New Approaches Are Needed to Improve Access to Veterinary Medicine - Dr. Kathryn Meurs, Dean at North Carolina State University College of Veterinary Medicine

Hillary Acer: Hi, I'm Hillary Acer, welcoming you to Raise the Line with Osmosis from Elsevier, an ongoing exploration about how to improve health and healthcare. 

We've devoted quite a bit of time on the podcast to learning about persistent workforce shortages in human healthcare and what is being done about them, but as yet have not turned our attention to the fact that veterinary medicine is facing the same headwinds. To find out more about how that challenge is being addressed and to learn about other current issues in veterinary medicine -- particularly from a research and education perspective -- we turn to Dr. Kathryn Meurs, the Randall B. Terry Jr. Dean at North Carolina State University College of Veterinary Medicine. 

Before assuming that role in 2022, Dr. Mears held other leadership positions at the school in research as well as graduate studies, following earlier stops at the Colleges of Veterinary Medicine at Washington State University and Ohio State University. She is board certified in cardiology and holds a doctorate in genetics with expertise in the genetic basis of feline and canine cardiac diseases. 

Thanks so much for joining us. 

Dr. Kathryn Meurs: My pleasure.

Hillary: I'd like to start with learning more about you personally and what got you interested in veterinary medicine.

Dr. Meurs: Okay. Well, I love being a veterinarian and I am a very common phenomenon in that I decided to become a veterinarian when I was seven years old. I don't know why. It's the first memory that I have of when someone asked me what I wanted to be when I grew up that I said I wanted to be a veterinarian. I am a little bit embarrassed by that because I think, you know, how could this be that you know at seven and that you stick with it? But I will say that that is very common amongst veterinarians, that it's something people decide to do at a very young age and stick with it, and I've never regretted it. So, I was very thoughtful at seven, apparently.

Hillary: Well, definitely. And I can share that most people hope to have that kind of clarity when they're younger to find a career path that's fulfilling and that they end up following through on. But obviously, you've had a pretty huge impact in veterinary medicine. Tell us a little bit about your path to get to where you are today.

Dr. Meurs: Great. Well, I actually grew up in a fairly rural part of Wisconsin. I grew up with many pets and horses and lived in a dairy area so I actually thought that I would graduate from veterinary school and return to that town and work predominantly with small animals and perhaps horses and be a local practitioner. When I was a first year veterinary student, I took a summer job working for one of the faculty members who was studying why Boxer dogs died of heart disease. That was the first time that it really occurred to me that one of the jobs of some veterinarians is to actually figure out why animals get sick and how to prevent it and how to come up with better treatments and they do that through research. 

That really opened my eyes to this concept that as a veterinarian in practice, it would be very rewarding and I would see and take care of one animal at a time, but if you took a research aspect of it, you could have an even greater impact by preventing a disease or developing a new treatment.  So, I got very interested in some type of career that would include research, and because I had that first job with a cardiologist who was a faculty member at University of Wisconsin, that was the first time I also learned that you could specialize in some disease process, some systemic organ like cardiology, and so I decided to go on to become a cardiologist and stay in a university setting where I could see cases and be a veterinarian that managed animals in that teaching hospital, but also would have some of my time doing research to try to figure out why dogs and cats get heart disease and if there was anything that I could do to prevent it.

Hillary: Wow. I'm curious, what did you find out in that research between the intersection of genetics and cardiology and why Boxers are getting heart disease? 

Dr. Meurs: So, if you want to specialize, veterinarians go to veterinary school for four years post-college, and then you can do a three-year residency in cardiology or neurology or whatever your specialty may be. As a young cardiologist, I saw that many heart diseases were very breed specific…Boxers got one disease, Doberman Pinschers got a different disease, Maine Coon cats got a different disease, and when you see something following a breed like that, you then think, I wonder if this is an inherited problem. 

