Proposed midlevel role poses unacceptable risks

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Although it ultimately failed, a bill that would have authorized the creation of the VPA role was introduced in the Florida House of Representatives earlier this year. Additionally, Colorado State University’s College of Veterinary Medicine in Fort Collins is in the process of developing a VPA degree program called a master of veterinary clinical care. Based on an available curriculum draft, the program would encompass a mere 65 credit hours—which is about half the credit hours required by most doctorate in veterinary medicine (DVM/VMD) programs—and consists of 3 semesters of fully online lecture with no laboratory, a fourth semester of truncated basic clinical skills training, and a short internship/practicum.

Currently, there is no accredited national educational program, no national test, and no regulatory structure to ensure people filling the proposed midlevel position would deliver safe and effective care. Yet, the intent is that these VPAs would be diagnosing, prognosing, recommending treatment, and even performing surgery. Allowing an insufficiently trained individual to perform these skills endangers patients and clients across practice types and poses unacceptable risks for animal health and public health, in general.

Complicating the concept of a midlevel practitioner is federal law that limits prescribing and dispensing medications to a veterinarian—meaning that what an MLP could do for their patients would be severely limited. Some have suggested that MLPs could operate from protocols, but any veterinarian in practice knows that protocols only go so far; patients are unique and so are their needs. Any deviation from a protocol would require intervention by a properly trained and licensed veterinarian, creating unnecessary duplication, risks for patients when such intervention must be immediate, and likely confusion in care provision. Addressing this functional issue would require legislative and regulatory changes in all 50 states and at the federal level, take many years, and be incredibly costly. In addition, given that the proposed MLP would operate under a supervising veterinarian, that veterinarian would be liable for all actions of the MLP.

There also are many unknowns regarding how an MLP role would affect the veterinary workforce. Although proponents of this proposed role argue that it would help relieve workforce shortages, there is no evidence to suggest these individuals would be any more likely than veterinarians to practice in areas that are underserved. Looking to human health care, we have seen that the disincentives that keep physicians from practicing in such areas also dissuade midlevel practitioners from practicing there.

Concerns also have been expressed about the potential negative impacts an MLP program might have on existing educational programs awarding doctoral degrees in veterinary medicine, as well as the ongoing value of the DVM/VMD degree, given overlaps in the MLP’s responsibilities with these professionals. Faculty, staff, and resources at colleges of veterinary medicine are already in short supply and stretched thin, and adding yet another program to already overloaded plates doesn’t seem smart or sustainable. Something will have to give, particularly with 13 new proposed veterinary schools in the pipeline. There are also questions about how these programs might affect colleges of veterinary technology and their graduates.

Surveys reaffirm these concerns

Two recent surveys reaffirm these concerns. Results from both surveys indicate the proposed MLP role does not appear to serve a necessary or sustainable role in a veterinarian-led team.

The first survey, conducted by the American Association of Veterinary State Boards (AAVSB), aimed to determine whether a hypothetical midlevel role (termed advanced animal health care provider in the survey) was necessary and wanted by veterinary teams. Responses were received from nearly 14,000 veterinarians and veterinary technicians.¹

When given the opportunity to comment, respondents expressed concern about creating a new professional role when veterinary technicians currently are not being used to their full extent. Given the survey’s results, the AAVSB, whose members include licensing bodies in more than 60 US and Canadian jurisdictions, decided against pursuing a midlevel position at this time.¹

The second survey, conducted by Veterinary Management Groups, captured practice owner sentiments regarding the creation of a midlevel position. Respondents voiced a variety of concerns and criticisms, including the following:

• The risks and potential complications that could be caused by nonveterinarians performing surgeries
• The decline in quality of care that may result from improper diagnosis or potential malpractice
• The push to create a midlevel position is driven by a desire to lower labor costs, rather than an actual need for the position.

Respondents’ suggested alternatives all touched on the better leveraging of veterinary technicians. These included increasing pay and support for credentialed veterinary technicians, expanding and enhancing veterinary technology specialty programs, and pushing for consistent title recognition and protection and licensure for credentialed veterinary technicians across states.

Pet owners agree: the midlevel practitioner is unneeded and dangerous

The above survey findings come on the heels of a 2023 survey of pet owner attitudes by the American Veterinary Medical Association (AVMA), which found little support for a midlevel position. Instead, pet owners voiced a strong preference for veterinarian-led care.^2,3 Indeed, most pet owners know that allowing someone other than a licensed veterinarian to diagnose, prognose, make treatment recommendations, prescribe, or perform surgery would jeopardize patient health and safety. They oppose delegating primary responsibility for care decisions to nonveterinarians.

Perhaps most importantly, as all 3 surveys confirmed, there is simply no clear need for a midlevel practitioner. Instead, we need to better leverage and support the talented team members we already have. This would mean increasing the number of veterinary technicians, veterinary technologists, and veterinary technician specialists in all types of practice; fully engaging them to the top of their degrees; and providing the pay and recognition they deserve.

Veterinarians need to trust and delegate more to veterinary technicians, and there’s plenty of opportunity to do so. Nearly 20% of veterinary technicians do not feel utilized to their fullest potential, according to a 2022 survey by the National Association of Veterinary Technicians in America.⁴ A top barrier to unlocking the full potential of veterinary technicians is a perceived lack of trust/confidence in the veterinary technician’s skillset by the veterinarian.

Make your voice heard

If your state is considering creating a veterinary midlevel practitioner or similar position, you can help maintain the integrity of credentialed veterinary technicians’ and veterinarians’ roles. Share this article with your state policymakers, point them to avma.org/Workforce for more information, and work with your state and local veterinary medical associations to build support for veterinary technicians and against proposed alternatives.

Fully empower your team members

Optimal engagement of the full veterinary team—including credentialed veterinary technicians—can help veterinary practices see more patients and meet client demand, without compromising patient health and safety, food safety, and public health. A great starting point for understanding the breadth of your veterinary technicians’ abilities is the AVMA Committee on Veterinary Technician Education and Activities Essential and Recommended Skills List. It details more than 200 tasks that veterinary technician students must be able to complete in order to graduate from accredited educational programs. Find it at avma.org/CVTEASkillsList.

The AVMA also has continuing education webinars and other tools to help you fully engage your practice’s veterinary technicians. Go to avma.org/VeterinaryTechnicians.

References

1. AAVSB veterinary team survey: understanding the results. American Association of Veterinary State Boards. Accessed August 12, 2024. https://vmb.ca.gov/meetings/materials/20240724-25_6.pdf
2. 2023 pet owner attitude survey: key findings. American Veterinary Medical Association. November 2023. Accessed July 17, 2024. https://www.avma.org/sites/default/files/2023-11/AVMA-2023-Pet-Owner-Attitude-Survey-For%20Release-20231101.pdf
3. Chart of the Month: pet owners prefer veterinarian-led care. American Veterinary Medical Association. January 18, 2024. Accessed July 17, 2024. https://www.avma.org/blog/chart-month-pet-owners-prefer-veterinarian-led-care
4. NAVTA 2022 demographic survey results: pay & education have increased; burnout & debt are still issues. National Association of Veterinary Technicians in America. Accessed July 17, 2024. https://drive.google.com/file/d/11pmYzIouybfL55YsduRbaZ1TtMD1i2DB/view