required by LAW CE

Medical guidelines should insists on proof that time-honored medical practices and procedures that cost money and may harm or kill patients are actually effective. This Forum is about how to force organized veterinary medicine to issue Evidence Based Guidelines.

required by LAW CE

Postby malernee » Mon Mar 30, 2009 3:08 pm

Drug companies have largely taken over the field of veterinary education, in part by bankrolling vet education courses at required by law CE courses.
Because vets in most states are required to earn continuing medical education credit, the drug companies have a captive audience

A Journal Sentinel investigation found that industry-funded human doctor education courses offered at UW often present a slanted view by favoring prescription medications over non-drug therapies and by failing to mention important side effects.

Among the findings: --Pharmaceutical giant Pfizer is spending $12.3 million on an online UW course for doctors to tell them how to get their patients to quit smoking. A top priority is prescribing Pfizer's drug, Chantix, which has been linked to serious side effects, including a rash of suicides. But mention of the side effects can't be found in course materials.

--The German company Boehringer Ingelheim Pharmaceuticals paid more than $320,000 to fund a UW course on a condition known as restless legs syndrome. The course said 10% of adults have the disorder, when other research suggests the actual figure is much lower.

--Two companies, Pfizer and Bayer, have spent more than $340,000 to fund a UW continuing education course for doctors that touts their drugs, among others, to treat an extreme form of PMS. Doctors taking the course online aren't told that some of these drugs may not work much better than a placebo.

Four of the nine UW doctor education courses offered online are funded by industry. Those courses are free, while the university-funded courses require doctors to pay a fee. UW officials defend the relationship with drug makers.

"All CME (Continuing Medical Education) courses at UW are evidence-based, free of commercial bias, and are designed to help physicians provide optimal, state-of-the-art care of patients," said George Mejicano, director of UW's Office of Continuing Professional Development.

It's in the financial interest of both academia and industry to join forces to teach doctors: Universities receive large sums of money from drug makers, while the companies get a stamp of legitimacy from the academic center. But critics see ethical problems with the relationship.

"What you are seeing in Wisconsin is just another example of what is going on all over the country," said Arnold Relman, professor emeritus at Harvard Medical School and a former editor of the New England Journal of Medicine. "It's unethical, and it is not in the public interest because it is going to bias doctors to use certain drugs." Drug companies spend about $13 million a year to fund UW medical education courses, and the university receives about 27%, or nearly $3 million of that money, according to records. The rest is going to private firms that put together the course materials.

And because doctors are required to earn continuing medical education credit, the drug companies have a captive audience, said Daniel Carlat, an associate clinical professor of psychiatry at Tufts University Medical School.

In Wisconsin, doctors must take 30 credits every two years. The UW's online courses run up to 2 credits per course.

"Drug companies have found this to be a highly effective way to attract the attention of physicians," Carlat said.

Mejicano countered that the courses "are not educational venues for pharmaceutical companies, but in fact are developed with the aim of improving the health of the public." Jack Cox, a Pfizer spokesman, said continuing medical education helps improve understanding of disease, expands evidence-based treatment and contributes to patient safety. He said all grants made by Pfizer are unrestricted. "We don't shape the curriculum." In January, the Journal Sentinel reported that a $12 million grant from Wyeth Pharmaceuticals was used to fund a UW course on hormone therapy that promoted its benefits and downplayed its risks.

The course ran for several years despite strong evidence that such drugs can cause breast cancer, heart disease, stroke and blood clots. Wyeth makes two of the most popular hormone therapy drugs. Course materials were taken off the Web site only after reporters began asking questions.

Panel appointed The drug industry has increased spending on doctor education from $302 million in 1998 to $1.2 billion in 2006, according to the Journal of the American Medical Association. It now pays for more than half of all such courses.

"Drug companies have essentially hijacked the highest level of medical education we have in this country," said Carlat, who also publishes a monthly continuing medical education psychiatry report that does not accept drug company funding.

UW officials in January appointed a panel to investigate the university's doctor education office. The action was taken after the Journal Sentinel exposed conflicts of interest and raised other questions about the university course on hormone therapy. The probe is part of a wide-ranging plan under consideration at UW to change the way its doctors interact with drug companies.

The UW continuing education courses offered at no cost to enrolling doctors all claim that drugs are the first line of treatment for the various diseases they discuss.

The five non-industry courses cost $20 a person and stress nutrition and quality of life issues for patients.

The Wisconsin Medical Society and Stanford University are among those that have called for severe restrictions on industry money.

How courses initiated A quick look at several drug company Web sites provides information about how these continuing medical education courses are initiated.

Drug makers solicit proposals from universities and private firms to create course materials for specific disorders.

For instance, Wyeth is currently asking for proposals for ailments such as "menopausal health," AstraZeneca is looking for someone to create courses on migraines and generalized anxiety disorder, and Boehringer Ingelheim is soliciting a course on a condition called female hypoactive sexual desire disorder.

Drug makers are eager to fund such courses because it allows them to get favorable treatment for their newer and more expensive brand-name drugs, according to records and several observers interviewed by the Journal Sentinel.

Indeed, it would cost $1,200 a year for Mirapex, Boehringer Ingelheim's restless legs syndrome drug touted in the UW course. Or, in the case of Pfizer's anti-smoking drug Chantix, $1,760 would buy an annual supply.

Observers and critics of the practice say drug companies solicit proposals soon after they have received FDA approval to market a brand-name medication.

Eager to promote their drug to doctors, the drug company typically will work with a private medical education company. The medical education company is paid a large fee to put together course materials about the disease.

While there may not be a written agreement, it is expected that the course materials produced by the medical education company will favorably mention the drug.

In the UW's restless legs syndrome course, Boehringer Ingelheim's drug, Mirapex, is described as one of two "first-choice" therapies.

In the case of the smoking-cessation course, Pfizer's drug Chantix, is described as the "first-line" therapy.

The companies also may hand-pick doctors who have financial ties to companies to serve as course faculty.

This pattern was seen in all of the UW courses reviewed by the Journal Sentinel. Each course relied on faculty with ties to the funder.

Once the medical education company is granted a drug company contract, it typically approaches a medical school such as UW to run the course. The medical school is paid a fee that can range from tens of thousands of dollars to several million dollars.

The arrangement works out well for most everyone involved: Doctors get their education subsidized by drug companies. Drug companies sell more of their products. Universities and medical education companies get a steady stream of big money.

