States divided on veterinarians' roles
posted April 28, 2011
Dr. Vince J. Collison would not be in favor of hiring a nonveterinarian to perform ultrasound pregnancy diagnosis or embryo transfers in his practice.
"It's just hard to go out and do some pregnancy diagnosing without talking about some herd health issues related to vaccinations, diseases, and management," Dr. Collison said. "And the same goes for embryo transfer: If I go out to collect embryos on some donors, there will always be some donors that require some medical attention."
Dr. Collison, of Collison Embryo in Rockwell City, Iowa, estimates he and another veterinarian at his practice performed about 3,300 transfers during 2010 and about 20,000 over the past decade. While he thinks most people could learn to perform basic embryo transfer procedures, being a licensed veterinarian provides a degree of assurance about competence and protects the public.
Much of his work involves some diagnosis and treatment, he said. "I'm routinely working on donors that have pathologies of the ovaries or uterus that we need to deal with in order to collect embryos from them," Dr. Collison said. "And there are a lot of concerns about food safety. Everything about the process requires prescription drugs."
However, George E. Seidel, PhD, a professor in the Animal Reproduction and Biotechnology Laboratory at Colorado State University's Department of Biomedical Sciences, said a veterinary degree, an advanced degree related to reproductive physiology, and experience with artificial insemination can each provide a foundation for learning to perform embryo transfers. He has trained people to perform transfers and written state competence examinations on the procedures. He and Sarah Moore Seidel, his wife, authored a training manual for embryo transfer in cattle that was published in 1991 by the Food and Agriculture Organization of the United Nations.
Dr. Seidel thinks supervisory veterinarians are needed to spot abnormalities and oversee prescription drug administration, although he thinks nonveterinarians can become skilled at spotting potential problems.
"Veterinarians should be involved in any embryo transfer program," Dr. Seidel said. "Now, do they need to be the ones who actually do the embryo transfer? Quite frankly, it's probably not a very good use of their time in many situations."
Legislation in Iowa would allow nonveterinarians to gain certification to perform embryo transfers and fetal aging examinations and use ultrasound to diagnose pregnancy. Legislators and livestock organizations in other states including Arkansas, Nebraska, Oklahoma, Tennessee, Texas, and Wyoming have also made efforts in recent years to remove cattle-related reproductive services from veterinary practice acts, or they contend that the practices were never exclusively granted to veterinarians.
VMA leaders see potential harm
The AVMA policy "Embryo Transfer Procedures" states that the AVMA believes transfers are a function of veterinary practice because of the need for diagnosis, the pharmaceuticals involved, and the potential need for surgery. Nonveterinarian embryo transfer technologists should work under a veterinarian's supervision, the policy states.
However, state practice acts are divided on who can perform these and related procedures in cattle and whether supervision is needed.
Dr. Stephen S. Galloway, president of the Tennessee VMA, noted that a state law passed in 2010 allows farmers to diagnose pregnancy in another farmer's cattle and remove embryos from livestock, provided that the farmers are not paid for the work and the diagnoses are for use only by the cattle's owners.
"Whenever you're seeing challenges to the veterinary practice acts, people are looking for less-expensive alternatives to veterinary services, and the quality of the services is not taken into consideration," Dr. Galloway said.
Dr. David B. Duxbury collects embryos from a cow at a facility
He also thinks that reducing the number of practices performed by veterinarians causes animal suffering and reduces public protection.
"Many of the practices that we lose are lost because an uninformed veterinarian who does not practice a specific service makes a public statement that the service is below professional standards of care or openly refers cases to nonveterinarians," Dr. Galloway said.
Dr. Bruce W. Brodersen, immediate past president of the Nebraska VMA, said that breaching the veterinary practice acts puts the public at risk and adversely affects animal welfare. A bill in his state's legislature, Legislative Bill 686, would allow a person to recover, freeze, and transfer bovine embryos if that person had a master's degree "with an emphasis in reproductive physiology."
The legislation is part of "piecemeal degradation of the presence of veterinarians in the state," Dr. Brodersen said.
Proponents cite veterinarian void
Pete McClymont, vice president of legislative affairs for the Nebraska Cattlemen, said a decline in the number of available food animal veterinarians combined with increased demand for reproductive procedures by beef producers made the legislation necessary. He thinks the bill's education requirements would allow nonveterinarians to safely meet that demand.