I was encouraged by my mentors to study that and decided that if I really wanted to truly have an impact, I should get a PhD in genetics. So, I studied with a human cardiologist -- an MD cardiologist who was studying cardiac disease that was inherited -- at the Baylor College of Medicine and was able to then use that knowledge to discover the causative genetic mutation that caused heart disease in Boxer dogs and a different one in Doberman Pinschers and then ultimately develop a genetic test that owners could do to see if their Boxer or their Doberman or their cat had that genetic mutation to try to breed it out or start them on therapy earlier because you knew your animal had the gene for that. 

Hillary: Wow. We are an education company that primarily has focused on human medicine, as I'm sure you're aware, but we're really interested in these intersections of human and animal medicine and what each field can kind of learn from the another. In fact, just last week, we had Dr. Sue VandeWoude on the podcast from Colorado State University talking about their One Cure initiative and some of the collaborations that they have. I would love your perspective on this since it's so relevant to us. What are some of the things that you're doing and seeing between human and animal medicine? And what are some of the research projects that North Carolina is doing today or that you're most interested in?

Dr. Meurs: Yes. And I know Dr. VandeWoude very well. Our career tracks have been very, very parallel and where Sue tends to study more on those infectious diseases that are shared across species, or zoonotic diseases, my focus, and I think our college’s -- although we do a lot with infectious diseases -- tends to be more of a comparative medicine perspective. So if, for instance, in cardiac diseases, the disease that Boxer dogs get and is inherited has a very similar disease in human beings, we are able then to look at similar aspects. Often this is the type of work that is funded by the National Institute of Health (NIH) to use this natural model disease of dogs and use research money to study it because dogs have a shorter lifespan than humans. In a human, maybe you have to wait for them to be twenty or thirty years of age. In the dog, that's two or three years of age, so you can study that disease earlier and learn more about whether medical treatment has an impact sooner. 

So, I really think of that as comparative medicine…tracking those diseases, both in animals and in humans, in our college. We also use that to study types of cancer, cardiac disease, gastrointestinal, and at any time we'll have about twenty-five different clinical trials going on where we're working with drug companies that come to us and say, I know you see a lot of animals with this disease, but we would like to study this new treatment, just like you might go and participate in a clinical trial. And at least some of those ongoing clinical studies we have are for a human drug, but they're interested in seeing if it helps that dogs that have this natural model of the disease first. If it works in dogs, then maybe we'll go ahead and spend the money and do a large human trial. If it doesn't work in dogs, maybe that's not going to be worth the billions of dollars to move it to a human trial. 

Because often in medical research, that work is done first in mice and then mice and rats, and then we have to make this big jump: it worked in rodents, should we now try it in human beings? A lot of the time it doesn't work because rodents are just too different, but there's a large amount of money that's used guessing that because it worked in rodents that it will work in people. If you can use natural animal disease in dogs, cats and horses to study it first, you can use that as a way to predict whether it's more likely to work in people. Dogs and cats tend to be closer to humans than the rodent models. 

Hillary: That makes sense. And though we don't want to have too much of a human-centric take here, I know we're all very interested in keeping our pets and wildlife healthy and living long lives. Have there been any recent instances of maybe human research supporting treatments and discovery in animal diseases? 

Dr. Meurs: That's actually quite common because there is a lot of research that's done on animal diseases. I think that's really important because there is so much more research work done in humans that sometimes in diseases, for instance, in cats, where there's just not as much medical research done for the cat itself, we often take things that are done in people for humans with heart disease or clotting diseases -- or diabetes would be another example -- where we see something that has worked very well for diabetic humans and then we'll take that and try that in cats with diabetes for the benefit of them and the benefit of their owners having a better treatment for it. 

Hillary: Well, hopefully we continue to see this kind of sharing of ideas and building upon these bodies of research to benefit both groups. Let's talk a little bit about North Carolina State College of Veterinary Medicine. Can you tell us a little bit about your role as the dean and some of your priorities going into the next couple of years? 

