.png){kind=logo}
Posted August 16th, 2024
.png)
Posted September 10, 2023
by Apryl Steele, DVM, CAWA
It Is Time For a “YES, and…” Approach to the Veterinary Workforce and Access To Care Crisis.
First, let’s explore the issue. Imagine if the American healthcare system defined the need for doctors, physician assistants, and nurses only by the number of people who could afford thousands of dollars of out-of-pocket expenses. Your child is hit by a car? Too bad, without cash there’s no care available. You’ve contracted COVID and are having trouble breathing but cannot come up with $5000? Too bad, there’s no care for you. This would be inhumane and unacceptable.
But this is exactly how veterinary medicine works. Access to life-saving veterinary care for severe injury or illness is virtually non-existent for pet caretakers who don’t have access to expendable funds. In a recent Forbes survey, 70% of pet owners reported that a veterinary bill of $1500 would be unaffordable. It is common for veterinary treatment to exceed $1500, resulting in pet owners having to make the difficult decision of economic euthanasia.
As long as the need for veterinarians is defined by the demand from pet owners who can afford these out-of-pocket expenses, we will never create the access to veterinary care that our pets deserve.
A 2023 study determined that in just seven years there will be a shortage of between 14,000 to 24,000 veterinarians in the US. And here is the kicker…these projections include ONLY those pet owners who can afford care. To address the 40 million pet-owning households who spent nothing on veterinary care, the need for veterinary professionals would increase drastically.
These numbers refer only to companion animal veterinarians. But the situation in our agricultural sector is even more dire. In a 2023 Colorado Cattlemen’s survey, members reported that access to veterinary care is their biggest challenge. Over half of the respondents reported that their livestock’s health and their business’s bottom line are affected by challenges in the delivery of veterinary care. Over 80% of surveyed livestock producers believe the availability of veterinary services will become more challenging in the next five years. Without innovation NOW, we are risking the safety of our food supply, the sustainability of our ranching operations, and the welfare of these animals.
This massive veterinary shortage has broad implications. Paramount is animal welfare, whether it be the dog that ate a ball and has an intestinal obstruction that goes untreated or a heifer with mastitis who receives no antibiotics, without care these animals suffer.
These numbers refer only to companion animal veterinarians. But the situation in our agricultural sector is even more dire. In a 2023 Colorado Cattlemen’s survey, members reported that access to veterinary care is their biggest challenge. Over half of the respondents reported that their livestock’s health and their business’s bottom line are affected by challenges in the delivery of veterinary care. Over 80% of surveyed livestock producers believe the availability of veterinary services will become more challenging in the next five years. Without innovation NOW, we are risking the safety of our food supply, the sustainability of our ranching operations, and the welfare of these animals.
This massive veterinary shortage has broad implications. Paramount is animal welfare, whether it be the dog that ate a ball and has an intestinal obstruction that goes untreated or a heifer with mastitis who receives no antibiotics, without care these animals suffer.
We are also facing a serious equity issue. Pet ownership provides physical, mental, social, and emotional benefits. It is unconscionable to restrict these benefits to only the privileged. Communities that experience systemic marginalization are most impacted by the inability to obtain veterinary care.
Additionally, the veterinarian shortage creates serious public health risks. Zoonotic diseases, those that are transferred from animals to people, are prevalent throughout the US. Whether it is an intestinal parasite that can cause blindness in a child, the fatal rabies virus, or one of the other 200 known zoonotic diseases, trained veterinary professionals are the first line of defense.
And finally, there are economic impacts to the veterinary shortage. In spending for companion animals alone, the economic impact of the veterinary shortage is estimated in the billions of dollars.
There are several innovative solutions to the veterinary workforce shortage, some with immediate impact and others with longer-term results, and we need to deploy every one of these solutions now.
We don’t have the luxury of choosing which tactic to use, but rather our success lies in a “yes, and” approach.
