The Bird Bath: Midlevel Practitioner Webinar Follow-Up
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Last week, we brought you a passionate panel, Midlevel Practitioner Position: Will Other States Follow and What It Means for You. Our panel of experts covered so much, but as with any panel, you can never hit on all the questions. Well, now we can.
Dr. Gail Golab, with help from the AVMA, and Ashli Selke, with help from the CVPA, took on the challenge to answer the outstanding questions.
All panelists were provided with the questions and the same amount of time to send in responses. We’ve used a random selector to determine order of answers. Ashli’s name was selected first, so her responses will be the first for each question.
A special thank you and applause for the team at Full Slice Agency for their incredible work organizing and producing this webinar, and our sponsor, CoVet, for supporting this important conversation.
So let’s get into it…
Career Development and Utilization and Training
Why isn’t more focus placed on standardizing and better utilizing the VTS pathway, improving pay, and creating career development opportunities for veterinary technicians instead of creating the VPA role?
Ashli Selke, CVT, RVT
The Veterinary Technician Specialist (VTS) designation is not an academic degree—it is comparable to a veterinary technician pursuing a residency in a specific field. While highly specialized, it does not provide the broad, comprehensive education that pursuing a master’s degree in veterinary clinical care offers.Additionally, obtaining a VTS designation is unattainable for most veterinary technicians due to several structural barriers:
Limited Training Programs: Programs for VTS training/mentorship have become increasingly difficult to access because of the significant logistical challenges academies face in accommodating applicants.
Minimal Guidance or Oversight: Unlike formal residency programs in human or veterinary medicine, there is minimal standardized oversight of VTS training, creating inconsistent experiences.
Restricted State Practice Acts: In most states, even VTS-credentialed technicians are legally restricted from diagnosing, prescribing, initiating treatment, or performing surgery. Only Arkansas has granted an expanded scope of practice for VTS professionals. And only in a handful of other states, VTS recognition is typically limited to title protection or basic role definition without additional responsibilities.
Despite its potential, only 2% of veterinary technicians in the U.S. hold a VTS credential due to these significant barriers.
Another challenge is that formal education is not a mandatory requirement for many VTS academies. Of the 16 recognized academies, 13 do not require graduation from an AVMA-accredited program. They may have acquired their credentials through alternate pathways or legacy periods, further complicating legislative efforts to standardize and promote the role. Also if it comes to public voting people understand a masters education and can get behind that, they do not understand how someone can become a specialist that may have had zero formal education.
Given these complexities, the VPA role offers a more structured educational pathway, ensuring academic oversight, formal residency training, and a defined career trajectory that can be more easily understood by the public, legislators, and employers alike.
Ashli provided a Veterinary Technician Specialist (VTS) Academies Overview
Dr. Gail Golab
Focusing on leveraging, better engaging, and enhancing the training and roles of veterinary technicians, veterinary technologists, and veterinary technician specialists (VTSs) is the most effective and immediate way to address workforce challenges. By ensuring career development opportunities for these professionals, we will see improved job satisfaction and retention, and this will also support better patient care, enhance practice productivity, and improve team wellbeing.Creating a new role like the VPA, which overlaps the duties of veterinarians and veterinary technicians, is unnecessary and will introduce additional challenges rather than serving as a solution. Instead, we should all be focused on maximizing the potential of the well-trained professionals who are already within the field.
Supporting and expanding veterinary technology programs, ensuring title protection and appropriate credentialing, working with NAVTA to further standardize VTS training, and advocating for better pay and benefits are key steps forward. The AVMA is actively supporting veterinary technicians in achieving many of these, particularly through the AVMA Committee on Veterinary Technician Education and Activities, the AVMA Committee on Advancing Veterinary Technicians and Technologists, advocacy efforts at the state level, and collaboration with NAVTA.
Are there specific restrictions or limitations for VTSs in Clinical Medicine that the VPA role might conflict with?
