotel rooms and a mountain of forms and essays (Example; ‘What animal would you most like to have dinner with?’ ‘What are your thoughts on cat juggling?’ ‘Dogs and cats living together – right or wrong?’).

After you apply and interview…you wait. For weeks.  It is similar to what people go through when applying to undergraduate school, but they seem to stretch out the process forever.  The majority of veterinarians don’t get in on their first try – the sheer number of applicants coupled with the low number of schools makes sure of that. I worked with a veterinarian when I was a technician who applied seven times before finally getting in.

Veterinary school is usually divided into the ‘pre-clinical’ years (usually the first three) and the clinical year.  The first three years are spent in the classroom, filling your brain with tables, graphs, algorithms and heuristics (unlike undergrad, where you are typically filling your brain with Cheetos, beer and pizza). Most veterinary schools have some exposure to clinical medicine scattered throughout the educational arc, but you really only get to work on actual living patients in the fourth year in the vast majority of cases.

Classes like anatomy, physiology, pharmacology and pathology dominate the early curriculum, and there are a few opportunities to rotate through working hospitals on externships and preceptorships as you near your fourth year.

The senior year is typically spent in the teaching hospital – seeing patients together with faculty, and learning the nuts and bolts of what it takes to become a proper veterinarian.  During the first three years of veterinary school you hopefully learn the theoretical underpinnings of caring for sick patients – it is in the fourth year that you learn to think and act like a doctor.

By the time you have completed your fourth year, you have reached the 20th grade – if they had let you know this in third grade, you would have thought this was some form of torture.

At this point you are faced with a decision; move into practice, or stay in school and complete an internship – the 21st grade.  This is one way in which veterinary medicine differs from our human-medcounterparts. Most, if not all, MDs continue on for an internship (and even beyond, into a residency) as an expected part of their training, but for veterinarians it is perfectly acceptable to hang up your shingle and go into practice – after a mere eight years of higher education (and the aforementioned hundreds of thousands of dollars in debt).

For those going into private practice right out of school, the path can be rigorous and perilous.  Many times, a practice owner will hire a new grad, toss them the keys to the practice and say see ya, wouldn’t wanna be ya and head off on vacation (often a well-deserved one that has not been taken in years).  This leaves the new grad, with a head full of book-learning and precious little practical knowledge, in charge of the caseload and patients’ lives.

Newly minted doctors tend to think that everything is sicker than it is, and that every case is suffering from some exotic and only-seen-once-since-the-Nixon-administration affliction – they need the benefit of an experienced guide to help them make the best call.  And…if your experienced guide just took the wife and kids to Aruba, you and your patient might just be s*%@ outta luck.

It is becoming an increasing trend for veterinarians to chose an internship instead of venturing right into private practice.  An internship is a low-paying and immersive training program with an amazing amount of duty hours and supervision.  Interns, I once figured out, make roughly $5 an hour, when you combine the low salary (often in the $20k range) with the long hours (80 hour workweeks are the rule – anyone working less is seen as a slacker). Burnout, depression and chemical abuse are ever-present dangers for interns, who often have the worst shifts and the worst cases. The payoff is the sort of ‘suffering builds character’ education that comes from surviving a test of wills – it either breaks you or it makes you a better doctor.

We have an outstanding lineup of eight  interns at Purdue, and I have personally seen the majority of them have meltdowns after a hellish night of ER work.  They work as hard as anyone in the hospital, and they do it for peanuts.  We guide them, we mentor them and we support them, but it is a harsh process that separates the wheat from the chaff.  It is not meant to be cruel, but sometimes it appears to be that way despite our best intentions.

For all this difficulty, both financial and personal, there must be some upside or no one would ever even consider entering the 21st grade. One of the benefits of doing in internship is the concept of mentoring – these new and green doctors don’t have to go it alone, because they almost always have a faculty member helping out with cases. They have brains to pick on challenging patients, and another set of eyes to help interpret X-rays. They also have their fellow interns to compare notes with, as it helps to get through this sort of trying personal journey when there are others right there along with you.