Do we need to increase efficiencies within veterinary practices? Absolutely yes. But can we increase production by 5%, 10%, 20%? And how is this done? Even an ambitious 20% increase in all veterinary practice productivity would only partially meet the need. When leaning on our veterinary teams to increase productivity, we must also remember two things. First, in rural practice, there are many areas without veterinary teams to make more efficient. Secondly, burnout among veterinarians is at an all-time high, with 20% of veterinarians attributing their burnout to being overworked.
So yes, and….
Perhaps we need to better utilize veterinary technicians. Absolutely! But here is the problem with this as a sole solution: the US has an even larger shortage of veterinary technicians than it has of veterinarians. It is estimated that it would take 30 years to graduate the number of technicians needed by 2030. Veterinary technician graduating classes have declined sharply since the pandemic, and many technicians leave the field within seven years of graduation due to being underpaid. Only 5% of veterinary technicians report feeling underutilized.
So yes, and…
How about veterinary technician specialists? VTS’s are experts that are undeniably underutilized. VTS’s have an average of an additional five years of training in a very specific role, such as critical care, anesthesia, nutrition, or dentistry. What tasks can they do with this additional training that they could not do prior to obtaining it? In most states, not a single one. The Veterinary Practice Act restricts the ability of a VTS to fully utilize their skills. This must change. And, with only 2% of veterinary technicians earning a VTS designation, it is unrealistic to pretend that increasing their ability to utilize their training will significantly impact the overwhelming shortage we are facing.
So, yes, and….
We must increase the number of trained veterinary professionals. The veterinary educational community is stretching class sizes, and even opening several new veterinary schools, but even with these additions, US veterinary schools will graduate around 5,100 veterinarians annually. With a shortage of over 20,000 veterinarians just to meet the demand of pet owners who can afford care, these additional doctors will not be able to resolve the shortage.
In veterinary medicine, care is provided by veterinary technicians who usually have a two-year associate’s degree and doctors of veterinary medicine who have, on average, nine years of college education (and the student debt that accompanies it). By creating a master’s degree veterinary professional, similar to a physician’s assistant in human medicine, we can significantly impact our veterinary workforce shortage. While this is not a solution for tomorrow, if the legislature acts urgently these professionals could be in the workforce within four years. Currently, most veterinary practice acts would restrict the ability of these graduates to work. Changes to practice acts are needed to fully deploy this solution.
The coalition for the VPA is advocating for the evolution of veterinary medicine through the creation of a VPA. This person will have completed a Master’s degree program with learning objectives closely aligned with those in the Doctor of Veterinary Medicine program. The VPA would work only under the supervision of a veterinarian, and the VPA’s work would be delegated by that DVM. Not only does this role increase available veterinary resources, but it also represents a career path for veterinary technicians who regularly leave the profession after only a few years.
Sadly, veterinary trade associations have vowed to “vigorously defend” against anyone, including veterinary technician specialists and VPAs, being allowed to diagnose, prescribe, initiate treatment, or perform surgery on animals. There is only one real reason for this organized opposition, and that is, in the AVMA’s economist’s own words, that “more veterinary professionals could mean less job competition and thus lower or stunted salaries…” This fear-based argument is inconsistent with business models. This fear-based argument is also contrary to the veterinarian’s Oath to use scientific knowledge and skills for the benefit of society through the protection of animal health and welfare, the prevention and relief of animal suffering, the conservation of animal resources, the promotion of public health, and the advancement of medical knowledge.”
Sadly, in this opposition, intentional misinformation is being used to sow doubt. Let’s explore a few of these arguments and shed some light on the reality of a VPA.
One common theme is that animal welfare will be negatively impacted because untrained people will be performing veterinary care. Not only is this untrue, it is offensive. Why would the animal welfare community so strongly advocate for something that would cause harm? We would not. The five semester master’s degree in veterinary clinical care programs that are being developed will prepare a VPA to perform in many delegated roles thoughtfully and successfully. Last year there were thousands of highly qualified applicants who did not earn admittance to veterinary school. Those folks who were not accepted are great candidates for the VPA program, as are veterinary technicians who have dedicated their lives to this profession. Additionally, both the supervising veterinarian and the VPA would be regulated by state boards of veterinary medicine, and standards of care would not change.
