AVMA News

How Colorado became ground zero for veterinary midlevel practitioner debate

Veterinary professionals and other stakeholders express concerns about Proposition 129

Updated October 22, 2024

A group in Colorado—All Pets Deserve Vet Care, funded in part by the Dumb Friends League and the American Society for the Prevention of Cruelty to Animals (ASPCA)—is proposing a new veterinary role called a veterinary professional associate (VPA). The group gathered enough citizen signatures to put a measure to establish this new role before voters on Colorado’s November 5th general election ballot.

This is a proposed master’s level trained individual who would be allowed to practice veterinary medicine—including diagnosing, creating treatment plans, and performing surgery.  Supporters of the measure have opined that a VPA would be able to perform limb amputations and splenectomies.

Yet, these individuals would complete roughly half the credit hours of a veterinarian—through a mostly online program—and there is no national test for competency, licensing, or curriculum. They would work under the supervision of a veterinarian, though, at what level of supervision remains unclear.

A veterinary technician treats a dog in an animal hospital
Emergency and critical care registered veterinary technicians (RVTs) are the primary caregivers for hospitalized patients. Colorado has recently expanded the scope of practice for RVTs and veterinary technician specialists (VTSs), to allow for more delegation of advanced tasks. Proposition 129 threatens the robust implementation of the law, better known as the Veterinary Technician Scope of Practice law. ([Photos by Brandy Tabor, RVT, VTS (ECC)]

In fact, many of the ideas put forth by Proposition 129 require clarification, says Dr. Jen Bolser, a veterinarian in Colorado who works at an open-admission shelter with a small animal clinic and access to care programs.

She says proponents have expressed the goal of indirect supervision for VPAs, in which case the veterinarian would not need to be on the premises but would give either written or oral instructions to the VPA. If Proposition 129 is approved, it would fundamentally change the way the veterinary profession operates, as currently only veterinarians can diagnose, create treatment plans, or perform surgery.

Colorado might not seem to be a likely place for this proposition to happen, especially when the state legislature recently approved bills that impact the veterinary profession, including a new law that elevates the status of registered veterinary technicians (RVTs) and veterinary technician specialists (VTSs), and where state legislative proposals to create a VPA position have previously failed.

“Why is this issue about our profession going to be decided by Colorado voters, through the general public?” said Dr. Bolser, who made her remarks during a recent bonus episode of the AVMA’s “My Veterinary Life” podcast. “For most of us, it seems kind of unbelievable we’re in this and it seems like major changes to the veterinary profession would go through a much different process and should … not become this marketing battle that’s being decided at a ballot box.”

So how did we get here?

VPA origins

Dr. Melanie Marsden, owner of a seven-doctor veterinary hospital in Colorado Springs, Colorado, also was a guest on the podcast episode, which was dedicated to the topic of Prop 129.

She said the idea of a VPA has been suggested by a faculty member at Colorado State University (CSU) for the last 10-15 years. That person had approached the Colorado VMA (CVMA) and others with the idea, but it had never gained support or traction in the past, said Dr. Marsden, who is a district director on the AVMA Board of Directors and a past president of the CVMA.

About four years ago, VPA proponents tried to bring forward a bill as the Colorado legislature went through a sunset review process of the state’s Veterinary Practice Act. Ultimately, the VPA did not advance, and the consensus was instead to include veterinary technicians in the Colorado Veterinary Practice Act along with a regulatory program, which granted them title protection.

Woman with long, wavy blonde hair wearing a black blouse and gold necklace
Erin Henninger, executive director of the Colorado Association of Certified Veterinary Technicians, says, “All eyes are on the (veterinary professional associate) instead of recognizing what a monumental thing Colorado did, with expanding the scope of practice and creating a regulatory program for veterinary technician specialists,” referring to two bills passed by the Colorado legislature earlier this year.

Erin Henninger, executive director of the Colorado Association of Certified Veterinary Technicians (CACVT), told AVMA News, “We looked at that as a foundational step to help the veterinary industry leverage veterinary technicians better, because they could know who was a registered veterinary technician and who hadn’t taken the extra step to be legally recognized.”

Yet, the VPA proposal came up again last year. Colorado Rep. Karen McCormick, who is a veterinarian from Longmont, Colorado, decided to convene a legislative working group on the topic.

Dr. Bolser and Henninger were both members of the working group. The working group looked at all angles of the potential impact of such a bill: animal safety, prescribing laws, liability issues for veterinarians, the veterinary technician workforce, and educational programs that are in development, including CSU’s College of Veterinary Medicine & Biomedical Sciences degree program for a master’s of veterinary clinical care (MVCC).

