15 Dec A letter to veterinary colleagues from Dr. Apryl Steele and Dr. Wayne Jensen regarding the mid-level veterinary practitioner
The mid-level practitioner…what is it, and how could it impact veterinary medicine in Colorado? For over a year, CVMA has been asking these questions to see whether a new veterinary professional could positively impact the delivery of veterinary medicine in Colorado. This article is the second in a series exploring the concept of the mid-level practitioner and examining what may make sense for Colorado.
Interested in being a part of the conversation? CVMA is hosting a town hall Q&A session on Thursday, January 19 — click here to register, and click here to submit comments/questions in advance.
This article was submitted by guest authors Dr. Wayne Jensen (head of the Colorado State University Department of Clinical Sciences) and Dr. Apryl Steele (president and CEO of the Dumb Friends League, and past president of CVMA); the article does not necessarily represent the views of CVMA. This article refers to the mid-level practitioner as “veterinary professional associate;” the two terms can be considered synonymous.
Dear colleagues,
We are facing an unprecedented time in veterinary medicine. The role of pets in American families has elevated substantially, and so has the need for veterinary services. Although we are busier than ever, we are failing to meet the needs of our communities for both routine and urgent care. Even in the face of increased demand, veterinary practices are limiting their hours and even their days of operations because of staffing shortages. This leads to delayed care, which not only impacts the patient’s health but also adds to the frustration and stress of their families. The combination of not having enough trained veterinary experts available, increased workloads, and growing client dissatisfaction is stressing our workforce, leading to mental health struggles and colleagues leaving the profession.
This is not sustainable.
Solutions to complex problems require innovation. One such innovation is the creation of a mid-level practitioner role: a veterinary professional associate (VPA). A VPA is an individual with a master’s degree in Veterinary Clinical Care working under the direct supervision of a DVM to improve workflow and generate revenue, thus decreasing burnout and giving a practice the ability to help more patients. Through delegating responsibilities to the VPA, the supervising DVM can tailor a VPA to their practice’s specific needs.
Expanding veterinary capacity, addressing animal suffering, improving veterinary team well-being, and increasing practice revenue and profitability so that veterinarians and support staff can be paid appropriately are just a few reasons why a VPA career path is necessary.
Addressing animal suffering
A 2020 Banfield study estimates that 75 million pets in the United States will likely be without veterinary care by 2030.[i] According to Mars Veterinary Health, this is largely due to increasing pet ownership trends and an insufficient growth in the number of veterinarians to meet the demand.[ii]
VPAs would help address the veterinarian shortage by assuming responsibility for much of the routine care currently provided by DVMs. This would allow veterinarians to focus their time on patients with more complex conditions.
We must empower all veterinary technicians to work at the highest level and enable technician specialists to deploy their advanced skills to increase efficiencies within our veterinary practices. However, with a looming credentialed technician shortage of approximately 59,000 individuals in the U.S., maximizing the capacity and efficiency of our workforce will not be sufficient to meet the need.[iii]
Under our current model, animals are suffering. Pets owners able to afford veterinary care are often unable to access it, so imagine the difficulty experienced by those with limited financial resources. And what about shelter animals? They are often left without access to preventative care and cannot obtain vital care when they are sick and injured. This drives both suffering and euthanasia based solely on economic factors. The capabilities of VPAs, combined with increased efficiency in service delivery, will enhance the productivity of the veterinary healthcare team and provide opportunities to increase access to veterinary care for underserved populations.
Importantly, the workforce shortage affects more than companion animals; in fact, the shortage of veterinarians is most pronounced in rural, agricultural communities, which directly impacts our food supply. In 2021, eight areas covering 25 counties in Colorado were identified by the U.S. Department of Agriculture (USDA) as areas of service shortage in food animal medicine.[iv] According to a 2011 National Research Council Report entitled, Workforce Needs in Veterinary Medicine, “In rural areas, where primary veterinary care is needed but there are too few farms to support full-time veterinarians, a system of animal health care involving rigorously trained technicians under the supervision of veterinarians could be developed.”[v] One goal of the VPA master’s program is to train graduates who could fulfill this role.
Improving veterinary team well-being
According to the Cornell Center for Veterinary Business and Entrepreneurship, burnout for veterinary teams costs the industry approximately two billion dollars a year.[vi] A Merck-sponsored study found that veterinarians have higher levels of burnout and turnover than human physicians and are 2.7 times more likely to have suicidal thoughts than non-veterinarians.[vii] Likewise, the 2021 AVMA Report on the Economic State of the Veterinary Profession reported that 38% of surveyed veterinarians have considered leaving the field, with poor work-life balance, work culture issues, and low compensation being the top three reasons. Retaining technicians is also challenging, with only 51% of those surveyed saying they are satisfied and will stay in veterinary technology. Reasons given for leaving include “low pay, compassion fatigue and burnout, [and] lack of recognition and career advancement.”[viii]
A VPA could ease the pressure on existing staff by performing various duties, such as examinations, diagnosis and treatment of uncomplicated cases, hospice care, dentistry, and minor surgery. Some argue that a VPA could not fulfill these roles because of possible federal restrictions on prescribing. However, the vast majority of a VPA’s impact would not require prescribing authority.