The second misunderstanding is that the Food and Drug Administration’s regulations limit the ability of a VPA to prescribe medications, and thus, a VPA could not be utilized. There is an FDA rule that restricts prescribing in two very specific situations. IF a drug is not labeled for use in the species to whom it is being prescribed (off-label drug use), or IF the drug is to be delivered to groups of livestock through their food, then a veterinarian is required. For all other medications, there is no clear directive. When the FDA was asked directly if a VPA would be allowed to prescribe medications based on standing orders by a veterinarian, their response was that the FDA does not regulate such activity and that we would need to refer to our state’s regulations. While the AVMA will say that prescribing by a VPA would be illegal, despite several queries to the FDA we have received no information from the FDA that changes their response.
Secondly, if the FDA determined at some point that a VPA could not use standing orders from a veterinarian to prescribe, this would only minimally decrease the ability of a VPA to augment the veterinary workforce. These professionals will be working under the supervision of a veterinarian, and, as was initially done between MDs and PAs, a DVM could sign off on prescriptions upon review of the case. Finally, there are many roles a VPA could fill even without ANY prescribing authority. These include wellness exams and vaccinations, dental procedures, spaying and neutering, hospice care and euthanasia, nutrition counseling, and so much more. In a Cattlemen’s Association survey, producers reported that the top services they have difficulty obtaining for their livestock operations were assistance with live births, surgical procedures, orthopedic and/or hoof care, and diagnostic testing. A VPA could do all of these things without the ability to prescribe. While drugs may be needed for some of these tasks, such as to sedate an animal, the supervising veterinarian could authorize those medications.
The third argument against evolving a VPA is a fear of liability for the supervising veterinarian. While some portray this as a negative, holding veterinarians accountable for what they delegate and to whom is one way to ensure thoughtful delegation. Some veterinarians report they would only hire a VPA if that person had their own liability insurance. The good news is that two providers of veterinary professional liability insurance coverage have stated that they will happily offer policies directly to a VPA. However, coverage for a VPA does not remove liability from the veterinarian. Current professional liability policies typically provide coverage if the veterinarian’s actions follow state and federal regulations. This is one more reason practice acts must be amended.
There are several arguments that are simply diversion techniques without merit. Some say that because the VPA will not initially be eligible for accreditation by the USDA, they will be unable to contribute to workforce needs. However, almost half of the licensed veterinarians have chosen not to be accredited by the USDA. USDA accreditation is not required for most of the work that a veterinarian does. Additionally, how could the USDA accredit a professional that does not yet exist? The USDA is committed to disease surveillance and to the mitigation of infectious diseases, so it stands to reason that once trained professionals are on the ground they will be utilized.
Finally, you might hear that animals will suffer because there is no national board exam or certification process for a VPA. How could there be a certification for a professional that does not yet exist? However, let’s put this argument to rest. Statutory changes can require a certifying exam that must be passed before the VPA can practice.
Let’s work together to yes, and so animals get the care they deserve.
.png)
Posted September 1, 2023
The Case for Veterinary Midlevel Professionals
In 2009, Kogan and Stewart initiated a discussion within the veterinary medical community bringing forth the concept of veterinary professional associates, midtier professionals similar to physician’s assistants (PAs).1 The article evaluated the need for such a role through discussion of societal needs for more veterinarians and described the motivations, developmental history, intended role, responsibilities, limitations, benefits, and certification process of PAs.
In the recent years, the veterinary technician (VT) profession has reached a new height, with 13 veterinary technician specialist (VTS) academies officially recognized by the National Association of Veterinary Technicians in America (NAVTA) and the entire field working toward a unified credentialing title. More than 850 credentialed VTSs have become certified through a rigorous application and examination process, with the majority practicing within the United States. Additionally, programs such as the biomedical sciences master’s program in veterinary medicine and surgery at the University of Missouri, which is offered to veterinarians, veterinary technologists, and VTSs, have emerged. The University of Missouri program is the first of its kind to target credentialed technicians and provide an advanced educational pathway geared toward career advancement opportunities.