Successful VTS legislation

After six months of learning sessions and stakeholder meetings, Dr. Bosler said, the proponents were still solidly in the camp of pushing for a VPA while most of those who were previously undecided, came away with a different conclusion.

Henninger is a VTS in emergency medicine and critical care. She said it seems many veterinarians or even veterinary technicians don’t know much about the VTS pathway, “which is something we explored in those learning groups and felt like a promising pathway for keeping people in industry but also expanding scope of practice for those who become a VTS.”

Information learned in the working group was used to create the Veterinary Technician Scope of Practice bill. The intention of the bill was to give veterinarians more clarity and leeway on which tasks to delegate to veterinary technicians and other personnel under appropriate levels of supervision and allow veterinary technician specialists to work fully under indirect supervision.

As a result, Colorado House Bill 24-1047 passed by near unanimous support in the state House and Senate. Gov. Jared Polis signed it into law this past April.

“It was a really thoughtful bill that had very broad animal industry support because of how much collaborating we did with everyone in the industry, including proponents of the VPA,” Henninger said.

Unknowns and concerns about the VPA

As proponents of the VPA realized their efforts to go through the normal legislative process weren’t succeeding, they pivoted their approach to, “Well, we’ll go to a ballot initiative and let voters decide,” Dr. Bolser said.

And yet, clear information about the proposed VPA position has been hard to come by. The draft VPA curriculum Henninger saw last year during the working group meetings had “a shocking amount of overlap” with the veterinary technician curriculum, she said.

Proponents have said the VPA position offers a career path for veterinary technicians who want to advance their careers. However, Henninger notes that only 30% of CACVT members have a bachelor's degree or higher. Having to complete a bachelor's and master’s degree, as well as take on educational debt, is unfeasible for many, she said.

Two veterinary technicians examine a dog on the floor in an animal hospital
Henninger says, “We have lots of career paths for veterinary technicians. I want to see the industry really stand behind vet techs and focus on robustly implementing the new veterinary technician’s scope of practice and paying them more.”

Dr. Marsden also noted that while VPA proponents say this position will help with access to care in rural communities, the program currently proposed has no large animal courses.

“In recent conversations, CSU says they will go ahead with program regardless of (the ballot) outcome,” she said. “How is creating a new profession with new schools, new test, new accreditation, all that—how does it make sense when we already have veterinary technicians? Let’s use people we know and trust.”

Impact to the public

Dr. Bolser adds that the marketing and argument behind the VPA is that the new position is needed for access to care and that a VPA would handle routine care.

“The specifics of that are unclear. Those working in access to care, we know type of cases we’re seeing and struggling with. Those cases struggling to get care are not routine. With the proposed VPA position and training we have seen, they are not going to be equipped to handle these cases,” she said.

Further, Dr. Bolser expressed concern about a VPA handling what proponents call “routine surgeries,” including abdominal spay and neuter procedures.

“We all know that surgery isn’t routine until it’s done, the animal is awake, and there weren’t any complications,” she said. “So, to think we can pick and choose the routine spay and neuter surgery for an individual with less training to perform is really unrealistic.”

Henninger said there is a reason that the idea didn’t get traction when it was initially proposed and that’s because people recognized RVTs and VTSs are already working with veterinarians but haven’t been allowed to function at the top of their license.

“The gap between what veterinarians and veterinary technician do can be very small,” she said. “Bringing another individual into that mix doesn’t feel like the right thing or at the right time when we haven’t yet seen how the industry will respond to the new regulations of veterinary technicians.”

HB 24-1047 directs the Colorado Board of Veterinary Medicine 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.

In addition, starting in 2026, the new law authorizes a veterinary technician to receive a VTS designation as part of the veterinary technician's registration. It grants title protection for VTSs and prohibits a person from practicing as a VTS if they are unauthorized.

“We have not even allowed this new law to be implemented by the veterinary profession. All eyes are on the VPA instead of recognizing what a monumental thing Colorado did, with expanding the scope of practice and creating a regulatory program for veterinary technician specialists,” Henninger said.

Dr. Bolser added, “Sadly, it’s a few individuals at the top of corporations, institutions, and nonprofits who are leading this initiative, and it is not the clinical practices’ vet techs or vets who are being included in the conversations and the concerns of these individuals are being ignored. It’s imperative that those of us on the front lines … we need to be voicing and advocating for that.”

Numerous organizations and individuals have come out against Proposition 129, from veterinary associations to animal owners to animal welfare organizations. Most recently, the American Animal Hospital Association and Student AVMA have voiced their opposition to the measure.