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Veterinary Career Choices

Dilys Robinson Hülya Hooker Linda Barber
Institute for Employment Studies Report

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Contents

1. Introduction
1.1 Background
1.2 Methodology
1.3 This report
2. Findings
2.1 Students
2.2 New qualifiers
2.3 More experienced veterinary surgeons
2.4 Experts
3. Conclusions and Recommendations
3.1 Summary of findings
3.2 Recommendations

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INSTITUTE FOR EMPLOYMENT STUDIES
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Copyright © 2004 Institute for Employment Studies

No part of this publication may be reproduced or used in any form by any means-graphic, electronic or mechanical including photocopying, recording, taping or information storage or retrieval systems-without prior permission in writing from the Institute for Employment Studies.

CN 6344

The Institute for Employment Studies

The Institute for Employment Studies is an independent, apolitical, international centre of research and consultancy in human resource issues. It works closely with employers in the manufacturing, service and public sectors, government departments, agencies, and professional and employee bodies. For over 30 years the Institute has been a focus of knowledge and practical experience in employment and training policy, the operation of labour markets and human resource planning and development. IES is a not-for-profit organisation which has over 60 multidisciplinary staff and international associates. IES expertise is available to all organisations through research, consultancy, publications and the Internet.

IES aims to help bring about sustainable improvements in employment policy and human resource management. IES achieves this by increasing the understanding and improving the practice of key decision makers in policy bodies and employing organisations.

1. Introduction

1.1 Background

The Institute for Employment Studies (IES) was commissioned, in March 2004, to carry out a study on behalf of the Department for the Environment, Food and Rural Affairs (DEFRA). The study has been supported, financially and practically, by the Royal College of Veterinary Surgeons (RCVS). The aim of the study was to explore the choices made by veterinary surgeons at the early stages of their careers, with particular emphasis on working with large animals. The background to the study is a concern that working with large animals - more specifically farm animals (cows and sheep) rather than equine - is becoming less popular, which may in turn be leading to potential shortages of farming veterinary expertise in some parts of the UK.

1.2 Methodology

The IES team carried out a series of interviews and discussion groups in April, May and June with veterinary students, newly qualified and more experienced veterinary surgeons, and veterinary experts. The details are given below.

1. Students: six discussion groups were held, at Glasgow (nine students), Edinburgh (12 students), Liverpool (11 students), Bristol (15 students) and London (two groups, one of 14 and one of 13 students). The University of Cambridge declined to participate. At Edinburgh, Liverpool and London, all students were in their final year; Glasgow offered a mixture of fourth and final year students; and at Bristol, all students were in their fourth year, due to the final year being occupied with examinations .

2. Newly qualified and more experienced veterinary surgeons: telephone interviews were held with 15 of the former and eight of the latter. A further four experienced veterinary surgeons did not want to be interviewed, but provided written comments; these have helped to inform the analysis.

3. Experts: expert interviews were held with Richard Halliwell, Roger Eddy and Lynne Hill of the RCVS; Tim Greet and Jeremy Johnson of the British Veterinary Association; Kate Richards of DEFRA; Stewart Donald of the State Veterinary Service, DEFRA; and Ruth Vernon of the British Cattle Veterinary Association. All but the last two were face-to-face interviews; the interviews with Stewart Donald and Ruth Vernon were carried out via the telephone.

1.3 This report

In addition to this introductory chapter, this report presents IES' findings (in chapter 2) and conclusions and recommendations (in chapter 3).

2. Findings

2.1 Students

2.1.1 Levels of interest

The students who participated in discussion groups at London, Edinburgh and Liverpool had all opted for the large animal/farm elective, and we were told by all three universities that this elective was over-subscribed. All of these students wanted to work either predominantly or exclusively with farm animals, or in a practice with a substantial amount of large animal work; the exception was a handful of students who planned to work mainly in equine practices. At Bristol and Glasgow, the groups were mixed, with students interested in a variety of possible careers. The majority of these students, however, also wanted to work in mixed practices at first, with a substantial amount of large animal work; only two students were certain that they wanted small animal work, due partly to feeling a greater affinity with such animals, and partly due to their own perceived lack of physical strength.

In the discussion groups, students informed IES researchers that around 70 to 80 per cent of students on the course as a whole were female; however, the gender balance of students studying on farm electives was more equal, as this particular elective typically attracts a high proportion of male students.

The reasons given by students for enjoying large animal work were varied, but consistent between the universities.

1. A desire to work outside, in the countryside, rather than being 'cooped-up' all day in a practice, was mentioned by many students:

'getting out and about'

'being in the open air'

'working outside, in nice countryside'

2. A belief that it would be possible to build really good relationships with client farmers and get to know them - rather than seeing small animal owners only - was mentioned frequently:

'You would be on a farm for half a day at least and on a regular basis but it is different with small animals. You would get different people coming in every five minutes so you would never have time to develop a relationship.'

