Stretch your bovine practice potential
       —use technicians to the max

Deborah Stevenson, a registered technician who works with Dr. Mark Hilton at Purdue, places a growth implant.

Fewer veterinarians choosing bovine practice means that some owners have been finding it impossible to hire an associate. For them, maximum utilization of veterinary technicians is of special importance. Practices that capitalize on the skills of a technician can better meet their clients' needs while increasing practice output and efficiency. It is also an ideal way to decrease the technical side of practice to allow for more consulting and family or recreational time.

The 2002 AABP conference in Madison, Sept. 26-28, offered several events where bovine practitioners could gain a better understanding of how to achieve this.

Know your practice act
This year, veterinarians were invited to bring their technicians to the conference for the AABP's first session on veterinary technicians in bovine practice, billed as one of the few CE opportunities for large animal technicians.

During the technician program, Dr. Frances O. Smith, immediate past president of the Minnesota Board of Veterinary Medicine, gave a presentation on the veterinary practice act. Her message to veterinarians who employ technicians: "Read and understand the veterinary practice act requirements of your state. Make sure you are well within the law."

States vary considerably, with Colorado being the most restrictive in which she is licensed, Dr. Smith said.

A veterinarian can't authorize an unlicensed employee (ie, anyone but a licensed veterinarian) to perform surgery, diagnose and prognose, or prescribe drugs, medications, or appliances, Dr. Smith noted.

"If we didn't have technicians, we couldn't do a tenth of what we do," said Dr. Smith, a theriogenologist from Burnsville, Minn. "Most states don't license technicians; they register or certify them," she noted. She underscored that veterinarians are responsible for making judgments about an animal's health needs. If a technician or other practice employee makes a mistake, the veterinarian who employs them is responsible.

The statutes and rules on embryo transfer work vary by state, she said. "In reproductive fertility, technicians are held to a tight rope." Asked whether technicians should be allowed to do ultrasonography, capture the image, and have a veterinarian read it, she said she believes it falls within a technician's purview.

Some practice acts exclude routine herd health tasks, Dr. Smith said.

What is a technician allowed to do?
Another AABP conference offering was a clinical forum on how to meet client needs with veterinary technicians. This small-group discussion format was offered twice, led by Drs. John Day, a dairy cattle practitioner in Jerome, Idaho, and Mark Hilton, a clinical instructor in beef production medicine and food animal ambulatory practice at Purdue University.

Most who came said they wanted to learn what they can legally delegate to technicians because of limited staff, or how they can use technicians more on the farm.

Dr. Hilton said that because the Indiana state practice act was written 30 years ago for small animal technicians, there is a movement afoot to get it amended. Veterinarians from two other states said their practice acts have "gray guidelines" for what a technician can do. Pursuing practice act changes may be necessary in states where technician provisions are obsolete.

It's important to recognize that there is a difference between the tasks a technician can legally do and those that can be assigned to veterinary assistants and other office personnel. A license, registration, or certification—whatever the state mandates—is the key to enabling technicians to perform many of the more sophisticated tasks. Some schools, such as Purdue, offer distance learning programs. Purdue's is a Web-based program that provides everything but the clinical experience. Courses can be taken on a part-time basis, so the length of the program will vary with the individual.

Dr. Hilton is a strong proponent of maximizing technician use. "It's a great way to do the kind of practice you've always wanted to do but couldn't, because you just didn't have enough hours in the day." Forum participant Dr. Patrick S. Farrell, a dairy health management consultant in Russell, Pa., said that 10 years ago, 60 percent of the work the veterinarians at his clinic were doing was technician work, but now, the veterinarians are doing all veterinary work. It can improve producer output as well. Dr. Day said that when the cow lockup period was shortened on the day of herd examination because a technician was helping on the farms, conception rates on that day actually rose in the dairies.

States such as Indiana require that if a technician is performing animal health care on the farm, the supervising veterinarian must be within the practice area, be reachable, and be able to step in if there's a problem.

