AVMA’s two faces
On March 22nd, 2023 the AVMA released a statement regarding recently passed legislation in Arkansas that defines and broadens the scope of practice for Veterinary Technician Specialists (VTS). Per usual AVMA engaged in scare tactics and incomplete truths to gain support with a terribly written, researched and offensive article.
What’s wrong with this ridiculous article?
“We believe better engagement of veterinary technicians, specifically VTSs was part of the intent of Arkansas HB 1182, now Act 161. However, even after substantive amendments, its provisions go too far. The new law inappropriately expands the VTS’s scope of practice beyond these professionals’ education and training by allowing a VTS to:
“Engage in the “joint management” of the health care of patients by creating a “collaborative practice agreement” with a veterinarian.”
Firstly, THIS IS VOLUNTARY AGREEMENT AND NO VETERINARIAN HAS TO AGREE TO THIS!!
If you are interested in seeing how one becomes a VTS please click here and here. Our training is not trivial and most VTS’s are at or exceed the knowledge one can expect from a recently graduated veterinarian in their respective specialty.
What the law actually says:
“(A) (a veterinarian) Retain[s] control of and authority over the care of the animal patient; and
(B) Review all record keeping and notes documented by the veterinary technician specialist on the charts regarding the care of the animal patient.
(1) A licensed veterinarian using, supervising, or employing a veterinary technician specialist is individually responsible and liable for the performance of the acts and omissions delegated to the veterinary technician specialist.
(2) This subsection does not relieve a veterinary technician specialist of any responsibility or liability for any of his or her own acts and omissions.”
AVMA keeps talking about credentialed veterinary technician (CrVT) utilization and engagement. Apparently, we are too stupid to help come up with treatment plans, despite doing it almost daily… Remember those CrVT’s that helped you as a student in vet school vet friends?
“Establish a temporary veterinarian-client-patient relationship (VCPR) on behalf of a collaborating veterinarian for new patients. This temporary VCPR must be “completed” by the veterinarian through an in-person visit within 15 days.”
What the law actually says:
“(A)(i) Establish care for new animal patients by forming a preliminary veterinarian-client-patient relationship on behalf of the collaborating veterinarian with the animal patient or client, order diagnostics, provide a diagnosis or a prognosis, and develop treatment plans with a collaborating veterinarian.
(ii) The collaborating veterinarian shall complete the veterinarian-client-patient relationship by personally seeing the animal patient within fifteen (15) days;
A preliminary VCPR is not a permanent VCPR especially when it is mandated the veterinarian must see the patient within 15 days. Yet, telemedicine will allow a DVM to establish a VCPR without having seen or touched the patient in real life? What is even more frustrating is all but a couple of VTS academies require mastery of performing a physical exam signed off by a veterinarian and more commonly a boarded specialist.
“Order diagnostics, provide a diagnosis or prognosis, and establish a treatment plan. A VTS may not prescribe.”
In the lab animal world and human nursing setting there is something called protocolized medicine whereby a flow chart or written protocol is followed by nursing practitioners who can decide on various diagnostics and even medications to give for treatment. The law also states this method.
“(B) Methods of management of the collaborative practice, which shall include protocols for technical duties and prescriptive authority;”
AVMA states concern with the following section of the new law.
“Perform “minor” dental and surgical procedures on animal patients. Specifically excluded are abdominal, thoracic, orthopedic, and neurologic surgeries.”
Many states including California with the largest number of CrVT’s allows CrVT’s to close skin and perform dental extractions. California’s case history will show this is not a consumer or patient protection concern. In this law it is the veterinarian’s responsibility to teach the VTS on what would be an agreed upon minor surgical procedure. Is this not the same as those vet student interns or first years learning from a senior veterinarian?
AVMA continues…
“Interestingly enough, and in contrast to what is authorized by Act 161, the NAVTA-approved Academy of Veterinary Dental Technicians does not authorize certified individuals to do extractions or oral surgery.”