'It's a different relationship with farmers - you can build relationships, and get involved with each others' businesses.'

'You can have a good relationship with individual farmers.'

3. Several students took their interest further, and expressed a positive wish to help the farming industry by supporting farming, helping farmers with their business efficiency and gaining a good understanding of the economics of the industry. Some of these students had a background in farming, from being brought up on a farm, or having relatives working in the industry. However, this was not necessarily the case; several students who expressed a firm desire to work with large animals had experienced very little exposure to farming before starting their course:

' …a personal mission to do something for farmers.'

'…doing something positive for farming - especially with the challenge of the financial constraint.'

4. An interest in herd health and animal welfare, and a perception that veterinary surgeons could really make a difference to the well-being of large animals on farms, was a motivating factor for several students:

'TB testing gives an opportunity to see all the animals and check on their welfare.'

'…with large animals you are working at herd level, looking for problems.'

Given these positive attitudes, and the fact that farm electives are over-subscribed, IES researchers feel confident in saying that there is clearly not a shortage of students who are willing to work with large animals. However, some of the aspects that students value highly when looking for their first position give a pointer towards the potential difficulties they might experience when trying to achieve their ideal careers.

2.1.2 Potential demotivators

Availability of jobs in a mixed practice

The majority of students wanted to find a job in a mixed practice, that would give them a good grounding in all areas, and enable them to acquire competence across the board.

'The first two years are to get as much experience as possible….to learn how to be a proper vet.'

Some students appeared to be 'hedging their bets' somewhat, in that they recognised the fact that farming was declining, and felt that they needed competence in small animal work, even if it was not their first choice, as they might have to fall back on it in the future.

'Where is the future for farm vets?'

'The jobs might not be available so we need to be able to get an understanding across the board.'

'Farms are disappearing.'

'Too early specialisation will reduce career options.'

Many students also recognised that achieving their ideal job in a mixed practice might present problems, as genuinely mixed practices were becoming less and less common, especially in many parts of England. The desire to gain competence in large animal work within the context of a mixed practice suggests that some students, despite their preferences, might find themselves working with small animals for a considerable percentage of their time.

Support

Students, overwhelmingly, cited good support when asked what they were looking for in their first job. By this they meant colleagues who would be willing to give advice when needed, while allowing them the degree of autonomy they wanted, to match their level of confidence. Students recognised that large animal work would be difficult at first, as they would be on their own on farms, whereas newly qualified veterinary surgeons in a small animal practice would have colleagues on hand to provide advice. For this reason, many students said they would want a practice with sympathetic colleagues who would not resent being consulted over the telephone, and would perhaps even accompany them on their first few calls.

'Partners who will come and help, including coming out at night.'

'Having help if needed - people at the end of a phone, especially if you're on your own at a farm.'

'…being trusted, but with good back-up available.'

This desire for support suggests that less confident new qualifiers, or those who have bad experiences in their first jobs, may be put off large animal work at a fairly early stage, despite early intentions.

On call arrangements

Students were prepared to work very hard in their first jobs, and expected to be on call, but most were anxious that the on call rota should not be too demanding -some said one in three, others would not accept anything worse than one in four. Support was also essential while on call, so that they could telephone for advice or help in an emergency. This implies a practice of a reasonable size, with a minimum number of qualified veterinary surgeons. Students were also very concerned that they might be asked to be on call for large animal work, without being given the opportunity to acquire competence in less stressful situations. Several students had heard of mixed practices where all large animal work was handled by one or two partners, who did not share their expertise during the day, but who expected their new qualifiers to tackle night-time emergencies on their own.

'Six or seven vets - two-men practices are a no-go area.'

'..not too tight a rota.'

'Partners tend to keep the farm stuff for themselves.'

'The first job will be very tiring - we'll need time to rest.'

This anxiety about on call arrangements suggests that a practice with only one or two large animal veterinary surgeons might not be able to attract or retain new qualifiers, as they might find the on-call requirements too onerous.

Work-life balance

Work-life balance was mentioned as an issue that would not necessarily be important for the first year or two, but would increasingly become so as time went on. Some students felt it would be easier to work part time in a surgery-based small animal practice, and that the on-call requirement would be less onerous.

'It's not an issue for the first year or two.'

'For the first three years, priorities are different.'

'…crucial as we get older.'

'Small animal work enables people to have children, but still earn good money working part time.'

'Part time work is harder with large animal work.'

The concern for longer-term work-life balance indicates that, if large animal work does not adapt to more flexible working arrangements, some veterinary surgeons may move across to small animal work to accommodate their domestic circumstances.

Location

Although most students said they would be willing to go anywhere for their ideal first job, when probed many said that they would not be happy if they were very isolated geographically, especially if they had no colleagues of a similar age and they were far from the nearest town.

