August 12, 2026
A RESPONSE TO MISSION PET HEALTH'S POSITION STATEMENT ON MID-LEVEL PRACTITIONERS AND VETERINARY PROFESSIONAL ASSOCIATES
Issued August 6, 2026, missionpethealth.com
Fountain Report - Antelligence c/o Mark Thill, Editor, Laura Thill, Editor, Chris Kelly, Managing Partner & Publisher
The Coalition for the Veterinary Professional Associates (CVPA) has reviewed the position statement published by Mission Pet Health on August 6, 2026, opposing the Veterinary Professional Associate (VPA) role established under Colorado Proposition 129 and House Bill 25-1285. We welcome the engagement of one of the nation's largest veterinary care organizations on this issue, and we agree with Mission on a foundational point: access to veterinary care is a genuine crisis, and the profession's response to it must protect the quality and safety of patient care. Where we differ is on the facts of the VPA framework itself. Mission's statement rests on an incomplete and, in several places, inaccurate characterization of the education, regulation, and purpose of the role. We offer this response in the spirit of professional dialogue, because a debate of this consequence should be conducted on an accurate record.
The Education Argument Misstates the Credential
Mission asserts that the VPA "lacks the rigorous education, training, and oversight required to meet the complex needs of modern veterinary medicine" and that the role "bypasses" the academic preparation foundational to the profession. This claim reflects a misunderstanding of both the credential and its intent. The VPA pathway requires a four-year undergraduate degree, documented veterinary-related experience, admission to and completion of a species-focused master's degree in veterinary clinical care, passage of a national credentialing examination, and registration with the state board, followed by practice only under the supervision of a licensed veterinarian. That examination is being developed and administered by the American Association of Veterinary State Boards, the same body that owns the national examination trusted for decades to credential veterinary technicians. This is not an unregulated shortcut; it is a defined, examined, board-registered professional tier.
Mission's own summary of the Colorado State University curriculum describes a graduate program of substantial depth, not an absence of rigor, and the full picture is stronger still. CSU's Master of Science in Veterinary Clinical Care comprises 65 credits across five semesters: three semesters of didactic instruction, a fourth semester of 416 hours of intensive hands-on laboratory training, and a fifth-semester clinical internship of 540 hours in practice. That is nearly 1,000 hours (approximately 956) of supervised, hands-on clinical experience, a figure flatly incompatible with the "minimal training" narrative advanced by opposition groups. Nor was this curriculum improvised. It was developed through a seventeen-step review process incorporating input from CSU faculty, animal welfare organizations, community members, and other academic institutions, supported in part by a competitive grant from PetSmart Charities, and built using the same course objectives, delivery of material, and assessment methods as CSU's top-ranked DVM program, focused on the common infectious and physiological diseases of dogs and cats.
A related mischaracterization deserves direct correction. Opposition statements have described the program as "mostly online," consisting of "fully online lecture with no laboratory" and only a brief internship. That description simply ignores two of the program's five semesters, the 416-hour laboratory semester and the 540-hour clinical internship, and misrepresents a curriculum with nearly a thousand hours of practical training as purely theoretical. Repeating that claim after the published curriculum has been publicly available does not make it more accurate; it makes the opposition's case less credible. It is also worth noting what Mission's DVM-hours comparison conceals: the VPA curriculum is deliberately species-focused. Where veterinary school must prepare graduates across all species, the Colorado framework limits VPA practice to canine and feline cases, allowing the program to concentrate its clinical hours on developing genuine depth within a narrow, clearly bounded scope. Alongside that clinical core, the curriculum explicitly trains communication, animal behavior, euthanasia practice, leadership, and team management. Lincoln Memorial University's Master of Veterinary Clinical Care, which welcomed its first student in 2022, was built deliberately on the foundation of veterinary technology training and includes dedicated coursework in veterinary management and leadership.
Nor is the role itself an improvisation. The mid-level concept was first recommended by faculty at Colorado State University's College of Veterinary Medicine and Biomedical Sciences in 2009 (Kogan and Stewart), modeled on the physician assistant role in human medicine. The VPA is the product of more than fifteen years of deliberate academic development, peer-reviewed scholarship, public review, and now statutory codification, with licensure administered through the Colorado Department of Regulatory Agencies.