This is true about the dentistry Academy however this may not hold true for much longer. The dental Academy cannot legally enforce their inappropriate stance when a particular skill is legally allowed by state practice acts. The dental Academy is ripe for a legal challenge to their unfair stance.
“Furthermore, receipt of a VTS certification does not provide greater technical competence beyond their specific discipline, nor does their training provide them with the foundational education that veterinarians receive and that is necessary to competently diagnose, prognose, and develop treatment plans that may involve prescribing and performing surgery.”
“It creates unnecessary risk by allowing a VTS to establish a VCPR, order diagnostics, provide a diagnosis and prognosis, and develop a treatment plan. In short, it means VTSs have been authorized for functions they simply do not have the knowledge, training, and skills to do.”
I would bet my license that VTS’s could easily talk circles around any of the non-specialized veterinarians serving on the AVMA Executive Board in their respective specialty.
VTS’s in a collaborative agreement are expected to work in the area of specialty they are trained in. This is supported not only by the intent of the law but the actual language. Practicing outside the scope of their specialty can lead to disciplinary actions.
(d)(1) A veterinary technician specialist shall complete an additional eight (8) hours of advanced continuing education in his or her area of specialty each year before veterinary technician specialist certification renewal.
(3) If a collaborative practice results in complaints of violations of this chapter, the Veterinary Medical Examining Board may review the role of the collaborating veterinarian or the veterinary technician specialist in the collaborative practice to determine if the collaborating veterinarian or the veterinary technician specialist is unable to manage his or her responsibilities under the collaborative practice agreement without an adverse effect on the quality of care of the animal patient.
(b)(1) A veterinary technician specialist may receive drugs, medicines, or therapeutic devices appropriate to the veterinary technician specialist’s area of practice.
“As originally introduced, HB 1182 provided a VTS with prescriptive authority, which was not only inappropriate given the training a VTS receives (more on this later), but was in direct conflict with federal law.”
This part is true; however, it was a trigger law (you know, those laws that were written but not enforceable that we recently saw a slew of created to strip women of their bodily autonomy when the Supreme Court struck down Roe…) as the authors already knew this would require a federal law change.
Can I also just add… Wasn’t it I that spoke 2–3 years in a row at the AVMA Conference with overflow rooms on cannabinoid medicine which focused heavily on the pharmacology of cannabinoids? On the doctor track? Or one of my anesthesia and analgesia pharmacology lectures? Wild.
AVMA then tries to make a compelling but tone deaf argument of…
“A missed or delayed diagnosis and/or an inadequate treatment plan can be life threatening for an individual veterinary patient, can be economically devastating for a client who owns an animal-based food production facility, and―if the disease is zoonotic or poses risk of becoming so―there can be significant consequences for public health.”
This is already happening given our staffing crisis!!!
AVMA then tries to coach.
“Rather than passing this law, we believe that if there was a need or desire in Arkansas to re-evaluate the actions that a veterinary technician specialist may take under immediate, direct, and indirect supervision, the better course of action would have been to work with the Arkansas Veterinary Medical Examining Board (AVMEB), the ArVMA, and the Arkansas Veterinary Technician Association (AVTA) to evaluate those tasks and potentially add to an already extensive list.”
The authors did ask ArVMA for input which was given. The authors conceded to all of the ArVMA’s demands who then approved of the bill but then did a 180 when AVMA stepped in.
AVMA, you don’t own this profession and I kindly ask you to step off. You are not our mommy or daddy; you don’t get to tell us what to do all the time. You are a professional organization that does not credential people. Yes you have lobby power based solely on claiming your member numbers which largely only exists for liability insurance as a member benefit. Let’s be honest.
Regarding HB 1673, maybe if you would have pushed for national standards for veterinary technicians…30 years ago we wouldn’t be here.
I highly encourage all to watch the legislative committee meetings on this law and hear how the legislators had to remind AVMA representatives about the absurdity of their arguments against the bill and watch how amazingly articulate and knowledgeable CrVT’s spoke for the bill which ended up making this historical legislation a reality. To them we all owe a huge thank you.