'The job is more important than where it is.'

'I'd travel to get to my ideal job - to Australia or New Zealand if necessary.'

'Not too isolated - near civilisation!'

'In Ireland and Wales there are some brilliant practices, but they're very isolated…'

'It can be very lonely, at first, being out in practice - especially if there are no young people at the practice.'

'Not necessarily other young vets - but others in the practice, like nurses, to socialise with.'

'Clubs aren't important but I'd need a local pub and some social life.'

This concern suggests that isolated practices, even those with a good percentage of large animal work, may not be able to attract and/or retain new qualifiers.

Interesting work

Almost all students said that they sought a variety of interesting work in their first positions. However, there were very different interpretations of what constituted 'interesting' work, especially when applied to working with large animals.

'Herd health is interesting because it is progressive and advisory.'

'You'd do everything there is to do with farm animals in two years, then get bored and want more challenge.'

'I'd want a variety of farm animal work - not just TB testing and inoculations.'

'TB testing, de-horning, castrating cattle - it's mundane work.'

'Vet schools are full of academic high achievers, who might start to find large animal work more boring compared to the more scientific things they can do with small animals.'

Such comments suggest that practices that are unable to offer new qualifiers a variety of experience, and give them routine work only, might lose them to small animal work after a year or two.

Student debt

Most students had very large debts to pay off (they cited amounts such as 20,000 to 40,000, some even 50,000). Their debts did not seem to be influencing their choice of first job, and most said they had not opted for a veterinary career to make money; it was more of a vocation. In one university, two students were even taking a first job working voluntarily for a charity abroad. However, there was a general consensus that a 'living wage' was required, and some form of career progression, to enable a reasonable life-style in the future. Some students were very ill-informed about veterinary salaries, and appeared to have no idea what they might expect; others had heard that small animal work was more lucrative, and were worried that they might be forced into working with small animals if large animal work did not pay enough. Jobs with a car and accommodation were considered very desirable by some students, which suggests that practices that can offer a good reward package might be able to outbid practices with the ideal mix of work, but without the resources to pay well. However, the initial package was of interest to a minority of students only; the longer term was of far wider importance.

'Vets don't earn a lot - not as much as doctors - it's more of a vocation.'

' We're not in it for the money.'

'We need to be able to live off our pay but it's not the main driver.'

'It's a huge investment, being a vet - we need some kind of recompense and quality of life.'

'Small animal vets get paid more, but farm vets can make adequate money.'

'Money would come into it in the longer term.'

These comments suggest that failure to progress in their chosen field might cause some veterinary surgeons to move into more lucrative areas after the first year or two, especially if their debts are large.

Risk of injury or exhaustion

Several students recognised that working with large animals carried a greater potential risk of injury, and wanted to gain some experience with small animals as an insurance against future injury. They cited this as one reason why university courses should not become too specialised.

'I'd like to stay with large animals if possible, unless I got injured - that would cause a career change.'

'…possible injury - farm animal work is more risky.'

'A cat or a dog will bite you but a cow or a horse will crush you and you are more likely to be out of work for a long time.'

Some students also mentioned the hard physical nature of the work.

'Retaining people to work with farm animals is a problem - it's hard work.'

'You need muscle but also technique.'

'I'm opting for small animal work because I'm just not big enough to wrestle a large animal to the ground.'

'Farm animal work is hard - it could get very tiring - people need some comfort.'

Although students were agreed that gender was not really an issue here, as most women opting for the farm elective tended to be strong physically, it is interesting to note that those who raised the possibility of injury were all women. One or two students had also heard that certain types of farm animal work would not be possible during pregnancy.

Concerns about injury or tiredness suggest that some veterinary surgeons who opt for farm animal work may find it too strenuous, or may switch to small animal work if they experience an accident.

Farmers

Students were well informed about the decline in farming generally. They were aware that smaller farmers were disappearing and that those remaining in farming tended to have bigger herds and a considerable amount of expertise. They did not, however, feel intimidated by farmers' knowledge and attitudes, and also did not feel that gender was an issue. Competence, however, was much more important.

'Farmers are not sentimental -they're happy to let students have a go.'

'Farmers want more experienced vets for the routine stuff - but female vets only have a problem in some practices.'

'Competence is more important than gender - the farmer watches you the first time, and if you can do it, that's ok.'

'Farmers are difficult and judgmental, but they're not too bad about gender now.'

These attitudes indicate that early bad experiences with farmers could lead some new qualifiers to lose their confidence, especially if they are not given enough opportunities to acquire competence.