Ashli Selke, CVT, RVT
Practice acts could create conflicts, but the roles can effectively co-exist.Advocating for VTS Integration Within the VPA Framework
Once the Veterinary Professional Associate (VPA) framework is established in states, our next initiative is to advocate for Veterinary Technician Specialists (VTSs) by collaborating with the Committee on Veterinary Technician Specialties (CVTS) to create a VPA-Specialist Pathway.
Our Vision for VTS Advancement:
VPA Equivalency Pathway: Develop a specialist-equivalency process where credentialed VTSs can transition into VPA-Specialist roles within their specific domains (e.g., emergency, anesthesia, dentistry).
Expanded Scope of Practice: Ensure VTSs receive the legal protections, expanded scope of practice, and title protections,etc they deserve, aligning with the VPA’s state-regulated licensure model.
State Legislative Advocacy: Work closely with state lawmakers to amend practice acts that currently limit VTS recognition, ensuring legal clarity and enforceable title protection.
Why This Matters:
Clinical Excellence: Combining the advanced expertise of VTSs with the formal legal framework of the VPA ensures higher standards of care and better patient outcomes.
Career Advancement: This pathway would provide career mobility, higher earning potential, and professional recognition that VTSs currently lack in most states.
Unified Profession: A collaborative model between VPAs and VTSs would strengthen the entire veterinary healthcare system, ensuring fair representation, equal opportunities, and consistent care standards.
By integrating VTSs into the VPA model, we can create a comprehensive veterinary healthcare framework that acknowledges advanced education, honors specialization, and protects patient welfare. This initiative reflects our commitment to advancing the entire veterinary profession—not just for VPAs but for all veterinary professionals working toward better care for animals.
Dr. Gail Golab
The VPA role would substantively overlap with the role of VTSs, who already have advanced training and skills in specific disciplines, as well as established credentialing. Accordingly, introducing this new role creates confusion and is likely to undermine and devalue the roles of not only VTSs, but veterinary technicians more generally. Introducing an ill-defined VPA is also inconsistent with well-established scope-of-practice regulations that are based on nationally agreed sets of competencies that are gained through training received from accredited programs, assessed through standard examinations, and that are designed to protect the quality of veterinary services and the patients and public that receive those services. Discussion about any gaps that need to be filled, what competencies are needed to fill those gaps, and how to ensure necessary competencies are achieved needs to happen before such a role is created.Unfortunately, that is not what has happened here, so we are left with redundancies, conflicting and duplicative roles, confusion, and existing veterinary professionals whose degrees and certifications lose value.
What qualifications will supervising veterinarians need, and what is their role in ensuring VPAs are appropriately trained and supervised?
Ashli Selke, CVT, RVT
Supervising veterinarians will need to understand their responsibilities when delegating duties to their VPAs. They must be familiar with the skill set of the VPA and delegate only within that skill set.Modeling after a successful PA construct, it is reasonable to expect a direct supervision requirement for a period of time that allows for the veterinarian to be assured of the skill set of the VPA.
Dr. Gail Golab
A significant concern with the VPA role is the lack of clarity around the type of supervision required—whether immediate, direct, or indirect. If indirect supervision is permitted, it could allow a single veterinarian to "supervise" a large number of VPAs (as has been mentioned by some as desirable to reduce labor costs). This creates considerable risks for patients and clients, especially during urgent or emergent situations when a VPA's abilities are insufficient, or an unanticipated medication is needed (federal law prohibits VPAs from prescribing) and the supervising veterinarian is not immediately available because they are offsite.Additionally, as the “supervisor,” the veterinarian would be legally responsible for all acts and omissions of the VPA in delivering care, leading to an unacceptable level of liability. This liability, coupled with the potential for compromised patient safety, makes the VPA role untenable for many veterinarians.
Results of a survey of Colorado veterinarians highlighted these concerns, with 95% indicating they would not hire a VPA due to the risks and challenges associated with supervision, patient safety, and liability.