But beyond the inherent conflict posed by drug companies paying for courses that disseminate information about their products, the funding raises a larger question: Why shouldn't doctors pay for their own education? "American doctors are the best paid doctors in the world," said Carl Elliott, a professor of bioethics at the University of Minnesota Medical School. "To hear them plead poverty and say they can't pay for their own education is the height of hypocrisy." Smoking cessation course Some of the biggest money paid to UW has been for its smoking cessation course, part of a national campaign funded by Pfizer.

Of the $12.3 million paid by the drug company to fund the course, $3.5 million is going to UW.

The course materials heavily promote Pfizer's drug, Chantix, considered to be the most effective drug on the market. But the drug is under investigation by the FDA, and in its relatively short history on the market, it has been linked to serious side effects, none of which is mentioned in the course.

Side effects include depression, agitation, suicidal behavior and blackouts. For two consecutive quarters, Chantix was connected with more serious injuries than any other prescription drug, according to an October report by the Institute for Safe Medication Practices. Since its approval in 2006, the drug has been linked to 3,325 serious injuries and 112 deaths in the U.S.

Last May, the FAA ordered pilots and air traffic controllers to immediately stop taking the drug because of safety concerns.

Course materials also fail to mention that large numbers of people were excluded from the clinical trials that led to the drug's approval, raising questions about its real world effectiveness.

For instance, a 2006 study headed by UW researcher Douglas Jorenby and funded by Pfizer found that 23% of Chantix users had abstained from smoking for one year, compared with 15% who got the drug bupropion and 10% who got a placebo.

But the study excluded a wide-range of subjects, including people with heart disease, mental illness, allergies and other conditions.

UW's Mejicano said he did not think the side effects or the people excluded from the clinical trials should have been included in the course. He said such courses are rarely comprehensive and are designed to meet selected learning objectives.

No strings, firms say Drug companies argue that funding for doctor education courses comes with no strings attached.

But when the content of such courses is put under a microscope, questionable practices are common.

Consider UW's restless legs syndrome course, which Boehringer Ingelheim paid nearly $321,000 to fund, including $17,000 to UW. Boehringer Ingelheim's Mirapex is used to treat the condition, which is marked by an irresistible urge to move limbs, along with a tingling sensation. The condition reduces the quality of life.

The course says about 10% of adults have the disorder.

But a 2005 study in the Archives of Internal Medicine found that moderate to severe restless legs syndrome, the kind that might be treated by a doctor, existed in only 2.7% of adults. And even that figure probably is too high, according to a 2006 article in the journal PLoS Medicine. The article noted that the survey used to do the 2005 study was done in a way that likely exaggerated the number of people who have the condition.

UW's Mejicano said it is common to have different prevalence rates for disorders. He said the course author and reviewer were comfortable with the 10% figure.

The percentage is important because critics say the more common doctors believe a condition is, the more likely it is they will diagnose it in a patient and prescribe medication.

Boehringer Ingelheim also paid speaker's fees and provided research funding for two non-UW doctors who served as faculty for the course.

Although the course can still be accessed online, as of August 2008 it was no longer available for credit.

Boehringer Ingelheim spokeswoman Lara Crissey said the company has no control over course content.

In October, the FDA issued a warning to the German drug company, demanding that it stop misleading consumers about the effectiveness of Mirapex.

Among other things, the FDA cited pharmacy handouts for consumers that suggested the drug could be used to treat up to 10% of the adult population when, in fact, it is approved to treat only a much smaller percentage of people with moderate to severe forms of the disorder.

The other drug mentioned in the course as a first choice therapy is Requip, made by GlaxoSmithKline. The company also provided funding to two outside faculty members for the course.

Financial ties For more than six years, the drug makers have relied on UW to promote its drugs to treat an extreme form of PMS.

Of the $340,000 Pfizer and Bayer spent to fund the course on premenstrual dysphoric disorder, UW received about $24,000.

The course was designed by the nonprofit Madison Institute of Medicine. The institute's three founders, all psychiatrists affiliated with the medical school, have financial ties to nearly two dozen drug companies, including Pfizer.

Several of the drugs promoted in the course are not approved by the FDA to treat the condition and have serious side effects not mentioned on the course Web site, including depression, stroke and blood clots.

Consider Pfizer's anti-anxiety drug Xanax.

The course cites a small study of Xanax, but fails to point out that only 37% of women who took it had significant improvement, compared with 30% who got a placebo. The course also does not mention Xanax's side effects, including the potential of dependency.

An internal UW review last June said the course could be viewed as "significantly commercially biased" in favor of treating the disorder with drugs. Little was done to address that concern in the final version.

Bayer spokeswoman Rose Talarico said company policy prohibits grants that are conditioned on prescribing, purchasing or reimbursement of any Bayer product.

In an interview, James Jefferson, the course's author and co-founder of the Madison Institute of Medicine, said the course material is unbiased and supported by scientific evidence.

"I don't believe in hyping products that haven't established themselves with good literature as being useful," he said.

Jefferson said the course materials make it clear which drugs are approved by the FDA.

UW's Mejicano said the course is in full compliance with national standards for disclosing potential conflicts of interest.

Drug approval Premenstrual dysphoric disorder, or PMDD, affects less than 8% of menstruating women. The condition can be diagnosed when at least five of 11 symptoms are found, including debilitating anxiety, depression, irritability and moodiness.

Pfizer stopped funding the class in 2006. The course started up again in 2008 with funding from Bayer, which got approval in 2006 for its heavily advertised drug Yaz to treat the condition.

In a review published in the Cochrane Collaboration earlier this year, the authors wrote that a "placebo would be less expensive for treating PMS and has fewer side effects than the active pill," meaning Yaz and similar drugs.

And while the course cited the review, it did not mention the conclusion.

Jefferson said it's up to doctors to warn their patients about potential side effects.

To see more of the Milwaukee Journal Sentinel, or to subscribe to the newspaper, go to
Site Admin
Posts: 462
Joined: Wed Aug 13, 2003 5:56 pm

Measures of Perceived Self-Efficacy

Postby malernee » Wed Aug 19, 2009 6:55 am

Found this study that tried to measure Perceived Self-Efficacy interesting. Reminds me of the words in "god we trust" printed on our money with no attempt to measure god, why we should trust god or if we trust god what outcome should we expect.

