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Prop 129

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The campaign to create a midlevel veterinary clinical role in Colorado and the counter effort to stop it were costly. Between them, the All Pets Deserve Vet Care (vote "yes") and Keep Our Pets Safe (vote "no") coalitions spent several million dollars.

Creation of a midlevel practitioner role in veterinary medicine for the first time in the United States is all but certain following a historic "yes" vote in Colorado that could fundamentally reshape the profession in the state and inspire others to follow. The close race was called late this morning in Colorado with 77% of ballots counted. 

The vote was more than 1.3 million to just over 1.2 million in favor of Proposition 129, which establishes by law a new veterinary clinical team position called a veterinary professional associate, or VPA. Somewhat comparable to nurse practitioners or physician associates in human medicine, the VPA would perform tasks that so far have been restricted to veterinarians, such as diagnosing conditions, providing prognoses and even performing some surgeries.

The battle over whether creating the role is an appropriate response to veterinary workforce shortages was heated, pitting a "yes" coalition of veterinarians led by the state's largest shelter organization against a "no" coalition comprising much of the veterinary establishment, led by the American Veterinary Medical Association.

Supporters say VPAs will take pressure off overburdened veterinarians, who will be able to delegate more tasks and, as a result, provide more access to care and possibly more affordable care — an argument that appears to have carried the day in Colorado.

Critics say delegating veterinarians' tasks to less educated and less experienced individuals will put animals at risk and devalue the role of veterinarians. They say doing more with registered veterinary technicians — existing staff roles roughly similar to nurses in human medicine — is the safer and more expedient way to improve clinic efficiency.

Dr. Apryl Steele, president and CEO of the Dumb Friends League, which spearheaded the proposition, told the VIN News Service on Wednesday that she was thrilled with what looked to be approval. "These animals … are finally going to get the care that they need and that they're not getting in the current system," she said.

She also struck a conciliatory note seeking "healing within the profession," adding: "I look forward to working together as a veterinary community to make this a really successful way to serve all the animals that need us, not just the ones that are privileged enough to afford our care right now."

Steele will need to find common ground with the opposition, which includes people like Rep. Karen McCormick, the state's only veterinarian legislator. (McCormick was re-elected Tuesday by a large margin.)

As 73% of the vote had been tabulated on Wednesday, McCormick described the likely outcome as "deeply heartbreaking" and "incredibly sad."

"As it is right now, the VPA will be given considerable authority over animal care without the training and accountability necessary to ensure that they deliver that care competently and safely," she said.

For the position to become reality, state lawmakers and regulators must create a legislative and regulatory framework for the VPA.

McCormick said that will be her focus next. "Me, personally, as a veterinary professional, and all the others in the Keep Our Pets Safe coalition, we're ready to work to make sure that there are regulations and safeguards in place to protect the animals of our state and the owners, and frankly, public health as well."

Matt Salois, an economist and president of Veterinary Management Groups (VMG), a division of Covetrus and a member-based organization of independent practice owners, said he was disappointed by the apparent outcome but not surprised.

"When you look at the landscape of things that the everyday person is thinking about and making decisions about … simple messages are the most easily sold," he said. "And the simple message on the one side here was, 'There's a shortage of veterinarians. We need something to address this. We want to expand access and make it more affordable.' It's very simple to buy into that."

The counterview, he posited, was too complicated and nuanced with its concerns around implications and potential dangers and questions about whether the "solution" is optimized and maximized in an appropriate, responsible way, along with the possibility of unintended consequences.

"The average person just doesn't have the patience or the desire to dig into that," he said.

In May, VMG surveyed its 1,700 members about their support for the VPA and a proposed curriculum for an associated master's degree and found strong opposition to both.

Many details still to come

The state initiative does not spell out a scope of practice for the new role, generally describing it as within the VPA's "advanced education and experience" and as delegated by the "supervising veterinarian."

The open-ended designation contrasts with recent efforts around the country to better define the scope of practice for existing members of clinical care teams: technicians. Colorado lawmakers passed a measure this summer requiring regulators to define certain tasks that can be delegated to veterinary technicians and veterinary technician specialists.