Role and Responsibilities
What specific tasks will VPAs be allowed to perform, such as surgery or prescribing medications, and how will these tasks be supervised (e.g., onsite or remote supervision)?
Ashli Selke, CVT, RVT
Specific rules will be determined by the state veterinary board in Colorado, and likely by state legislators and veterinary boards in other states. In Colorado, VPAs will be trained (almost identically to DVM students) to perform surgery, understand pharmacology and prescribing, biology of disease etc. Supervision will be articulated in rulemaking, and it is expected this will include varying levels of supervision based on the task and the environment (companion animal practice vs rural large animal practice).
Dr. Gail Golab
The only legal description of a VPA currently available is approved Proposition 129 in Colorado, which indicates a VPA would be allowed to “practice medicine under the supervision of a licensed veterinarian.” Proponents interpret this to allow a VPA to practice the core aspects of veterinary medicine – diagnosing, creating treatment plans, prognosing, and performing surgeries. And all this after having completed only a mostly online master’s degree with minimal on-site clinical exposure (not only less exposure than veterinarians receive, but less exposure than provided to those completing programs in veterinary technology). What the VPA would not be able to do is to prescribe medications, because that activity is limited by federal law to veterinarians.“Supervision” is not defined, so could be interpreted as immediate, direct, or indirect. If indirect supervision is permitted, it could allow a single veterinarian to "supervise" a large number of VPAs (as has been mentioned by some as desirable to reduce labor costs). This creates considerable risks for patients and clients, especially during urgent or emergent situations when a VPA's abilities are insufficient or an unanticipated medication is needed and the veterinarian is not immediately available because they are offsite.
How is "routine care" defined for VPAs, and how will they be prepared to handle cases that become non-routine?
Ashli Selke, CVT, RVT
VPAs will be trained in normal and disease states of animals. They will be trained to understand when a condition needs to be referred back to their supervising DVM, much like general practitioners refer to specialists and tertiary hospitals.
Dr. Gail Golab
“Routine care" for VPAs has not been clearly defined. Many cases initially considered "routine” can quickly become "non-routine”, including some specific cases that it has been suggested VPAs can handle, such as respiratory and ear infections, spays, neuters, and dentals. Many of these “routine” cases are among the most frequent subjects of malpractice claims according to the PLIT.Without a clear scope of practice and robust training to handle emergencies, VPAs will be ill-equipped to manage cases that deviate from the routine, leading to missed diagnoses, delayed interventions, or inappropriate treatment/responses, especially if the supervising veterinarian is not immediately available. Proper patient care requires highly trained and competent professionals with the ability to recognize and manage complications in real-time—something for which the VPA will not have been properly prepared based on what we know about the proposed master’s program that would lead to this role.
What mechanisms will ensure VPAs adhere to routine conditions and do not exceed their scope of practice?
Ashli Selke, CVT, RVT
“Routine conditions” will not be written into a scope of practice. As noted in the previous question, there is no way to define that phrase. The statue language in Colorado is that delegation must be within the expertise of the VPA, and the veterinarian must know their VPA to fulfil this requirement.
Dr. Gail Golab
Scope and requirements for practice are typically defined by state practice acts and accompanying regulations, which are enforced by state veterinary regulatory boards. However, the scope of practice for VPAs has yet to be defined, and corresponding regulations have not yet been established. The overlap in roles among VPAs, veterinarians, and veterinary technicians, along with the challenge of defining what constitutes a “routine condition,” adds to the complexity of drafting and enforcing necessary changes to the state practice act and its regulations.Additionally, expectations for veterinarian supervision; the respective accountabilities of veterinarians and VPAs; and requirements for education, competency demonstration, credentialing, and licensing or registration for VPAs will need to be addressed.
Who will carry liability insurance for VPAs—the supervising veterinarian, the VPA, or both?