Measures of Perceived Self-Efficacy as a Method of Evaluating Educational Outcomes:
An Introduction
Eric D. Peterson, EdM
Academy for Healthcare Education, Inc, New York, New York
Continuing education (CE) providers for the healthcare professions
are under increasing pressure to demonstrate that their educational
programs have a positive impact on provider behavior and
ultimately on the quality of care provided to patients. Because it is
difficult and expensive to demonstrate impacts on healthcare providers,
measures of perceived self-efficacy may serve as a useful proxy for
healthcare provider performance in some situations.
Perceived Self-Efficacy
Perceived self-efficacy is a belief in one’s ability to organize and
execute the courses of action required to produce given attainments
and confidence in one’s ability to perform the necessary tasks to
achieve a particular goal.
Social Modeling
Individuals adopt a behavior of social modeling by observing
others like themselves succeeding at a task through sustained
effort and forming the belief that they have the capacity to
achieve similar success.
Social Persuasion
When others convey their confidence that an individual can succeed
and avoid placing that individual in situations where he or she
might fail before experiencing a degree of success, they engage in
social persuasion.
Mastery Experiences
Experiences that convey a realistic view of what is required for success
and provide to learners practical experience with overcoming obstacles
and managing potential failures are referred to as mastery experiences.
Measures of perceived self-efficacy may prove to be a practical and
valid measure of the impact of educational activity. Self-efficacy, a construct
from social cognitive theory, was first proposed by Bandura in
1977 [1] and has produced an extensive research tradition. Bandura
conceptualizes human beings as proactive agents who form intentions
for action and create strategies to achieve a desired result. He defines
perceived self-efficacy as “beliefs in one’s capabilities to organize and
execute the courses of action required to produce given attainments”
[2]. It is important to note that self-efficacy is not a general trait, but
a belief held by an individual related to his or her ability to achieve a
Correspondence: Eric D. Peterson, EdM, Vice President, Continuing Education, Academy for Healthcare Education, Inc, 330 Madison Avenue, New York, NY 10017;
212-404-7704 (
Introduction: Continuing education (CE) providers for the healthcare professions are under increasing pressure to demonstrate that their educational programs
have a positive impact on provider behavior and ultimately on the quality of care provided to patients. However, gaining insight into the practice behavior of healthcare
providers is both difficult and expensive. This article proposes that measures of perceived self-efficacy may serve as a useful proxy for healthcare provider
performance in some situations.
Discussion: The construct of self-efficacy has been extensively researched and found to be broadly useful. This article summarizes literature supporting the use
of this construct as an accurate predictor of clinician performance, discusses issues related to study design, and provides a few examples from preliminary studies
conducted from this perspective.
Conclusions: Measures of perceived self-efficacy have been demonstrated to predict performance and can be transformed through mastery experiences. Measures
of perceived self-efficacy collected before and after participation in an educational intervention designed to contain sufficient elements of mastery may be
useful in assessing the impact of these interventions on the future performance of learners.
CE Meas. 2006;1:35-39. doi:10.1532/CEM06.06505 | ©2006 The University of Medicine and Dentistry of New Jersey
particular outcome in a specific domain of functioning.
Individuals will vary in their self-efficacy beliefs related to
different tasks. For example, one would expect that a professional
tennis player would have robust efficacy beliefs
related to his ability to return the serves of another tennis
player, but may have far less vigorous efficacy beliefs
related to his ability to play the violin. Bandura points out
that efficacy beliefs are not in and of themselves an indication
of skill. However, when
confronted with the same task,
individuals with strong efficacy
beliefs are willing to expend far
more effort to achieve their goal
than those with weaker efficacy
beliefs. They are also more willing
to attribute failure to achieve
that goal to lack of effort compared
with those with lower
perceived self-efficacy. Finally,
people with high efficacy beliefs
display more resiliency in managing
their anxiety related to
task performance.
Bandura proposes several ways of transforming an
individual’s efficacy beliefs, including social modeling
(observing others succeeding through sustained effort)
and social persuasion (being persuaded by others that
one has the ability to succeed). An individual’s interpretation
of his or her emotional state also influences efficacy
beliefs. Individuals often consider tension or anxiety
when performing a task an indication of their inability
to execute the task properly (Table 1).
The most important influence on self-efficacy beliefs is
what Bandura refers to as a mastery experience. Mastery
experiences give individuals the information and skills
necessary to attain a specific goal and provide them with
a realistic assessment of the effort required to perform a
specific task. Mastery experiences also provide the individual
with enough experience to persevere when faced
with difficulties as well as to manage anxiety [3].
Many CE interventions contain adequate elements to
transform the efficacy beliefs of participants related to a
clinical skill. For example, a general internist who lacks
the confidence to manage patients with advanced cardiovascular
disease may enroll in a weekend course on cardiovascular
disease. During the course, she will receive
valuable information concerning the management of
patients with cardiovascular disease and gain practical
experience in applying the information through case
discussion and practice exercises (mastery experiences).
She may interact with other general internists who are
more confident in managing this type of patient (social
influence) and may receive positive encouragement from
an instructor (social persuasion) that she will master
the skill. She will return to practice with new information
and resources and new beliefs about her ability
to successfully manage her cardiovascular patients.
Although one weekend may not be enough time for her
to entirely consolidate the skill set necessary to manage
these patients, her transformed efficacy beliefs will have
a direct causal relationship with her subsequent behaviors:
she will attempt to manage patients that she would
have previously referred to a specialist. She will also be