Dr. Meurs: Yes. I'm so proud of North Carolina State College of Veterinary Medicine. This is actually one of the newer colleges of veterinary medicine. It graduated its first class in 1985. It grew out of the North Carolina red clay in the middle of 1980s and it really had this idea of paying it forward. That the role of this college should certainly be to train the next generation of veterinarians, but that also everything we do should be to advance veterinary medicine. With every animal that we see in our teaching hospital, we should be learning something that helps the patient that comes in the next day. 

So, everyone in our college is involved with education, but also research or discovery, meaning that we all have a role in helping us practice veterinary medicine better tomorrow than we do today. If some of that helps human beings as well, that's wonderful. And that's where the comparative medicine aspect comes from I think.

I love that because the college is fairly young, it's been able to really think about what do we want this college to be about, and so much of that has been not just dealing with the problems of today, but also how do we pay it forward, how do we make things better for the profession, the next generation of veterinarians, and also all of the cases that we're seeing through the hospital? We really think about that. That's part of our culture. How are we contributing to taking veterinary medicine forward? We talk about everybody's job -- whether you're more involved in teaching or research or seeing cases in the hospital -- you're all one part of this college. 

We're also certainly very committed to the state of North Carolina and all that it did to come up with this concept of having a new veterinary school and what they wanted it to be. I really want our citizens of North Carolina to know that they can come here with their beloved pets and their agricultural species that have very complicated diseases, and that we're here to help them, and that we also do have that role in biomedical research, even helping them with human problems. So, I want the citizens of the state to really understand how we're here to help them as well. We're not just a college of veterinary medicine here as a silo.

Hillary: That's a great resource for the community, and actually, living close to a veterinary school I can share that I've benefited from the research and the innovation that you get by being so close to that kind of institution. So, hopefully more and more people visit you all and take advantage of that. But about the program itself, I know you've recently kicked off the Veterinary Academic Leaders Program, which is aimed at preparing students to succeed in academic careers. What was the impetus behind that and what is this program aiming to achieve?

Dr. Meurs: Oh, thank you for asking that. We also call that our VALS program. As I was just saying, it’s important for us to pay back and improve the profession, and many of our veterinary students come here thinking, like myself, that they will graduate and go into a practice setting and see patients and help their owners and that's a wonderful job. We really need people to do that. But we realize that a lot of them don't come here with the idea that they can have this large impact on research or teaching the next generation. So, we wanted to create a program where we provided young veterinarians who raised their hand and said ‘I think I might be interested in having a career where I teach and/or do research and I want to develop those skills to be a success in an academic setting’ with additional opportunities for them during their training program. Opportunities where we were spending time with them and giving them additional skills in how to teach, how to develop a research program, how to balance it all as a faculty member and really set aside time to help them feel a little bit special. This is a career that you might want, so we're going to spend some additional time mentoring you, making sure you have the tools and helping them set up for it. 

So this program, we started with ten of out what we call “house officers.” They're people that are already veterinarians specializing in various aspects of veterinary medicine. They meet with us once a month for a several hour session where we give them some of these skills and then by participating, we also provide them with some money to do a research project and attend special meetings throughout the country, actually, about how to teach and develop those educational skills as well. 

Hillary: Sounds very fruitful. And we know that there's just such limited time in these veterinary programs or medical programs, right? You can't fit all of these skills and competency trainings into four short years, so it's great that you've developed other programs that help to really foster the leadership skills in the next generation who will be soon leading the way. We actually have a couple of programs within Osmosis that focus on similar skills for medical, PA, nursing and hopefully soon veterinary students. It's definitely an area we're looking to build into more. 

Veterinary medicine is unique in some ways, but actually parallels some of the trends that we're seeing in human medicine and human healthcare education as well. One of the things that I think is a bit surprising is actually the workforce shortage. So obviously, we hear about the issues within healthcare especially as we have this gray wave, we have more boomers entering the healthcare system, but we don't have enough graduated or trained professionals to really meet those needs. What are you seeing in veterinary medicine and what are some of the solutions that you and other leaders are thinking about for meeting demand?