Ashli Selke, CVT, RVT
It will be up to the DVM. Professional liability insurance for the VPA will be available, and the DVM’s liability product (as currently written) would typically cover them. It would be irresponsible to remove all DVM liability when supervising the VPA as that could set up the system for irresponsible delegation.
Dr. Gail Golab
The veterinarian supervising the VPA’s activities would, under current proposals, be responsible for all the acts and omissions of the VPA, and that’s one of the reasons many veterinarians are vehemently opposed to creating this position. They don’t want to be liable for the actions of an undertrained VPA. Among the highest number of AVMA Professional Liability Insurance Trust (PLIT) complaints are those related to spays, neuters, anesthesia, and dental procedures, all of which a VPA could do under current proposals. Veterinarians would be highly vulnerable to board complaints and malpractice claims. Proponents, often not veterinarians, are asking veterinarians to shoulder all the risk.The liability insurance issue is much more complex than most acknowledge. Can you buy a policy to cover your employees? Yes. Do those policies often exclude professional conduct? Yes. Can you buy insurance to cover someone you don’t employ, but do supervise? Not clear. Can a VPA obtain a generic professional liability policy? Maybe, but coverage and good coverage are often not the same thing. And these are just a few of the questions that emerge. Liability coverage is a very real concern that must be addressed by those supervising and/or employing a VPA before allowing them to practice.
Financial Impact
How will the costs associated with the VPA role—such as salaries and training—impact the affordability of veterinary care compared to enhancing the VTS pathway?
Ashli Selke, CVT, RVT
Ashli provided three economic papers from Michigan State University’s Department of Agricultural, Food, and Resource Economics Staff Paper Series.
The Veterinary Professional Associate Financial Model: General Practice
The Veterinary Professional Associate Financial Model: Specialty Practice
The Veterinary Professional Associate Financial Model: Shelter Practice
Dr. Gail Golab
Time, money, and effort are best invested in better leveraging, paying, and supporting the career development of our veterinary technicians.While the cost for training a VPA is anticipated to be lower than that for educating a veterinarian, it is expected to be higher than that for training a veterinary technician or a veterinary technician specialist. Not to mention considerable concerns about the quality of the VPA’s proposed education, whether their contributions will warrant a salary that is sufficient to repay their debts, and their ability to sustain a viable career given veterinarians’ seeming reluctance to hire or supervise one.
Some proponents of the MLP argue the position would reduce the cost of care. However, individuals who lack the appropriate education are more likely to make mistakes, leading to misdiagnoses, ineffective treatment plans, and repeat visits, which will lead to additional suffering for the animal and increased costs for the client. Even if introducing an MLP reduces labor costs, there is no evidence to support the idea that a reduction in labor costs will be passed onto clients as lower fees. In a for-profit business environment, it would be surprising if they were.
What are the costs of the Master of Science in Veterinary Clinical Care (Colorado State University), and Master of Veterinary Clinical Care (Lincoln Memorial University), and how does it compare to the cost of pursuing a VTS designation?
Ashli Selke, CVT, RVT
Lincoln Memorial University is ~$20,000 for 30 credits at this time. The cost will increase as the credits in the program increase.The MVCC at Colorado State University (63 semester credit hours and five semesters) will be about $47K for in state students.
There is little data on the cost of a VTS designation.
Dr. Gail Golab
AVMA is not able to provide a response to this question as CSU has not yet provided final tuition costs for the Master of Science in Veterinary Clinical Care program.Various estimates have been shared, but those have been wide-ranging.
Industry Concerns
How will the introduction of VPAs affect the recognition, utilization, and retention of credentialed veterinary technicians?
Ashli Selke, CVT, RVT
The VPA pathway is an excellent career advancement opportunity for veterinary technicians. These critical team members are typically leaving the field after only 5-7 years, often transitioning to human healthcare. Offering these technicians a career path within the field they love is vital to our profession’s future. CSU has received hundreds of inquiries from veterinary technicians who were planning to leave veterinary medicine but who see hope for their future within the animal care field because of the VPA opportunity.
