10/19/2024
I have had multiple people ask me for clarification on Proposition 129. Here is a concise explaination written by Dr Michael Hupp. In a nutshell, my vote is NO.
QUESTIONS ON COLORADO PROPOSITION 129?
Now that ballots are officially arriving in mailboxes, I have had many people reach out to ask about Proposition 129. As a veterinarian with a healthy interest in the legislative process, I thought it would be helpful to collect and share my thoughts and try to talk about the pros and cons of the bill in an honest way.
WHAT DOES THIS BILL DO?
This ballot measure would create a new subset of veterinary provider called a Veterinary Professional Associate (VPA). A VPA would be able to perform some tasks that currently only veterinarians are allowed to perform. A VPA would be required to have a master’s degree in veterinary clinical care, and would still require supervision by a licensed veterinarian. There would be licensing and continuing education requirements similar to veterinarians and veterinary technicians. This is somewhat similar to a nurse practitioner (NP) or a physician’s assistant (PA) in human medicine. Colorado would be the first and only state in the nation to create a position like this.
WHO IS *FOR* THIS BILL?
Proponents of the measure recognize there is a shortage of qualified veterinary professionals and believe that this would allow more people the opportunity to provide care. Many cite a shortage of veterinarians and difficulty getting in to see a vet on short notice. Some hope that having more people able to care for pets may lower costs for pet owners. The Denver Dumb Friends League and the ASPCA, (two organizations I admire) support this bill.
WHO IS *AGAINST* THIS BILL?
Opponents worry that lowering the academic standards and training required to provide care would lead to lower quality of care for animals. The Colorado Veterinary Medical Association (CVMA) and the American Veterinary Medical Association (AVMA) are against this bill.
WHY *I* AM AGAINST THIS BILL:
To start, there is no academic curriculum currently in place for a master’s degree in veterinary clinical care. Colorado State is currently writing the outlines of a program, but it is not yet finished. We don’t know what these students will learn and veterinary medicine is such a broad profession, it is hard to imagine that they could cover all the potential aspects of clinical care in just two years. Would there be tracks for small animal medicine and large animal medicine? There would almost have to be, but who knows?!
Additionally, the bill does not specify what tasks a VPA could perform. Licensed veterinary technicians can already assist veterinarians with numerous procedures while under supervision. The bill states that the tasks that a VPA would now be able to perform need to be clarified by the state board. It is widely assumed that they would be able to perform routine surgeries like spays and neuters, order tests and diagnostics, but again, the bill authorizes the state board to make those determinations at a later time. I’d like to know what I’m voting for, not guess what the board may agree to. Would they be able to take and interpret radiographs? Would they be able to perform ultrasounds and make diagnoses? Would they be able to prescribe some/any medications? I assume they would not be able to prescribe controlled substances, but what about the medicines that are not controlled but have the potential for abuse? Would they have to take classes on radiation safety and learn about drug diversion? Would they be able to perform euthanasias, which require the use of controlled substances? Who knows?! (Hint: Not even the state board of veterinary medicine knows at this point!)
WHO WANTS TO BE A VPA?
Veterinary medicine attracts people that are generally altruistic and have a love of animals. Despite what many think, people do not get into veterinary medicine to make a lot of money. (Trust me, if they do, reality comes at them fast!) As this new position would require a master’s degree, (that is four years of undergrad and a two-year master’s program) there is still a high academic and financial threshold. In comparison, licensed technician’s usually require a high school diploma and completion of a two year program. This VPA job requires a significant amount of student loans and a lot of time, to end up with a salary slightly higher than a technician, (and still require supervision).
WHO WANTS TO HIRE A VPA?
I suspect few veterinary practice owners would hire a VPA knowing they would need to pay them more than a licensed technician, but still need to supervise their actions. The practices that would benefit are the very large (often corporate-owned) veterinary centers that could run surgeries all day, in multiple surgery suites, with a single veterinarian providing oversight, similar to how large human hospitals use PAs or NPs.
The scenario I envision where a mid-level practitioner could be most beneficial is shelter medicine. A single veterinarian could supervise multiple VPAs while they performed spays and neuters and other basic procedures and treatments. A shelter or rescue could employ one DVM and multiple VPAs rather than having to hire multiple DVMs or overwork a single DVM. This would absolutely increase the bandwidth of animals that could be treated, and is definitely an area where we need to find creative ways to manage the health of unowned or unwanted animals.
Additionally, who will absorb the liability for the VPAs? Leaving aside arguments about whether or not animals would get substandard care, complications are a part of all medical practice. Doctors and veterinarians carry liability insurance to protect themselves from litigation arising from mistakes and complications. If the veterinarian is required to supervise the VPA, who is liable when complications arise, the VPA, the supervising veterinarian, or the practice? What would that do to my liability premiums if I hire a VPA? Lots of questions… insurance companies haven’t answered as they are waiting to see what voters decide.
A RESPONSE TO THE PROPONENTS:
Proponents say there is a shortage of veterinarians in Colorado, and this bill would help with that. Unfortunately, yes there is, and no it won’t. The larger population centers in Colorado, including Denver, up and down the front range, and along the western slope have numerous options for veterinary care. There are many large practices and even more smaller neighborhood clinics. The areas where Colorado is specifically lacking in veterinary care are in rural areas and especially the large animal and food animal segments. Because VPAs require supervision, these areas would not benefit as they are serviced, generally, by smaller practices, and are often ambulatory. How does it help the veterinarian or the animal owner to have a veterinarian roll up to the farm with a VPA riding shotgun? How does it benefit a small rural practice with only one surgical suite?
Proponents also believe that having more practitioners would lower costs for consumers. As payroll is one of the highest costs any veterinary practice has, I fail to see how a smaller “neighborhood” practice would hire a VPA when a licensed technician could do much of the same work while under supervision. If they did hire a VPA, consumers would not benefit because the practice would be paying a VPA more than they would a licensed technician. While a practice could potentially see more patients, payroll costs would be higher while the cost of goods sold would stay the same. Since many of the larger practices that would benefit from this are now owned by corporate entities, I think it is naive to believe that prices would go down, rather than allowing corporate profits to go up.
IN SUMMARY:
I recognize this may sound like professional gatekeeping, but I will be voting NO on 129. Veterinarians go through a rigorous four-year program to learn the vast library of knowledge and clinical skills needed to be competent. If it could be shortened to two years, I suspect someone would have done it by now! In fact, just the opposite, more and more graduates elect to do an internship to gain advanced clinical skills and mentorship following graduation. Surgery in particular is something I have grave concerns about allowing a graduate of a two year program to perform. One of my mentors once told me that the definition of “routine surgery” is surgery performed on somebody else. It’s never routine when it’s you or your pet. Another mentor remarked that general anesthesia is the closest anyone can come to death without actually dying. Even for “basic surgery” like spays and neuters, I believe that should only be entrusted to those with significant training.
I fail to see how Colorado voters or their animals would benefit from this change to existing laws and requirements. Consumers won’t pay less, veterinarians will not be able to treat significantly more animals, and young professionals looking to become VPAs would need to incur significantly more debt to only minimally increase their earning potential.
Finally, the language in the bill is vague. The academic curriculum is undeveloped at this time and the veterinary tasks allowed are undefined. It would be easier to support this legislation if we knew what we were actually supporting. For all of these reasons, I will be voting NO on 129.
To be clear, I encourage each voter to consider multiple (trustworthy!) sources and ultimately vote their conscience. If you have any questions, as always, feel free to reach out or comment below and I will do my best to respond! If you are so inclined, you are free to share this.
- Michael Hupp, DVM
