The midlevel veterinary professional: Has the time come?

Just as physician assistants and nurse practitioners deliver healthcare to patients in remote areas, a veterinary professional associate (VPA) could be mobilized to help underserved pets not currently receiving veterinary care (Getty Images).Here in Colorado an interesting conversation is taking place-a potential development that could change the trajectory of the veterinary profession and is already generating controversy. It's the idea of a mid-tier veterinary professional, similar to a physician assistant (PA) or nurse practitioner in human medicine.

At a recent Colorado Veterinary Medical Association (CVMA) Big Ideas Forum in Denver, Wayne Jensen, DVM, PhD, MBA, associate head of clinical sciences at Colorado State University (CSU), introduced the idea of a veterinary professional associate (VPA) master's program that would be completed in three semesters. In the same way PAs do, VPAs could focus on serving underrepresented areas and populations, much like the 1950 midwifery depicted in the popular BBC series Call the Midwife.

In human medicine, solo practices employing a PA report greater efficiency, expanded practices and overall better healthcare for their patients, according to a 1994 survey by the American Medical Association Socioeconomic Monitoring System. Physicians in these practices say they're able to work, on average, one week less per year than those without PAs yet still increase the number of hours they offer for office visits and patient care, resulting in a net income increase of 18 percent. Cost-benefit studies of PAs report that for every dollar PAs generate, their employer pays 28 cents. Other positive aspects of employing PAs include reduced waiting times and improved patient satisfaction.

The idea, Jensen says, is that VPAs could stretch the capacities of veterinarians, both in terms of the geographical area they serve and also in the breadth and depth of services that can be provided, as well as lower costs. By performing some of the routine aspects of veterinary medicine under the supervision of a veterinarian, VPAs could give veterinarians the time to focus on the more challenging aspects of veterinary medicine, help them avoid career burnout that can accompany long hours and on-call services, and fill the growing need for veterinary services in public health and lab animal medicine. A VPA's duties would be limited by state veterinary practice acts, Jensen says, and would vary according to each state's codes and laws. It would be up to the profession to enact any changes at the state level.

Speaking from experience, we all know how difficult it is to find (and keep) a good technician. Many veterinary technicians-the vast majority of whom are female-battle it out every day to make ends meet doing the job they love. Although in some areas there are plenty of positions and opportunities for professional growth, veterinary technicians complain of a pervasive disconnect between their skills and their potential earnings, and they express frustration at their lack of ability to impact the financial growth of their hospitals.

Stephen Cital, a veterinary technician at the California National Primate Research Center at the University of California, Davis, notes that a veterinary technician's education is as substantial as that of a nurse-and the job typically requires a broader range of skills-and yet the average pay is a fraction of what a nurse earns. A NAVTA survey in 2008 found that pay was the number-one concern: Nearly 79 percent surveyed felt that veterinary technicians were so underpaid that the feasibility of staying in the profession was declining. Only 43 percent reported being satisfied and definitely planned to stay in the profession.

The disappointment with potential salaries is compounded for some technicians by high college debt. Although two-year veterinary technician programs are offered at many inexpensive community colleges, the private veterinary technician programs are costly-as much as $30,000 to $40,000 per year for a two-year program. The proposed one-year VPA program at CSU could cut college costs for paraprofessionals, lower hiring costs for veterinary clinics, create a valuable position with the potential for higher income earnings, and provide a more satisfying career path for people wishing to pursue veterinary medicine at a paraprofessional level.

At this point, the idea of a mid-tier veterinary role is not widely supported by the profession. “There is definite concern among veterinary students at CSU about how this will negatively impact the job market,” Jensen says. “CSU would not proceed with this program without the support of the profession. But we know there is a huge reservoir of animals not currently receiving veterinary care for a myriad of reasons, and the need for veterinary services is expected to grow in the future. This could be a mechanism to increase the efficiency of veterinarians, generate more income and control rising costs of veterinary care.”

At this point, the CVMA has voted to engage with CSU to learn more about the potential VPA program. President Erin Epperly, DVM, offered me this statement: “CVMA has significant concerns about the benefits of the VPA program, both to veterinarians and to potential graduates. Currently, we have submitted a detailed list of questions to CSU about the program and are engaging with them in dialogue sessions. CVMA has no position on the program at this point yet as we are still in the information-gathering phase.”

The creation of the PA position took the medical profession more than 20 years to adopt. With the financial crises facing veterinary medicine, I'm not sure veterinary medicine has the luxury of that much time. Whether or not a VPA is the answer, we can't sit back and do nothing.

While the image of the James Herriot veterinarian who does everything is valuable, the impending growth in demand for veterinary services, shortage of food-supply veterinarians that is forecast to get worse, exploding debt for new graduates, and rapidly changing social environment strongly suggest that veterinarians cannot continue to do it all or do it all alone. Perhaps a new veterinary professional associate is worthy of discussion. Kudos to CSU for having the chutzpah to start the conversation.

In the same way PAs do, VPAs could focus on serving underrepresented areas and populations, much like the 1950 midwifery depicted in the popular BBC series Call the Midwife. (Full episodes: http://video.pbs.org/program/call-midwife/episodes/.)

Dr. Sarah J. Wooten is an associate veterinarian at Sheep Draw Animal Hospital in Greeley, Colorado, and a frequent contributor to dvm360.com.