EAGLE POST

Thomas Donnelly, BVSc, DipVP, DipACLAM reports from the US.

Is veterinary medicine ready for a mid-level practitioner?

Driven by issues such as poor pay, lack of respect, underutilization, and few opportunities for career advancement, veterinary nurses or technicians as they are known in the US, according to the American Veterinary Medical Association (AVMA), have among the greatest turnover rates of any health care occupation. Technician turnover is seen widely as an important workforce test for the profession. Some educators, practice owners, and technicians believe establishing a mid-level role between veterinarians and technicians would help keep technicians in the field and advance efficiency on hospital teams. Even among veterinarians who once opposed creating something like a veterinary nurse practitioner are those who say they would welcome a new category of professionals as they struggle to fill openings for veterinarians.

Now, a proposed degree, a Master of Veterinary Clinical Care, from the new Lincoln Memorial University (LMU) College of Veterinary Medicine in Tennessee has become a new incentive in discussions about creating a midlevel practitioner role. LMU is proposing that courses for the new degree be online, with clinical work happening in the practices the university uses for student clinical rotations. Like many new US veterinary schools, LMU does not have a university hospital, and students do their clinical rotations in practices associated with the school. The proposed curriculum is similar to a veterinary one but “less in-depth,” with foundational courses in anatomy and physiology. It will also include high-level nursing-type training, such as advanced case management and care coordination. Initially, it would be offered only to credentialed veterinary technicians and is aimed at those who want to further their training but are not prepared to invest the money and time required to attend veterinary school. (Animal technicians who have met some state or professional standards for education and experience are known as “credentialed veterinary technicians, however, standards vary widely.) The proposed tuition is $25,000 for thirty credits, which could be completed in three semesters.

Although there is no national examination, job title, or credential associated with LMU's new degree, advocates see it as a step toward restructuring veterinary care teams. The nonprofit industry association, Veterinary Innovation Council (VIC), is promoting a mid-level role at state and national conferences between veterinary technicians and veterinarians to expand career opportunities for technicians and improve efficiency on hospital teams.

Interest in a midlevel position goes back at least a decade when it was presented as an extension of v Michigan State University's veterinary technology education planning. Since then, a number of papers, including a 2021 article,1 have identified support for a more advanced role on veterinaryteams. An intermediate position was floated well before 2011. Vanderbilt University economist Malcolm Getz in the late 1990s, proposed a degree that would take fewer years of higher education than the eight it takes most veterinarians to earn a DVM in the United States. Getz proposed an intermediate degree as a way for veterinary schools to attract students by creating more balance between starting salaries and education costs. He believed it would improve practice efficiency to have non- veterinarians covering more routine services, allowing veterinarians to focus on tasks requiring specialized DVM training. There was significant pushback to his proposal when he wrote his book, driven chiefly by financially struggling veterinarians wanting to protect their positions. Resistance seems to have diminished since then. The research also determined that a midlevel practitioner would optimally have a separate role beyond what veterinary technician specialists

and veterinary technicians are trained and permitted to do. Getz advocated it as a means to free veterinarians from low-margin duties and permit them to concentrate on higher-margin activities to increase their revenue. Getz wrote, “The midlevel practitioner would be independent and able to lighten the veterinarians’ workload to bring the greatest value, and it is most viable if the volume of visits, the client satisfaction, and the overall clinic revenue increase.” Unfortunately, such changes would require revising state practice acts, which restrict veterinarians to the jobs of diagnosing illness or injury, developing a prognosis, prescribing medication, and performing surgery. Creating an effective mid-level practitioner would require slicing out circumstances under which the new practitioner could perform some of these duties in certain circumstances. This practice model could have the additional benefit of lowering the costs of routine care, which could help curb the rising cost of veterinary services.

The midlevel professional could also help shave away at another challenge for the profession: lack of diversity. Individuals from underrepresented groups often look at the debt-to-income ratio in veterinary medicine and forgo the profession despite their interest in the field. Amaster's degree leading into a midlevel practitioner position could provide a more appealing entry point.

Many veterinarians are now stretched to their limit, unable to find an associate and tapping their veterinary technicians to the full degree of their training and experience. What some veterinarians feel is needed is someone who could share responsibilities restricted to veterinarians. Amongst those need-to-do duties are surgery and complex cases. One practitioner said, “I would treat them like a vet. They would have their own patients and be available to consult or step in as needed.” Veterinarians in favor of mid-level practitioners would likely pay them similar to an associate. Current median annual salary for veterinary technicians is around $36,000 and for veterinarians is $99,250, according to the US Bureau of Labor Statistics. Associates typically receive a base salary plus production, based on revenue a practitioner brings to the practice. Suggested salaries for a credentialed mid-level practitioner might be $60,000 to $75,000, a range based on discussions with practice owners and managers. In 2020, a working group was created by the AVMA to examine how to increase technician utilization ñ this meant allowing veterinarytechnicians to perform the full array of tasks in which they have been trained. The organization has also looked directly at the question if a mid-level professional and studied whether and where shortages may exist. The AVMA cautions against allowing concerns about what feels currently like a workforce crisis to push for a new position prematurely. In the Sept. 15 issue of JAVMA,2 Matthew Salois, the AVMA chief economist, and Gail Golab, the chief veterinary officer, said it is not clear a new mid-level position is needed or would help. It is because “Öno comprehensive examination has looked at the degree to which such professionals are needed and whether they would be used appropriately” under the heading “Avoiding Knee-Jerk Reactions.” They contend that “a thorough evaluation of the overall market is necessary before making any attempts to create any new position within the veterinary profession.”

References

1.Fults MK, Yagi K, Kramer J, et al. Development of advanced veterinary nursing degrees: Rising interest levels for careers as advanced practice registered veterinary nurses. J Vet Med Educ 2021;48:242-251. https://doi.org/10.3138/jvme. 2019-0041. 2. Salois M, Golab G. Are we in a veterinaryworkforce crisis? Understanding our reality can guide us to a solution. JAm Vet Med Assoc 2021;259:560566. https://dpi.org/10.2460/javma.259.6.559.