AVMA Board chair addresses challenges to VCPR, advocacy efforts

Rural workforce shortages, strategic plan also top Board agenda
Dr. Charles Lemme
Dr. Charles Lemme

Dr. Charles Lemme was elected chair of the AVMA Board of Directors this past July during AVMA Convention 2023 in Denver. About halfway through his term, he spoke with AVMA News about the Association’s grassroots opposition to a “well-funded” campaign to redefine the veterinarian-client-patient relationship (VCPR). He also shared other areas of AVMA engagement, including federal advocacy and support for technological advances. The following interview has been lightly edited for brevity and clarity.

Q. Maintaining a requirement that the VCPR be established in-person before using telemedicine and a newly proposed midlevel veterinary position (MLP) have been critical issues for the AVMA over the past year. Why are these two issues so important?

Dr. Lemme responds:

We are extremely concerned about these issues because their outcomes will affect the health and wellbeing of our patients, and potentially public health. I was a small animal practitioner for over 40 years. To properly diagnose and treat even the routine cases that we see daily, such as skin problems, ear infections, or vomiting and diarrhea, you need to put your hands and eyes on the patient. And, often, diagnostics like cytology are needed. That can’t happen without an in-person visit.

Veterinarians are highly trained to diagnose and treat disease in animals. Any effort to allow lesser-trained individuals to diagnose, prognose, perform surgery, or prescribe drugs will not result in improved care for animals. We need to continue to work on having veterinary practices fully leverage the skills and training of credentialed veterinary technicians to improve practice efficiency before we even consider making such a radical change to how veterinary care is delivered.

Q. Can you update us on the AVMA’s work in both areas?

A. We are focused on raising awareness across the profession and with the public about the risks to animal and public health if such proposals are adopted. The AVMA has worked with multiple state VMAs to help them lobby against legislation related to both of these issues, has submitted detailed comments in response to legislative and regulatory proposals, and has had volunteer leaders and advocacy staff testify at committee hearings. There are well-funded groups pushing hard on this, so it is going to be a long-term effort.

Q. Related to the VCPR, does the AVMA still support veterinary telemedicine?

A. For sure! When used properly, telemedicine will help veterinary practices work more efficiently and deliver quality patient care. The AVMA is one of the co-founders of the Coalition for Connected Veterinary Care, a group that is focused on raising awareness of the benefits of embracing telehealth, including but not limited to telemedicine, as a tool for veterinary practice. The AVMA was the first organization to develop resources to help veterinary teams use telehealth in their practices, which can be found on the AVMA website at avma.org/telehealth.

Q. How do you see technological innovations, including telemedicine and artificial intelligence (AI), further impacting veterinary medicine?

A. I think we are seeing some pretty exciting applications of these technologies already. For example, the availability of continuous glucose monitoring has really changed treating a diabetic cat. Similar at-home monitoring for other conditions could make following a case via telemedicine much more effective.

I suspect we will be shocked at how much AI works its way into veterinary practice over the next few years, but I think it will be similar to “self-driving” cars—you will still need to have a human (veterinarian) holding onto the steering wheel (managing a case), just in case the computer wants to drive you off a cliff.

Q. Aside from the VCPR and MLP issues, what topics has the Board worked on since your election as chair that members should know about?

A. A major focus through the fall of 2023 was finalizing the Strategic Operating Plan for 2024, making sure that we are putting our resources into priorities that meet member needs and enhance the value of membership.

The Board also met with representatives from the American Association of Swine Veterinarians in September to learn about current swine practice, swine education, and the issues they are facing. We also had the opportunity to tour the new Veterinary Diagnostic Laboratory at Iowa State University and the U.S. Department of Agriculture (USDA) Agricultural Research Service’s (ARS) National Animal Disease Center. We met with veterinarians to learn about the great research they are doing as well as the workforce and funding challenges they face.

As part of our commitment to improving diversity, equity, and inclusion (DEI) in the Association and the profession—and to support a great AVMA program—the Board is doing Journey for Teams modules during our in-person meetings. It has been a great experience so far, and something I would recommend all our members consider using in their practices.

Q. Can you summarize AVMA’s federal advocacy efforts, particularly in areas such as the Farm Bill and Rural Veterinary Workforce Act?

A. Well, to even summarize the AVMA’s federal advocacy efforts would fill most of an issue of JAVMA. Our advocacy team does an amazing job of monitoring, supporting, and opposing legislation that affects animal health, One Health, and the practice of veterinary medicine. I served as chair of the AVMA Legislative Advisory Committee for a couple of years and was able to witness firsthand the tremendous work supporting our profession on behalf of our members.

The Farm Bill contains many priorities for the AVMA and needs to be reauthorized every five years. It authorizes funding for several programs important to the veterinary profession like the Veterinary Services Grant Program (VSPG), Food Animal Residue Avoidance Database (FARAD), and programs that fund veterinary research. The AVMA advocacy team also works with other stakeholders to ensure continued funding, and in some instances, increased funding for these critical programs.

The Rural Veterinary Workforce Act (formerly known as the VMLRP Enhancement Act) is one that we have been supporting for a few years. It has many co-sponsors and we are hopeful it may move forward in 2024. The bill would remove the awards from the taxable income of the recipient. Under the current law, the USDA is required to pay the tax on behalf of the award recipient out of the funds appropriated for the program. So, eliminating the tax would allow those dollars to support more awards in shortage areas even if the appropriated amount stays at the same level.

Maintaining veterinarians’ access to xylazine suddenly became a priority about a year ago when we learned about legislative proposals to make xylazine a controlled substance. Early discussion included an emergency scheduling as a Schedule 1 drug! The AVMA advocacy team has worked very hard to make sure the veterinary profession’s concerns are addressed. There have been highs and lows as the legislative process has moved, and the AVMA advocacy team is still working hard to get the veterinary profession the best possible outcome. 

Q. Is there anything else you want to address?

A. I would like to express my gratitude for having the opportunity to serve on the Board for these last six years, and also for being able to serve in many other volunteer positions with the AVMA, American Animal Hospital Association, and my state association over the last 40 years or so. Each position has been an opportunity to meet great veterinarians from around the country and to learn about things I never would have otherwise. For me, it provided a nice break from the stresses of practice and an opportunity to grow as a person. I would really encourage all of our members to consider volunteering with their state or local association and keep an eye on the AVMA Volunteer Opportunity list. If you see something that looks interesting, let us know and we can help you with the nomination process.

A version of this story appears in the February 2024 print issue of JAVMA