After an internship, doctors have yet another fork in the road to take – the leap into private practice (armed with the experience that an internship provides) or enter the 22nd grade and complete a residency.  Residency training is specialized – this is where you learn to become a cardiologist, internist, surgeon, ophthalmologist or any of the dozens of specialties available.  Veterinarians are not quite as pigeon-holed as MDs are (for example we do not have pediatricians or gerontologists), but the number of specialties grows every year, as do the number of specialists. When I became board-certified in emergency medicine, I was one of only 200 such individuals in the country.  With the release of 30 to 50 more every year, our number is now over 500 and climbing.

A residency is to an internship what Abbot was to Costello; longer and narrower. Residencies typically last for three years, and are limited to one field of study (such as the ones mentioned above; mine was in emergency medicine and critical care).  On the brighter side, the pay is better – most residents get paid somewhere in the vicinity of $6 an hour for the privilege of practically living at the teaching hospital (it is called a ‘residency’, after all), endless on-call duties and making sure interns don’t kill too many patients.

After this lengthy, exhausting path, you now find yourself completing the 24th grade – the last year of your residency.  You now have reached the pinnacle of your profession, its very Zenith (or perhaps its Amana or Radarange) – you know as much as you are ever going to.

Your reward for all this toil? You get to take a three- or four-day examination, and pay lots of money in order to do it.  Yes, after making single digit hourly less-than-the-fry-guy-at-Arby’s wages for three years you have to lay upwards of a grand down to sit in some fluorescent hell somewhere and take your board exams.  Lucky you.

Board exams are the brick wall that every resident slams into when they are done – they are the gatekeeper between what you have been trained to do and what you are able to do.  Mine were in New Orleans, and lasted three solid days.  I can honestly say they are only a blur now, and all I can remember are tears, maniacal laughter, furious scrambling through notes, and perhaps a redheaded midget wearing roller skates and clutching a rotten tomato on a string.  I am little fuzzy on that last bit – that might be the peyote.

Once successfully passed (the pass rate usually hovers around 30 percent for most specialties) you are able to call yourself a specialist in your discipline.  You have graduated the 24th grade – here’s your tie pin. Now go play.

That’s a pretty impressive litany of steps to go from everyday shlub to veterinarian and then onto veterinary specialist.  Most days, I will still say it was all worth it – the great saves, the interactions with the many gifted and interesting people I have become acquainted with along the way (both pet owners and colleagues), the midgets. On occasion, I look back and question the wisdom of my choices, but who doesn’t do that as part of being alive?

But, if I had my druthers, I think 12 grades is really plenty.

Filed under: pets, connected,veterinary medicine — Dr. Tony Johnson @ 8:09 am

23 Comments »

  1. Okay, that sounds horrible. And I wish I was doing it right now.

    It would have helped to have read this post 20 years ago, when I was working two ‘jobs’ at Auburn University School of Veterinary Medicine as a pre-vet research assistant (a.k.a. “you get to go check the petri dishes at 3:00 a.m. and … if you are lucky you can hold the cow’s tail at 6 a.m. every Thursday while we stick our arm up it’s *** to feel the ovaries) for two years.

    As an army brat, raised my my Dad (“Mom” left when I was 5 yrs. old), I had my share of hard knocks in life, but trying to get into Veterinary School pretty much killed me. Never mind undergrad Organic Chemistry (the course from hell – and no, geometric isomers have never been of use to me in life at ALL – and the fact I was way uncool because I stayed in to study freakin science, physics and math ALL THE TIME while my roommates went to every frat party and sorority rush they could.

    Auburn sucked (back then at least) at helping pre-vet students understand the process of applying to vet schools. I also didn’t have anyone from the home to guide me as I was the first in our entire family to go to college.

    I applied to Auburn University School of Veterinary Medicine one time. Did not make it. I never tried again. I thought that was it.

    So, I ended with a degree in Molecular Biology and forever had a hole in my heart which I believed becoming a veterinarian would fill.

