Colorado_capitol

Photo by Jacki - stock.adobe.com

The Colorado General Assembly this spring put its stamp on rules dictating how the newly created midlevel veterinary practitioner will be allowed to operate in the state. Not everyone welcomed their involvement in the regulatory process.

An effort by Colorado lawmakers to limit the scope of practice for what will be the country's first-ever midlevel veterinary practitioner has met with mixed results.

While the veterinary workforce bill cleared both chambers in the General Assembly and is on its way to the governor's desk for a promised signature, many of its most restrictive provisions were watered down or eliminated along the way.

The bill was a legislative response to Proposition 129. Colorado voters passed the citizen initiative last fall authorizing the creation of a veterinary professional associate (VPA), a new practitioner role to operate under a veterinarian but with a wider scope of practice than a veterinary technician. The measure was promoted as a way to address what the proposition defined as a "critical veterinary workforce shortage" and to expand access to care in the state.

As is typical of citizen initiatives, Prop. 129 was short on specifics. The job of creating detailed rules for practice, including the all-important questions of what tasks a VPA will be able to perform and under what sort of supervision, was delegated to the state Department of Regulatory Affairs (known as DORA) and the state veterinary medicine board.

Lawmakers, however, added an additional step to the process with a bill establishing some regulatory guidelines for regulators to follow. Among those pushing for the bill was Rep. Karen McCormick, who is the only veterinarian in the General Assembly.

Regulatory agency staff are supposed to "fill in the gaps of statutory language," McCormick told the VIN News Service. "To turn this brand-new-baby position that doesn't exist on planet Earth over to people that are not professionals in the field did not make any sense at all," she said.

Some in DORA have said they didn't need the legislature's help.

"DORA has everything we need to implement the will of the voters," Sarah Werner, a deputy division director at the regulatory agency, told lawmakers during a House hearing on the VPA bill in March. "The administration is concerned that passing this bill, which would leapfrog the rulemaking process given to the board by the voters … is incongruent with our statutory mandate."

Advocates for the VPA position agreed. They had wanted all the VPA rules to be hammered out during public meetings with the regulators, a generally more transparent and interactive process than the legislative process.

They also complained the bill, as it was proposed, repudiated what the voters wanted.

Dr. Apryl Steele, president and CEO of Humane Colorado (formerly the Dumb Friends League), told VIN News the original bill "put so many restrictions on the ability for a VPA to practice that they wouldn't be able to increase access to veterinary care."

Humane Colorado and the Vet Care Coalition spearheaded the campaign to pass Prop. 129.

McCormick, who had opposed Prop. 129 last year, has said on several occasions that regardless of not wanting the VPA in the first place, she did not intend to overturn the will of the voters.

"Now that we have it, let's make sure that we fully realize the will of the voters and truly deliver to the state of Colorado the expectations that the voters have in mind," McCormick said. "They expect quality care; they expect safety for their animals; and they want those consumer protections in place, just like they have for vet techs and veterinarians."

There are still plenty of rules to be determined by regulators, now within the parameters set by the legislature. They continue their work with a public meeting on May 7.

'Thoughtful guardrails'

The bill covers a wide swath of practice from professional behavior (a VPA must identify themselves as such to clients) to employment rules (an employer cannot require a veterinarian to supervise a VPA as a condition for continued employment) to what animals they can see (VPAs can only treat species for which they have received training).

But it was measures aimed at limiting VPA's scope of practice and independence that drew fire from advocates of the midlevel position, resulting in multiple revisions, additions and deletions before passage.

For example, in its initial form, the bill required that the veterinarian provide immediate or direct supervision of a VPA and that a veterinarian could supervise only one VPA at a time.

Negotiated revisions allowed for "appropriate" levels of supervision, including "indirect supervision" in some instances. In addition, veterinarians can supervise up to three VPAs. Regulators could limit — but not expand — that number.

In addition, a provision prohibiting VPAs from practicing veterinary telemedicine was struck out entirely.

