10/18/2024
This is a very long read, but it's extremely important. While I don't have very many contacts in Colorado, this could easily catch on nationwide. Nobody who understands Veterinary medicine supports this idea.
Please do your research. Is your vet office corporate owned? You might want to consider switching. You'll often find the care you get from a privately owned practice is more individual, personable, and the same cost or even cheaper (because you aren't funneled into a corporate-created "treatment plan" where profit is the objective). Plus you're supporting a small business.
This is primarily for any friends/family in Colorado. However, it applies to any pet owner in the U.S., because what's happening in Colorado will happen in your state sooner or later, guaranteed. It is very long, but if you have a pet, this should matter to you.
Coloradans are being asked in this year's election to vote on Proposition 129, which would establish a mid-level veterinary position (Veterinary Professional Associate, or VPA). Think of this like a Nurse Practitioner or Physician Assistant, positioned between the veterinarian and the veterinary technician.
I know it sounds good, but I would very strongly encourage you to vote against this if you live in Colorado.
It is being proposed as a way to relieve a hypothetical veterinarian shortage by creating a position that could perform all the functions of a veterinarian (except, currently, prescribing medication due to FDA restrictions) - but with far less training. And yes, they explicitly would be allowed to perform complex surgical procedures. The argument in favor generally posits that by reducing the training requirement, the cost of education will be lower. This will make it a more financially bearable choice, enticing people into the field, and thus relieving the (hypothetical) shortage of veterinarians by providing an alternative care-giver to the veterinarian. They also argue that it 'frees up' the veterinarian to focus on more complex cases by offloading more commonplace responsibilities, which they claim will reduce veterinarian burnout by lightening our load. The cost of care will go down, they say, because VPAs don't need to be compensated like a veterinarian.
All sounds great, right? Who wouldn't vote for something whose promoters are promising quicker and cheaper access to veterinary care?
But it's a sham. A complete, utter, disingenuous sham driven by greed.
IT WILL NOT REDUCE THE COST OF CARE:
1) Don't kid yourself - the corporations that have largely taken over veterinary medicine are not going to reduce the cost of an appointment and cut into their profit just to make it more affordable to you. They're going to hire VPAs that they pay less to replace veterinarians, and pocket the difference in salaries.
2) The cost of the consultation is a relatively small percentage of the overall bill. The remainder of the bill would be unchanged, regardless of whether you see a veterinarian or a VPA.
3) There is good data in human medicine to suggest that NPs and PAs increase the cost of care (though it is somewhat dependent on the area of practice, to be fair) through excessive use of diagnostic testing, over-referral to specialists, and potentially by increasing follow-up visits when they fail to address a problem correctly on the first interaction. There is no reason to think it would be any different with VPAs.
4) Did your cost of health care go down as NPs and PAs have expanded their role? Mine sure didn't. Corporations - especially insurance providers - have simply increased their profit.
THIS WILL NOT REDUCE VETERINARIAN BURNOUT:
1) Dealing with only complex cases is not what most general practice vets want. They enjoy some of the 'easier' cases - it's a chance to take a breath during their day and potentially bond with an owner when they see a healthy kitten for vaccines. It gives them a break between tough cases. Dealing with only complex, sicker patients is what we do in emergency medicine - and it is taxing and definitely not for everyone and the burnout rate is high. Specialists also only deal with more complex patients - but they deal with far fewer patients per day than a typical general practitioner.
2) A veterinarian would be required (by law) to oversee a VPA. So the workload reduction by transferring cases to a VPA is a wash, because now the veterinarian who would have had to see those has to review the cases from the VPA anyway. Instead of staying late to write your own charts, you get to stay late reviewing the VPA's charts!
THIS WILL BE DANGEROUS FOR PETS:
1) The master's degree required for this (created by Colorado State University, which deserves censure within the veterinary community for this - shame on you, CSU) is almost entirely online, and is highly abbreviated. There is one 2-credit course (online) on surgery, and one 2-credit lab. That's it. Four credits for surgery, and then turned loose to cut! Other areas of practice have similarly limited training.
2) VPAs would be allowed to perform surgery, including open abdominal procedures, amputations, etc. I realize that to most owners a 'spay' sounds like a very easy procedure, but it's actually not. You are removing an entire organ system from within the abdomen. Do not confuse 'routine' with 'easy'. There are many GPs who do not like to perform the procedure, and there are many patients (especially older overweight dogs) for whom it is a very difficult procedure. I have seen a third year surgery resident - i.e. someone at the end of very extensive surgical training - sweat and swear and struggle to perform a spay. Do you want someone with almost entirely online training cutting your dog? Do you think they'll know how to handle it if something goes wrong? Because things go wrong - more often than you might suspect. But trained veterinarians just adjust, deal with the problem, and move on. A VPA? Good luck!
