In Arkansas, a recently adopted law, Act 161 (formerly HB 1182), will expand veterinary technician specialists’ (VTS) scope of practice. Another bill (HB 1673) still under consideration would dilute the educational background required for veterinary technicians to qualify for licensure. We want to share why the Arkansas Veterinary Medical Association (ArVMA) and the AVMA actively opposed HB 1182 and continue to oppose HB 1673. Concerns include patient safety, client service, food safety, public health, and recognizing and continuing to ensure the value of degrees in veterinary technology.
Before we delve into what is going on in Arkansas, we want to be very clear that we strongly support and highly value veterinary technicians and VTSs. Every day, they make essential contributions to our practices and enable us to provide top-quality services for our patients and clients. Across the veterinary profession, we are striving to better integrate technicians as key members of our veterinary healthcare teams and to allow them to work to the top of their training and education. There is no doubt that fully utilizing the skills of our team members, including veterinary technicians and VTSs, helps our practices run more efficiently and effectively1,2,3.
We believe better engagement of veterinary technicians, specifically VTSs was part of the intent of Arkansas HB 1182, now Act 161. However, even after substantive amendments, its provisions go too far. The new law inappropriately expands the VTS’s scope of practice beyond these professionals’ education and training by allowing a VTS to:
- Engage in the “joint management” of the health care of patients by creating a “collaborative practice agreement” with a veterinarian.
- Establish a temporary veterinarian-client-patient relationship (VCPR) on behalf of a collaborating veterinarian for new patients. This temporary VCPR must be “completed” by the veterinarian through an in-person visit within 15 days.
- Order diagnostics, provide a diagnosis or prognosis, and establish a treatment plan. A VTS may not prescribe.
- Perform “minor” dental and surgical procedures on animal patients. Specifically excluded are abdominal, thoracic, orthopedic, and neurologic surgeries.
Furthermore, under Arkansas Act 161, a licensed veterinarian using, supervising, or employing a VTS is individually responsible and liable for their performance, including both acts and omissions related to their services.
Substantive and critical amendments were made along the way from the bill’s introduction to its becoming law, in no small part due to the efforts of the Arkansas VMA with support from the AVMA.
As originally introduced, HB 1182 provided a VTS with prescriptive authority, which was not only inappropriate given the training a VTS receives (more on this later), but was in direct conflict with federal law. Drugs are regulated differently in veterinary medicine than in human medicine. Federal law limits the dispensing of veterinary prescription drugs to the order of a “licensed veterinarian,” rather than that of an “authorized prescriber” as is the case in human medicine.4 This is, in part, to protect the food supply and public health, including ensuring the judicious use of antimicrobials in animals. Any change would require an act of Congress, which is very unlikely given increasing concern around these issues. HB 1182 also only excluded “major” abdominal, thoracic, orthopedic, and neuro surgeries from the VTS’s scope of practice, and allowed a VTS to be independently compensated.
Fortunately, the bill was amended and now the law does not allow a VTS to prescribe, and abdominal, thoracic, orthopedic, and neurologic surgeries are all specifically identified as being out of scope. An internal language conflict within Act 161 regarding independent compensation remains. Once this is corrected by new legislation (HB 1566) already introduced by HB 1182’s sponsor, it will be clear that a VTS may not receive compensation other than that paid by the veterinarian or veterinary practice by whom/which they are employed.
Even with these changes, we do not believe this new law serves the best interests of patients, clients, or the public. It creates unnecessary risk by allowing a VTS to establish a VCPR, order diagnostics, provide a diagnosis and prognosis, and develop a treatment plan. In short, it means VTSs have been authorized for functions they simply do not have the knowledge, training, and skills to do.
In thinking about the roles of the veterinarian, the veterinary technician, and the VTS, it’s important to understand the differences in education among each of the groups and to recognize that education for each group is structured with the individual’s role within the veterinary team in mind. The difference in time, breadth, and depth of education between the veterinary technician’s two-year associates or four-year bachelor’s degree and the veterinarian’s four-year doctoral degree (which is only pursued after completing rigorous collegiate prerequisites) represents a significant difference in the extent and sophistication of these professionals’ understanding of animal health care, as well as the implications of that care for food safety and public health.