In 2016, 6667 highly competitive candidates applied for admission to US and international Association of American Veterinary Medical Colleges member institutions, with only 4227 accepted as first-year veterinary students.2 If this trend continues, more than 2000 highly qualified candidates will be denied a path to a doctorate degree in veterinary medicine each year. While many might reapply the subsequent year, establishment of a midlevel veterinary professional (MLVP) position would provide an alternate career path in veterinary medicine, leading to the entry of bright minds into the field in a different form. Could these individuals be MLVP candidates, and should this role exist? If so, how might it be established? REFERENCE: https://todaysveterinarynurse.com/practice-management/the-case-for-veterinary-midlevel-professionals/
In the recent years, the veterinary technician (VT) profession has reached a new height, with 13 veterinary technician specialist (VTS) academies officially recognized by the National Association of Veterinary Technicians in America (NAVTA) and the entire field working toward a unified credentialing title. More than 850 credentialed VTSs have become certified through a rigorous application and examination process, with the majority practicing within the United States. Additionally, programs such as the biomedical sciences master’s program in veterinary medicine and surgery at the University of Missouri, which is offered to veterinarians, veterinary technologists, and VTSs, have emerged. The University of Missouri program is the first of its kind to target credentialed technicians and provide an advanced educational pathway geared toward career advancement opportunities.
In 2016, 6667 highly competitive candidates applied for admission to US and international Association of American Veterinary Medical Colleges member institutions, with only 4227 accepted as first-year veterinary students.2 If this trend continues, more than 2000 highly qualified candidates will be denied a path to a doctorate degree in veterinary medicine each year. While many might reapply the subsequent year, establishment of a midlevel veterinary professional (MLVP) position would provide an alternate career path in veterinary medicine, leading to the entry of bright minds into the field in a different form. Could these individuals be MLVP candidates, and should this role exist? If so, how might it be established? REFERENCE: https://todaysveterinarynurse.com/practice-management/the-case-for-veterinary-midlevel-professionals/
.png)
Posted September 2, 2023
The Veterinary Nurse Practitioner Will See You Now Is Veterinary medicine ready for a mid-level practitioner?
Picture for a moment, a world in which veterinary medicine takes a step closer to human medicine. Instead of calling your vet’s office and being set up for vaccines with your veterinarian, you are instead set up with a veterinary nurse practitioner — or VNP let’s say.
With burnout in the field becoming an increasingly publicized situation, many wonder if implementing a midlevel practitioner (MLP) is the solution to alleviating some of the profession’s woes. The burning question now is whether or not this is a good idea.
First, what is a VNP or MLP? Simply, with additional certification, a veterinary technician could conceivably expand their scope of practice. This would allow them to begin seeing and treating general appointments. It could empower them to see routine examinations to update vaccines, treat ear infections, diagnose basic skin conditions, etc. This would be a role more similar to a Nurse Practitioner’s or Physician Assistant’s.
This role could potentially mitigate the volume accumulating on the veterinarians in a practice and allow the more specialized skills of the veterinarian to be allocated towards surgeries, complex medical cases, and others.
In this scenario, a client would benefit from a decreased wait time for routine appointments, potentially a lower fee to pay, and perhaps more access to practitioners for general questions and concerns. In addition to their volume mitigating role, an MLP status would allow for upward mobility in the veterinary technician field. Currently, veterinary technicians have a remarkable 25% turnover rate. This is higher than both registered nurses (~18%) and nurse practitioners (~9%). One suggested reason for this turnover rate is a lack of upward mobility in their positions.