Dr. Gail Golab
The introduction of VPAs is likely to have complex effects on the recognition, utilization, and retention of credentialed veterinary technicians.The overlap in roles between VPAs and veterinary technicians could diminish the value of veterinary technicians’ knowledge and skills, particularly with regard to technical tasks the VPA might also be trained to perform. Practices will need to adapt workflows to ensure veterinary technicians' skills, and particularly those of veterinary technician specialists, are fully utilized and not overshadowed by the presence of VPAs.
Concerns about role redundancy and reduced career growth opportunities could lead to frustration and lower job satisfaction among technicians, exacerbating retention challenges. And, while the intent is that VPAs alleviate some workload pressures for veterinarians, they will also require support from veterinary technicians, potentially increasing the burden on an already short supply of veterinary technicians.
How will shelters and practices balance expectations for reduced costs with the salaries and responsibilities of VPAs?
Ashli Selke, CVT, RVT
Ashli provided three economic papers from Michigan State University’s Department of Agricultural, Food, and Resource Economics Staff Paper Series.The Veterinary Professional Associate Financial Model: General Practice
The Veterinary Professional Associate Financial Model: Specialty Practice
The Veterinary Professional Associate Financial Model: Shelter Practice
Dr. Gail Golab
Some proponents of the MLP argue the position would reduce the cost of care. However, individuals who lack the appropriate education are more likely to make mistakes, leading to misdiagnoses, ineffective treatment plans, and – in the case of private practices – repeat visits, which will lead to additional suffering for the animal and increased costs for the client. There are also questions about whether the contributions a VPA makes will warrant a salary (estimated at $100,000) that is sufficient to repay their educational debt, particularly since, under current proposals, the shelter or practice will need to hire a veterinarian(s) anyway to supervise the VPA(s). And, just like veterinarians in private practice, many shelter veterinarians are not enthusiastic about hiring or supervising a VPA.Even if introducing an MLP reduces labor costs, there is no evidence to support the idea that a reduction in labor costs will be passed onto clients (whether of shelters or private practices) as lower fees. In a for-profit business environment, particularly, it would be surprising if they were.
Why are corporate practices and universities supporting the VPA role instead of investing in existing professionals like RVTs and VTSs?
Ashli Selke, CVT, RVT
At this time, no corporate veterinary entity is endorsing or funding the VPA initiative. This is a false narrative. Funding for the ballot measure in Colorado received less than 1% of funding from corporations.PetSmart charities (a non-profit organization) gave CSU a grant to work on the master’s degree program as one of their many investments in access to veterinary care. The shortage of veterinary technicians is even more severe than the shortage of veterinarians, and giving them a career path is investing in them.
LMU’s program is only available to credentialed veterinary technicians.
Ashli provided records of financial supporters and opposition to Prop. 129.
These records have not been verified by The Bird Bath. We are republishing the data provided.
Dr. Gail Golab
Some private equity is on record touting veterinary care a “cash business”. As such, some – not all – companies appear to view veterinary medicine as a lucrative investment vehicle and are championing the VPA as a path to simultaneously increase revenue by generating headcount and reducing labor costs, thereby increasing profits.Analogously, some – not all – universities, dogged by dwindling state government support, appear to view VPA programs as an opportunity for increased high-margin tuition revenue through masters-level tuition and fees, and by leveraging as many additional spin-off offerings as possible (e.g., certificate programs). We understand that DVM students at CSU are quite concerned about their education and degree being devalued by a VPA.
This approach, motivated by financial incentives, is at odds with the profession’s commitment to providing quality care for animals and maintaining high ethical standards.