Veterinary technicians are educated and have demonstrated their competence in performing technical tasks. The extensive education that veterinarians receive, both in the theory and practice of veterinary medicine, uniquely positions them to function safely and effectively as medical decision makers. As a practical example, veterinary technicians are educated on radiation safety and how to position animals for quality radiographs, while veterinarians are also educated to interpret the radiographs, and use this information to diagnose, prognose, and formulate a treatment plan.
With their additional training, VTSs can perform technical tasks at a higher level of proficiency in their chosen discipline. Important to note is that veterinary technician specialty academies, which are approved by the National Association of Veterinary Technicians in America (NAVTA), provide qualifications in a particular area, such as veterinary emergency and critical care, internal medicine, and particular types of clinical practice (e.g., production medicine). Interestingly enough, and in contrast to what is authorized by Act 161, the NAVTA-approved Academy of Veterinary Dental Technicians does not authorize certified individuals to do extractions or oral surgery. Furthermore, receipt of a VTS certification does not provide greater technical competence beyond their specific discipline, nor does their training provide them with the foundational education that veterinarians receive and that is necessary to competently diagnose, prognose, and develop treatment plans that may involve prescribing and performing surgery. VTSs are well-trained, but they are not licensed veterinarians. A missed or delayed diagnosis and/or an inadequate treatment plan can be life threatening for an individual veterinary patient, can be economically devastating for a client who owns an animal-based food production facility, and―if the disease is zoonotic or poses risk of becoming so―there can be significant consequences for public health.
There were many important tasks that veterinary technicians and VTSs were authorized to perform before the adoption of Act 161 in Arkansas. Rather than passing this law, we believe that if there was a need or desire in Arkansas to re-evaluate the actions that a veterinary technician specialist may take under immediate, direct, and indirect supervision, the better course of action would have been to work with the Arkansas Veterinary Medical Examining Board (AVMEB), the ArVMA, and the Arkansas Veterinary Technician Association (AVTA) to evaluate those tasks and potentially add to an already extensive list. Such efforts are being made across the veterinary profession as we work to better integrate veterinary technicians and VTSs as key members of our veterinary healthcare teams. In November 2022, the AVMA announced the formation of the Committee on Advancing Veterinary Technicians and Technologists (CAVTT), which will examine ways to better support and advance veterinary technicians and VTSs and empower them to use their full skill set and education in all aspects of veterinary practice.
To make matters worse, shortly after passing this bill, the same Arkansas legislators introduced another bill, HB 1673, that would expand who may qualify for licensure as a veterinary technician. Currently, Arkansas law requires those to be credentialed as veterinary technicians to have successfully completed a program in veterinary technology accredited by the AVMA Committee on Veterinary Technician Education and Activities (CVTEA). If adopted, HB 1673 would expand eligibility for licensure to include those holding “a bachelor of science degree in animal science with a preveterinary emphasis.” Just as Act 161 reflects a failure to understand the differences between a veterinarian’s and a veterinary technician’s (including a VTS's) education, HB 1673 reflects a lack of understanding of the differences between the curriculum that leads to an academic degree in animal science, and the curriculum that includes knowledge and skills specific to the delivery of technical healthcare services that leads to an associates or bachelor’s degree in veterinary technology. Just as a bachelor’s degree in biology, anatomy, or physiology does not expose students to the knowledge and skills needed to become a registered human nurse, a bachelor’s degree in animal science doesn’t include the curriculum and hands-on skills needed to become licensed as a veterinary technician. Unfortunately, it isn’t a stretch to think that these same legislators (or others) might attempt to further extend duties now accorded to VTSs to graduates of animal science or other academic programs as well, or even try to equate a master's or PhD in animal science with a doctor of veterinary medicine degree.
The rationale posed for HB 1673 is the shortage of veterinary technicians. The AVMA CVTEA currently accredits 223 veterinary technology programs. Of those, 10 are distance-learning programs that provide a viable and reasonably priced option for those unable to enroll in a site-located program. We believe increasing support for the development and expansion of accredited veterinary technology programs and facilitating access to accredited distance-learning education is a much more appropriate way to increase the number of individuals qualified for licensure as veterinary technicians than adoption of HB 1673. Allowing animal science graduates to sit for the licensing examination may increase numbers, but also comes with clear risks for patient safety, quality of services provided for clients, and public health, including food safety and containment of potentially zoonotic or economically devastating diseases.