Opposing midlevel practitioner proposals

Crazy! Who thought of this?? Talk about putting the entire animal population at risk! Might as well have our licensed technicians doing the same duties. This is ridiculous!

Midlevel practitioners are going to come. The AVMA has been so oblivious to the need for more help in clinics that they have forced the issue. Not all clients want to be treated like part of an assembly line. You can only work so efficiently before it feels like a manufacturing facility. Places like ER clinics, Equine clinics, and Urgent Care clinics can only work so efficiently before euthanasia becomes standard treatment. Clients whose world is this pet, like senior citizens, want to know that their companion is more than a blip on the data sheet. As long as we keep thinking the answer to work more efficiently like corporations, the more people will push for midlevel practitioners. As long as I keep seeing the AVMA push the agenda of work more efficiently, we will continue to see a push for midlevel practitioners. It will happen. We need to either quit saying just work more efficiently or we need to accept that midlevel practitioners are coming.

Colorado also has a ballot issue to end predator hunting/trapping. Like it or not it keeps nature in order. It's conservation!! Leave it to the experts to manage wildlife!! Just as this should be left to the experts, the veterinarian!! Coloradans need to start voting differently, or the animals, wild and domestic are going to suffer!!

The proposed mid level practitioner position is not a good idea on so many levels. This is a slippery slope which will cheapen and tarnish our profession and will create unsafe care for our patients.
Carefully research the roots of this proposal and as usual, follow the money. I and many other colleagues strongly oppose this.

There are hordes of people who I run into practically every day who are presenting themselves as an “Equine Dentist” and who have promoted themselves as a professional with qualifications more advanced than a Veterinarian. The public often is led to believe the person who uses the title “ Equine Dentist, Equine Dental Technician, Dental Practitioner, and the like are professionals with Doctorate level degrees, have passed board examinations, and are licensed similar to a Human Dentists.
These so called “equine dentist” are misleading the public. They are actually pulling teeth, using sedation, diagnosing, treating, and Practicing Veterinary Medicine without a license and without going to Veterinary School. They are doing a vast disservice to the horse, the public, and the profession. It is happening all over the United States. We need to advocate more for the Horse, this must be stopped.
I have clients who have literally told me these fraudulent, self-proclaimed so called “Equine Dentist” are more qualified, better skilled, and more knowledgeable than Veterinarians. The clients (horse owners) do not realize the difference between a Veterinarian’s education and those that have little to no instruction or a “Certificate”. These “Equine Dentist” may go to an unaccredited so-called “school of equine dentistry” for a week and are given a “certificate” or “degree” in “Equine Dentistry” and then call themselves an “Equine Dentist” and often use a title of Doctor. With little exception, most of these self-proclaimed dentists often do more harm than good, in my opinion, when they perform dentistry on horses.
Here are several areas where the self-title “Equine Dentists” violate many tenets of practice acts:
18. "Practice of veterinary medicine" means:
1. To diagnose, prognose, treat, correct, change, alleviate, or prevent animal disease, illness, pain, deformity, defect, injury, or other physical, dental, or mental conditions by any method or mode; including the:
i. performance of any medical or surgical procedure, or
ii. prescription, dispensing, administration, or application of any drug, medicine, biologic, apparatus, anesthetic, or other therapeutic or diagnostic substance, or
iii. use of complementary, alternative, and integrative therapies, or
iv. use of any procedure for reproductive management, including but not limited to the diagnosis or treatment of pregnancy, fertility, sterility, or infertility, or
v. determination of the health, fitness, or soundness of an animal, or
vi. physical rehabilitation, meaning the use of therapeutic exercise and the application of modalities intended to restore or facilitate movement and physical function impacted by disease, injury, or disability.
vii. rendering of advice or recommendation by any means including telephonic and other electronic communications with regard to any of the above.

2. To represent, directly or indirectly, publicly or privately, an ability and willingness to do an act described in subsection 18(1).