"We've been told there are more food animal vets coming, and we're frustrated that we haven't had any luck as a state gaining more food animal vets," McClymont said. "We have a problem, we're trying to address it, and we feel awkward that we're doing it against somebody we consider an ally."
Dr. Duxbury looks for embryos in collection fluid.
In Iowa, House Study Bill 164 would allow nonveterinarians to become certified by the state board of veterinary medicine to transfer livestock embryos and diagnose livestock pregnancy through use of ultrasound while under a veterinarian's supervision and while employed or working under contract with that veterinarian. Senate File 288 would allow nonveterinarians to gain certification to perform the same livestock pregnancy services, but they could perform the work only while under the direct supervision and employment of a veterinarian, and only if the nonveterinarian was covered by insurance and completed a technical course related to certification.
Dr. Tom J. Johnson, executive director of the Iowa VMA, said his organization opposes both bills. He thinks that veterinarians are the best trained and qualified to perform these procedures and that proponents of the bills have not proved that too few veterinarians are available to perform them.
"We are also concerned about the drugs involved being used without veterinary supervision," Dr. Johnson said. "We believe there is a public health and food safety issue when veterinarians are not directly involved with these procedures."
Dr. Johnson said this type of legislation could decrease business for veterinarians, potentially reducing the number of young veterinarians who would choose to enter livestock-related veterinary practice. Having fewer available veterinarians would also increase the harm and recovery time if an epizootic were to spread among livestock, he said. Veterinarians have also told him that pregnancy diagnosis brings them to farms, where they talk with owners about herd health, vaccinations, and other routine care.
Dr. David B. Duxbury, a veterinarian who performs embryo transfers in Minnesota and Wisconsin as owner of Midwest Embryo Transfer Service and a past president of the American Embryo Transfer Association, said embryo transfer and pregnancy diagnosis are parts of veterinary medicine.
When cows fail to become pregnant, a veterinarian determines whether any specific abnormalities or diseases are preventing pregnancy and what, if any, treatment is needed, Dr. Duxbury said. With pregnant cows, a veterinarian similarly determines whether the pregnancy is proceeding normally and whether any treatment is needed. In addition, a veterinarian is needed to analyze trends and treatments across groups.
The same diagnostic procedures are needed during embryo transfers, particularly because prescription drugs are used during these procedures, Dr. Duxbury said. While he thinks nonveterinarians can be taught to perform some veterinary procedures, he expressed concern about the risks if those nonveterinarians encounter abnormalities or other problems.
"When a veterinarian does that same procedure, they bring with them a body of knowledge from their pre-veterinary and veterinary curricula, their state licensing qualifications, their federal accreditation, their many hours of continuing education, and their experience," Dr. Duxbury said. He added that veterinarians can also provide safety nets through malpractice insurance.
Dr. Randall H. Hinshaw exclusively performs embryo transfers and reproductive ultrasound examinations for a seven-veterinarian practice in Harrisonburg, Va. He thinks livestock owners benefit from veterinarians' knowledge of animal physiology and reproduction and the protections and competence assurances provided by state veterinary practice acts. Although no groups are currently working to remove these practices from his state's practice act, he said the efforts in other states are a concern.
Citing a report in the April 15, 2010, issue of JAVMA on results of a survey of reasons why veterinarians leave rural practice, Dr. Hinshaw noted that about 28.1 percent of veterinarians who reported leaving rural veterinary medicine included lack of stimulation as a factor in their decision. He said the ability to use cutting-edge techniques or technology and to perform interesting procedures, such as those involved in assisted reproduction, add to the variety that attracts veterinarians to rural medicine.
Dr. Hinshaw also sees irony in the fact that some states' are developing educational loan forgiveness programs to attract young veterinarians while concurrently giving laypersons pieces of those veterinarians' practice. He thinks states could allow nonveterinarians to become trained to perform nearly any veterinary procedure, but he doubts such actions are beneficial.
"Embryo transfer and other assisted reproductive technologies are some of the more profitable parts of veterinary medicine," Dr. Hinshaw said. "So if you carve those out and give them away, you are giving away important parts that help make a veterinary practice sustainable, particularly in a rural setting."