The AVMA policy on veterinary technology, mentioned at the clinical forum and the technician program, "urges the full utilization of veterinary technicians whenever possible in veterinary research, regulatory, and health care activities." It goes on to say: "The duties of veterinary technicians shall be performed under the direction, supervision, and responsibility of veterinarians. These duties shall be accomplished in compliance with federal, state, and local laws and shall not include diagnosing, prescribing, or performing surgery."

Don't diagnose; observe and report
Though technicians must not overstep their legal limits by diagnosing, they can be of great value in preparatory work and in reporting signs they observe in the patients.

If a farmer says his cow has milk fever but the technician sees it's probably coliform mastitis, the technician can call the veterinarian and describe the signs.

Dr. Day is considering teaching his technician, Jannell Kral, to necropsy. A technician can't interpret what is seen in the necropsy but could call the veterinarian from the farm and describe them, or bring a digital camera so the veterinarian can see the necropsy photos later. There are a number of opportunities to gain further information from the dead cows, but they're missed because the animals are not necropsied. Utilizing a technician can allow veterinarians to provide the service to their clients at a more economical cost and allow for more necropsies to be performed.

How about rectal examinations? Dr. Hilton said that determining pregnancy or identifying a freemartin, for example, would be considered diagnosing, but the technician can describe whether they found a uterus. Is toggling considered surgery? Yes, but Dr. Day said technicians can do the preparatory work.

Dr. Farrell said he considers nurse practitioners as a legal model for veterinary technicians. "My licensed technicians have just as much training."

Expand your technician task list
Technician work is expanding into new areas. Dr. Hilton challenged veterinarians to compile a list of tasks they're doing that their technicians could assume.

Dr. Hilton uses technicians for overflow and value-added work. He now assigns some of his dehorning and routine vaccinations to technicians. They do ration balancing for feedlots, set up consultative herd visits, and help with heifer development work. His technician teaches producers the proper placement of growth implants in feedlot cattle. She has also completed artificial insemination school and offers that service to clients.

Dr. Day has Jannell give vaccinations and hormone injections, check the urine pH of close-up cows, do body condition scoring of dry and postparturient cows, do metabolic profiling on herds, and monitor the records of postparturient cows for stillbirth, milk fever, and mastitis.

Attendees added to the list: drawing blood samples, preparing an animal for surgery, administering antimicrobials, helping with restraint, doing blood work, stocking the truck, and keeping client records.

Other considerations
Compensation for technicians varies. One attendee said he extends his licensed technicians' work hours from 40 a week to 60 in summer and has a modified pay schedule so they can earn more, along with a two-tiered pricing system for veterinarian and technician calls. Another veterinarian computer-tracks his technicians' contributions and rewards them accordingly. Some employers provide a paid vacation, bonuses, and retirement plans.

The employer should verify that technicians are recording their work and remembering to charge for services, medications, and supplies.

Dr. Hilton suggested letting technicians shine and build credibility on the farm. At the same time, technicians may develop a close relationship with a client and must understand the need to maintain a small degree of separation.

It is fine to allow a division of labor to capitalize on any unique talents the technicians possess, but cross-training is also a wise idea.

Can't find a technician?
A practice owner may want to work in tandem with technicians, but they are admittedly in short supply. What if you can't find a technician for your practice? Some forum attendees knew of practices that went to the extreme of hiring unlicensed foreign veterinarians to fill that void. Dr. Hilton suggested talking to students from a reputable technician program that incorporates large animal experience into their training. These students are generally required to perform an externship, and it is a wonderful opportunity to introduce them to your practice. The list of AVMA-accredited technician schools is posted online at www.avma.org in the Resources section.

A technician speaks
Another speaker on the technician program was registered technician Deborah Stevenson, who works with Dr. Hilton at Purdue. In her talk on thinking outside the box, she described a sample heifer development program that technicians could manage, and presented case scenarios involving technicians. She also discussed legal issues, defined some practice act terms, and outlined traditional nursing and herd health tasks.

According to Stevenson, "Our goal is not to assume the veterinarian's role, but to make the business more profitable by increasing the amount of tasks shared between veterinarian and technician."