Course experiences

When asked what they particularly enjoyed about their courses, and what they had not liked, responses were very consistent. Invariably, participants had much preferred the last year or two of their courses to the first three years, as this was when they had started 'doing hands-on work with real animals'. At this point, they felt that had started to understand what it would be like to be a veterinary surgeon. Some students suggested that their course could do more, however, to prepare them for the reality that lay ahead. Three main suggestions were made:

1. Some of the procedures that students had been taught, or observed, were felt to be far removed from the reality of day-to-day large animal work: 'We would have very detailed lectures on surgery that we would not be doing unless we specialised. A quick lecture on castration would have been so much more useful.'

2. Courses did not include enough information about the economics of farming, and ways in which new qualifiers could gain credibility by advising and helping farmers: 'We need to be able to present issues like herd health to farmers in an economic sense - the course need more input here.'

3. Students need more information about the different models of veterinary practice (there was widespread recognition that the James Herriott model needed updating) and also wanted more advice about the sorts of things they should be looking for in their first and subsequent jobs. Advice on practice size and mix was felt to be particularly important, as was guidance on expected salary, on call requirements, career progression and CPD provision. Some students also expressed a wish for more input on business skills. In some universities, students felt they did not have sufficient information about practices where others had done extra-mural studies placements. There were also some assumptions being made about certain types of practice, such as the belief (held by students in one group) that exclusively large animal practices were not interested in recruiting new qualifiers, so there was no point applying to them.

Although universities will probably argue that students' perceptions of their courses is inaccurate, it is possible that some students are not getting enough guidance, and are therefore not fully equipped to deal with early experiences. This may result in a degree of disillusionment when faced with the reality of life as a new qualifier.

2.2 New qualifiers

Large animal practices

Two of the new qualifiers are in predominantly or entirely large animal practices, and love everything about their jobs and their lifestyle; they work in the countryside out in the open air, doing exactly what they had anticipated of their first jobs. They are well supported in friendly, sociable and well-managed practices, find the work interesting, are getting involved with clients and their businesses, and appreciate working with professional farmers.

'You make more of an impact on farm animals than small. Farmers are great and very interesting.'

'Farm animal work isn't declining here - public health issues are generating more work, and the foot and mouth epidemic demonstrated the need for more vets for farm animals.'

'TB jabs etc. are less stimulating but have the advantage of enabling me to meet farmers and learn from them.'

'Large animals provide more opportunities as farmers usually only call out vets if they cannot cope with the problem. Small animals are more repetitive and linked into the bureaucracy of pet insurance etc.'

'You have to be selective in choosing your employer, though, to get the right sort of support. I only do a one in six on call rota.'

Equine

One new qualifier had opted for a predominantly equine practice, despite early intentions to work in a mixed practice, and also loves it - particularly being outside and feeling a particular affinity with horses. This individual now intends to specialise in equine work.

Given up

One new qualifier is not working as a veterinary surgeon at all, but had given up after six months.

'Vets have awful financial prospects and this is a poorly paid profession with a terrible career path…. I may go back to working with small animals one day…. The problem with farm work is that the farming sector is in trouble so people feel less assured about a future.'

Mixed practices

The majority of new qualifiers are in a mixed practice, mostly (but not all) still in their first job. Their experiences are very variable, and in most cases are clearly influencing their career choices already.

One new qualifier in a large mixed practice (50 per cent small, 50 per cent large/equine) is having a good experience of large animal work, in contrast to some of her friends: 'I really enjoy large animal work and do it at least 50 per cent of the time….I am very keen to work with large animals although there is an uncertainty about large animal practices….Most practices seem to offer a very small component of large animals - seeing a cow every other week is not enough to build up experience. Some of my friends only get really boring large animal jobs. The support aspect - being out on the farm without support - puts many new graduates off.'

Another, in a similar position, is also having a positive experience: 'I love the farm work… I like dealing with farmers and I love being outside. However, most practices do not seem to want to employ new graduates who are interested in large animals. They want those with practical experience…. Overall, I am glad that I held out for my current position rather than going into small animal practice out of desperation.'

Several, however, are finding that they are moving towards small animal work, even if that had not been their original intention, for a variety of reasons. Some of these have already been identified above, from discussion with students; others had come to light only when the new qualifiers started working.

1. Three new qualifiers have now opted firmly for small animal work, and are clear about the reasons for not working with large animals:

'I want to specialise in cats… I would never work with farm animals. The hours are worse and I have ethical issues with farming. The pay is also worse. Friends who decided to go into large practices are always complaining about out of hours and pay.'

'I really would not consider working with large animals now… There is no money in the area… It is terribly hard work, with so much paper work…. I was quite enthusiastic about farm animals at first but soon realised it was not for me…. Farmers know much more about their animals …and don't particularly like younger vets.'

'On call is worse when you are dealing with large animals… Farming in general has no money in it any more… Those working with large animals have a limited budget…. no guaranteed income or job prospects.'

