The Contested Rise and Scope of the Mid-Level Veterinary Positions
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Key Facts
- Mid-level positions like VPAs are proposed to perform diagnoses and surgeries under supervision.
- The role aims to bridge gaps in care access but faces opposition regarding safety.
- Distinctions between VPAs and credentialed veterinary technicians remain a primary point of friction.
- New licensing and accreditation standards would be necessary for implementation.
- Pet owner education is critical to managing expectations regarding provider qualifications.
Table of Contents
- Introduction to Mid Level Positions
- Understanding the Mid Level Practitioner Role
- Impact on Veterinary Teams
- Pet Owner Perception and Education
- Mid Level Positions and the Veterinary Medical Association
- Closing Thoughts
The veterinary profession currently stands at a regulatory crossroads, facing a divisive proposal to introduce a new tier of provider: the mid-level practitioner. Proponents argue that mid-level positions are aimed at improving access to veterinary care, especially in underserved areas. This potential shift creates an immediate tension between the urgent need to expand access to care and the absolute imperative of maintaining patient safety standards.
As industry stakeholders debate the viability of these roles, the conversation forces a re-evaluation of how veterinary medicine is licensed, delivered, and perceived by the public. Implementing mid-level roles would require legislative changes at both state and federal levels, which can be a lengthy and complex process.
Industry stakeholders and regulators are evaluating the potential impact of these changes. A national association could play a key role in establishing professional standards and credentialing for mid-level practitioners.
Introduction to Mid Level Positions
Mid-level positions, frequently exemplified by the proposed Veterinary Professional Associate (VPA) , have ignited significant debate across the industry [1]. The VPA role is defined as a proposed mid-level veterinary professional position with a scope that includes providing routine care and performing certain medical procedures under the supervision of licensed veterinarians. The educational requirements for the VPA role are still being developed, leading to concerns about the lack of standardization, potential safety risks, and the impact this role could have on the existing veterinary workforce and education pathways. Proponents argue that introducing these roles is a necessary evolution to alleviate workforce shortages and improve access to care in underserved areas. However, this perspective is met with sharp resistance from those who fear that delegating core medical responsibilities dilutes the standard of care.
The central premise involves mid-level practitioners working under the supervision of licensed veterinarians. Their proposed scope includes providing routine care and performing specific medical procedures previously restricted to fully licensed veterinarians.
Organizations such as the American Veterinary Medical Association (AVMA) have scrutinized the proposal, weighing the hypothetical benefits against the tangible risks. The discourse underscores that veterinary medicine is not merely a collection of tasks but a complex field requiring deep expertise. Consequently, any structural change must be rigorously evaluated to ensure it does not compromise animal health and welfare.
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Understanding the Mid Level Practitioner Role
The definition of a mid-level practitioner fundamentally alters the traditional binary of veterinarian and technician. Specifically, VPAs would be tasked with high-stakes responsibilities, including diagnosing conditions, formulating treatment plans, and performing surgical procedures under supervision.
Allowing an insufficiently trained individual to perform skills such as diagnosing, prognosing, recommending treatment, and performing surgery endangers patients and clients across practice types and poses unacceptable risks for animal health and public health.
This scope creates a clear demarcation between mid-level practitioners and veterinary technicians or technologists. While technicians are highly trained to execute specific technical tasks delegated by a veterinarian, the mid-level role encroaches on decision-making and surgical domains.
Implementing this tier would necessitate a complete overhaul of the current regulatory structure. New licensing and accreditation standards would be required to govern this practice. The American Animal Hospital Association (AAHA) has voiced concerns regarding these risks, specifically pointing to the dangers of inadequate training and the logistical challenges of supervision.
To mitigate these risks, a Veterinary Professional Associate would require a robust educational foundation, likely involving a graduate degree in veterinary clinical care, ensuring they possess the competency to deliver high-quality medicine.
Is the Veterinary Professional Associate Just a Copy of Human Medicine?
We always compare things to what we know. It’s natural. So when people talk about this new veterinary professional associate role, they immediately point to human medicine. You walk into a doctor’s office and seeing a physician assistant or nurse practitioner is normal. Routine, even. The argument is simple. If it works for humans, why wouldn’t it work for veterinary medicine? (It’s a fair question). But animals aren’t people. They can’t tell you where it hurts.
And that’s where the significant differences come in.
Proponents like Wayne Jensen and the team at Lincoln Memorial University College of Veterinary Medicine are betting big on this. They are developing a curriculum they believe proves a graduate’s readiness. The idea is to create a master’s degree program. Something distinct. Not a vet, but more than a tech.
But the veterinary community is skeptical. Skeptical might be too light a word. Some are terrified. They worry that a veterinary midlevel practitioner won’t have the depth of knowledge to handle emergencies when the supervising vet is busy. Or at lunch.
There is talk of a national test to standardize this. To make sure patient health isn’t a gamble. But right now? It’s all theoretical. Some are trying to map a similar position from human healthcare onto a system that is fundamentally different. And federal law regarding drugs adds a whole other layer of headache.
Currently, there is no established licensing or testing to evaluate the graduate’s readiness for practice, which can result in unintended fatal errors, increased morbidity/mortality, and more liability for veterinarians and veterinary practices.
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Impact on Veterinary Teams
Introducing a new layer of medical authority inevitably disrupts existing team dynamics. The roles and responsibilities of veterinary technicians and technologists would face significant adjustment. Credentialed veterinary technicians, who already navigate a complex scope of practice, would need to establish new collaborative workflows with mid-level practitioners to ensure patient care remains seamless.