far more resilient when faced with difficulty.
The role of perceived self-efficacy has been investigated
extensively over a wide range of human functioning
and has proven to be broadly useful [4-12]. Specific
results relevant to CME include the consistent finding
that measures of self-efficacy accurately predict student
academic performance [9]. A meta-analysis has also
demonstrated that self-efficacy reliably predicts work
performance in a variety of settings [12]. Finally, in a
study with student physician assistants, measures of selfefficacy
proved to accurately predict both academic and
clinical performance [13].
If measurement of perceived self-efficacy predicts
actual performance, and CE includes many of the factors
that can transform self-efficacy beliefs, then measurement
of perceived self-efficacy might serve as a useful
tool for evaluating CE outcomes. Toward that end,
it is helpful to discuss some of the practical implications
of using self-efficacy to evaluate educational outcomes
and relate some preliminary explorations of the
36 Peterson
Table 1. Factors Influencing Self-Efficacy Beliefs [2]
Source of Influence Definition
Social Modeling Individuals observe others whom they identify as being like themselves succeeding through sustained effort
and form the belief that they have the capacity to achieve similar success
Social Persuasion Others convey their confidence that the individual can be successful and avoid placing that individual in
situations where he or she might fail before experiencing a degree of success
Mastery Experiences Experiences that convey a realistic view of what is required for success and practical experience with
overcoming obstacles and managing potential failures
Physical and Emotional States Individuals often interpret tension and anxiety as indications that they are not capable of performing
a task
Self-efficacy is not a general
trait, but a belief held by an
individual related to his or
her ability to achieve a particular
outcome in a specific
domain of functioning.
CE MEasure • Volume 1, Issue 1 • 2006 37
The first important consideration involves selecting an
appropriate CE intervention for using the self-efficacy
model of outcomes evaluation. It is important to determine
if the intervention is designed to teach or facilitate
the acquisition of a new clinical skill or simply to disseminate
information. Only the former would be appropriate
for a self-efficacy measurement. Also, a measure
of perceived self-efficacy is appropriate only when an
educational intervention provides the learner with sufficient
elements of mastery experience, social modeling,
or social persuasion to affect the individual’s perception
of self-efficacy relative to the new skill.
Measures of self-efficacy should be collected before
and after an educational intervention, and the tasks measured
should be relevant to the course material. Ideally,
the provider would link a specific learner’s pre- and posttest
results. To guard against bias in the responses, learners
should respond privately. Their
pre- and posttest results may be
matched through the use of a code
that protects the confidentiality of
the individual respondents. In less
rigorous settings, useful data may
be obtained without matching
specific pre- and posttest results, as
long as the sample is large enough.
Providers should also consider
additional follow-up surveys at a
later date to assess whether or not
healthcare providers have incorporated
the skill into their practice.
Regarding the construction
of scales to measure self-efficacy,
Bandura has provided a useful
guide that includes many examples
[14]. A survey or test item is presented
as an affirmative statement,
to which respondents reply by
assessing their confidence in performing
the stated task according to a numerical
scale. The scale recommended by Bandura ranges
from 0 (cannot do at all) to 100 (highly certain
can do) including a midpoint (moderately certain
can do), but scales can be reduced to a range
from 0 to 10 for convenience. Alternately, an
investigation by Pajares and colleagues compared
more conventional 6-point Likert scales with
0 to 100 scales and found the responses to be
roughly equivalent [15].
When constructing the items, one should
consider the domains of function that are to be
explored, ensuring that items address efficacy
beliefs relevant to those domains. A domain of
function refers to a set of related and sometimes
dependent skills. An individual’s assessment of
her ability to accurately measure blood pressure may not
be relevant to her ability to make appropriate treatment
decisions for patients with different presentations of
hypertension or who have other comorbid conditions.
While the ability to obtain the blood pressure value is
required before one can acquire more advanced skills
such as interpreting the blood pressure data or making
treatment decisions, these complex tasks represent separate
and distinct tasks within a single domain.
It is also important to include enough items related
to a given domain of function to adequately explore the
efficacy beliefs related to that domain. Individuals differ
in their ability to perform under certain conditions, such
as time constraints or a stressful situation. To the extent
that it is important to the domain of function, items
should reflect gradations of challenge. Figure 1 shows an
example of a self-efficacy scale, with 3 items of increasing
level of challenge.
Figure 1. Example of a self-efficacy scale with items of progressive challenge in one
domain, the use of spirometry, a diagnostic test measuring lung function.
Figure 2. Data collected before and after a 2-hour COPD symposium, presented in a 1-5 Likert scale.
The percentages at the right indicate the increase in confidence from the prior-to-meeting text to the
follow-up survey.
My colleagues and I have performed several pilot
studies using self-efficacy as an evaluation measure, with
interesting results. These preliminary data have resulted
in considerable refinement of our research designs.
Figure 2 shows data collected before and after participation
in a 2-hour activity addressing the management
of patients with chronic obstructive pulmonary disease
(COPD). In addition, we collected data approximately
6 to 8 weeks after the activity. The example suffers from
imprecision in the framing of the items and in the construction
of the scales. However, despite these limitations
we were able to measure immediate gains. The
long-term follow-up data were limited by low numbers
of respondents and showed a modest drop-off after 6 to
8 weeks. Although the low numbers may not allow for
strong conclusions, they are generally consistent with
what we know about the outcomes of low-intensity
Figure 3 shows data collected before and after a 4.5-
hour case-based, interactive activity also devoted to the
diagnosis and management of COPD. This CE intervention
was better suited to a self-efficacy outcomes
measure because the interactive format provided elements