One aspect of practice that was addressed, then revised but not necessarily resolved in the bill revolves around the veterinarian-client-patient relationship (VCPR).

An original provision in the bill stated that the veterinarian is the only person who can establish and maintain the VCPR. Colorado requires a practitioner to examine a patient in person to establish the relationship before they may diagnose and treat the patient. The rationale behind the VCPR is that because animals cannot verbally communicate their health status, a physical exam is indispensable to assessing the patient's condition.

McCormick said VPA supporters requested "at the last minute" a change to the bill that would allow VPAs to establish the VCPR. She did not agree to the change, saying it would violate state law.

She also said it's unnecessary. "This person can practice without creating the VCPR because they're under a veterinarian's supervision; the veterinarian creates the VCPR," McCormick explained.

However, the statement restricting the VCPR to the veterinarian was cut from the bill during final amendments in the Senate.

Despite their request to add the VCPR to the midlevel practitioner's bailiwick, VPA supporters say the ability to establish the VCPR is baked into the role anyway.

"The ballot measure says that a VPA can practice veterinary medicine," Steele said, explaining the argument. "The practice act says you cannot do those things, if you don't have a VCPR. So, the legal question is going to be: Because this authority was granted, was the authority to create a VCPR also granted? We believe it was, and McCormick believes it was not."

Allowing the midlevel professional to establish the VCPR is central to the vision of expanding care for Steele. "That's a control point that I know a lot of veterinarians want," Steele said, "but that's not what's going to increase access to care in the way that we need."

Steele predicts the VCPR will be "the next big fight" in establishing rules for the midlevel practitioner.

Steele and others who pushed back on the more restrictive covenants in the legislation had an ace up their sleeve during the process. Gov. Jared Polis, who endorsed Prop. 129, said he would veto the bill until the constraints were dialed back enough to satisfy VPA advocates, which eventually happened.

"It got to a point where some of the thoughtful guardrails we wanted in place are there, and it's not causing any harm," Steele said. "I feel like we got to an OK place with it."

Steele_McCormick

From left: Humane Colorado photo;
photo courtesy of Rep. Karen McCormick

Two veterinarians have been at the center of the effort to create a veterinary professional associate (VPA) in Colorado. From left: Dr. Apryl Steele, president and CEO of Humane Colorado, has been pushing for a midlevel practitioner with broad responsibilities to address veterinary workforce shortages. State Rep. Karen McCormick, who opposed the proposition that created the VPA, recently sponsored a bill to limit the scope and independence of the position.

Alternative education pathway

One of the more surprising provisions in the bill allows regulators to establish an alternative education pathway to VPA registration for veterinary technician specialists.

A veterinary technician specialist, or VTS, is a credentialed technician who has 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 has passed a specialized exam. In Colorado, a VTS is qualified to take on additional tasks restricted for veterinary technicians.

"We wanted to bring in this alternative pathway because we heard so much from our registered vet tech and vet tech specialists about being left out of this process," said McCormick, who sponsored legislation last year creating a state registration for the VTSs.

Prop. 129 defined the education requirement for VPAs as a master's degree, "or the equivalent."

"We took that 'or the equivalent' and ran with it," McCormick said. "We are not going against the will of the voters. It's just we have some imagination going on here."

While she posited that a VTS is likely to have more hours of hands-on training than a VPA out the gate, she also conceded that because their supplementary training and experience is by design narrow, they likely will need additional education to fill in knowledge gaps.

Prop. 129 supporters were disheartened that lawmakers opened the door to a VTS pathway.

"We're fully supportive of a VTS having increased scope of care," Steele said. However, she posed the question: Is an associate's degree followed by four or five years of self-study equivalent to a master's degree? "Is that what the voters thought they were getting?" she asked. "It felt very much like a way to undermine the credibility of a VPA."

Ultimately, both sides said they were satisfied with the additional requirement that if the alternative pathway is created, VTSs would have to pass the same national exam as VPA candidates with the master's degree.