2. Some new qualifiers found, when they arrived in their first job, that there were 'not enough' (this seems to mean, in practice, only one or two) veterinary surgeons doing large animal work, so the on-call was very demanding. In addition, they were getting insufficient exposure to large animal work during the day, so handling on-call emergencies was very daunting; one new qualifier described it as 'terrifying' due to the lack of support.

'I found the responsibility of being on call for large animals too great as I was not able to gain access to enough routine farm work to become experienced or confident.'

'If you go somewhere with less than four vets, you know that you would get to be on call a lot.'

3. In addition to having a heavy on call burden, a few new qualifiers say that they are bored with the routine, repetitive work they have to do with large animals. TB testing, cattle de-horning, inoculating and DEFRA paperwork were mentioned on several occasions. This contrasted with both their university experiences and the relatively exciting, high- technology, skilled work some had been able to do with small animals.

'Our tutors were research-based and intellectual; it wasn't good preparation for actually working with large animals.'

'I think you need to want to work with farm animals. Farm work is very routine and repetitive. You will be there all day injecting cattle….. Also TB testing involves too much paper-work.'

4. A few feel that their university experience of farm work was not entirely realistic, and they were not fully prepared for the economic nature of farming. They feel frustrated because they want to help animals, but cannot do so because farmers are unprepared to spend much money on 'economic animals' (this is, animals that have a set economic value): 'The perception of farmers is that it's not worth it - it's quite depressing… The future lies in health schemes, herd management, prevention - but you can't get farmers here interested in this sort of thing.' One new qualifier felt there was little hope unless the government intervenes: 'If the funding was from the government, more people would go into working with farm animals…. The government needs to support farmers more… At the moment, farming as a business is a dead end and newly qualified vets do not want to be part of this business.' Another feels DEFRA needs to play a part: 'DEFRA is the main problem for farm animal practice… It needs to become sexy and get some spin, and a better media image.'

5. Animal welfare is also an issue for some, who have issues with the ways in which animals were being managed on farms. By contrast, pet and horse owners are prepared to spend a lot of money on their animals, which make the new qualifiers feel that they are really helping the animal and its owners - doing what they had been trained to do: 'You get to see nice clients with small animals.' One new qualifier was especially opposed to farming methods for ethical reasons, and had decided not to work with large animals because of this objection. Another has been put off by her experiences: 'I would love to work with large animals but there are huge welfare issues. We're expected to castrate animals without anaesthetic and are only called out to deal with calving when it's been bodged up… It's frustrating because I enjoyed it in college… The veterinary profession should be better at enforcing its own standards… There is amazing apathy in the profession and a big gulf between the ethical standards applied to small and large animals.'

6. Several new qualifiers said that farmers are very demanding and increasingly knowledgeable and specialist, and do not like to have to deal with a new recruit rather than with a partner. This does not seem to be a gender issue, but is purely related to the inexperience of the new qualifiers. The interviewees felt that this should not, in theory, be a problem, as they should be able to build up their relationship with the farmers gradually, supported by the experienced partners. In practice, however, this was not always happening, because the partners had 'creamed off all the interesting work'. As a result, new qualifiers felt disillusioned, unable to build up good client relationships, and very exposed when on call, and were not getting the experience they needed to acquire competence. We have encapsulated these views in figure 1.

Figure 1: The spiral of disillusionment

Source: IES

'I was initially keen to work with dairy herds, but didn't get enough routine grounding.'

I feel I am a little ill-prepared for dealing with large animals. I don't get as much exposure to them as I do to small animals.'

7. Support structures in the practice - equipment, diagnostic facilities and veterinary nurses particularly - had proved to be an issue for a minority of new qualifiers, who felt that large animal work was a 'poor relation' and was relatively badly supported.

8. On the positive side, none of the newly qualified interviewees had experienced any problems getting released for CPD activities, although opportunities were limited in more remote areas.

2.3 More experienced veterinary surgeons

The more experienced interviewees had all qualified around five years ago. Most are in their second or third jobs since qualifying, and several had spent some time abroad. Some are now partners. As with the new qualifiers, experiences were varied, but it is clear that most have now settled down into a particular area of work - although not necessarily the one they had first intended.

Working with large animals

Two interviewees are now partners in mixed practices, specialising in large animal work. A third interviewee is now working as an assistant veterinary surgeon in a mixed practice, again predominantly with large animals. All stressed their enjoyment of being ' out and about' while at work, and all had received good support in their early years after qualification. They all have strong views about the future of large animal work and the need for change and action.

'I enjoy being on farms and working with herds…. The economics of disease control at a herd level….is the future of farm animal practice.'

'It is most important that large animal practices change and develop themselves within the requirements of the farming industry…. Farmers' demands will be changing… More educated farmers won't require the after-hours they used to demand…. We are in for a big change in the next four years - a reduction in the number of practices offering farm animal work but a growth in specialisation.'