Dr. Meurs: Yes, we see very similar challenges. When I go out in the state or go to national hospitals, I see a lot of people who are not going to go to the national veterinary medical meetings. That is something that I hear from our alumni, from veterinarians within our region… that they're really struggling to hire enough veterinarians, often to replace them. They're thinking that they want to retire in a few years, and they would like either to sell their practice or at least bring in some associates who would get to know the patients in their area before they go away. Or, they're so busy because they have expanded the number of animals in their family, that they just aren't able to keep up with it. 

So we, as well as several other colleges of veterinary medicine, have increased our class size this year. We went from a hundred to a hundred and twenty and that's not enough to solve all of the problems. So I think there are other, perhaps, flexible things that people can work with and there are other, perhaps, flexible things that people can think about. 

For instance, are there opportunities for people to think about working part-time? Traditionally, most veterinarians have worked more than forty hours a week. They maybe owned their practice, and they dealt with all of the emergencies, they managed the staffing, they did all of those business aspects as well. Are there ways, as someone thinks about retirement, that perhaps they still want to work ten hours a week? Or are there ways that they can think about working part-time so that they can stay connected with their community keep their hand in a little bit in their practice while other people come in? Are there ways that veterinary technicians -- or what we might think about as veterinary nurses -- could take on doing additional tasks that they certainly have the skills to do, but we may not have been thinking about, ‘let's have a veterinary technician take on some of these abilities?’ So, I think we're really looking at how we can think about doing things a little bit differently than we used to. 

We have some challenges to that. Certainly with pets, similar to pediatrics, you can't do it all by telemedicine, because you can't just Zoom with someone and examine that animal. Whereas with an adult human, they may be able to have good conversations with you about where their pain is, and how their symptoms are. With an animal, you really want to have more of a hands -on opportunity to examine it. So there's some challenges to some parts of telemedicine that we may not be able to do as easily. But I do think it's 2024, and it's an opportunity for us to think out of the box a little bit about this labor shortage. Are there people that may want to stay in the workforce or enter the workforce but because they have a young family, they just don't want to work the traditional type of ways that we used to? We really need to think about that. 

As a dean, as I hire faculty members, that's something I need to keep in mind as well. It may be that someone doesn't want a traditional full-time faculty position. Is there a way that we can flex the job a little bit?

Hillary: Interesting. We're seeing this kind of flexibility in workforces that I think happen across lots of different industries, including in the tech and healthcare education sectors with telemedicine or maybe online education or things like that. I'll be following this and seeing where it goes, but I love the idea of extending these very tenured, very experienced veterinarians' careers in part-time or kind of mentorship or advisory-type roles and also trying to get younger folks or veterinary technicians into these roles sooner that can maybe be expanded and take more off of the veterinarian's plate. It's interesting. 

So on the flip side of this, we know that it is very difficult to get into veterinary medicine programs. They are highly competitive. In fact, I've heard that they are sometimes more competitive than medical schools. Why is this? And maybe what advice do you have for anyone aspiring to get into a veterinary program?

Dr. Meurs: Well, first, I think it's an amazing job. As I said at the beginning, I have an amazing career or vocation and I've never regretted it. It is highly competitive just because we don't have enough slots. There aren't enough openings every year in the current number of colleges of veterinary medicine that exist. However, I do think that is changing. There are several new veterinary schools coming online and many veterinary schools that have increased their class size like ours. 

For many years, we've just had so many outstanding candidates -- often three or four to every one position that really met all the qualifications and would do an outstanding job -- but there just weren't enough spots for them. Those spots will open as we increase the number of students each school takes. However, it still is a job where you have to be a good student. You have to be someone who's very dedicated to reading and keeping up with whatever the newest medicine is. You need to like to problem solve and you need to like to work with people.

Often our students think this is a job where they work with animals and if they love animals, that's enough. But you need the person to bring the animal in and to help make sure they get their medications and manage the issue. So, it really has so much to do with working with people, even more so, I think, than working with animals.

