AVMA pledges to 'vigorously defend' against expanding scope of practice

Broadening nonveterinarians' scope of practice would compromise the quality of veterinary care, thus threatening animal and public health, according to the AVMA. The AVMA House of Delegates (HOD) approved a new policy July 14 that directs the Association to "vigorously defend" against such expansions.

While affirming the skills and competencies of recognized veterinary professionals such as credentialed and licensed veterinary technicians (LVT) and certified veterinary assistants (CVAs), this policy puts the AVMA on record as opposing expanding the scope of practice of nonveterinarians, including the creation of a veterinary midlevel practitioner.

Several state VMAs, including Texas, California, Illinois, Indiana and Nevada, proposed the policy, "Safeguarding Care for Animals with Veterinarian-Led Teams." The AVMA Board of Directors (BOD) and House Advisory Committee (HAC) recommended delegates vote for the resolution, which passed on the final day of the House's regular annual session, held July 13-14 in Denver in conjunction with AVMA Convention 2023.

The policy states: "Animals deserve safe, efficacious, and high-quality care, and animal owners should be able to fully trust the veterinary services provided for them. Accordingly, the AVMA will vigorously defend the practice of veterinary medicine—which includes the ability to diagnose, prognose, develop treatment plans, prescribe, and/or perform surgery—against scope of practice expansions by non-veterinarians that threaten patient health and safety, the safety of animal products, and/or public health. Veterinary healthcare is enhanced through efficient utilization of each member of the team through appropriate delegation of tasks and responsibilities by the veterinarian."

"Human medicine is often suggested as a model for a veterinary midlevel provider," said Dr. Rena Carlson, 2023-24 AVMA president. "But while the first nurse practitioner program was established nearly 60 years ago, human medicine is still struggling with the issues created by moving forward without standardized education, credentialing, and licensure. We don't want educational programs that fail to prepare students appropriately and put patients at risk. There is increasing concern in human medicine that profits are being put ahead of patient care when health care decisions are not driven by physicians who seek to provide patient-centered, high-quality medicine. We should not go down the same path. Animals deserve safe, efficacious, and high-quality care, and delivering that care depends on having consistent and trusted training and credentialing."

The group of VMAs wrote the new policy after a report from the Texas VMA (TVMA) task force on veterinary paraprofessional utilization was accepted by the TVMA board of directors this March. Specifically, the task force was charged with exploring the expansion of the scope of practice for LVTs, CVAs, and noncredentialed personnel working in veterinary medicine.

The task force met several times to discuss issues within their charge, including researching veterinary practice acts in other states; reviewing the American Association of Veterinary State Boards' (AAVSB) "The Model Regulation—Scope of Practice for Veterinary Technicians and Veterinary Technologists;" and surveying Texas VMA members and leadership on leveraging veterinary staff members.

Dr. Jodi Long, TVMA president, told AVMA News that not one member of the group thinks that, at this point in time, a midlevel practitioner would be of benefit to veterinary medicine.

"From Texas's perspective, we understand and appreciate what our veterinary support staff does," she said. "We also understand that those individuals have not always been utilized to the fullest extent that they could be under our practice act. And we absolutely—absolutely—believe that the veterinarian-client-patient relationship (VCPR) should remain in the hands of the veterinarian."

Background information given to delegates regarding the resolution explains that the sponsoring organizations believe a strong, national stance by the AVMA against "scope of practice incursions" is of "utmost importance to the AVMA, its members, the health and welfare of our patients, public health, and the continued trust of our clients."

Such a stance, the background continues, "limits the acts of diagnosis, prognosis, treatment planning, prescribing, and surgery to the veterinarian, while appropriately recognizing the considerable knowledge and skill sets of veterinary technicians; supports full utilization of credentialed staff; and maintains the integrity of the VCPR."

The background provides examples of scope of practice incursions as proposals for a midlevel professional and inappropriate expansions of veterinary technicians' scope of practice.

Earlier this year, Arkansas adopted a law that will expand veterinary technician specialists' (VTS) scope of practice. It allows these individuals to establish—on a temporary basis—a VCPR on behalf of the veterinarian and then diagnose and develop a treatment plan.

"In addition to not being in the best interest of our patients, clients, and the public, such proposals are not compliant with existing federal requirements for prescribing and dispensing and place unacceptable liability on supervising veterinarians," the Resolution's background information states.

A version of this story appears in the September 2023 print issue of JAVMA