To be clear, a VPA is neither a veterinarian nor a veterinary technician and would not replace these roles. Rather, they could enhance a practice by increasing efficiency and impact while decreasing burnout. Inclusion of VPAs may also generate more revenue for the practice, resulting in higher salaries and greater work-life balance for all employees. In addition, a VPA degree would provide credentialed veterinary technicians with a path to a career with greater responsibility, recognition, and compensation.
Moreover, the VPA role could improve diversity through an accessible pathway for those often excluded from our profession. Diversifying our field and representing underserved communities are critical to our profession’s continued success and credibility.
Increasing practice revenue and profitability
VPAs will also provide revenue generating services. If a VPA generates $500K in production and earns 17% of their production, they would make $85K per year. The supervising veterinarian should also earn a portion of the VPA’s production; at 5%, this would be an additional $25K per year for the DVM. Overall, this business model has the potential of generating more revenue and profit for the practice, resulting in higher salaries and greater work-life balance for all practice employees.
Over the last several months, Representative Karen McCormick has led a taskforce with the AVMA and CVMA, CSU, veterinary technicians, and Colorado animal welfare leaders to better understand the opportunities and challenges of creating a VPA role. Two persistent concerns have emerged from these conversations—liability and financial feasibility.
With direct supervision over the VPA, the DVM will be liable for the VPA’s performance. Liability insurance policies typically provide coverage for those working under the supervision of a veterinarian if that work is in accordance with the law. Ensuring that VPAs can fully deploy without violating the Veterinary Practice Act is critical to limiting this liability. Modification of the Colorado Veterinary Practice Act to allow veterinarians to delegate the responsibilities related to diagnosis, treatment, and surgery to a VPA under their direct supervision and whose performance they assume responsibility for addresses this liability concern.
While some veterinarians will be comfortable with the liability risk, others will choose not to incorporate a VPA into their practice. Should we not let individual veterinarians make the choice that is right for them?
Having a VPA assume responsibility for much of the routine care currently provided by veterinarians would allow veterinarians the opportunity to focus their time on more complex patients, thereby generating more revenue. This, combined with the compensation for supervising the VPA, would result in higher salaries for DVMs. The combined revenue generated by the VPA and DVM results in increased practice revenue.
The proposed VPA master’s degree program at CSU
The VPA master’s program will build upon a student’s undergraduate studies in the life sciences to provide advanced knowledge and technical competencies in the administration of routine veterinary care. The proposed program, designed to be completed in five semesters (the first three will be delivered online), will accomplish this goal through a rigorous curriculum that:
- Provides in-depth knowledge in infectious, metabolic, neoplastic, and degenerative disease.
- Includes the development of technical, communication, and leadership expertise.
- Offers learning opportunities at CSU’s College of Veterinary Medicine and Biomedical Sciences and the Dumb Friends League Veterinary Hospital at CSU Spur.
Conclusion
The development of a VPA career path will help address the significant challenges facing the veterinary profession and the animals and people in our shared communities. Our Veterinary Oath states, “for the benefit of society.” Finding innovative ways to solve important societal issues, such as access to quality veterinary care, should be a priority for the profession.
“We cannot become what we want by remaining what we are.” – Max De Pree
Check back for the next article in this series on Friday, December 23.
Have questions or comments? Click here to submit them! CVMA will host a member town hall January 19 during which submitted questions will be addressed.
[i] https://www.banfield.com/en/about-banfield/newsroom/press-releases/2020/75-million-pets-may-not-have-access-to-veterinary
[ii] https://www.marsveterinary.com/tackling-the-veterinary-professional-shortage/
[iii] Lloyd, J.W. (2021, August 23). Pet healthcare in the US: Are there enough veterinary nurses/technicians? Is there adequate training capacity? Animal Health Economics, LLC.
[iv] https://www.colovma.org/industry-news/usda-identifies-8-veterinary-shortage-areas-in-colorado-applications-now-open-for-veterinary-loan-repayment-program/
[v] Workforce Needs in Veterinary Medicine. National Research Council. (2011). Page 2.
[vi] https://www.vet.cornell.edu/news/20220829/burnout-takes-heavy-financial-toll-veterinary-medicine
[vii] https://www.merck-animal-health-usa.com/offload-downloads/veterinary-wellbeing-study
[viii] AVMA 2021 Economic State of the Profession. American Veterinary Medical Association. (2021).