'The problem we have is not getting people into working with large animals, it is keeping them there. Rural communities are very isolated…the work is physical…on-call work gets too much in smaller practices….TB testing involves too much paperwork.'

One interviewee who worked with large animals said, interestingly, that farm animal work was actually more relaxed once the veterinary surgeon was established and had a good rapport with client farmers. It was a pleasant lifestyle, requiring regular updates in business skills, but was not stressful due to the relatively small demand for advanced procedures; small animal work, by contrast, required frequent updates and demanded a high level of technical expertise: 'You build strong relationships with farmers of a social nature… It's easier to coast.'

Small animal or equine work

Several interviewees had started off in mixed practices intending to gain experience across the board, but had moved fairly quickly into small animal work. The reasons given were fairly consistent, around the theme of small animal work giving greater security, less risk and a better (and more certain) level of financial reward. Lack of support or opportunity in the early years appears to have contributed very heavily towards early decisions to specialise in small animals. For some the move into small animal work had been more of a drift than a deliberate intention; they felt their practices, due to the way in which they operated, had not offered them enough day-to-day exposure to farm animal work, which meant they had not gained confidence or competence in the area.

'I gave up on equine and large animals very early on in the job… I have many friends who work with large animals. I know from them that it is not good financially. Also working hours and environment aspects are very poor. There is not enough commitment from bosses or older vets into developing knowledge in this area. Vet students are keen to go into mixed practices but they are put off by these aspects. I used to enjoy working with large animals so it is not about interest not being there.'

'One of the issues is that farmers are not willing to spend much money on their stocks. A lot of practices are closing down their large animal practices because there is not money in it. Farming is in crisis.'

'I would consider working with large animals. However, in general the large animal area is more difficult to get into…especially for new graduates.'

'Overall it is much easier with small animals. You are based in one place, you don't need to travel. Unsociable hours are much worse with large animals; large animals' call-outs take much longer and also it is less pay.'

'Although I worked with mixed animals, more than 70 per cent of them were small. I don't feel that I have seen many large animals so I don't feel confident. Also, when I get a call, I'd rather go to a nice warm surgery than a cold farm. Working with large animals is also more physical…. When you are working, by yourself, making the decision, I don't feel that I got enough experience with large animals. That is the main reason for me.'

'Motivation deteriorates through lack of large animals, leading to infrequency of calls, leading to dread when called out in the middle of the night to perform a procedure which should take a fraction of the time that it actually takes you.'

Female interviewees, and those with family responsibilities, had a further reason to work with small animals, namely the comparative ease of getting part-time jobs in this area; they had found it very difficult trying to find part-time positions in large animal work. They also found the on call commitment in small animal work fitted better with family life.

'If you have a look at the large animal practices, it is mostly men and single people in cattle work. People with families do not want to do it…. If out of hours were more regulated, it would make a big difference. You can do the out-of-hours for the first two years but after that it becomes unbearable.'

'Work-life balance is very important for me.'

'The work-life balance has become very important, especially now I am pregnant… It is difficult to get part-time work in this profession.'

One interviewee had been badly injured by a horse, and now felt unable to work with any large animals as a result: 'I had a really bad accident in my first job. Six months into my job, I was dragged by a horse. I tried to stay on another two years but I couldn't work with large animals, it didn't work out.'

Financial constraints was mentioned by several participants as a main reason for not staying in large animal work: 'Farm work has declined so much we have very little to do, despite being a rural practice that was once mainly a farm practice. Much of the stimulation of being a vet, for me, is the intellectual challenge of working out what is wrong. These days that has largely disappeared from beef and sheep work as the animal's value simply does not justify anything but the most basic interventions. Thus, it is small animal work for me…'

One participant who gave farm animal work a try, but did not stick with it, feels very strongly about the welfare aspects: 'I found that due to financial constraints vets weren't called out in time to be able to do much for the animal. Much of my work consisted of certifying for slaughter or occasionally having to shoot a cow… It didn't provide much job satisfaction so I went into small animal practice… The main part of my work involves dealing with people who care about their pet's welfare… I became a vet because I cared about the quality of animals' lives.'

Several interviewees offered the observation that diagnostic facilities, equipment and support ( eg by veterinary nurses) were better in small animal work. This seems to be a contributory factor in making small animals work more attractive, rather than a main driver - but one that could perhaps tip the balance when decisions about future direction are being made.

One interviewee felt that the veterinary profession needed more professional advice, union support and regulation, which would help to maintain standards and support veterinary surgeons in their career choices. Although this was a minority view, it was strongly held by the individual: 'This is a poorly regulated and inspected profession.'