REFERENCE https://medium.com/@pawspressplay/the-veterinary-nurse-practitioner-will-see-you-now-eded5e7f872b
With burnout in the field becoming an increasingly publicized situation, many wonder if implementing a midlevel practitioner (MLP) is the solution to alleviating some of the profession’s woes. The burning question now is whether or not this is a good idea.
First, what is a VNP or MLP? Simply, with additional certification, a veterinary technician could conceivably expand their scope of practice. This would allow them to begin seeing and treating general appointments. It could empower them to see routine examinations to update vaccines, treat ear infections, diagnose basic skin conditions, etc. This would be a role more similar to a Nurse Practitioner’s or Physician Assistant’s.
This role could potentially mitigate the volume accumulating on the veterinarians in a practice and allow the more specialized skills of the veterinarian to be allocated towards surgeries, complex medical cases, and others.
In this scenario, a client would benefit from a decreased wait time for routine appointments, potentially a lower fee to pay, and perhaps more access to practitioners for general questions and concerns. In addition to their volume mitigating role, an MLP status would allow for upward mobility in the veterinary technician field. Currently, veterinary technicians have a remarkable 25% turnover rate. This is higher than both registered nurses (~18%) and nurse practitioners (~9%). One suggested reason for this turnover rate is a lack of upward mobility in their positions.
REFERENCE https://medium.com/@pawspressplay/the-veterinary-nurse-practitioner-will-see-you-now-eded5e7f872b
.png)
Posted September 3, 2023
What is a Veterinary Professional Associate?
The role of veterinary professional associate (VPA) might offer one possible solution to problems with access to veterinary care for pets. What is a veterinary professional associate? Let's take a look.
I'll preface all this by saying that by far the best ongoing medical care I ever received came from a nurse practitioner (NP) — not a physician assistant (PA) and not a primary care / family practice doctor (MD). This started many, many years ago. Once she up and left the practice, I've never recreated the experience.
So even though most conversations about veterinary professional associates put them more in a PA role rather than NP, I remain hopeful about a future in veterinary medicine where VPAs might help pets get easier (and maybe even more affordable) access to veterinary care. Veterinary Professional Associate, What Is That?More than a nurse (or veterinary technician) but not a veterinarian So, basically, a VPA would be something called a "mid-level provider" in the veterinary world. From my work in higher education, writing about many advanced degree nursing programs such as a Doctor of Nursing Practice (DNP) ... which is a PhD-level degree for nurse practitioners ... the idea of establishing a new role in veterinary medicine makes a lot of sense to me. Nursing education is much more patient-focused than the way a doctor's education gets done.
In many veterinary practices now, you already can make a "technician appointment" for things like:
• Suture removal• Simple illness or injury recheck appointments• Some vaccinations or routine lab tests Yet with SO many veterinary technicians fleeing the profession for reasons that include total burnout, not being used to their full potential, and ridiculously low salaries/wages despite their level of education + experience + areas of major responsibility for pets' care. REFERENCE https://championofmyheart.com/veterinary-professional-associate/
So even though most conversations about veterinary professional associates put them more in a PA role rather than NP, I remain hopeful about a future in veterinary medicine where VPAs might help pets get easier (and maybe even more affordable) access to veterinary care. Veterinary Professional Associate, What Is That?More than a nurse (or veterinary technician) but not a veterinarian So, basically, a VPA would be something called a "mid-level provider" in the veterinary world. From my work in higher education, writing about many advanced degree nursing programs such as a Doctor of Nursing Practice (DNP) ... which is a PhD-level degree for nurse practitioners ... the idea of establishing a new role in veterinary medicine makes a lot of sense to me. Nursing education is much more patient-focused than the way a doctor's education gets done.
In many veterinary practices now, you already can make a "technician appointment" for things like:
• Suture removal• Simple illness or injury recheck appointments• Some vaccinations or routine lab tests Yet with SO many veterinary technicians fleeing the profession for reasons that include total burnout, not being used to their full potential, and ridiculously low salaries/wages despite their level of education + experience + areas of major responsibility for pets' care. REFERENCE https://championofmyheart.com/veterinary-professional-associate/