Supervision protocols are the linchpin of this model. Without carefully defined boundaries, the risk of error increases. Veterinary teams would be forced to adapt their communication patterns and daily workflows to accommodate this new hierarchy. Ultimately, the successful integration of mid-level positions depends on variables ranging from the specific latitude granted to the practitioner to the unique needs of the practice’s client base.
Where Credentialed Veterinary Technicians and Veterinary Assistants Fit In
Let’s be real for a second. The people most freaked out by this midlevel position aren’t just the doctors. It’s the veterinary care teams. Specifically the credentialed veterinary technicians and veterinary technician specialists. They have spent years fighting for respect. Fighting for title protection. They went through grueling veterinary technician education programs. Now they see a proposal that says someone with an online master’s degree can come in and technically outrank them.
It feels like a slap in the face.
Veterinary assistants are watching this too. Wondering where they land. The fear is that clinics will hire a midlevel practitioner to diagnose conditions or develop treatment plans instead of hiring two or three skilled techs. It comes down to money. It always does.
Survey respondents from the technician community have been loud about this. They see significant risks. If you have a VPA trying to perform surgery or manage internal medicine cases without the years of residency a vet has, who catches the mistakes? The technicians. Usually.
But there is another side to it. Some veterinary practices are drowning. They simply need more hands on deck. If a midlevel pro can handle wellness care or basic food safety checks, maybe the techs can focus on anesthesia. Or the veterinary technologists can run the lab work without interruption. It’s messy.
Pet Owner Perception and Education
Public reception remains a critical, yet unpredictable, variable. Pet owners have expressed mixed reactions to the concept of mid-level positions. Some view the model as a practical solution to scheduling backlogs and accessibility issues. Others express apprehension regarding the safety and quality of care delivered by non-veterinarians.
Bridging this gap requires substantial education and outreach. The industry must clearly articulate the differences between mid-level practitioners and licensed veterinarians to avoid consumer confusion. The AVMA and allied organizations have stressed that patient safety must remain the focal point of these communications. Perception will ultimately hinge on the public’s understanding of the mid-level practitioner’s qualifications and their direct experiences with the care provided.
The Politics of Veterinary Professionals and Access to Care
This isn’t just a workplace debate. It’s a political one. We saw this play out with Colorado voters recently. The November ballot initiative brought this whole midlevel position argument out of the clinics and into the voting booths. The pitch was attractive. More veterinarians isn’t happening fast enough. So why not this? They promised lower cost services. They promised more patients could get seen.
But changes to allow mid level veterinary positions require legislative and regulatory action. And that process is slow and tricky.
Veterinary state boards are scrambling to figure out how to regulate this. If a VPA screws up, is the supervising veterinarian liable? Or is the VPA? Title protection becomes a legal nightmare here. The American Association of Veterinary State Boards has to weigh in. And they have to do it while the AVMA committee is raising red flags about public health.
Currently, there is no accredited national educational program, no national test, and no regulatory structure to ensure people filling the proposed midlevel position would deliver safe and effective care. The AVMA opposes legislative initiatives that would authorize a midlevel position or other nonveterinarian to diagnose, prognose, develop treatment plans, prescribe, and/or perform surgery, due to the threat from such legislation to patient health and safety. Proponents want to make the supervising veterinarian legally responsible for all of the acts and omissions of a midlevel position, which may not be covered by veterinary malpractice policies if they are not the employer of the MLP.
The current model is broken. Getting an appointment takes weeks. But does a veterinary professional associate fix that? Or does it just create a full extent of new problems? Pose threats to the existing ecosystem?
The general consensus is that veterinary practitioners are split. Some say bring it on. Others say it’s dangerous. But the legislative machine is already moving.
Mid Level Positions and the Veterinary Medical Association
The American Veterinary Medical Association (AVMA) has adopted a cautious stance, citing significant concerns regarding patient safety and the potential for insufficient training or supervision. Their position reflects a broader anxiety that accelerating the creation of mid-level roles could undermine the profession’s integrity.
Similarly, the American Animal Hospital Association (AAHA) has aligned with these concerns, emphasizing the potential negative impact on quality of care. Veterinary medical associations act as the primary gatekeepers in this discussion, shaping the regulatory landscape to ensure that any evolution of the workforce aligns with the core principles of animal welfare.
The path forward requires the AVMA to collaborate closely with all stakeholders—including pet owners and veterinary professionals—to ensure that if mid-level positions are adopted, they are implemented with rigorous safeguards that prioritize the patient above all else.
Closing Thoughts
So here we are. Stuck between a rock and a hard place. The veterinary profession needs help. That much is obvious to anyone who has tried to get a sick dog seen on a Saturday. But is the midlevel practitioner the answer?
Maybe.
But maybe not the way it’s currently proposed. The bottom line is that patient safety can’t be the thing we trade for convenience. We can’t just copy the human model and hope for the best. Animals deserve better than a copy-paste solution. But we also can’t keep doing nothing. Burnout is real. Shortages are real.
At the end of the day, whether this happens or not, the conversation has forced everyone to look in the mirror. To value the technicians we already have. To question how we train Vets. (And that’s a good thing). Whatever happens next, it’s going to be a bumpy ride. But it’s a ride some need to take.
References
[1] Niemiec, R., Champine, V., Frey, D., Lobdell, A., Steele, A., Vaiden, C., Kogan, L., & Mertens, A. (2024). Veterinary and pet owner perspectives on addressing access to veterinary care and workforce challenges. Frontiers in veterinary science, 11, 1419295. https://doi.org/10.3389/fvets.2024.1419295
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