We are all aware of the workforce challenges impacting veterinary practice. These challenges are not uniform across the profession, however. There are unique challenges related to geography, lifestyle, and practice type. The inability to hire and retain veterinarians and staff can be exacerbated in rural areas and food-animal practice. Estimates regarding the future availability of, and demand for, veterinary services are often used to support calls for broad changes in the delivery of veterinary medicine. One such proposed solution is the development of a veterinary midlevel professional (MLP).
Simply saying that there will be a future shortage of veterinarians does not adequately consider the differing impacts on the broader profession and the upcoming increases in veterinary supply. Existing veterinary schools are increasing the student capacity and at least 15 new veterinary schools are in various stages of development, with 3 of those graduating their first class by 2025. In addition, there are legislative efforts to encourage veterinary students to consider rural practice and other identified shortage areas.
Regardless of the veterinary supply and demand question, an MLP has a number of inherent issues that may pose a risk to future veterinary practice or run afoul of regulation. It also ignores the availability of certified veterinary technicians (CVT) and veterinary technician specialists (VTS), which are already recognized and regulated in state-level veterinary practice acts. Using these folks to the extent of their training and ability could provide practices some relief for overworked veterinarians and address some level of understaffing.
It is currently unclear exactly how an MLP would or could be used in the delivery of veterinary medicine. There is no structure to provide evaluation and certification for MLPs or even an accredited curriculum. In addition, to offer services, every state would have to modify their veterinary practice acts to define their role. Similarly, federal regulations would have to change if MLPs were allowed to prescribe veterinary drugs or use drugs in an extra-label manner. Both of those activities currently require the involvement of a licensed veterinarian, as does the establishment of a veterinarian-client-patient relationship. Current regulation would also prevent an MLP from performing regulatory animal health certifications such as issuing certificates of veterinary inspection or performing regulatory diagnostic testing.
Furthermore, it seems likely that the establishment of an MLP could negatively impact the value of CVTs, VTSs, and veterinarians at a time when the cost of veterinary education has increased significantly. Decreased salary opportunities would further limit the ability of future students to enter the profession. The MLP is often compared to a physician’s assistant (PA) in human medicine. As currently proposed, an MLP would have to work under the supervision of a veterinarian and the veterinarian would be legally responsible for delivery of the veterinary services. It is my understanding that, in most cases, supervising physicians are not automatically liable for the actions of the PA. It seems there are more effective and efficient tools already approved and available to help ease the workforce challenges impacting swine practice than the introduction of another level of veterinary professional.
The AASV Board of Directors recently established a subcommittee to propose a position on the issue of an MLP. After evaluating the workforce challenges facing swine veterinary practices, the available opportunities to use farm and clinic staff, the potential to better use CVTs and VTSs, and the challenges associated with developing and implementing an MLP, the subcommittee recommended, and the Board approved, a position statement expressing a lack of support for the proposed development of a veterinary midlevel professional. This, and all the AASV position statements can be viewed on the AASV website at aasv.org/aasv/positions.
Harry Snelson, DVM
Executive Director