McCormick: Ballot question not the solution to rural vet shortage
Rep. Karen McCormick, D-Dist. 11, said the frustrating thing about the possibility of the veterinary professional associate or VPA being created via ballot proposal is the lack of research and expertise at play. If passed, Colorado Proposition 129 would allow non-veterinarians to diagnose, prognose, recommend treatment plans and perform surgeries. The measure is vehemently opposed by veterinary groups nationwide.
McCormick, a veterinarian and Colorado state representative from Boulder County, brought two veterinary bills before the legislature last year that were eventually signed into law, but both of those were introduced only after years of research and stakeholder input.
“We listened, we learned, we asked, we had hundreds of hours of listening to experts, including several veterinary economists who study trends and finances in veterinary medicine across the nation,” McCormick said. “We talked to the head of veterinary medicine at the FDA, the USDA. We’ve talked to many universities with veterinary programs, accreditation teams, the veterinary liability insurance providers, professional organizations that represent our veterinarians, as well as our registered vet techs, nonprofits, private practice owners, and rural voices.”
She said when the possibility of amending the Veterinary Practice Act to create a veterinary professional associate was brought forward in 2020, she asked a few basic questions.
Proponents, she said, couldn’t provide answers. It was then she knew she had to begin digging into the potential formation of a VPA.
ASKING QUESTIONS, LISTENING TO ANSWERS
McCormick hosted 13 meetings during the summer, each an hour and a half, with over 35 people in attendance each time asking questions.
“We learned through scientific inquiry of the many barriers and serious concerns of the ability of a proposed veterinary professional associate to ever being able to help us increase access to care or to lower the cost of care or to do any of the things that we were defining as issues or problems to address,” she said. “And through that entire discussion too, we learned many of the aha moments of what we could do. What can we do to help? And that’s what flowed into House Bills 1047 and 1048.”
McCormick said she didn’t come to her strong opposition of Proposition 129 overnight. Two of the weightiest questions have been who is behind the measure and who it will really serve. The answer, she said, is not rural Colorado, and said the claim of easing the burden to rural and ag producers is inaccurate.
“In reality, these folks will be critically under trained and not have really what they need to be able to diagnose and do surgery, which is what is proposed by this plan,” she said. “The proposed curriculum is all in companion animal medicine. There’s nothing for food animal, equine, none of that is even on this very limited curriculum that is being proposed.”
McCormick said the proponents’ claim that the measure’s passage will solve the rural veterinary shortage and lower costs, but she disagrees. Better utilization of the existing, trained veterinary technicians and assistants, she said, will be key and that is in place in statute.
“That’s why we expanded the scope of practice for our registered veterinary technicians, our veterinary technician specialists, to be able to not only show and put into statute that they are allowed to do more, but teach our veterinary teams to start having our qualified, educated, credentialed veterinary technicians work to the full scope of their education, training and competency.”
The current veterinary technician program requires a significant amount of hands-on training.
“The veterinary technician specialist credentialing program is much more stringent and involved than what this proposed curriculum is. We have, again, an opportunity to build more pathways to veterinary technician specialists. It makes no sense to go down this road.”
A VPA, she said, would not be able to assist livestock producers with Veterinary Feed Directives as VFDs fall under the same set of rules set forth by the Food and Drug Administration that allows only a licensed veterinarian in the course of their practice to prescribe VFDs. The same holds true for prescribing and dispensing medications, which according to the FDA, may only be done by a licensed veterinarian.
She said to think the proposed VPA would relieve access constraints in rural areas is a false flag. It’s also, she said, not comparable to a physician’s assistant in human medicine. McCormick said PA candidates complete thousands of hours of training with clinical work and rotations.
“This person will have none of that,” she said. “Most of the training will be online, which is super concerning to be able to be competent in much of anything without a lot of clinical training and hands-on experience. There’s very little of that proposed and I see that as a serious problem.”
NO LABOR SAVINGS
A VPA, if able to correctly diagnose a condition utilizing the proposed curriculum, which McCormick places little faith in, would have to consult with the veterinarian overseeing them so the veterinarian can prescribe. It does not, she said, appear to be a labor savings.