I think if you are someone who has decided that this is the career for you, I really would encourage you to study hard, even if it does become less competitive academically. You do need to have the knowledge base and have studied science and mathematics, but also social aspects because you are dealing with people and bioethics and so many different aspects. So, it does take a lot of study, a lot of hard work and dedication and discipline, but it's a wonderful career. So, I encourage people to stick with it if you don't get in right away and continue to try to make yourself academically a little bit stronger.

Also, we really look for students that have spent time with a veterinarian because it's a hard job. It's not always easy. There aren't always cases that you can solve and you are dealing with sad situations and so we want to make sure that the students we accept into our program have spent time working with a veterinarian and spent time in a clinic and maybe in a research lab and maybe even around a veterinary school a little bit to learn what that career is really like before they try to take it on. 

Hillary: That's great advice. And I can say I think it takes a very special person to be a veterinarian, given what I've seen growing up in a veterinary hospital with my mom practicing for over thirty years. But I love that you mentioned that the communication skills and working with people is a core part of this role because I think we often think that veterinarians are just working with animals and it's kind of a telepathic medicine of sorts because you can't get information directly from them. You know, you have to do certain tests, and really look at their results and try to figure out what's going on. 

One thing that my mom used to always joke about was that human doctors only had one species to learn about and veterinarians have multiple. So, it's a very complex kind of role that we don't always see on the surface and there's really a lot going on between communicating with the clients and the owners, as well as really understanding the differences between each species and how they are needing to be treated differently. So, you have to be a very special person to be a veterinarian. 

Dr. Meurs: I think that's very kind of you. I'll just say one other thing about the human aspect: I think that even if you're someone who says, “You know what, I don't care. Really, it's the animals that I care about and I'll just make the human part work out.” It's so important. You can do the best job diagnosing a case and have figured out what the problem is, but you're really so reliant on the people following through on getting that medicine in, bringing the animal back in for a recheck or making sure that the dog with the broken leg doesn't overexert itself with that fracture repair. It's so important that you're in a friendly partnership with the person who really manages that patient's care once it leaves your hospital. If that person doesn't have confidence in you or didn't feel that you really cared or were really listening to them, then all the great work that you did with the animal may dissolve when they leave the hospital.

So, I think that human part is almost just something that a person has to view as actually part of practicing veterinary medicine, to ensure that that patient gets the medical care that you're hoping for. I try to talk to our students about that, too. It's not just, ’I need to be good at that because they're coming in’ but also so that they finish the medical care that you're planning on for that animal.

Hillary: Yeah. It sounds like you've had a couple of those conversations with your students and hopefully it's coming through. We obviously want the treatments to be successful, so that partnership will be really critical and a very important skill set to learn, especially as a new grad. 

I know we're getting short on time, so I just have one final question for you. We're a teaching company and one of the things that we love to do is fill in knowledge gaps and try to bridge these education access and just coverage issues. Is there a topic that you think Osmosis should make a video about or a particular area you'd like to see more information on?

Dr. Meurs: Hmm, I do think that in terms of comparative medicine -- which some people prefer to call One Health -- it is very important for the world to understand that many of the diseases that we see in people are in animals and that there are a lot of similarities to studying them in both species, and that that relationship is really a win-win. Particularly environmentally.

If you see that something in the air or on the grass is picked up by the dog or cat that's living in your household, that dog or cat may be the first sign that there's something that could cause problems in people. I think that both groups can win from really looking at the shared experiences, shared genetics, shared nutrition of those species that we live so close to. I'd love to see a topic that talks about comparing medicine across the different species.
 

Hillary: Well, perhaps there's a future partnership on that where we can pull together you and Dr. VandeWoude and others who have a lot of time studying that and create something. Thank you so much, Dr. Meurs, for being with us today. We've really enjoyed our conversation. 

Dr. Meurs: And likewise. Thank you very much for inviting me. I really enjoyed it.

Hillary: I'm Hillary Acer. Thanks for checking out today's show. Remember to do your part to raise the line and strengthen the healthcare system. We're all in this together.