The comparison to the Doctor of Veterinary Medicine degree, meanwhile, answers a question no one is asking. The VPA is not a veterinarian and is not licensed to practice as one. Judging a supervised mid-level credential against the standard of an autonomous doctoral license is the same category error human medicine confronted decades ago with physician assistants and nurse practitioners, clinicians who also train for a fraction of a physician's timeline, and who nonetheless expanded access and improved practice performance precisely because their scope was defined and their supervision was structured.
Supervision and Liability Are Design Questions, Not Disqualifiers
Mission raises the burden of oversight on supervising veterinarians and the exposure of their licenses. These are legitimate operational questions, and they are questions Colorado's framework has already begun to answer. House Bill 25-1285 and the Board of Veterinary Medicine's rulemaking cap the number of VPAs a single veterinarian may supervise, scaled to the supervisor's experience, precisely so that oversight remains meaningful rather than nominal. Supervision of mid-level practitioners is not a novel burden the profession must invent from scratch; it is a mature, well-understood discipline in human medicine, with decades of workable models for delegation protocols, escalation standards, and documentation. Also, employing VPAs will be optional rather than required, and those who choose to supervise could also receive compensation through a revenue-sharing arrangement.
On liability specifically, Mission presents risk as if it must be concentrated entirely on the supervising veterinarian. It need not be. VPAs, as credentialed and registered professionals, can carry their own professional liability insurance, exactly as physician assistants and nurse practitioners routinely do. Individual coverage for VPAs, paired with clear statutory scope and defined supervision ratios, distributes risk appropriately across the parties responsible for care rather than leaving it ambiguous. The insurance market has underwritten mid-level practice in human medicine for two generations; there is no structural reason it cannot do so in veterinary medicine. The CVPA is currently working with companies that are developing VPA liability insurance. These are implementation details to be refined through regulation, employer policy, and coverage products, not evidence that the role itself is unsound. Notably, the profession's own scope-awareness training treats escalation to the supervising veterinarian as a core competency and responsibility of the role, not an afterthought, for all employees/team members supervised. The Workforce Argument Looks Past the Crisis in Front of Us Mission argues that projections suggest an adequate supply of veterinary graduates by 2035, that clinical volumes are softening, and that VPAs are unlikely to serve underserved communities. Each of these points warrants scrutiny. A projection that supply may balance demand nearly a decade from now offers nothing to the communities in shortage today, and it sits uneasily beside workforce analyses cited by the AVMA itself projecting a need for roughly 41,000 additional veterinarians by 2030, against a system graduating on the order of 4,000 new veterinarians per year through an eight-year educational pipeline that cannot be expanded quickly.
Demand, meanwhile, has structurally shifted: approximately 70 percent of American households now own pets, up from 56 percent in 1988. The United States Department of Agriculture and access-to-care researchers have identified hundreds of areas, rural and urban alike, across nearly every state, experiencing critical veterinary shortages. Roughly half of rural veterinarians are within five years of retirement, and shelter and animal welfare organizations report vacancy rates that have left millions of routine and lifesaving procedures unperformed. Aggregate national supply figures also obscure the distribution problem: even a nation with "enough" veterinarians on paper can leave entire counties without accessible care, which is precisely the condition that moved Colorado voters to act. Mission's observation that clinical volumes and new-client visits are declining is not evidence against the VPA; it is evidence for it. The decline is driven substantially by affordability. Recent industry data indicate that 19 percent of dogs and 45 percent of cats did not see a veterinarian in the survey period, with 29 percent of dog owners and 22 percent of cat owners identifying cost as the primary barrier. Pets are not disappearing from American homes; they are disappearing from examination rooms because their owners cannot afford the visit, and the pressure is worsening, with Bureau of Labor Statistics data showing veterinary service prices rising 5.6 percent year over year, more than twice the rate of general inflation. A supervised mid-level provider who can deliver routine care cost-effectively is precisely the mechanism by which practices can lower the price of access, recapture the patients currently going without care, and grow the total volume of medicine delivered, rather than fighting over a shrinking pool of visits. The claim that VPAs would decline to work in underserved areas is speculation presented as fact. The leading VPA programs draw heavily from experienced, credentialed veterinary technicians: professionals who already live and work in these communities and who are seeking a pathway to serve them at a higher level. And because the VPA credential carries a fraction of the educational cost and debt of a DVM, practice in lower-revenue rural and shelter settings is economically viable for a VPA in ways it increasingly is not for a heavily indebted new veterinary graduate.