of social modeling and social influence, and the
case study format provided a greater degree of mastery
of the use of the information in a meaningful context.
Furthermore, we paid closer attention to the construction
of the items and the scales and subjected the data to
more rigorous analysis. We were able to measure statistically
significant changes in perceived self-efficacy related
to specific, clinically relevant tasks. We have since conducted
several more rigorously designed studies and look
forward to sharing these data with the CE community in
the near future.
Because of concerns about the cost and quality of
healthcare [16-26], providers are under pressure to
demonstrate the effectiveness of CE for physicians and
other healthcare professionals in improving patient care.
Increasingly, providers, grantors of funds, and the public
are looking to healthcare professional performance as a
primary measure of the value of educational investments
(Table 2). The cost and range of application of traditional
measures of physician performance, such as chart
reviews and standardization of patient interaction, have
led health science researchers to look for convenient and
valid proxies for physician performance.
Measures of perceived self-efficacy have been demonstrated
to predict performance accurately, and mastery
experiences, such as those provided by CE activities,
have the ability to considerably transform efficacy beliefs.
Therefore, measures of perceived self-efficacy may be
very useful in assessing the impact of selected educational
interventions. Although the application of this method
requires some skill, this method has advantages over other
methods in terms of less expense and ease of application.
Preliminary studies using self-efficacy as an outcome
measurement have yielded interesting results, along with
information helpful in refining study design. The results
of subsequent, more rigorous studies will be available
soon. Overall, the findings are encouraging, and self-efficacy
measures may soon be a useful tool for CE providers
to demonstrate the effectiveness of CE interventions
for influencing clinician behavior.
The author acknowledges the valuable assistance provided
by Annette Schwind and Sandi Lusk in the preparation
of this manuscript.
38 Peterson
Table 2. Levels of Educational Outcome*
Level Outcome Definition
1 Participation Number of target audience members who
2 Satisfaction Degree to which the participant’s expectations
were met
3 Learning Changes in knowledge, skill, or attitude
4 Performance Changes in practice behavior that resulted
from learning
5 Patient
Changes in patient health status that
result from changes in practice behavior
6 Population
Changes in the health status of a population
that result from changes in practice
*Source: Moore DE. A framework for outcomes evaluation. In: Davis D, Barnes BE, Fox
R, eds. The Continuing Professional Development of Physicians: From Research to
Practice. Chicago: AMA Press; 2003. Copyright 2003, American Medical Association.
Adapted with permission.
Figure 3. Data collected before and after a 4.5-hour interactive, case-based activity, presented in a
0-10 Confidence scale.
CE MEasure • Volume 1, Issue 1 • 2006 39
1. Bandura A. Self-efficacy: toward a unifying theory of behavior
and change. Psychol Bull. 1977;58:143-159.
2. Bandura A. Self-Efficacy: The Exercise of Control. New York:
W. H. Freeman; 1997:3.
3. Bandura A. Swimming against the mainstream: the early
years from chilly tributary to transformative mainstream. Behav
Res Ther. 2004;42:613-630.
4. Boyer DA, Zollo JS, Thompson CM, Vancouver JB, Shewering
K, Sims E. A quantitative review of the effects of manipulated selfefficacy
on performance [poster abstract]. Annual Meeting of the
American Psychological Association; Miami, Florida; 2000.
5. Gully SM, Incalcaterra KA, Joshi A, Beaubien JM. A metaanalysis
of team-efficacy, potency, and performance: interdependence
and level of analysis as moderators of observed relationships.
J Appl Psychol. 2002;87:819-832.
6. Holden G. The relationship of self-efficacy appraisals to
subsequent health outcomes: a meta-analysis. Soc Work Health
Care. 1991;16:53-93.
7. Holden G, Moncher MS, Schninke SP, Barker KM. Selfefficacy
of children and adolescents: a meta-analysis. Psychol
Rep. 1990;66:1044-1046.
8. Moritz SE, Feltz DL, Fahrbach KR, Mack DE. The relation
of self-efficacy measures to sport performance: a meta-analytic
review. Res Q Exerc Sport. 2000;71:280-294.
9. Multon KD, Brown SD, Lent RW. Relation of self-efficacy
beliefs to academic outcomes: a meta-analytic investigation.
J Couns Psychol. 1991;38:30-38.
10. Sadri A, Robertson IT. Self-efficacy and work-related
behavior: a review and meta-analysis. Appl Psychol Int Rev.
11. Stajkovic AD, Lee DS. A meta-analysis of the relationship
between collective efficacy and group performance. Presented
at: National Academy of Management Meeting, Washington,
DC; August 2001.
12. Stajkovic AD, Luthans F. Self-efficacy and work-related performance:
a meta-analysis. Psychol Bull. 1998;124:240-261.
13. Opacic DA. The relationship between self-efficacy and student
physician assistant clinical performance. J Allied Health.
14. Bandura A. Guide for constructing self-efficacy scales.
In: Pajares F, Urdan T, eds. Self-Efficacy Beliefs of Adolescents.
Greenwich, CT: Information Age Publishing; 2006.
15. Pajares F, Hartley J, Valiante G. Response format in writing
self-efficacy assessment: greater discrimination increases
prediction. Meas Eval Couns Dev. 2001;33:214-221.
16. Institute of Medicine. In: Kohn KT, Corrigan JM,
Donaldson MS, eds. To Err Is Human: Building a Safer Health
System. Washington, DC: National Academy Press; 1999.
17. Leape LL. Institute of Medicine medical error figures are
not exaggerated. JAMA. 2000;284:95-97.
18. Starfield B. Is US health really the best in the world?
JAMA. 2000;284:483-485.
19. Gurwitz JH, Field TS, Judge J, et al. The incidence of
adverse drug events in two large academic long-term care facilities.
Am J Med. 2005;118:251-258.
20. Phillips DP, Christienfeld N, Glynn LM. Increase in US
medication-error deaths between 1983 and 1993. Lancet.
21. Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse
drug reactions in hospitalized patients: a meta-analysis of prospective
studies. JAMA. 1998; 279:1200-1205.
22. Healey MA, Shackford SR, Osler TM, Rogers FB, Burns E.
Complications in surgical patients. Arch Surg. 2002;137:611-618.
23. Zhan C, Miller M. Excess length of stay, charges, and mortality
attributable to medical injuries during hospitalization.
JAMA. 2003;290:1868-1874.
24. Centers for Disease Control and Prevention. Monitoring
hospital-acquired infections to promote patient safety—
United States, 1990-1999. MMWR Morb Mortal Wkly Rep.
25. Wenzel R, Edmond M. The impact of hospital-acquired
bloodstream infections. Emerg Infect Dis. 2001;7:174-177.
26. Leape LL, Berwick DM. Five years after To Err Is Human:
what have we learned? JAMA. 2005;293:2384-2390.