2.4 Experts

It is hard to make general observations from the expert interviews, because every expert had a viewpoint coloured partly by their professional role and partly by their own veterinary experiences. One common view, however, was the recognition that farming is changing and slowly declining, and that this was having a big - although gradual - impact on veterinary practices, especially in England. Livestock farming was becoming increasingly concentrated in certain geographical areas in England; farms were becoming bigger, as economically unviable smaller farmers sold out to their larger neighbours; and farmers were more knowledgeable, professional and demanding. The nature of veterinary services to farms was therefore changing, and moving increasingly into herd health management and disease prevention. This requires a greater business awareness among veterinary surgeons, although 'hands-on' is still needed for emergency situations.

Expert interviewees varied in their assessment of whether or not there was a shortage, overall, of large animal veterinary surgeons. The prevailing view was that there was not an overall shortage, but that certain parts of England, and remote areas of Scotland - areas where farming was clearly declining - were not well covered. In these areas, veterinary practices were giving up their large animal work, or selling it to neighbouring practices, and were retiring or moving into small animal practice exclusively. The impact of such shortages in these geographic areas was felt to be potential rather than actual, at least in the short term. Risk areas were animal welfare (animals possibly suffering because of infrequent visits from veterinary surgeons, and having to wait a long time in emergencies due to the distances to be travelled) and disease surveillance (diseases not being spotted early due to infrequent visits, or poor intelligence due to inadequate knowledge of the local area).

To minimise the impact, some experts suggested that TB testing - which attracts DEFRA funding, and currently allows some mixed practices to stay in large animal work - must remain with the veterinary profession. If contracted out to lay professionals, more practices will fold entirely, or give up their large animal work, resulting in an even greater potential risk to both animal welfare and disease surveillance. (Interestingly, some students had also picked up the financial and welfare importance of TB testing: 'Giving TB testing to lay staff is a very bad idea. It provides most of the income for some practices - and gives an opportunity for the vet to look at herd health issues and maintain a rapport with the farmer. Testing sheep for scrapie is now done by lay people and this has caused a lot of problems.')

Another recommendation by some experts was that veterinary surgeons must be allowed freedom in dispensing; farmers are not prepared to pay high prices for veterinary consultations (one expert noted wryly that ' the vet's is the last bill that farmers settle'), so practices are able to stay in business only by charging realistic prices for medication and inoculations.

A further suggestion was government allowances, to be paid to veterinary surgeons who are prepared to work in remote areas and keep practices going that would otherwise fold, putting animal welfare and disease surveillance at risk.

The difficulty of ensuring an adequate future supply of large animal veterinary surgeons is recognised as a serious issue by some experts. This is partly due to the acknowledged difficulty in understanding how many veterinary surgeons are required to meet current and future levels of demand in this area of work. The problem of new qualifiers having bad experiences in their early years, and therefore moving into small animal work (perhaps unwillingly) is also recognised as an issue. One expert believed that a ' critical mass' of at least three large animal practitioners is needed in a practice for it to become a viable environment for training new qualifiers - and the experiences of several interviewees would seem to bear this out. If there are fewer than three experienced practitioners, new qualifiers do not get good support or a variety of experience, and are burdened with an over-demanding on call rota.

The concept of omnicompetence was raised by some experts, who felt that the nature of veterinary work was becoming increasingly specialised, resulting in a need for university courses to also specialise. While this appears an attractive proposition, it is not popular among students and teachers at universities; the uncertain future of farming in the UK and Ireland - especially in parts of England - means that students feel they need to gain a good grounding in small animal work, even if they intend to become large animal specialists, by way of an insurance policy. Several students pointed out that the perceived problem is currently almost uniquely English, or perhaps English and Scottish; in Ireland and Wales, for example, the old model of mixed practice appears still to be the norm, and many practices welcome new qualifiers who want to get a grounding in all areas of veterinary practice. Several of the students to whom we spoke had done their extra mural studies in mixed practices in Ireland or Wales, and were intending to return to these areas for their first jobs.

Some experts raised the possibility of a professional development year, during which the new qualifiers would be carefully mentored within the practice while they build up their competences; training posts would have to be inspected and monitored to ensure their suitability. Students had mixed views about this idea, as they were impatient to start practising and felt that the bureaucracy that such a scheme would require might prevent some practices taking on new qualifiers, thereby cutting down the options available to students.

3. Conclusions and Recommendations

The following observations are based entirely on the contributions of the experts, students, newly qualified and more experienced veterinary surgeons interviewed by IES between April and June 2004. Although the sample sizes were small, there was a remarkable degree of consistency of response, enabling IES researchers to be confident that these views are representative.

3.1 Summary of findings

1. Firstly, we found no evidence to suggest that students and new qualifiers do not want to work with large animals; in fact, quite the reverse. Farm electives are over-subscribed, and only a small minority of students expressed a wish to go straight into small or equine work; the majority want a genuine mix of experience for the first year or two of practice, and a further minority are committed to a predominantly large animal career. The majority of new qualifiers to whom we spoke had opted for a mixed practice in the hope that they would be able to acquire a variety of experience before making a decision about preferred area of work.