As for competition with new veterinarians, the published economic modeling points the opposite direction. Peer-reviewed research by Smith (Pepperdine University), Lloyd (Animal Health Economics), and Harris (Michigan State University), published in the Journal of Applied Business and Economics (Vol. 27(5), 2025), combined more than forty structured interviews with industry leaders and practice owners with a partial budget model of a typical 3.5-veterinarian companion animal practice. The model projects that adding a single full-time VPA increases annual practice revenue by $566,500 and net profit by $177,850, while supervising veterinarian compensation itself rises by an estimated $62,050 through increased individual productivity and revenue sharing.
Critically, the study's sensitivity and scenario analyses showed the core finding held across variations in salary, staffing costs, fee structures, and supervision time. And the access implications are just as significant as the financial ones: the modeled practice's annual appointments grow from 5,000 to 8,700, a nearly seventy-five percent increase in delivered care capacity from one practitioner. Those gains come not from a VPA displacing a veterinarian's caseload, but from task shifting: routine rechecks, preventive care, and straightforward urgent visits move to the VPA, so veterinarians concentrate on new patients, complex medicine, and surgery, the highest-value work only they can perform. Indeed, one of the core problems the VPA concept was developed to solve is the difficulty new graduate veterinarians face generating sufficient revenue to service their student debt. A role that raises practice productivity and veterinarian compensation is not a threat to indebted new graduates; it is part of the answer to the economic squeeze they are entering. The VPA is designed to be complementary to the veterinarian, not a substitute for one, the same labor-complementarity dynamic documented over four decades of physician assistant and nurse practitioner research in human medicine, which the study reviews in detail. The Proposed Alternative Is Not an Alternative; It Is the Same Cause Mission proposes investing in credentialed veterinary technicians, title protection, expanded scope, and Veterinary Technician Specialist programs as the answer instead of the VPA. The CVPA supports every one of those measures. But they are not in tension with the VPA; they are part of the same continuum. Lincoln Memorial's program was expressly designed as a career ladder for veterinary technicians, a profession its Executive Dean has described as suffering an extremely high burnout rate in significant part because it has lacked exactly this kind of advancement pathway. The VPA does not bypass credentialed technicians; it is, in practice, where many of the most experienced technicians are choosing to go. A profession that tells its technicians to advance, and then opposes the graduate credential built for them to advance into, is not offering an alternative. It is offering a ceiling. On Consensus and Legitimacy Mission notes the opposition of the AVMA, state veterinary medical associations, AAHA, and NAVTA. We do not dismiss those organizations, and we have said consistently that their concerns about implementation (educational sufficiency, supervision structure, and liability) deserve serious, ongoing engagement. But professional association opposition is not the final word on public policy, and history counsels humility here: organized medicine once opposed the physician assistant role that it now regards as indispensable. In Colorado, the VPA was created by a vote of the people, enacted into statute by the General Assembly, signed by the Governor, and implemented through formal rulemaking by the State Board of Veterinary Medicine, with credentialing entrusted to the AAVSB. The role exists in law and in classrooms, and Colorado now serves as a real-world proving ground: as the founding programs graduate their first cohorts, the profession will have actual data on outcomes, safety, and effectiveness, the same evidence base that ultimately settled the debate over physician assistants. The productive question before the profession, including large hospital networks such as Mission, is no longer whether the VPA should exist, but how it will be prepared, supervised, insured, and integrated responsibly. That is a leadership question, and it is one we invite Mission to help answer rather than to sit out. The CVPA shares Mission Pet Health's commitment to safe, high-quality veterinary care and to the wellbeing of the veterinary workforce. We respectfully submit, however, that