3) Other procedures are not as easy as the supporters of VPAs are making it seem. They have specifically mentioned splenectomies, for instance. In dogs, the most common indication for a splenectomy is due to a ruptured mass where the abdomen is full of blood. These are often unstable patients who are literally bleeding out, and it is a race against time to stabilize them, open them up, stop the bleeding, and extract the spleen. It's not just about cutting the spleen out - it's about managing a patient who is bleeding to death with an elevated heart rate, decreased blood pressure, and poor oxygen perfusion: these are patients who are trying to die. Do you really want someone whose training is abbreviated and online doing that with YOUR dog? There are many, many veterinarians who don't even want to perform that procedure - it's absolutely absurd to think someone with half the training could be considered competent to do it.
4) The timeline for dealing with pet problems is often much quicker than humans. It is very easy to miss critical problems in pets because they can't talk to us and because they hide signs of illness - often by the time you realize something is wrong they are in distress. Do you trust someone trained largely online to correctly assess your pet? I don't.
5) The proposed training for a VPA consists of 65 credits, most of which is online. (I had to have 60 credits just as pre-requisites to get INTO vet school.) Vet school itself was around 200 credits plus electives (I forget how many I took, but it probably added 10-20 credits.) I have seen comments that VPAs would receive "half" the education of a veterinarian. In truth, it is actually less. So why should they be doing a veterinarian's job? Common sense says that it's silly.
THIS IS NO VETERINARIAN SHORTAGE:
1) A recent study commissioned by the AVMA concluded that there is no veterinary shortage. The perception of shortage arose during COVID when a surplus of money (and, perhaps, time) due to federal government stimulus caused a dramatic increase in veterinary visits. Those visit numbers are on the way back down. There are some veterinarians who still report excessive load, but there are many discussing how their caseload has dropped significantly. The study concluded that because of the addition of around 15 veterinary schools in the U.S. (at varying stages currently) there is likely to be an OVERSUPPLY of veterinarians within 10 years. So the the VPA proposal is solving a problem that doesn't likely exist.
2) It's true that there is a deficit of veterinary services in many rural areas. But this will not fix it because the shortage isn't from not having veterinarians interested in those locations - it's because the economics don't support a veterinarian. Since a VPA requires oversight by a veterinarian, it's a moot point - you can't have a VPA in rural Montana taking care of cattle unless there's a veterinarian already there doing it. You can't just graduate VPAs and send them to rural areas - it won't happen any more than NPs and PAs "flocked" to rural areas to solve the same problem in human medicine (free pro tip: they didn't).
3) There IS a veterinary technician shortage, which is interesting for two reasons. First, technicians are likely to be a sizable percentage of VPAs. So VPAs are likely to exacerbate the veterinarian technician shortage. And we can't function without our techs - they are the lifeblood of the hospital. Second, VPAs will need techs, too. So if there are already too few technicians - just who is going to do the tech work for VPAs? It doesn't matter how many veterinarians (or VPAs) you have - if you haven't fixed the tech shortage, you haven't increased access to care.
ADDITIONAL THOUGHTS
1) It's very telling that the proponents of this are almost entirely veterinary corporate groups. Think about that. Think really hard about that. Why would it be that a very large majority of private practitioners oppose it, but corporate interests promote it? Money. They want more. That is literally the only reason they are pushing for this - so they can reduce the number of veterinarians they employ, replace some with mid-levels, and pocket the difference in human resources costs. Do not believe them when they say that you - the pet owner - will see some of that money. When was the last time a corporation, out of the goodness of its 'heart', cut back its profit margin?
2) It's also very telling that the supporters initially tried to gain support within the industry - and failed. Then they tried a legislative approach - and failed. So now they utilized Colorado's constitution, which allows for it to be put to popular vote. In other words - experts understood it to be bad for pet and pet owners and rejected it. The legislature understood it. So they went to the public, where they can create deceitful propaganda to convince you it's in your best interests. After all, it's easy to ask leading questions like "wouldn't you like the cost of care to be cheaper?"
3) Note that the American Veterinary Medical Association opposes this. As does the American College of Veterinary Surgeons. As does the Colorado Veterinary Medical Association. As do 75% of veterinarians in Colorado. As does almost every other expert organization that has stated their position.
4) There are some excellent NPs and PAs in human medicine. And there likely would be some excellent VPAs in veterinary medicine. But it is really, really crucial to separate out anecdotal ("but I've had a great experience with my PA!") information from large-scale data. And the data doesn't lie with regard to the negative impact of NPs and PAs in human medicine. There are pockets where these 'physician extenders' have benefited health care, but overall the impact has been negative.
5) It's also important to remember that the scope of care for a typical small animal veterinarian is much larger than a typical MD, where hyper-specialization is routine. A typical small animal veterinarian functions as internal medicine doctor, anesthesiologist, surgeon, geriatrician, pediatrician, dentist, etc. Replacing that with a VPA is simply impossible without the same training.
6) As a "this would be funny if it weren't so terrifying" footnote: one of the supporters of VPAs recently suggested that the VPA position would be great for people who were unsuccessful getting into vet school. Stop and think about that for a moment - he is literally saying that someone who didn't meet the criteria to be a doctor ... should be allowed to doctor things. It's utterly insane.
This proposal will not help your pet. It will not lower your costs. It will not increase your access to care. It WILL increase the risk to your pet. It WILL increase profit for large corporations.
Vote against it.