Site Admin
Posts: 462
Joined: Wed Aug 13, 2003 5:56 pm

Veterinary CE a April fools joke

Postby malernee » Sat Apr 03, 2010 8:49 am

sad to say vets must produce hours of CE for their veterinary boards that are not measured in hours. I think many vets like the system of tooth fairy CE where nothing is measured except how may drinks they can have before they drive home.

art malernee dvm
fla lic 1820

IRS and Veterinary Leaders Agree on Veterinarian CE Tax Reform
By Dr. Doug Mader
April 1, 2010
In a marathon arbitration session that ended just hours ago the movers and shakers from the veterinary community and the Internal Revenue Service (IRS) hammered out new rules and regulations that pertain to the “tax deductibility” of veterinary continuing education (CE) courses that are sure to shake up the veterinary community, the educators, and the accountants alike.

“Historically, veterinarians have chosen venues for CE that have taken them to recreational or hedonistic locations such as Disney World and Las Vegas,” a representative for the IRS stated in a scripted press release under the veil of anonymity. “They then charge these trips to their businesses and write off all the expenses as 'business related.'"

“Years ago veterinary CE was basically a gathering of educators and veterinarians with the specific purpose of learning new concepts in veterinary medicine,” Dr. Henry Childers, a 57 year veterinary veteran and former president of the American Veterinary Medical Association, stated in a phone interview. “ You never had buffets with prime rib, drink tickets and over-the-hill rock and roll bands.” Childers continued, “watching these old guys in spandex just isn't right.”

New regulations would also apply to the “e-learning” CE revolution that is sweeping the country. “We hope to make the veterinarians an example,” the IRS report claimed. “We know that MDs, dentists and, God forbid, lawyers, all do the same thing. It is just that veterinarians are so much easier to go after. They tend to be nonconfrontational. We certainly don't want to start this witch hunt by going after the attorneys.”