    My husband, a plastic surgeon who is board certified in plastics and hand surgery, two fellowships and a two year stunt at Mass General for vascular research added at end “for fun” (I don’t even know what grade that would be? 27th? 30th?) has made me feel much better by explaining the process of entering medical school (where he said many veterinary applicants end up because it is harder to get in vet school than med school!?)is not a one-shot one-school try. Applicants apply to numerous schools and sometimes reapply over and over.

    Well, my one shot try failed. I wish I knew then what I know now.

    My daughter, who is in 7th grade, has wants to go to Harvard (H.H., can you write a reference letter one day? Or Gina, help me spell check it? LOL) to then on to medical school to eventually become a pediatric surgeon. She will succeed. Her father and I will guide her. Btw, my son, who is in 4th grade, either wants to be a chef or an engineer. Uh-huh. Maybe NASA needs space station kitchens designed?

    So, Dr. Tony, I am glad you don’t go ballistic when you hear someone ask you if you had to go to school to be a veterinarian. I would have.

    Comment by ericka — September 24, 2010 @ 8:55 am

  2. How did the midget get the rotten tomato to stay on the string?

    Also, while you were sleeping in a Dirck cage and breakfasting on Mountain Dew and Science Diet, they said they want to be called little people.

    Comment by H. Houlahan — September 24, 2010 @ 8:56 am

  3. Ericka, anything I sign with my own name that goes to Hahvahd will not help your daughter’s chances. Godforbid anyone there actually remembered me, for example.

    And it is grotesquely overrated as an undergraduate institution.

    A nice note for Amherst I would do.

    Comment by H. Houlahan — September 24, 2010 @ 8:59 am

  4. Heather, I’m sure they’d remember you if they believed you had money to give them.

    Harvard considers “money” to have lots and lots of zeros, of course. My school of non-choice (accepted at Cal, but my father said no to “Commie U”) was a state university that mostly cranks out correctional officers, teachers and state workers, and is happy for a check with a single zero on it.

    But yeah, big name schools are over-rated. My pal Russ, BFF from that same generic state university, is the editor of the L.A. Times, boss of all kinds of smart kids from Stanford, Duke and all the Ivys.

    Makes me smile, it does.

    Anyway … I find it incredible that anyone would ask “do you have to go to school for that?” of a veterinarian.

    But then, I also find it incredible that people write checks based on whiny ads with celebrity spokesnits.

    Dr. Tony rocks.

    Comment by Gina Spadafori — September 24, 2010 @ 9:08 am

  5. “Dumbass trifecta”? That’s funny. I heard a snake biologist say that a person’s chances of being bitten by a snake is inversely related to the “tooth-to-tattoo ratio.”

    Comment by Barbara Saunders — September 24, 2010 @ 9:10 am

  6. P.S. That picture is NOT Dr. Tony. But it could be. Because he’s JUST that studly. :)

    Comment by Gina Spadafori — September 24, 2010 @ 9:17 am

  7. Dr. Tony accurately describes a long, arduous, expensive journey to become a veterinarian. The biggest issue facing recent graduates and the future of veterinary medicine is the extreme amount of debt compared with expected income. Student debt should be one year’s salary ($65K) and it now averages $125K. Put another way, experts say you can afford to pay 10% of your monthly salary towards student debt and it’s currently 25%. This isn’t a sustainable economic model. Increasingly, you have to have family wealth in order for a child to pursue a career in veteirnary medicine. While literally nobody goes into veterinary medicine for “the money,” you do have to make enough to pay your debts. Various groups in organized veterinary medicine (AVMA), industry (Pfizer, who sponsors our search engine) and the governement are working to ease student debt, incentivize veterinary students to practice food animal medicine and make it possible for minorities to pursue a career in veterinary medicine.

    On the flip side, the journey is still worth it for the vast majority of veterinarians. You get to sniff puppy breath, stick your hands in a kinetic mass of kittens, feel a horse’s velvety muzzle, pull a pet from the jaws of death and return it to a family, or ease a pet’s suffering and help a family say goodbye with competence and compassion.

    Long after adults have forgotten about childhood dreams of wanting to be a nurse, fireman, fighter pilot, actor or teacher…they still say “I always wanted to be a veterinarian.”