Mission's position statement argues against a version of the VPA that does not exist: an unexamined, unsupervised, unregulated substitute for the veterinarian. The actual role is a graduate-educated, nationally examined, board-registered professional who practices under defined veterinary supervision, within statutory limits, and with the option, which we endorse, of carrying independent professional liability coverage. Colorado has built the framework. The founding universities have built the curricula. The credentialing body the profession already trusts is building the examination. We invite Mission Pet Health to move from opposition to participation, and to help ensure that the first generation of VPAs is integrated in a way that strengthens veterinarians, elevates technicians, and above all brings care to the animals and owners who are waiting for it. Respectfully submitted,
Robert Murtaugh, DVM, MS, DACVIM, DACVECC, FCCM, FNAPPresident, Coalition for the Veterinary Professional Associates
Steven L May, CVJ, VRCEExecutive Director, Coalition for the Veterinary Professional Associatesstevenmay@cvpa.vet, cvpacommittees@gmail.com, www.cvpa.vet References: Colorado Proposition 129 (2024); Colorado House Bill 25-1285 and State Board of Veterinary Medicine rulemaking (effective January 1, 2026); Colorado Department of Regulatory Agencies; American Association of Veterinary State Boards VPA credentialing materials; Colorado State University, Master of Science in Veterinary Clinical Care curriculum; Jensen, W.A., “Proposed Masters of Science Veterinary Professional Associate Program,” Colorado State University (2017); Lloyd, Jensen, Anderson, Hoffman, and Tams, “The Veterinary Professional Associate (VPA) Concept: Suggested Roles, Responsibilities, Skills, Knowledge, and Competencies”; Lincoln Memorial University, Master of Veterinary Clinical Care; Smith, D.M., Lloyd, J.W., and Harris, D.L., “Optimizing Veterinary Practice Economics: The Impact of Mid-Level Practitioners on Revenue, Profitability, and Workforce Efficiency,” Journal of Applied Business and Economics, 27(5), 2025, pp. 35-50; Kogan, L.R., and Stewart, S.M., “Veterinary Professional Associates,” Journal of Veterinary Medical Education, 36(2), 2009; U.S. Bureau of Labor Statistics, Consumer Price Index (2025); AVMA veterinary workforce reporting; American Pet Products Association, National Pet Owners Survey; USDA veterinary shortage-area designations; accesstocare.org; Mission Pet Health, “Mid-Level Practitioners and Veterinary Professional Associates Position Statement” (August 6, 2026). All trademarks are owned by their respective companies, corporations, organizations and entities. _________________________________________________________________________________________________________________________________________
On liability specifically, Mission presents risk as if it must be concentrated entirely on the supervising veterinarian. It need not be. VPAs, as credentialed and registered professionals, can carry their own professional liability insurance, exactly as physician assistants and nurse practitioners routinely do. Individual coverage for VPAs, paired with clear statutory scope and defined supervision ratios, distributes risk appropriately across the parties responsible for care rather than leaving it ambiguous. The insurance market has underwritten mid-level practice in human medicine for two generations; there is no structural reason it cannot do so in veterinary medicine. The CVPA is currently working with companies that are developing VPA liability insurance. These are implementation details to be refined through regulation, employer policy, and coverage products, not evidence that the role itself is unsound. Notably, the profession's own scope-awareness training treats escalation to the supervising veterinarian as a core competency and responsibility of the role, not an afterthought, for all employees/team members supervised. The Workforce Argument Looks Past the Crisis in Front of Us Mission argues that projections suggest an adequate supply of veterinary graduates by 2035, that clinical volumes are softening, and that VPAs are unlikely to serve underserved communities. Each of these points warrants scrutiny. A projection that supply may balance demand nearly a decade from now offers nothing to the communities in shortage today, and it sits uneasily beside workforce analyses cited by the AVMA itself projecting a need for roughly 41,000 additional veterinarians by 2030, against a system graduating on the order of 4,000 new veterinarians per year through an eight-year educational pipeline that cannot be expanded quickly.