In order for veterinary CE expenses to be legitimate tax write-offs, the new regulations are clear that veterinary CE meetings can no longer have any social components. This is done for several reasons, but mainly, the document states, to prevent excessive drinking and partying amongst the attendees.

“How can you expect a veterinary doctor to sit in a classroom and learn anything if they have been out drinking and cavorting all night long?” The IRS representative stressed the latter.

In addition, the IRS does not want veterinarians bringing their spouses, significant others, and especially their families to meetings as they feel it would be a distraction to learning.

“Again, these vets are supposed to be learning and studying. I remember in tax school, we used to stay up all night studying and preparing for our learnings the next morning. This just is not possible if you have to spend time with the kids.”

The new tax rules state that “all veterinarians must pass a test on any subjects that they attended prior to leaving the venue, with a score of at least 71%, or the CE credit hours will not count.” If an attendee fails to score less than the minimum they may retake the test after reviewing the proceedings or pay a supplemental fee in cash to the proctor in order to receive credit.

“This is terrible news. It is going to be devastating to veterinary CE as we currently know it.” Dr. Colin Burrows, Executive Director of the NAVC demonstrated angst while at an emergency meeting of the IAVCEED (International Association of Veterinary Continuing Education Executive Directors). With his iconic British accent he deadpanned, “Me thinks it may be the end of the NAVC if we take away the big mouse!” (referring, of course, to Disneyland).

“I don't think we could get a single veterinarian to come to Vegas if they couldn't gamble or drink.” Dr. Guy Pidgeon, the Executive Director of the Western Veterinary Conference lamented. “What happens in Vegas, stays in Vegas!” Dr. Pidgeon proclaimed, but then added “Except, of course, the CE part. They always take that back to their practices.”

The new rules and regulations will start April 1st (April Fool's!), 2010.

Share ThisPrint
65 comments so far...

Funny.....take a pill people!
Hilarious article....I was suspicious as it came out on April fools day and by the second paragraph assumed it was a joke. All the people slamming it need to ease up and get a life!
Fri, 04/02/2010 - 08:56 — Roger Smith, DVM (not verified)
What is wrong with you, "I Believe It?"
If you believe it, it's only because you're one of those gullible, tea-bagging, birther nut-jobs that are going to ruin the country long before any so-called "socialist" agenda has a chance to. Lighten up, wacko. Maybe you should just join some militia and "prepare for Armageddon."
Fri, 04/02/2010 - 08:44 — Deborah Cottrell (not verified)
That was awesome!
Colin Burrows does have a sense of humor. Totally believable quote from him...the big are funny Mader!
Fri, 04/02/2010 - 06:44 — Rod Winchester (not verified)
April Fools
Thanks for a good joke Doug!! Always the clever one...
Fri, 04/02/2010 - 00:07 — Kerry L (not verified)
Veterinary CE Tax Reform
Gentlemen, I am sad that you have the time to write such a ridiculous article. So MANY Vets and the PUBLIC have read this, not knowing it was an April Fools Joke! Veterinarians work so hard to maintain qualities of dedication and work ethics, no other profession can match. Why would you degrade them? What imagage are you giving Society and of course, the Federal Govt.- C E Seminars are worth the Comradeship and exchange of ideas, if nothing more! Do you honestly think the Medical, Dental and Bar would be this stupid? Wake up gentlemen- you have a sick sense of humor!!! Maybe you can spend some time in Haiti or with our boys over seas- see what American is all about!
Thu, 04/01/2010 - 23:07 — Guest (not verified)
oh please.
i hope your comment was a joke, b/c it is certainly ridiculous and in hysterics.
Thu, 04/01/2010 - 23:00 — Guest (not verified)
Thu, 04/01/2010 - 22:56 — Guest (not verified)
They should consider testing
They should consider testing blood alcohol content. If you pass, you get CE credit. And why not make it across the board for CE in all the professions. This is ridiculous.
Thu, 04/01/2010 - 22:22 — Guest (not verified)
I believed it b/c it is
I believed it b/c it is certainly in line with all the other socialist/communist/totalitarian things that are coming out of this Administration. Would not be surprised if it came true.
Thu, 04/01/2010 - 21:19 — Guest (not verified)
You all need to be shot for
You all need to be shot for this! As I was reading nearer the end. I actually thought, "This is a joke!" I was too relieved to see that it was. You Got Me!! ;} HEHEHE!
Thu, 04/01/2010 - 20:58 — Gina (not verified)
you got me, too!!!
That is so funny!!! I just finished complaining to my husband, who is also a vet, about it. Well done.
Thu, 04/01/2010 - 20:31 — Jen (not verified)
Nice one
I haven't been had in years, and you got me with this! Way to go! My blood pressure was up and I was trying to figure out where vets could go and not drink (Merced, CA?) Great joke, and thanks for ending my day with a laugh. I shared with my associate and had her hook, line and sinker, too.
Thu, 04/01/2010 - 20:23 — Ken Sawyer DVM (not verified)
Article was awesomely funny
I'd volunteer to do some of the surgeries - but after reading some of these comments - I fear many of these folks have the pole in far too tight for successful removal!!!
Thu, 04/01/2010 - 19:25 — Guest (not verified)
Thank you
Thank you for having a great sense of humor. Well written and I'm sure enjoyed by most. The rest of you who didn't get it need to take a vacation.
Thu, 04/01/2010 - 19:15 — SM (not verified)
You got me! I was about to
You got me! I was about to call my congressman. The best part was about how "non-confrontational" we are. Heehee. First time I was fooled today. Good job.
Thu, 04/01/2010 - 18:31 — Rachel Roark (not verified)
You had me - I was getting quite upset as I read down the article. That said, I was SO HAPPY when I read the last line - ***REALLY WELL DONE!**** Thanks for your great writing and I hope this is not your last blog!
Thu, 04/01/2010 - 18:31 — Grayson (not verified)
I meant I agree with Wayne
I meant I agree with Wayne
Thu, 04/01/2010 - 18:15 — Debbie Moore DVM (not verified)
I so agree with you.
I so agree with you.
Thu, 04/01/2010 - 18:13 — Debbie Moore DVM (not verified)
Man was I caught by that one hook, line, and sinker. I was even kind of insulted by the witch hunt and spandex comments, thinking, hey there's nothing funny about this. Anyone that isn't ROFL after reading that needs to have funnybone reconstruction surgery.
Thu, 04/01/2010 - 16:48 — Guest (not verified)
I love a good joke and am
I love a good joke and am guilty of plenty of them myself. However, your timing and venue stinks! Why publish such an article. Why waste my time. Why present ideas so ridiculous that they would fit right in with the government regulation and legislative bills we are already fighting only to give our legislators and government agencies more ideas to consider? Good Idea, Good Joke, WRONG PLACE!!!!
Thu, 04/01/2010 - 16:43 — Wayne Morris, DVM (not verified)
Goes to show that it COULD be worse!!
I thought I made it through the day without getting April fooled. That was awesome. Whats even funnier is reading the comments from the folks that haven't realized its a joke yet.
Thu, 04/01/2010 - 16:40 — Guest (not verified)
veterinary income
We veterinarians do not have the income that MD have nor will we ever until our patients get "medicaid and medicare". The American Medical Association is one of the strongest Lobbying organizations in Washington!!!! Do you think the senators and representatives are going to attack any organization that they themselves most likely have a vested interest in...........probably own stock in a pharmaceutical company or hospital chain or nursing home or insurance company. God forbid them attack the very organization they are depending on for retirement income dollars or possibly a hunting trip to Montana or fishing in Florida and stay in Company owned lodging..........they are going to vote for what ever is in THEIR best interest, not the low income veterinarian that does not have medicaid or medicare to commit legal larseny on and cannot "wine and dine" them!!! We are a weak organization and always will be. When the government runs out of money and the hospitals no longer have the medicaid and medicare dollars to keep there doors open.........then perhaps there will be MD looking for a job in the veterinary profession
Thu, 04/01/2010 - 16:40 — Melanie (not verified)
Would be funny....
This would be funny if it couldn't actually be true in today's environment. Read on and you'll see comments chastising those blaming Obama, etc., for stuff like this, but the reality is that we veterinarians are completely over-regulated as it is, both from a medical and especially a small-business standpoint. Call me paranoid, but the "IRS statements" don't sound that far-fetched to me. And further, I could actually see my veterinary representatives, God forbid, selling out and going along with the big-government types (see AMA & Obamacare).

