Idea of midlevel practitioner rejected in favor of better support, engagement of credentialed veterinary technicians

The idea of creating a midlevel practitioner in veterinary medicine generated much discussion at the regular winter session of the AVMA House of Delegates, held in conjunction with the AVMA Veterinary Leadership Conference, Jan. 5-7 in Chicago.

The consensus from conversations during the HOD’s Veterinary Information Forum on the topic “The veterinary healthcare team—Is there a need for a mid-level position?” was that a midlevel practitioner would not be a smart solution to workforce or access-to-care concerns. Rather, time and effort should be spent on resources, tools, and programs designed to retain veterinarians and credentialed veterinary technicians; further develop veterinary technician specialties; help veterinary practices operate at optimum efficiency; and effectively collaborate—within practice teams and across the profession—to meet clients’ needs for high-quality veterinary services.

The HOD reference committee assigned to the topic encouraged the AVMA Board of Directors to “consider including in the charge to the Committee on Advancing Veterinary Technicians and Technologists the following areas: title protection, standardization of nomenclature, retention within the veterinary technology field, financial security, support for the acquisition of veterinary technician specialists, and consider incorporating the recommendations from the Task Force on Veterinary Technician Utilization.”

Challenges ahead

Current market conditions have pushed the idea of a midlevel practitioner to the fore as veterinary practices have struggled to meet service demands. This issue has been compounded by continued inefficiencies in practices as pandemic disruptions persist and client expectations for availability and convenience. Inflation has also increased costs for labor and for products such as medical equipment and medications, creating additional concern around clients’ ability to afford needed care. Additionally, retention of veterinary practice staff members and attrition from the profession are ongoing and increasing concerns.

On the HOD floor, delegates pointed out that it’s not just the veterinary profession that is struggling to acquire and retain people. According to the U.S. Chamber of Commerce, there is a massive shortage of skilled workers.

According to the chamber: “We have more than 3.3 million workers missing from the labor force based on labor force participation rates and 4.3 million more job openings than unemployed workers. Businesses are still struggling to get the workers they need, even while inflation receives most of the attention from policymakers.”

Dr. Danielle Mayr, Wisconsin alternate delegate, questioned how a midlevel practitioner could attract more people to the profession and help with workforce shortages when current federal and state programs to bring veterinarians to rural areas in return for repayment of educational debt aren’t able to fully match the demand.

She asked: “If we can offer all these benefits to veterinarians and still can’t get them to come to rural areas, what is the attraction of midlevel person to that area if a veterinarian won’t come? Or a vet tech doesn’t come?”

Dr. Lori Teller, AVMA president, said one reason that veterinarians can’t see more patients is because they don’t have enough staff members. So how would adding another position solve that issue? Midlevel providers would need support staff members as well.

Dr. Clare Scully, alternate delegate for the American Association of Small Ruminant Practitioners, asked who would teach in educational programs for midlevel practitioners.

“We can’t fill faculty positions for veterinary students, much less a new program. And the money needed for infrastructure. It doesn’t make sense to me why we’re reinventing the wheel,” she said. “It seems like money could be better spent on what already exists.”

Long-term barriers

Developing educational and regulatory frameworks for a midlevel practitioner would be a long-term and expensive process—and will not be the silver bullet some are hoping for.

Currently, no health profession accreditation body is set up to evaluate midlevel veterinary practitioner educational programs, and there is no national examination to assess the competence of graduates. In addition, no state regulatory framework exists for a midlevel practitioner to license them to practice. And, even if all these barriers were overcome, such a provider would be prohibited from prescribing because statutory language at the federal level is specific to veterinarians, and it would take an act of Congress to change that language.

A midlevel practitioner also would not be able to issue certificates of veterinary inspection or perform testing for disease control programs because of state and federal requirements. Further, the veterinarian-client-patient relationship cannot be delegated by a veterinarian, meaning the midlevel position could not establish one.