Demand, meanwhile, has structurally shifted: approximately 70 percent of American households now own pets, up from 56 percent in 1988. The United States Department of Agriculture and access-to-care researchers have identified hundreds of areas, rural and urban alike, across nearly every state, experiencing critical veterinary shortages. Roughly half of rural veterinarians are within five years of retirement, and shelter and animal welfare organizations report vacancy rates that have left millions of routine and lifesaving procedures unperformed. Aggregate national supply figures also obscure the distribution problem: even a nation with "enough" veterinarians on paper can leave entire counties without accessible care, which is precisely the condition that moved Colorado voters to act. Mission's observation that clinical volumes and new-client visits are declining is not evidence against the VPA; it is evidence for it. The decline is driven substantially by affordability. Recent industry data indicate that 19 percent of dogs and 45 percent of cats did not see a veterinarian in the survey period, with 29 percent of dog owners and 22 percent of cat owners identifying cost as the primary barrier. Pets are not disappearing from American homes; they are disappearing from examination rooms because their owners cannot afford the visit, and the pressure is worsening, with Bureau of Labor Statistics data showing veterinary service prices rising 5.6 percent year over year, more than twice the rate of general inflation. A supervised mid-level provider who can deliver routine care cost-effectively is precisely the mechanism by which practices can lower the price of access, recapture the patients currently going without care, and grow the total volume of medicine delivered, rather than fighting over a shrinking pool of visits. The claim that VPAs would decline to work in underserved areas is speculation presented as fact. The leading VPA programs draw heavily from experienced, credentialed veterinary technicians: professionals who already live and work in these communities and who are seeking a pathway to serve them at a higher level. And because the VPA credential carries a fraction of the educational cost and debt of a DVM, practice in lower-revenue rural and shelter settings is economically viable for a VPA in ways it increasingly is not for a heavily indebted new veterinary graduate.
As for competition with new veterinarians, the published economic modeling points the opposite direction. Peer-reviewed research by Smith (Pepperdine University), Lloyd (Animal Health Economics), and Harris (Michigan State University), published in the Journal of Applied Business and Economics (Vol. 27(5), 2025), combined more than forty structured interviews with industry leaders and practice owners with a partial budget model of a typical 3.5-veterinarian companion animal practice. The model projects that adding a single full-time VPA increases annual practice revenue by $566,500 and net profit by $177,850, while supervising veterinarian compensation itself rises by an estimated $62,050 through increased individual productivity and revenue sharing.
Critically, the study's sensitivity and scenario analyses showed the core finding held across variations in salary, staffing costs, fee structures, and supervision time. And the access implications are just as significant as the financial ones: the modeled practice's annual appointments grow from 5,000 to 8,700, a nearly seventy-five percent increase in delivered care capacity from one practitioner. Those gains come not from a VPA displacing a veterinarian's caseload, but from task shifting: routine rechecks, preventive care, and straightforward urgent visits move to the VPA, so veterinarians concentrate on new patients, complex medicine, and surgery, the highest-value work only they can perform. Indeed, one of the core problems the VPA concept was developed to solve is the difficulty new graduate veterinarians face generating sufficient revenue to service their student debt. A role that raises practice productivity and veterinarian compensation is not a threat to indebted new graduates; it is part of the answer to the economic squeeze they are entering. The VPA is designed to be complementary to the veterinarian, not a substitute for one, the same labor-complementarity dynamic documented over four decades of physician assistant and nurse practitioner research in human medicine, which the study reviews in detail. The Proposed Alternative Is Not an Alternative; It Is the Same Cause Mission proposes investing in credentialed veterinary technicians, title protection, expanded scope, and Veterinary Technician Specialist programs as the answer instead of the VPA. The CVPA supports every one of those measures. But they are not in tension with the VPA; they are part of the same continuum. Lincoln Memorial's program was expressly designed as a career ladder for veterinary technicians, a profession its Executive Dean has described as suffering an extremely high burnout rate in significant part because it has lacked exactly this kind of advancement pathway. The VPA does not bypass credentialed technicians; it is, in practice, where many of the most experienced technicians are choosing to go. A profession that tells its