    Comment by Dr. Marty Becker — September 24, 2010 @ 9:19 am

  8. @Gina

    “My pal Russ, BFF from that same generic state university, is the editor of the L.A. Times, boss of all kinds of smart kids from Stanford, Duke and all the Ivys.”

    That is funny

    Comment by ericka — September 24, 2010 @ 9:24 am

  9. Try answering the question “Where did you go to school for that?” when you are a dog trainer.

    It gets weird when your formal education was at places, and of a type, better known for producing Senators (GO CHRIS COONS!), Nobelists, novelists, scholars, musicians — as well as less savory types, such as corporate lawyers and Wall Street thugs.

    No, it does not require anything like the formal educational process of a DVM, MD, DO or PhD.

    Little Debbie Dropout can hang out a shingle, and frequently does, sometimes empowered by a whole two weeks of “school” and a certificate. Also, she “just loves doggies!” So can Amy Academy, who has spent six years studying the mating calls of the lesser Madagascar Wizzletit and is allergic to dogs and a little bit afraid of them because of that one time the scary collie barked at her. They are equally inept, but Amy has learned all about hollow dominance posturing in grad school. (And also learned to deny that dogs engage in it, but that’s another topic.)

    And sometimes Debbie’s brilliant, talented, and unschooled cousin, Donna, can train rings around everyone else AND explain things well to her clients AND conduct herself with the utmost professionalism.

    Comment by H. Houlahan — September 24, 2010 @ 9:26 am

  10. Tony: I thought I had an appreciation for the daunting road veterinarians have to tread. Wow, was I uninformed. That’s a path that would make Dante say “Whoa, seriously dude, that’s too cruel”. It’s intriguing that a residency isn’t a de facto requirement as it is with MD’s, especially given the range of patients you’d need to become comfortable with. I can’t imagine what it must be like to go through the gauntlet, make it to the board certification exams, and then NOT pass them. Running into a brick wall feels like it would be an apt analogy.

    And Ericka, I would echo what Heather said, only louder and while jumping up and down and waving my arms. Off the top of my head I can think of 20 schools where one can receive a far better undergrad education than Crimson State (among the many nicknames I have for the place). “Grotesquely overrated as an undergraduate institution” should be engraved on one of the campus gates facing Mass Ave, preferably the one facing Bartley’s Burger Cottage, so I could throw soggy onion rings at it. Hell, it’s not even a pretty campus.

    Comment by David S. Greene — September 24, 2010 @ 9:34 am

  11. Hmmm, I’m trying to figure out if I am the model for “Amy Academy”. I spent 6 years in grad school studying obscure things like house dust mites and now I offer dog-training, along with pet-sitting. :)

    Comment by Amy — September 24, 2010 @ 9:41 am

  12. The biggest issue facing recent graduates and the future of veterinary medicine is the extreme amount of debt compared with expected income.

    This is generally true, and it doesn’t really matter who the speaker is or what the graduate’s degree is.

    Higher education is getting crazy expensive, and the absence of cost feedback loops is only now starting to make things felt.

    Comment by Rob McMillin — September 24, 2010 @ 9:44 am

  13. Okay- so no one likes the big H.
    Actually, their prep school is fond of Davidson. Have to read up on that.

    Well, it’s a long ways off. They might even decide to becomes veterinarians (although growing up with me, the neurotic Mom who has 8 cats, may have skewed them away from any animal profession.)

    Comment by ericka — September 24, 2010 @ 10:06 am

  14. I live in Ithaca and counsel Cornell vet students interested in buying a home. The really sad thing is that the vets will have the same student loans as human doctors but never make the same income.

    Just remember, some of us appreciate all the effort and energy you put into your education.

    Comment by Pamela — September 24, 2010 @ 10:19 am

  15. Fantastic article!

    One thing that is not mentioned in it is something that, in my opinion, makes veterinary school much more difficult and challenging than medical school: the fact that vets have to study anatomy not just for one single species, but for multiple and sometimes widely different ones.

