Colorado ballot measure calls for nonveterinarians to diagnose, do surgery

An unprecedented ballot measure in Colorado seeks to create a new midlevel practitioner (MLP) position in veterinary medicine that, if approved by voters this fall, raises serious concerns about the future of quality care for veterinary patients.

Colorado Proposition #129, formerly known as Proposed Initiative #145, will ask voters whether the state should establish the position of veterinary professional associate (VPA). The VPA’s duties would overlap those of a veterinarian and veterinary technician. Working under the supervision of a licensed veterinarian, they would be able to diagnose, prognose, recommend treatment plans, and perform surgery.

One of the campaign’s sponsors, All Pets Deserve Vet Care, submitted about 200,000 signatures for the initiative on July 29. To qualify for the ballot, 124,238 valid signatures were required. The Colorado Secretary of State certified the ballot initiative on August 28, which means Colorado residents will have their say on November 5.

The AVMA opposes the initiative as do multiple other veterinary organizations, including the American Association of Bovine Practitioners (AABP), American Association of Swine Veterinarians (AASV), American Association of Equine Practitioners (AAEP), American Veterinary Dental College (AVDC), American College of Veterinary Surgeons (ACVS), Independent Veterinary Practitioners Association (IVPA), and Veterinary Management Groups (VMG) as well as the Colorado VMA (CVMA) and others across the state. Three out of four veterinarians in Colorado oppose the measure, according to a CVMA survey.

AVMA President Sandra Faeh said, “This ballot measure attempting to create a ‘veterinary professional associate’ would be disastrous for pets and other animals and endangers public health, considering that 75% of emerging infectious diseases in humans originate with animals.

“The proposed training for this position is completely inadequate and will lead to missed or delayed diagnoses, ineffective treatment and repeat visits, all of which lead to more suffering for the animal and increased cost for the client.”

The Animal Welfare Association of Colorado, the American Society for the Prevention of Cruelty to Animals (ASPCA), and the Virtual Veterinary Care Association support the initiative.

The measure “Establish Qualifications and Registration for Veterinary Professional Associate” brings up concerns about scope of practice, legal liability, and patient care.

VPA position details

The ballot measure says the Colorado State Board of Veterinary Medicine (CSBVM) would oversee the examination and qualification processes for this midlevel position as well as issue and renew registrations and set fees. This would all take effect January 15, 2027, if passed.

Were that to happen, further legal and practical hurdles would remain, chief among them being federal regulations. Currently, only veterinarians can prescribe and dispense medications, according to the Food and Drug Administration (FDA). Addressing this functional issue would require legislative and regulatory changes not only in Colorado, but also 49 other states, territories, and at the federal level.

“Why would we be creating a position that mimics and duplicates what we already have … if this person is not allowed to do their own diagnosing and prescribing (without a supervising veterinarian present)? They are just basically following a recipe,” said Colorado Rep. Karen McCormick, who is a veterinarian from Longmont.

The VPA position would require a master’s degree. However, there is no currently accredited national educational program, national test, or regulatory structure to assure competence and public protection.

Colorado State University (CSU) College of Veterinary Medicine & Biomedical Sciences is in the process of developing a degree program for a Plan B Master’s of Veterinary Clinical Care (MSB VCC) to fulfill the requirements.

Rep. McCormick, who has seen the proposed curriculum, said the program would consist of three semesters of fully online lecture with no laboratory, a fourth semester of basic clinical skills training, and a short internship.

“How do we assure the public that this person has the proper skill set to perform surgery or prescribe? That they have reached a baseline level of competency and have had enough practice and training to minimize mistakes or miscommunications? None of that is in place or plans to be in place in the near future for this potential position,” she said.

Rep. McCormick added that, given the proposed VPA would operate under a supervising veterinarian, the veterinarian would be liable for all actions of that VPA, including errors made during surgery.