2. However, early bad experiences of some new qualifiers - particularly those working in mixed practices where there are only one or two large animal practitioners, or where farm work is declining rapidly - are resulting in a drift towards small animal work, which offers better support to inexperienced veterinary surgeons. The combination of a lack of support, inadequate exposure to large animal work and frightening on-call experiences is sapping confidence at a very early stage, and leading to decisions to specialise in small animals. IES researchers heard the same story, with only small variations, so many times that we have labelled it 'the spiral of disillusionment'. Disillusionment, if it happens, seems to be setting in at a very early stage; the majority of new qualifiers in our sample had worked for less than a year, but appeared to already know where their careers were going.

3. A further important reason for a drift towards small animal work is that it appears to offer better career prospects and financial reward. Although these aspects are not important to most students, they acquire much greater prominence as time goes on - perhaps as student loans have to be repaid, and people settle down and acquire new responsibilities. From the comments made to IES researchers, it is clear that veterinary surgeons tend to keep in touch with their former course members and compare notes about their jobs and experiences, which has led to a belief that large animal work is both tougher and less well rewarded than small or equine. Again, it appears that early intentions to work with large animals are being thwarted by experiences, although in this case the experiences are not necessarily personal.

4. Those veterinary surgeons who are doing predominantly large animal work in well-supported first jobs, or who have achieved their ambition of specialising in large animal work, however, appear to be very happy in their jobs and are thoroughly enjoying their work and their lifestyles. This suggests that a career in large animal work is both achievable and rewarding, given the right circumstances.

3.2 Recommendations

It is important to stress that these recommendations are based on comments and suggestions made to us in the course of carrying out this study, rather than from any detailed veterinary knowledge.

1. The fact that the first job is so important to future career direction suggests that universities need to offer very good career advice to students who want to work with large animals, and should also give students a realistic picture of what the work involves, and the different models of veterinary practice operating in different geographical areas, to prevent disillusionment. Several new qualifiers claimed that the reality of working with large animals was very different from their college experiences, which suggests that more input on the economics of farming, herd health, farm animal welfare, and disease surveillance and prevention might help students to decide whether or not they really want to work in this area.

2. To enhance understanding, further work - to establish more precisely the number of large animal veterinary surgeons actually required, and the different models of practice in different parts of UK and Ireland - is probably needed. The nature of veterinary practice, and the ways in which practices are changing, varies depending on geographical area and country, so imposing a single 'solution' is unlikely to succeed.

3. A variety of government actions - for example, related to drugs prescription and supply, TB testing and allowances for practising in remote areas - could help to maintain veterinary services in some parts of the UK, thereby ensuring adequate minimum standards of animal welfare and disease surveillance on farms.

4. Ending the requirement for omnicompetence may help to ensure a more certain supply of veterinary surgeons in different areas of practice, but is not popular with students and teachers, who have anxieties about the potential loss of career flexibility. Students are aware, for example, of the decline in farming, and may feel that opting at an undergraduate stage for a large animal career is too risky, even if that is where their interests lie.

5. Students are also somewhat sceptical about the idea of a professional development year, as they feel it would not serve a useful purpose. In particular, they believed it might narrow their options, would delay their ability to earn a living wage, and would not necessarily help new qualifiers who are unfortunate enough not to be well supported. However, a minority felt that it might result in better careers guidance and that students would not resent it if they knew, at the outset of their course, it would be happening. To overcome students' scepticism, it will be important to put across the concept of a professional development year in a very positive way, and explain it carefully. It is likely that support funding will also be needed to encourage practices to participate.

6. Part-time opportunities appear to be relatively unusual in the veterinary profession (although it is becoming more common in small animal practices), which, given the extent to which the profession has become 'feminised' over the past ten to twenty years, is surprising. Men, too, would like a better work-life balance - partly because of societal changes which encourage fathers to become more involved in child-rearing, and partly due to the need to consider partners' careers as well as their own. The view in some practices appears to be that flexible working practices are not applicable to their situations. One way of encouraging greater flexibility, therefore, might be to provide veterinary practices with more practical advice about different working options, perhaps with some case study examples.

7. To monitor careers over time, it is recommended that the RCVS membership survey always contains questions about career choices, and the reasons why veterinary surgeons are opting for a particular area of work. The importance of the first year or two after qualifying suggests that a large sample of new qualifiers - perhaps all - should be surveyed separately every year, to ask detailed factual and attitudinal questions about their jobs. These individuals could then be tracked over time. The following areas should be covered in the survey:

a) expectations and the extent to which these have been met
b) experiences to date of working with different types of animals and clients
c) on-call arrangements
d) salaries
e) CPD opportunities
f) career intentions
g) extent to which their course provided them with the grounding and information they needed.