Kudos, CB, for your attempt at an April Fool's joke. But after years of Americans electing big-government Nannies that appoint even bigger-government Nannies to unelected positions that harm my livelihood, I'll pass on this type of humor.
Thu, 04/01/2010 - 16:03 — Ryan Gates (not verified)
You got me! I was almost ready to call my congressman. We all need a sense of humor to get through these trying times. Yes, we are a hardworking wonderful group of professionals and this makes the article even funnier.
Thu, 04/01/2010 - 15:59 — Guest (not verified)
not so funny for those who were audited last year
I am someone who tries to legitimately pay my taxes, but would appreciate if we could deduct medical expenses, just like the big companies. I was audited here Jan - April of 09, and the Bizplan contact we set up at our accountant's urging to pay my wife to run the accounting side of things, then pay her benefits blew up in my face as they disallowed it because 'no one would legitimately work for that low pay only for benefits.' She did not see this year when even when grossing 330K, I made less than my CVT... So forgive me if I have very little humor for this type of thing - it is all to frequent. Oh, and the reason my return was flagged? I was a DVM with more mileage than most claim (even though I had claimed that amount of mileage for the past 15 years of doing locum tenens -relief- work).
Thu, 04/01/2010 - 14:55 — Ray Ramirez DVM (not verified)
When you get Dr. Burrows to go along with such a gag, it makes it all that much funnier. The gammitt of responses to this article are as diverse at the personalities of my graduating class in veterinary school. Some of them still can't take a joke but some of us keep trying to get a smile out of them. RB Leonard, DVM University of Florida 1986
Thu, 04/01/2010 - 14:36 — RB Leonard (not verified)
you suck ;^)
you suck ;^)
Thu, 04/01/2010 - 13:29 — Guest (not verified)
I was so mad I almost stopped reading in disgust. Wow am I glad I finished or it would have mad me angry the rest of the day! I can't wait to show it to my associate. I want to want her face turn red like mine did. Whew!
Thu, 04/01/2010 - 13:19 — Debo (not verified)
You really had me going, 'til
You really had me going, 'til the very end. I was a bit suspicious when you first started quoting the anonymous IRS spokesperson, and it seemed the IRS had a sense of humor or true feelings, which they NEVER let on to. But I read the article at break-neck speed with my mouth agape to the end, and I saw the first comment re-assuring this was all an elaborate prank. GOOD STUFF. I think it's perfect for today, and highlights that we do need a healthy sense of humor to get through practice days with our personalities intact. The only thing I find incredible in the end is that there are naysayers out there concerning this spoof!
Thu, 04/01/2010 - 13:04 — RTH (not verified)
Gullible in Fort Collins
It's a good thing I work with a bunch of non-veterinarians. You had me completely fired up until I forwarded it to them and they started laughing at this and at me! Henry, I was a bit miffed with you :-) Thanks for my only joke and good laugh so far today....
Thu, 04/01/2010 - 12:54 — Liz Whitney (not verified)
LOL! I really fell for it!
GOOD ONE! I was getting really steamed until I hit the end and realized I got "got". Stuff like this not only gives me a good laugh, but reminds me that fun and lightening up is an important part of life.
Thu, 04/01/2010 - 12:49 — Cindy, Vet Student (not verified)
You got me!
I was thinking this was a bit to ridiculous and inflammatory to be true, but I was buying it. Good one!
Thu, 04/01/2010 - 12:09 — Guest (not verified)
Are you for real? Lighten
Are you for real? Lighten up!!!!!!
Thu, 04/01/2010 - 11:56 — Guest (not verified)
Totally caught me off guard until I read the line about veterinarians being non-confrontational. Good one NAVC!
Thu, 04/01/2010 - 11:48 — Guest (not verified)
Lighten up (or have a drink at least)
Oh my God! After reading some of the comments, I can't help but wonder how tight some of the readers' undergarments are! It was a JOKE. If the two minutes it took to read the article seemed "stolen" from your life, I would suggest surgery to remove that pole from your backside.
Thu, 04/01/2010 - 11:41 — Dan (not verified)
The comments are funnier than the column
I thought this column was hilarious. I thought the comments were even funnier, especially the knee jerk attack on Obama. Perhaps we could have a column linking his administration to the existence of all disease and suffering on the planet? Nothing is funnier (albeit sort of scary) than people in the throes of rabid partisanship. As for the people who didn't find it "professional" - these are clearly the people who actually go to CE for the classes. Let the rest of us enjoy our spandexed rockers and feeble April fools jokes in peace. Don Woodman DVM
Thu, 04/01/2010 - 11:27 — AHNorthwood
The Onion
Having gone to Veterinary school (and law school) at the University of Wisconsin in Madison I am well used to The Onion--the spoof news publication. I forgot it was April 1, but the tone of the article clearly was something The Onion would have done, and it didn't take me long to suspect that this was less than factual. Thanks for the laugh. I wonder if The Onion publishes actual stories on April 1, just to shake things up.
Thu, 04/01/2010 - 11:27 — Deanna MIller (not verified)
Thats RIDICULUS!!! Im at the
Thats RIDICULUS!!! Im at the CEing confrence right now and we have not been drinking too very much and everybody is learning real What? Sorry I thought you said something to me. Don't interupt me that is very rude because I am talking to you about these important things in the vet medicine and it is important and you need to listen to me about what I am saying. Everybody is learning real good and being profesional and smart and nobody is cavorting because that word is made up. I always learn a lot at the confrences and I never drink too much so the IRS is stupid. Thats ok about the families though because I don't bring my wife because she is mean to me but not you. You are so nice and pretty and you listen so hard to me when I talking. Whats your name?
Thu, 04/01/2010 - 11:26 — Guest (not verified)
Hilarious!! Years of working with pranksters makes me skeptical of everything I see, hear, AND read today. Good one!
Thu, 04/01/2010 - 11:23 — Guest (not verified)
Ah, ya got me
I was starting to get perturbed a bit until I saw the ending. Excellent April Fool's joke.
Thu, 04/01/2010 - 11:23 — Steve Lavallee, DVM (not verified)
Have a beer
They did this last year, too. Remember self-service veterinary stations in pet stores? The other articles don't say anything about April fools in them, and the information isn't ridiculous. Maybe you need to go to one of these CE events and loosen up a bit.
Thu, 04/01/2010 - 11:13 — Guest (not verified)
This was great-it really had
This was great-it really had me going for a bit until I finally realized it is April Fool's Day. Then I got a good laugh at myself. Come on people:complaining about this being unprofessional-you need to lighten up a little! You really think this article is truth, then shame on you for believing everything you read verbatim without THINKING about it.
Thu, 04/01/2010 - 11:12 — Guest (not verified)
I made my long aggravated comment and posted it and then read the April fools comments which weren't there when I started writing. If this is truly an April fools joke, I don't think it is very funny but I would much rather have that than it being the truth, so hats off to you.
Thu, 04/01/2010 - 11:01 — KK, DVM (not verified)
As a busy wife, mother and
As a busy wife, mother and veterinarian, I appreciate the value of receiving email notices of your publication, along with current content. CB definitely provides value to my practice by offering pertinent topics at the convenience of my personal computer time. Thank you for your efforts. After reading the entire article and discovering it was a joke (not to me as I am faced with economic and employment issues, trying to pay this year’s taxes and budget for next year’s) I was aggravated and disappointed. I have come to expect high quality articles and accurate information from Clinician’s Brief. Not jokes and tricks. Yes, you did fool me with the IRS article. However it left me wondering what else in this issue was also a joke. Perhaps there is really is nothing to feline DJD or resistance to flea products. And perhaps the ‘Webinars with CE Credit’ topic shown directly below the IRS link is also a joke. The only thing that IS funny is that I do not feel like reading anything else in this issue to find out. Contrary to how this reply may sound, I do have a quirky sense of humor and love jokes, even veterinary one’s. I just don’t believe that your editorial staff made a wise decision in allowing one ‘April Fool’ article to show up in the midst of sound, scientific information. Next time, if there has to be one, I would suggest an entire issue ‘obviously’ devoted to spoofery. Or better yet, just don’t waste my time.
Thu, 04/01/2010 - 11:01 — Guest (not verified)
Good Grief, Don't Give the
Good Grief, Don't Give the IRS any IDEAS!!!
Thu, 04/01/2010 - 10:59 — Guest (not verified)
It's about time!!
There are some of us who actually go to meetings to learn something. Which is very difficult to do when the hungover veterinarian next to you is intermittently dozing off and leaning on your shoulder as you try to take notes. It will also be nice to go out to dinner around a convention center without someone spilling their drink on you as they are drunkenly trying to demonstrate how they were able to tube a 100lb bloat dog by themselves. Of course it has been nice to have the Sunrise CE sessions to myself up until now, as all the others try to sleep it off. I guess you have to take the good with the bad. See you bright and early in the front row.I'll be the one asking all the questions.
Thu, 04/01/2010 - 10:59 — Rob Castillo, DVM (not verified)
Love it!
Love it! Some of us do have a sense of humor (and aren't believing anything today anyway...)
Thu, 04/01/2010 - 10:58 — Karen Matlock (not verified)
Oh, I think it is hilarious!
Oh, I think it is hilarious! You've gotta find the humor in it. No one has played a successful April Fool's joke on me in a decade - this was welcome. Thanks, CB!
Thu, 04/01/2010 - 10:58 — Guest (not verified)
Loved it!
Especially loved the line "veterinarians are so much easier to go after...we certainly don't want to start this witch hunt by going after the attorneys". Great April Fool's Day joke! I'm passing this on the my colleagues.
Thu, 04/01/2010 - 10:56 — Guest (not verified)
OMG It's a JOKE people. Love
OMG It's a JOKE people. Love that you immediately blame our President. Don't' like it?
Thu, 04/01/2010 - 10:54 — Guest (not verified)

Reply to Message Mark Message Unread
(Msg Id: 216324:66335)
#2 - Posted on 4/02/10 at 12:21 PMRe: Post #1

Quahog 25
View Profile
Send Mail
Ignore Author
Send IM
Rating: (by 0 people)
Please sign in to rate this post.
“We hope to make the veterinarians an example,” the IRS report claimed. “We know that MDs, dentists and, God forbid, lawyers, all do the same thing. It is just that veterinarians are so much easier to go after. They tend to be nonconfrontational. We certainly don't want to start this witch hunt by going after the attorneys.”

Pretty much says it all
Before you get too excited, do check the date of the release. - Dr. Mac
Site Admin
Posts: 462
Joined: Wed Aug 13, 2003 5:56 pm

Return to evidence based vet guidelines

Who is online

Users browsing this forum: No registered users and 3 guests