That said, although the bill allows regulators to establish an alternative pathway, it doesn't compel them to do so.

Who will educate VPAs?

The education program that Prop. 129 supporters had in mind for VPAs is a newly minted master's degree in veterinary clinical care at Colorado State University. Recently approved by CSU's governing board, the program expects to enroll its first class, between 20 and 30 students, this fall and to graduate that cohort in two years, according to a press release.

The five-semester, 65-credit curriculum comprises three semesters online, a fourth semester featuring laboratory classroom training at CSU's veterinary school campus in Fort Collins, and a final semester in a clinical internship. The program will require a final examination that will eventually be replaced by a national credentialing exam. Neither Prop. 129 nor the new VPA bill specify a deadline for the creation of the exam.

"Students would be trained to identify abnormal findings on physical examinations and medical tests, and to diagnose and treat routine medical and surgical conditions, such as perform spay and neuter operations — all for dogs and cats only," a program description on CSU's website says.

The American Veterinary Medical Association has been a vocal critic of the CSU proposed master's degree curriculum.

"There can be no shortcuts to ensuring the competence of those who treat animals," Dr. Robert Knapp, AVMA Board of Directors chair, told a reporter for the Journal of the American Veterinary Medical Association last fall. "This program is just that—a shortcut. This curriculum shortchanges foundational knowledge and skills in subjects like physiology, anatomy, and pathology by omitting critical laboratory exposure. Despite this, graduates will be expected to successfully diagnose, prognose, recommend treatment plans, and perform major surgeries, including spays [and] neuters ...."

The first and only other master's in veterinary clinical care in the U.S. was started in 2022 at Lincoln Memorial University in Tennessee. The program is like CSU's in name only. The 30-credit, entirely online program was not originally pitched as a step to a midlevel practitioner role. It was promoted as a way for credentialed veterinary technicians to expand their training.

That's about to change, according to Dr. Stacy Anderson, executive dean of LMU's veterinary school.

"We are just going through the final approval processes at our institution to revise our current MVCC curriculum," Anderson told VIN News by email. She explained that starting in the fall, that curriculum will be offered as a master's in veterinary medical technology.

Meanwhile, the MVCC will transition to being half online and half in-person and will essentially double in credits — putting it more in line with CSU.

"We aren't quite ready to release the final curriculum as it isn't fully approved yet, but it will be ready to go by the end of the month," Anderson said.

An open question is what organization will accredit these new programs, as required in Prop. 129. (The new bill gives the veterinary board until 2033 to approve an accrediting body. Until then, the veterinary medical board will be charged with approving master's programs. Graduates of programs that are eventually accredited for VPA education will retroactively be considered graduates of an accredited program, McCormick said.)

The American Veterinary Medical Association, which accredits veterinary schools and veterinary technician education programs, didn't directly answer a VIN News question about whether the organization had been asked to or would consider accrediting VPA education. Instead, a spokesperson provided via email the following statement from Dr. Sandra Faeh, AVMA president.

"The AVMA opposes the creation of a veterinary professional associate because there is currently no well-established need or clearly defined role for this proposed midlevel practitioner in veterinary medicine. This lack of role clarity poses significant challenges for any potential accreditor, because the development of rigorous, meaningful accreditation standards depends on a deep understanding of the educational and professional requirements for program graduates who will fulfill a given role, as well as broad support and engagement from the veterinary community and other key stakeholders."

LMU's Anderson said the Coalition for Veterinary Professional Associates (CVPA), an advocacy group for the midlevel practitioner, is already developing accreditation standards with the Commission on Accreditation of Allied Health Education Programs. The commission accredits programs in 23 human health fields, including anesthesiologist assistants, art therapists, cardiovascular technologists, kinesiotherapists, medical assistants and specialists in blood bank technology. Anderson said CVPA also is close to an agreement with an organization that will create and administer a national credentialing exam.

Final rules for the VPA are required to be in place Jan. 1, 2026.