3. To use any title, words, abbreviation, or letters in a manner or under circumstances that induce the belief that the person using them is qualified to do any act described in subsection 18(1).
Some of the things that the so called “Equine Dentist”, that I follow do, that is harmful to horses:
Inadequately float teeth, leaving many sharp points and projections;
Fail to reduce abnormalities of wear including wave over eruptions, step molars, rostral hooks and caudal hooks;
Perform dental extractions, often breaking the teeth off and leaving the tooth remnants;
Aggressively over floating or more specifically destroying viable tooth material with today’s motorized dental instruments;
Often sedate horses they are working on themselves with sedation medication, they are not authorized to administer;
All of this is a terrible disservice to the horse and the horse owner. It would be beneficial if the AVMA could make it clear that Equine Dentistry is Veterinary Medicine and should be performed by a Veterinarian. At best these people should be called tooth floaters. They should not be called Certified at all in any shape, way, or form. They should not use the Title Equine Dentist, Equine Dental Technician, Equine Dental Practitioner, or any of the misleading titles they are giving themselves. In doing so is misleading and by condoning it is irresponsible.

Although I think this particular program is not a good idea, I do think the idea in general has merit. Making veterinary students go to school and learn both large animal and small animal is a waste of time for those of us who knew we only wanted to do small animal. If the veterinary license could be specialized, it would cut down on student debt tremendously. I have been small animal only for 29 years, ABVP canine /feline for 20 years. I regret the time and money that I spent learning large animal. Students need much more experience in both surgery and dentistry before they graduate. If they could focus solely on small animal or large animal, they would come out of school better prepared for practice.

Well I sure hope the pay for school like I did- I still owe a crap- load of money to the government. I think that right there is my DVM degree .

This is a ridiculous proposition. Decreasing the quality of veterinary services for what reason??

There are hordes of people who I run into practically every day who are presenting themselves as an “Equine Dentist” and who have promoted themselves as a professional with qualifications more advanced than a Veterinarian. The public often is led to believe the person who uses the title “ Equine Dentist, Equine Dental Technician, Dental Practitioner, and the like are professionals with Doctorate level degrees, have passed board examinations, and are licensed similar to a Human Dentists. All of this is a terrible disservice to the horse and the horse owner. There are 35 Veterinary Schools in the United States and more to open soon. This is the highest number of Veterinary Schools the United States has ever had. Additionally, the AVMA has accredited a number of foreign Veterinary Schools. My experience is that these so called “Equine dental providers” are practicing veterinary medicine without a licensed. If they want to practice veterinary medicine, then they should become a veterinarian.

There is no question that the current veterinary programs are rigorous, costly and selective. Also currently many vets are overworked, stressed, and financially strained. There is a need for for more help and this is a step in the right direction but the program for these mid level practitioners needs to be honed and changed to be more elaborate and maybe not perform surgery? They should have the ability to diagnose and treat with lesser issues so that our trained doctors can focus on heavier and more intensive cases. Specialities I think are important. Playing devils advocate here and I think they could be valuable if trained and educated appropriately and given the experience.

I think AVMAs position is very short sighted. Multiple studies suggest we don’t have too few vets but rather too few hours worked. Even though associates or employees vets are in high demand presently within 10 years there will be a huge number of new graduates that will flood the market from all the new vet schools just as corporate vet med has “figured out practice” and wages will plummet. Congress has already introduced bills in states due to the fact vet services are too expensive and outpaced inflation. We need to adapt and think out of the box. My seasoned assistants are regulated by the state board not to even perform procedures that volunteer EMTs perform on a regular basis on people after 2 months of only on the job training. As a profession we need to reconsider where we are headed. I feel for the longshoreman on strike but suspect the request to allow “no new automation” for the simple fact to protect jobs at the expense of fellow Americans will not be popular and ultimately the public will view AVMAs stance on this position no differently. As a private practitioner for nearly 30 years I have seen a ton of change in our profession and today more then ever the client determines who remains in business long term and our protectionist attitudes will result in not only the inevitable “loss of our seat at the table but also end up as the main course for a corporate dinner.” There will be an abundance of hour hungry employee DVM’s to man their large marginally profitable but sustainable hospital models and then they will encourage state boards to enact rigorous regulations to open or maintain facilities in the name of “what’s best for the animal” which will eliminate most small clinics and what arguably made this one of the most admired and respected professions. Just one opinion.