(The latter was established in the bill as a formal state designation. In the veterinary community, veterinary technician specialists are understood to be licensed technicians who have been certified by the National Association of Veterinary Technicians of America as having supplementary education and experience in a particular area, such as anesthesia and analgesia or emergency and critical care, and passed a specialized exam. In Colorado, veterinary technician specialists are qualified to take on additional tasks.)

McCormick sponsored the technician measures and has said that her hope was to improve technician utilization, which is the practice of allowing them to work within the full scope of their training and experience, in order to help retain technicians and provide a safer and more expedient path toward helping overburdened doctors.

Nationwide, technicians struggle with a patchwork of credentialing and training requirements, which are regulated by states and vary from jurisdiction to jurisdiction. Some states have no requirement that technicians be licensed or credentialed. Some critics of Prop. 129 say that the lack of established profession-wide credentials for VPAs sets up a repeat of the problems faced by technicians.

The measure charges the Colorado Veterinary Medical Board with establishing requirements for licensing VPAs and approving a nationally recognized credentialing organization to oversee education programs and a national exam.

Right now, there is no nationally recognized credentialing organization for VPAs. The AVMA accredits veterinary schools and veterinary technology programs. Veterinarians' national licensing exam is administered by the International Council for Veterinary Assessment, while the American Association of Veterinary State Boards administers a national exam for technicians.

Beyond Colorado, advocates for establishing a midlevel practitioner nationwide are trying to develop an alternative credentialing pathway, owing to the AVMA's opposition.

The Coalition for the Veterinary Professional Associate, a two-year-old advocacy group, is exploring whether the Commission on Accreditation of Allied Health Education Programs, which accredits a variety of medical professional schools around the world, could be an accreditor for VPA education programs, according to Dr. Robert Murtaugh, who chairs the CVPA's industry relations committee.

Murtaugh said that the CVPA has been talking to three examining boards, including the board that administers the licensing examination for veterinarians in North America, about administering a national VPA exam.

Prop. 129 is the second development in Colorado aimed at creating a veterinary midlevel practitioner. More than a decade ago, long before the initiative effort, educators at Colorado State University College of Veterinary Medicine and Biomedical Sciences set about creating a master's program for the envisioned role. Now, such a degree, known as a master's in veterinary clinical care, is the educational requirement for VPAs prescribed in the proposition.

The proposed curriculum — 65 credits with a mix of online and on-campus training — has been winding its way through university approvals. It has also drawn strong criticism from the AVMA and other groups as insufficient. Meanwhile, program leaders at CSU hope to seat the first class next fall.

CSU's would not be the first such master's program. In 2022, Lincoln Memorial University College of Veterinary Medicine in Tennessee began offering a master's in veterinary clinical care pitched toward veterinary technicians with bachelor's degrees. The program is 30 credits and fully online.

Whether an individual with the LMU master's degree would qualify as a VPA in Colorado is yet to be determined.

What happens next beyond Colorado?

Expanding adoption of midlevel professionals will require changes to veterinary practice acts one state at a time.

Many who spoke to VIN News yesterday agreed that such a push is now more likely to happen. There was talk of "rising tides" and "precedents."

"I suspect there are bigger proponents behind this, because the seed of this idea didn't necessarily start here," McCormick said. She added that this was why she and her fellow coalition members were fighting so "adamantly against the measure."

One group likely to be active in creating VPAs in other states is the American Society for the Prevention of Cruelty to Animals, an animal welfare organization that supported the Prop. 129 push in Colorado.

"We regularly partner with local groups like Dumb Friends in order to help advance these types of measures," said Kevin O'Neill, vice president of state affairs for the ASPCA. "This one for us is very important to help expand access to care."

In addition to the Colorado measure, the ASPCA has been focused on Florida, where last year a VPA bill passed unanimously in the House but stalled in the Senate. That effort is likely to be resurrected in January, according to O'Neill.

In addition to Colorado, 20 states allow citizens to initiate ballot measures. Asked whether the apparent success of using the initiative process in Colorado would lead to copycat efforts elsewhere, O'Neill replied: "We're committed to working with legislators and helping to educate them on our perspective," adding that the ASPCA employs around 300 veterinarians and technicians.

O'Neill conceded that talking directly to Colorado pet owners seems to have worked. "[I]t was clear that Colorado voters and pet owners have experienced the crisis that is currently unfolding with the veterinary shortage and wanted a solution," he said.