Tracey Gray-Walker, AVMA Trust CEO, told the AVMA House of Delegates earlier this year that among all claims made to the Professional Liability Insurance Trust (AVMA PLIT), slightly over 10%—regardless of species—pertained to spays and neuters. For companion animal claims alone, it rises to about 20%, and represents about 50% of the top five small animal surgical claims.

The American College of Veterinary Surgeons (ACVS) issued a statement earlier this year saying that it stands universally opposed to allowing nonveterinarians to perform any surgical procedures on animals.

“The American College of Veterinary Surgeons (ACVS) strongly opposes these efforts and believes they will result in increased risk to animal health and safety. All surgical procedures, even those considered routine, have inherent risks that can lead to serious complications (e.g., bruising, pain, bleeding) and even patient death if not performed by trained, qualified personnel. Only a licensed primary care veterinarian and for many procedures a board-certified veterinary surgeon has the education and training necessary to safely perform surgeries on animals and address any associated issues that can arise when performing these surgeries,” according to the statement.

Support and opposition

Dr. Apryl Steele, CEO of the Dumb Friends League, which sponsors the initiative, has cited a workforce shortage for the reason behind the proposed position. Meanwhile, there’s been a slowdown in the volume of veterinary services, according to the Veterinary Industry Tracker, with visits down 2.5% year-to-date.

Recent surveys of veterinarians have indicated widespread opposition to the creation of a midlevel position.

A 2023 American Association of Veterinary State Boards (AAVSB) survey found most North American veterinarians and veterinary technicians are opposed to creating a new MLP and supported better utilization of credentialed veterinary technicians (CrVTs) as a means to help alleviate veterinary workforce shortages.

VMG, a professional membership organization for practice owners who want to improve the business side of their practice, also conducted a 2024 survey regarding the creation of a midlevel position. Their surveyed members were overwhelmingly against the idea of the position.

There also many unknowns regarding how a midlevel veterinary practitioner would impact the veterinary workforce. While proponents of this proposed role argue that it will help relieve workforce shortages, there is no evidence to suggest these individuals will be any more likely to practice in areas that are underserved than will veterinarians.

In fact, Colorado’s legislature passed a bill earlier this year, sponsored by Rep. McCormick, that addresses much of what the ballot measure proposes to do.

Colorado House Bill 24-1047 clarifies and expands the scope of practice for registered veterinary technicians (RVTs) and veterinary technician specialists (VTSs) while also providing clarity for veterinarians on tasks they can delegate to veterinary staff members. This law goes into effect January 1, 2026.

It directs the CSBVM to adopt rules by September 1, 2025, that give licensed veterinarians the ability to delegate certain technical tasks—and with what level of supervision—to RVTs, VTSs, or other veterinary staff members.

For example, under the law, veterinary technicians are allowed to assist with surgical procedures and place abdominal, thoracic, esophagostomy, or percutaneous endoscopic gastrostomy tubes under immediate supervision. Under direct supervision, they may perform dental procedures and treat minor medical conditions under certain circumstances. Any other task may be delegated to an RVT or VTS under indirect supervision. Meanwhile, tasks performed by nonveterinary technician “other personnel” must be delegated at a minimum of direct supervision.

The current ballot measure would negate much of what was achieved in that bill.

Dr. Kelly Walsh, president of the CVMA, has said the current ballot measure would compromise and threaten the health and safety of animals and pets. In an op-ed she wrote in July, Dr. Walsh said it “presents dangerous risks by permitting VPAs to practice the full scope of veterinary medicine—including performing surgery—with inadequate, mostly online training. Surgical procedures, even routine surgeries, are highly complex and require extensive veterinary training and expertise. Allowing inadequately prepared individuals to perform such procedures fundamentally undermines veterinary care and places animal lives in jeopardy.”

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

Correction: A previous version of this story inaccurately described the level of supervision required for veterinary technicians when performing dental procedures.

Clarification: A previous version of this story included the initial name for Proposition #129.