technicians to advance, and then opposes the graduate credential built for them to advance into, is not offering an alternative. It is offering a ceiling. On Consensus and Legitimacy Mission notes the opposition of the AVMA, state veterinary medical associations, AAHA, and NAVTA. We do not dismiss those organizations, and we have said consistently that their concerns about implementation (educational sufficiency, supervision structure, and liability) deserve serious, ongoing engagement. But professional association opposition is not the final word on public policy, and history counsels humility here: organized medicine once opposed the physician assistant role that it now regards as indispensable. In Colorado, the VPA was created by a vote of the people, enacted into statute by the General Assembly, signed by the Governor, and implemented through formal rulemaking by the State Board of Veterinary Medicine, with credentialing entrusted to the AAVSB. The role exists in law and in classrooms, and Colorado now serves as a real-world proving ground: as the founding programs graduate their first cohorts, the profession will have actual data on outcomes, safety, and effectiveness, the same evidence base that ultimately settled the debate over physician assistants. The productive question before the profession, including large hospital networks such as Mission, is no longer whether the VPA should exist, but how it will be prepared, supervised, insured, and integrated responsibly. That is a leadership question, and it is one we invite Mission to help answer rather than to sit out. The CVPA shares Mission Pet Health's commitment to safe, high-quality veterinary care and to the wellbeing of the veterinary workforce. We respectfully submit, however, that Mission's position statement argues against a version of the VPA that does not exist: an unexamined, unsupervised, unregulated substitute for the veterinarian. The actual role is a graduate-educated, nationally examined, board-registered professional who practices under defined veterinary supervision, within statutory limits, and with the option, which we endorse, of carrying independent professional liability coverage. Colorado has built the framework. The founding universities have built the curricula. The credentialing body the profession already trusts is building the examination. We invite Mission Pet Health to move from opposition to participation, and to help ensure that the first generation of VPAs is integrated in a way that strengthens veterinarians, elevates technicians, and above all brings care to the animals and owners who are waiting for it. Respectfully submitted,
Robert Murtaugh, DVM, MS, DACVIM, DACVECC, FCCM, FNAPPresident, Coalition for the Veterinary Professional Associates
Steven L May, CVJ, VRCEExecutive Director, Coalition for the Veterinary Professional Associatesstevenmay@cvpa.vet, cvpacommittees@gmail.com, www.cvpa.vet References: Colorado Proposition 129 (2024); Colorado House Bill 25-1285 and State Board of Veterinary Medicine rulemaking (effective January 1, 2026); Colorado Department of Regulatory Agencies; American Association of Veterinary State Boards VPA credentialing materials; Colorado State University, Master of Science in Veterinary Clinical Care curriculum; Jensen, W.A., “Proposed Masters of Science Veterinary Professional Associate Program,” Colorado State University (2017); Lloyd, Jensen, Anderson, Hoffman, and Tams, “The Veterinary Professional Associate (VPA) Concept: Suggested Roles, Responsibilities, Skills, Knowledge, and Competencies”; Lincoln Memorial University, Master of Veterinary Clinical Care; Smith, D.M., Lloyd, J.W., and Harris, D.L., “Optimizing Veterinary Practice Economics: The Impact of Mid-Level Practitioners on Revenue, Profitability, and Workforce Efficiency,” Journal of Applied Business and Economics, 27(5), 2025, pp. 35-50; Kogan, L.R., and Stewart, S.M., “Veterinary Professional Associates,” Journal of Veterinary Medical Education, 36(2), 2009; U.S. Bureau of Labor Statistics, Consumer Price Index (2025); AVMA veterinary workforce reporting; American Pet Products Association, National Pet Owners Survey; USDA veterinary shortage-area designations; accesstocare.org; Mission Pet Health, “Mid-Level Practitioners and Veterinary Professional Associates Position Statement” (August 6, 2026). All trademarks are owned by their respective companies, corporations, organizations and entities. _________________________________________________________________________________________________________________________________________
- Coalition for Veterinary Professional Associates Calls for Action:
- Addressing the Veterinary Workforce Shortage and Advancing the OneHealth Initiative
- WIMBERLEY, TEXAS – DECEMBER 17, 2024, The Coalition for Veterinary Professional Associates (CVPA) has issued a call to action supporting the OneHealth initiative and addressing the growing need for veterinary services amidst a serious shortage of veterinary professionals in Florida and across the nation. This critical need was underscored during a recent meeting held in early December 2024 in Orlando, Florida, where stakeholders emphasized the importance of increasing access to veterinary care and spaying and neutering services for shelter and family-owned pets.
