Animal welfare advocates will keep trying to expand veterinary care, telehealth in Colorado

A coalition of animal welfare advocates said it is not giving up on its efforts to expand care. The Vet Care Coalition says it will try again next year to get the state Legislature to create a new position and enable more use of telehealth.

The Dumb Friends League is one of the organizations that has been pushing for a law that would create a new occupation in animal clinics and hospitals called veterinary professional assistants or VPAs.

If approved, they might be able to treat dogs like Muppet at some stage, who was still shaking after surgery. 

The volunteer holding the small terrier said, "It's a pretty normal side effect from the anesthesia, but we do check the temperature on all their vitals to make sure they recover nicely."

Dr. Rimme Singh is the Chief Veterinary Medical Officer at the Dumb Friends League Denver facility and feels the new position is necessary.

"By creating an intermediate position between a technician and a veterinarian we are hoping we are able to allow people to get access to medical care for pets faster," Singh said.

There is a veterinarian shortage in Colorado and those supporting the measure feel the new position could relieve some of the pressure on vets. 

Rachel Heatley, the advocacy director at the Dumb Friends League listed some of the duties a VPA could perform, "Initiating treatment, possibly prescribing within FDA guidelines, minor surgeries."

Another measure proposed would expand the use of telehealth to help treat animals. 

Dr. Singh feels that is valuable as well, "I think for people who are unable to leave their homes in a rural area and the nearest vet is 100 miles away, telehealth would give options to seek that care for their pets."

But for now, opposition from other groups has stalled the measures it was hoping the Colorado Legislature would pass and send to Gov. Jared Polis. 

The Colorado Veterinary Medical Association opposes the creation of the professional assistant position. The association was unable to provide an interview, but issued a lengthy statement to CBS News Colorado:

Telehealth

CVMA is very supportive of the use of telehealth technologies within the context of existing relationships between a veterinarian, their client, and the animal. Using telehealth within a relationship with a veterinarian can allow for better and more timely care for animals; used appropriately, it can help expand access to care, especially for people who have existing relationships with veterinarians and who may be unable to travel to the veterinary clinic.

Veterinary telehealth should only be conducted within an existing veterinary relationship VCPR, with the exception of advice given in an emergency until the patient can be seen by the veterinarian. An in-person examination or a timely visit to the premises where the animal or animals is kept prior to engaging in telehealth is critical. A veterinarian must be familiar with the animal, its medical history, and the client to provide the best possible care. As animals are non-verbal beings, it is challenging for an animal owner to accurately communicate an animal's signs to a veterinarian so that a veterinarian can properly diagnose the animal; a familiarity with the animal is vital to protect both animals and their owners and ensure proper diagnosis and treatment.

It is important to note that the American Telemedicine Association recommends telehealth services not be provided to children under two years of age in their home or other non-clinical setting except for when the provider has a previously established in-person relationship with the patient. As veterinarians also care for non-verbal beings, we believe animal telehealth should be approached in a similar fashion as pediatric telehealth.

Veterinary professional associate (mid-level practitioner)

CVMA strongly opposes the mid-level veterinary practitioner as a new professional, and opposes any education program that would educate and graduate such a professional.

Origin of the mid-level veterinary practitioner

During the 2021-2022 renewal of the Colorado Veterinary Practice Act, an idea surfaced to create a mid-level professional in veterinary medicine (this professional would be similar to a physician assistant in human medicine). The proposed profession has been offered to alleviate worker shortages and access to veterinary care by increasing practice efficiency. CVMA's Practice Act Sunset Review Task Force considered the concept and presented the idea to the CVMA Board of Directors. The CVMA board responded that because there was limited information about this new professional in addition to unresolved questions, further analysis of the issue was needed. In summer 2022, Rep. Karen McCormick formed a stakeholder working group so that all stakeholders had an opportunity to weigh in and understand the ramifications of creating a mid-level practitioner in Colorado.

CVMA thanks Rep. McCormick for her leadership and comprehensive examination of the access to care issue, and appreciates the interest and commitment of all who participated in the highly informative stakeholder working group over several months. CVMA has carefully considered the expert presentations and discussions of the working group to form a position on this issue.

CVMA supports increased utilization and education of veterinary technicians

CVMA supports the following recommendations as alternative solutions to access to care issues in veterinary medicine.

• Statutory solutions and/or education to promote optimal utilization of veterinary technicians: CVMA strongly supports both immediate statutory solutions and near-term educational programs that will elevate the role of veterinary technicians, a group of veterinary professionals that is currently underutilized. CVMA supports education and policy clarifying what tasks are prime for delegation under levels of supervision by veterinarians to veterinary technicians, and educating and informing veterinarians and veterinary technicians on the efficiency and utilization improvements that can be achieved in veterinary practice by fully utilizing the demonstrated, tested, competence of veterinary technicians.

• Creation of advanced educational programs for registered veterinary technicians: CVMA strongly supports the creation of advanced educational programs for registered veterinary technicians that will result in:
• Robust utilization of RVTs in clinical settings
• Expedite RVTs achieving their Veterinary Technician Specialist designation
• Improve engagement and retention of RVTs in the veterinary profession
• Help ensure that veterinary technicians are paid a living wage that reflects the high value of their work

Key barriers to the mid-level veterinary practitioner

CVMA cannot support the proposal to create a new profession because of the numerous, significant barriers to public health and productivity that the professional would face and/or create. Therefore, CVMA cannot support the educational and financial investment required to develop, launch, and operate a degree program for such a new profession. Colorado deserves a better return on its investment.

There are numerous barriers to the successful integration and utilization of this brand-new veterinary professional.

1. FDA allows only licensed veterinarians to prescribe. This means that unlike human medicine, a mid-level professional would be unable to prescribe independently.

1. USDA accreditation is available only to licensed veterinarians. This means that according to federal requirements, USDA-required tests, CVI health certificates, and veterinary feed directives can only be performed by licensed veterinarians.

1. Only licensed veterinarians can legally perform four essential tasks: diagnose, initiate treatment, prescribe, and perform surgery. This means that the proposed mid-level practitioner would not be able to perform these tasks in Colorado and most of the U.S. without changes to individual state laws; any professional performing these tasks would need to do so under a veterinarian's liability insurance.

1. Procedures and systems for determining professional competence to practice do not exist, and will take years to create. This means that owners, employers, and colleagues cannot be assured of a mid-level practitioner's competence to practice.

1. Mid-level professionals will demand time, training and mentoring from veterinarians, as well as support from other veterinary personnel. This means that any efficiency improvements or increases in capacity will not be immediate.

1. The projected salary for mid-level practitioners does not fit the current reality. In 2022, the AVMA reported that only 43% of all 2021 veterinary graduates earned $80,000 per year or more; it is not clear why it is assumed that the mid-level practitioner would earn $80,000 per year.

CVMA supports existing law

CVMA endorses and supports existing Colorado law that clearly designates diagnosing, prognosing, developing treatment plans, performing surgery, and prescribing drugs for animals as the work of veterinarians. CVMA believes that these veterinary medical tasks require both the expertise and accountability to the public by veterinarians who have met legal standards by completion of an accredited programs and demonstrated their competence through successful passage of a nationally-recognized examination.

In conclusion, CVMA does not support the creation of a mid-level practitioner in Colorado. There is a better way forward: CVMA encourages increased utilization and education of existing veterinary technicians as a more robust and straightforward solution to veterinary issues in Colorado.