This proposition’s passage would require, according to the American Veterinary Medical Association, legislative and regulatory changes not only in Colorado, but in the other 49 states, territories, and at the federal level
“There’s a huge barrier to that person truly helping when there is no way they will ever be able to legally prescribe a single medication, not even over the counter Benadryl,” she said. “We have federal law that preempts whatever the heck we do here in Colorado that says only a licensed veterinarian can prescribe anything to an animal. They have that rule and regulation in place as a matter of public health, food safety, and to make sure that the pharmaceutical agents, antimicrobials, antiparasitic, all the medications that we use are all used in a way that is controlled, targeted, limited so that if and when any of those medications are needed in the protection of human health, we haven’t diluted their potential use.”
While Colorado State University is compiling a potential master’s program if this measure passes, they have been criticized for that decision by the Colorado and American Veterinary Medicine Associations.
According to the statement, “The American College of Veterinary Surgeons (ACVS) strongly opposes these efforts and believes they will result in increased risk to animal health and safety. All surgical procedures, even those considered routine, have inherent risks that can lead to serious complications (e.g., bruising, pain, bleeding) and even patient death if not performed by trained, qualified personnel. Only a licensed primary care veterinarian and for many procedures a board-certified veterinary surgeon has the education and training necessary to safely perform surgeries on animals and address any associated issues that can arise when performing these surgeries.”
Dr. Kelly Walsh, president of the Colorado Veterinary Medical Association, said the current ballot measure would compromise and threaten the health and safety of animals and pets. In an op-ed she wrote in July, Dr. Walsh said it “presents dangerous risks by permitting VPAs to practice the full scope of veterinary medicine — including performing surgery — with inadequate, mostly online training. Surgical procedures, even routine surgeries, are highly complex and require extensive veterinary training and expertise. Allowing inadequately prepared individuals to perform such procedures fundamentally undermines veterinary care and places animal lives in jeopardy.”
The American College of Veterinary Surgeons issued a statement saying that it stands universally opposed to allowing nonveterinarians to perform any surgical procedures on animals.
According to the ballot analysis in the Blue Book, the argument for the measure is potentially expanded access to veterinary care in rural and agricultural communities. The argument against cites vague training requirements, no current academic programs for the profession, and potential risk to animals by creating a new and untested profession.
She said she is deeply troubled also by the lack of consumer protection and what she calls a nearly predatory nature to the funneling of students into a master’s program. These students, she said, will potentially shoulder $80,000 in debt to earn the degree to work as a VPW with no economic analyses to prove the existence of a job market that will provide them the ability to work and pay off the debt.
“That that also bothers me tremendously,” she said. “So. Here we are. It’s on the ballot. There are powerful forces that do have money that are going to continue to push this issue. The only benefit I can see is to some of the corporate-owned companion animal practices that foresee a way for potentially lowering their payroll expenses. It’s not about access to care. It’s not about better care.”
It is though, she said, illogical, to create a new medical profession by way of a ballot initiative.
BEHIND THE PROPOSITION
The main proponent of the proposition is All Pets Deserve Vet Care, whose licensed agent is Apryl Steele. Steele is the president and CEO of Denver Dumb Friends League. The New York-based American Society for the Prevention of Cruelty to Animals and Dumb Friends League are the primary supporters and donors to the campaign, according to campaign contribution records. Dumb Friends League has donated over $1 million of the $1.2 million raised with ASPCA donating over $250,000 plus in-kind donations from both entities. Proponents also count Colorado Gov. Jared Polis and Gia, the state’s First Dog among the measure’s supporters and in Gia’s case, endorsers.
McCormick said it’s absolutely true that there is a need for more veterinarians, especially in rural, large animal and food animal sectors.
“And in response to that, veterinary schools across the nation, including CSU, are increasing their class sizes very soon by 15 to 20 percent across the nation, which is hundreds more in the pipeline,” she said. “And on top of that, there are 13 brand new veterinary schools in some degree of coming online. That’s a lot considering there’s only 32 total to begin with right now. We have an incredible pipeline to churn out more veterinarians to meet, if not exceed, the projected need by 2030.”
This, McCormick said, is much better than a new position created by the ballot that hasn’t gone through a credentialed program with no guaranteed jobs for a position unable to legally prescribe medications. Focusing on existing veterinary technicians and VTSs, she said, is where capacity can be built out all while better utilizing those professionals and enticing them to stay in the field.
“Colorado is the test ground for this,” she said. “They’re hoping that if Colorado falls, that they’ll take this game plan to states across the nation. Realize that this position, this VPA, does not exist anywhere on planet Earth. There are no jobs out there for these folks. There is no data that shows there’s a need for this job.”