Alternatively, we can support economic success, while at the same time protecting the health and safety of our patients, by focusing on maximizing the potential of the well-trained professionals who are already within the field; specifically, our veterinary technicians and veterinary technician specialists.
What is the strategy for persuading states to recognize the VPA role under their veterinary practice acts?
Ashli Selke, CVT, RVT
Without practice act changes, no one other than a DVM can practice veterinary medicine with few exceptions. There are not enough DVMs to meet the need of animals in our society.To safely and thoughtfully increase opportunities for animals to be healed, we must increase the healing resource in our communities. The VPA represents and consistent training mechanism to ensure those treating animals are well trained to do so.
Dr. Gail Golab
This is a question for the proponents of the VPA, rather than for those who are not supportive of creating this new position.We can tell you that with the exception of one state, whose Board has not yet met to discuss it, all state, district, and territorial veterinary medical associations have indicated their opposition to creating a VPA, as have species-specific allied veterinary associations (e.g., AAHA, AAFP, AAEP, AAAP, AABP, AASRP, AASV), the Student AVMA (SAVMA), some practice-type specific veterinary associations (e.g., relief veterinarians), some veterinary specialty organizations, and multiple state veterinary technician associations, as well as American Humane, and the American Kennel Club.
How will the AVMA address concerns about VPAs potentially replacing DVMs and protect the integrity of existing veterinary roles?
Ashli Selke, CVT, RVT
I would defer this to the AVMA as I cannot speak for them.
Dr. Gail Golab
VPAs are required to be supervised by a veterinarian, which is clear recognition that there is no replacement for a veterinarian, who undergoes years of comprehensive and accredited education and training, completes a rigorous national exam, and who is credentialled and licensed before being allowed to practice veterinary medicine. Veterinary technicians and veterinary technician specialists are likewise appropriately educated and their competence evaluated, in accordance with a national standard, before they are allowed to practice veterinary technology or a specialty within that field.There can be no shortcuts when it comes to the training and clinical experience required to safely and effectively care for animal patients, which is why we are so concerned about the inadequacy of the education currently being proposed for a VPA, coupled with the absence of a nationally recognized competency assessment and agreed scope of practice.
The AVMA will continue to oppose creating a midlevel veterinary practitioner who lacks the appropriate training and assessment, thereby putting animal health and safety, food safety, and public health at risk. If such a position is created, such as happened in Colorado, the AVMA will work aggressively to put appropriate guardrails around their practice to protect veterinary patients and clients.
Will creating the VPA role devalue the role of DVMs by suggesting mid-level practitioners can perform comparable tasks?
Ashli Selke, CVT, RVT
The exact opposite has happened in human medicine—the PA is deferential to the MD. Patients know that they will see an MD if their situation is complex or not responding to treatment. Since VPAs will not be able to perform tasks unless delegated by a DVM, a hierarchy is automatically established within the regulations. If the veterinary community insists and protectionism over providing care for animals, they themselves will impune their reputations and devalue their roles.Ashli provided a report by the Colorado State University Animal-Human Policy Center which conduct a survey of veterinary professionals in the Colorado. The survey effort was designed to understand veterinary workforce and access to veterinary care challenges and veterinary professionals’ perspectives on potential policy solutions or programs to address these challenges in Colorado.
Dr. Gail Golab
VPAs are required to be supervised by a veterinarian, which is clear recognition that there is no replacement for a veterinarian, who undergoes years of comprehensive and accredited education and training, completes a rigorous national exam, and who is credentialled and licensed before being allowed to practice veterinary medicine.Without a clear scope of practice and robust training to handle emergencies, VPAs will be ill-equipped to manage cases that deviate from the routine, leading to missed diagnoses, delayed interventions, or inappropriate treatment/responses, especially if the supervising veterinarian is not immediately available. Proper patient care requires highly trained and competent professionals with the ability to recognize and manage complications in real-time—something for which the VPA will not have been properly prepared, based on what we know about the proposed master’s program that would lead to this role.
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