- Keynote speaker Michael J. Blackwell, DVM, MPH, Assistant Surgeon General, USPHS (Ret.), and Director of the Program for Pet Health Equity at the University of Tennessee, delivered a powerful address on The Importance of Addressing Access to Veterinary Care and OneHealth. Dr. Blackwell highlighted three psychographic factors critical to understanding families' access to pet care:
- • Bonded Family Society – The majority of U.S. households include pets, reflecting a deeply rooted human-animal bond.
- • Financial Challenges – Forty-one percent of U.S. households face significant economic hardships, limiting access to essential veterinary services.
- • Barriers to Care – More than one in four families encounter obstacles in accessing veterinary care, primarily due to financial constraints.
- Dr. Blackwell referenced the HABRI report, which highlights that living with pets contributes to an estimated $22.7 billion in annual human healthcare cost savings, including benefits for mental health, obesity prevention, and chronic disease management. He emphasized the critical role of access to veterinary care in safeguarding these benefits. However, a stark imbalance exists in provider availability: there are 252 physicians per 100,000 people, but only 37 companion animal veterinarians per 100,000 dogs and cats, leaving a significant gap in care.
- The Growing Veterinary Workforce Crisis
- Animal shelters in Florida and nationally are struggling to fill critical veterinary positions to address the mounting demand for spaying, neutering, and other essential services. One study, co-authored by Susanne Kogut of Petco Love and Drs. Meredith Montgomery and Julie Levy of the University of Florida, found that 73% of animal sheltering organizations (ASOs) reported being short-staffed for veterinarians. The repercussions are significant, with 91% of these organizations experiencing backlogs in spay/neuter surgeries.
- Last year, the shortage of veterinary professionals significantly impacted animal shelters, as highlighted by the American Veterinary Medical Association (AVMA). Reports from California shelters revealed that nearly half of veterinarian roles and over half of technician positions remained vacant, leaving 344,000 animals without sufficient care. In Colorado, a study noted a backlog of spay/neuter surgeries caused by the shortage, and nationwide data estimated 2.7 million such procedures were not performed(1).
- Access-to-Care Clinics (ATCCs) are also facing staffing difficulties, with 72% reporting shortages. This has led to extended waiting times for pet owners, with delays exceeding two months in many cases and up to six months in some situations for vital services(1).
- Impact on Animal Welfare and Public Health
- These workforce shortages not only delay critical medical procedures but also have broader implications for public health, animal welfare, and the human-animal bond. Overcrowded shelters, unperformed procedures, and limited access to care exacerbate the emotional and financial stress on families and contribute to burnout among veterinary professionals.
- Innovative Solutions: Veterinary Professional Associates
- The CVPA is advocating for the introduction of a new role, the Veterinary Professional Associate (VPA), to help bridge the gap in access to care. Modeled after Nurse Practitioners and Physician Associates in human medicine, VPAs would perform routine procedures and support veterinarians in underserved areas.
- Dr. Robert Murtaugh, President of the CVPA, stated, "The shortage of veterinary professionals has reached a critical level, threatening the welfare of millions of animals and the families who love them. By creating the Veterinary Professional Associate role, we can alleviate workforce pressure, expand access to care, and support the well-being of both pets and their owners."
- The CVPA invites veterinarians, policymakers, and advocates to collaborate on solutions that address these urgent challenges and ensure equitable access to veterinary care nationwide. To advocate and bridge the gap in animal health, visit https://cvpa.vet/becomecvpa-advocate/ and www.cvpa.vet.
- ABOUT
- The Coalition for the Veterinary Professional Associate (CVPA) is a 501c4 (pending) nonprofit organization born from the need to expand the roles of veterinary professionals to better serve our animal companions and all stakeholders. With solid support from universities, rural settings, shelters, and companion animal environments, this group has come together to lobby for and support the creation of these new mid-tier veterinary providers.
- Visit www.cvpa.vet
- Reference:
- 1. UFHealth-University of Florida; UF Shelter Medicine Program-COLLEGE of VETERINARY MEDICINE – published March 30, 2024, site; https://sheltermedicine.vetmed.ufl.edu/2024/03/30/the-nonprofit-veterinarian-shortage-who-will-care-for-the-pets-most-in-need/#:~:text=Meredith%20Montgomery%20and%20Julie%20Levy,backlogs%20in%20spay%2Fneuter%20surgeries
Posted August 16th, 2024
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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.
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/
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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
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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/