    Comment by Ingrid King — September 24, 2010 @ 10:22 am

  16. Great article! Thanks for writing it. Will use it as a reference for anyone interested in vet school.

    Comment by glock — September 24, 2010 @ 10:30 am

  17. The second most common statement from the people who ask if you have to go to vet school…”I was almost a vet, I went to school for it.” when in reality, they went to a school that offered agricultural and animal husbandry courses. And they dropped out of those.

    I guess you have to love this profession. Many assume that since you are a “Doctor” you are rich and that you get free vacations and cars and girls and big screen TV’s and …did I say girls? from the drug companies. I get a free meal once in awhile to hear about how I can, for only 1200$, get the newest cure all for what ails you (don’t use said drug on sick or debilitated or furred animals. May be back ordered allow 12-14 weeks for delivery. Shipping and handling extra…side effects may occur. Not sold in stores but available on the internet at Weselldrugscheap.com). (just realized you can read that Weasel drugs cheap :))

    But we do it still. I don’t have that mansion I expected (yeah …I knew from the start I wouldn’t be rich…I hope my numbers hit Saturday). So glad that after 20th grade I am toward the top of the food chain….uh…excuse me the cat just barfed and I have to clean it up

    Comment by Dr Monte — September 24, 2010 @ 10:32 am

  18. People here, in a country that supposedly dotes on their pets, seem to have the attitude that vets are in it for the money. I’ve sat in the vet’s office listening to well off people complain about the total bill.

    However, my American friends and I find the vet bills to be relatively low here, compared to what we’ve paid in the US. (Could be that school is much less expensive here–students in any profession rarely have more than £20k in school loans.)

    I wish I could show this article to a few people!

    Comment by KathyF — September 24, 2010 @ 10:34 am

  19. Comment by Dr Monte — you get free vacations and cars and girls and big screen TV’s and …did I say girls? from the drug companies.
    __________________________
    Now I’m a little curious about the girls you get from the drug companies. Dr. Tony, you didn’t mention that. Dr. Becker didn’t, either. Is this after residency or the 20th grade, or what? And which drug companies? Do you get to pick? Are there refills? Different dosages? Time release?

    Comment by David S. Greene — September 24, 2010 @ 10:39 am

  20. David, that’s because Dr Tony and Dr Marty go to the same seminars I go to…the ones that give you a letter opener, a pen and mystery chicken (and I am willing to bet that both of them are on the dias so they have to work for the pen ;)). I think it is the major corporation CEOs who get the vacations and girls.

    Honestly, I have had people (I won’t call them clients because they usually don’t come back) tell me that they know I am subsidized by major drug manufactures. That veterinarians get vacations to Hawaii and Disney world (I wanna see Mickey!!!!) and new laptops and once one told me they knew of an outing where the vets got to golf and bikini girls rode in the carts (fascinating since more than half the vets now are female….wonder why that company didn’t supply Chippendales??

    (patiently awaiting big money from drug manufacturers)

    Comment by Dr Monte — September 24, 2010 @ 2:31 pm

  21. I just hate it when people complain about their vet bills! My vet isn’t the cheapest by far, but all of the doctors in that office are among the smartest people I know – and I know A LOT of really smart people! They are kind, compassionate, and they care. A lot.

    This past year, my dog nearly died after she ate a toy she couldn’t pass. She had emergency surgery and was basically in ICU for three days. Total cost? Less than $5,000. THAT would make an MD laugh hysterically.

    Comment by Sherron — September 24, 2010 @ 7:26 pm

  22. Dr. Oz went to Harvard. It didn’t seem to hold him back. Also, he gets to give out gifts (to the audience)rather than taking them. Maybe he takes gifts, too, who knows.

    Just to state one of the reasons for it being more difficult to get into vet school than medical school is that there are less vet schools around the country. There is a whole lot more reasons, I am sure.

    Comment by Evelyn — September 24, 2010 @ 7:43 pm

  23. I always love the follow up question “Why didn’t you become a “real” doctor?”. My poor husband (recent vet grad) hears this all too often. Drives me batty! DVM’s are indeed “real” doctors.

    I’m going to join Dr. Monte and wait for the check from the big drug companies to arrive. My husband and I have to start paying back his loans any day now.

    Comment by The Other Lori — September 25, 2010 @ 6:28 am

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