There is also concern that opportunities for a midlevel practitioner might not be financially sustainable and could devalue credentialed veterinary technicians and veterinarians at a time when recruiting, appropriately remunerating, and retaining veterinary personnel is challenging.

In June 2022, Colorado state Rep. Karen McCormick convened a working group of approximately 35 stakeholders to determine whether a midlevel practitioner might be a potential solution for veterinary workforce issues.

The group has met for 90-minute sessions biweekly. The AVMA has helped to identify and has provided experts, and the Colorado VMA appointed nine members to a CVMA task force that has provided input.

“At this time, we feel there are too many obstacles for the CVMA to support such a program in Colorado,” said Dr. Curtis Crawford, Colorado delegate, during the Veterinary Information Forum.

Response from veterinary technicians

The board of directors of the National Association of Veterinary Technicians in America issued a statement, read by 2022 NAVTA President Ashli Selke during the meeting of the HOD reference committee to which the topic was referred. The board states that NAVTA’s recent member survey shows strong interest in title protection for credentialed veterinary technicians, optimizing engagement of veterinary technicians, and increasing wages and compensation as more immediate priorities. Creating a midlevel position ranked seventh out of eight priorities listed for ranking by respondents.

According to the statement: “The board of directors agrees with overwhelming data and the survey and supports the profession putting efforts behind the issues of title protection, utilization, and higher wages. But the NAVTA board also notes there are other significant issues with the mid-level position that warrant more attention and a slow approach. These issues include definition of a clear and unique skill set, program assessment and accreditation, regulatory structures at both the state and federal level, and financial sustainability of the new position.”

The state regulatory landscape for veterinary technicians varies. Illinois has developed a grid laying out tasks that can be done under immediate, direct, and indirect supervision by certified veterinary technicians, while nine states do not mention licensure of veterinary technicians in their veterinary practice acts.

Dr. Tiffany Healey, Wyoming alternate delegate, said her state is one of the those that don’t require licensure of veterinary technicians. She is leading an effort to do so but says it has been challenging, with many people against regulation in general and limited commentary available from which to model in the current version of the AVMA Model Veterinary Practice Act.

Dr. Teller noted that the members of the AVMA Council on Veterinary Service initiated their scheduled review of the AVMA Model Veterinary Practice Act last year. “One of their main focuses is to expand that whole section on veterinary technicians and scope of practice,” she said.

Ed Carlson, immediate past president of NAVTA, said one of the reasons for a shortage of veterinary technicians is that state veterinary practice acts largely do not have a definition for what unlicensed veterinary technicians can do.

Referring to credentialed veterinary technicians, he asked, “Why would someone want to go to college and endure debt and go to a practice and train individuals with no animal experience to do the same things they do and went into debt for?”

Other delegates said that if state veterinary practice acts are to change, they should account for differences in rural and urban practice. Dr. Lee Jones, Georgia delegate, said the desire to allow veterinary technicians to perform more duties has been discussed often, especially in rural areas.

“It’s not economically worthwhile for a veterinarian to leave a busy practice for a half-day to see 30 cows,” Dr. Jones said. “So, if we have someone who has gone through … (veterinary) technician school, how do you get that person with that training who could go out and do somethings and be an extension of the veterinarian?”

AVMA efforts

The AVMA has been providing ongoing support for existing educational programs for veterinary technicians, including efforts to optimize accreditation processes and hiring additional AVMA staff members in this area as well as support for efforts to increase the scale of those programs. The AVMA and NAVTA have been working together to support improved recognition of the knowledge and skills of veterinary technicians and better engagement of veterinary technicians within practices.

As part of those efforts, the AVMA is researching behavioral barriers to such engagement within practices and looking at retention and attrition among the veterinary profession.

Further, the AVMA is creating a Committee on Advancing Veterinary Technicians and Technologists to actively work on many of the issues identified by delegates during the Veterinary Information Forum.

“Before we go to midlevel, we need to leverage our credentialed staff,” said Dr. Richard Posey, Texas alternate delegate.