The role of veterinary technicians, governance housekeeping and a practice act rewrite are up for debate during the American Veterinary Medical Association Veterinary Leadership Conference, which kicks off this week in Chicago.

The House of Delegates, the main policymaking arm of the AVMA, will gather on Friday at the Chicago Marriott Downtown to consider revisions to the Model Veterinary Practice Act, up for review for the first time since 2013, along with other agenda items.

The model practice act is intended to serve as a framework for state authorities that govern veterinary medicine. The revision process has been ongoing since 2016, organized by the AVMA Council on Veterinary Service. The AVMA sought public comments last spring, asking stakeholders to weigh in on the proposed changes. Nearly 200 comments were received.

Among the proposed changes are clarifications of indirect and direct veterinary supervision; exemptions of veterinary-client-patient relationship (VCPR) requirements for practitioners dealing with cases of emergency or ugent care; and increased recognition of veterinary technician credentialing.

One of the most contentious topics covered in the model practice act is whether a veterinary-client-patient relationship can be established remotely, particularly when using telehealth technologies in practice. Part of a much larger, ongoing debate is whether veterinary medicine should follow human health care in its embrace of telehealth. At least 48 states permit physicians to establish relationships with patients remotely, no longer requiring face-to-face office visits.

The American Association of Veterinary State Boards, a national organization for state regulators, promotes a similar position. In September, AAVSB modified its own model practice act to say a VCPR may develop online in some instances, without a hands-on physical exam.

Contrary to the AAVSB and human health care, the AVMA concludes that an in-person physical exam is needed before a patient can be treated remotely — a stance the association now seeks to cement. A VCPR "generally cannot be adequately established by telephonic or other electronic means," the draft model practice act states. 

A resolution to enact the draft model is up to delegates to decide. 

Dues hike proposed

AVMA officials want to raise dues for regular and affiliate members to avoid financial hardships for the association, according to resolution 2, submitted by the Board of Directors. 

The cost of an AVMA membership is $330 a year. The increase proposed would unfold in phases, beginning with a bump of $30 in 2020, generating $2.4 million for the association. If necessary, an increase of $10 would follow in 2021 and again in 2022, raising dues to $380. The resolution says AVMA officials will determine whether the incremental dues increases are necessary based on financial "analysis of the outcome of each year." 

The last time the AVMA raised dues was in 2015. 

"The AVMA has been fortunate to balance its operational budget over the past five years, without the need for an increase in dues," the resolution says. "With expanding services, delivering additional value, and the continuing rise of expenses it is increasingly difficult each year to balance our budget — AVMA is forecasting a projected $1 million deficit in 2020."

Bylaws overhaul

Delegates also will consider a slew of proposed changes to the AVMA Bylaws. Among them is a bid to upend how the AVMA investigates complaints and internally disciplines or dismisses members for unethical conduct.

Bylaws amendment 5 initiates the process of terminating the AVMA Judicial Council, which is comprised of five voting members who are elected by House delegates. Instead, ad hoc entities — appointed by the Board of Directors on an as-needed basis — would be responsible for adjudicating complaints. 

The new system alleviates the need to maintain a standing committee due to the infrequent occurrence of disciplinary hearings, the amendment says. Rather, board officials will rely on the expertise of in-house legal counsel and staff. If delegates adopt the amendment, the AVMA must revise its process for disciplinary action and process for advising on questions of veterinary medical ethics, both outlined in the bylaws, to reflect the change. 

If delegates reject the change, the current system will remain in place. Other proposed bylaws amendments impact several volunteer councils and committees:

• Bylaws amendment 1 would add a veterinary technician to the Council on Veterinary Services, a body charged with developing ways to deliver professional veterinary services to the public with consideration of economic and social matters. The addition would bring the group to 11 voting members. "… A veterinary technician would provide the council with an important perspective," the amendment says. 
• Bylaws amendment 2 initiates changing the name of the Council on Public Health and Regulatory Veterinary Medicine to the Council on Public Health. The change clarifies that the entity’s focus is public health; other committees and councils deal with regulatory medicine, the amendment says. 
• Bylaws amendment 3 would relieve the Council on Research of the responsibility of advising the AVMA Board of Directors on the quality and relevance of the American Journal of Veterinary Research to the scientific community. The directive is obsolete, the amendment says. 
• Bylaws amendment 4 would relieve the Council on Biological and Therapeutic Agents of the responsibility of advising the advertising manager of association journals on whether to accept advertising related to biologic and therapeutic agents. The directive is obsolete, the amendment says.
• Two bylaws amendments offer new requirements for constituent allied groups to retain representation in the House. In recent years, some constituent organizations have faced expulsion from the House because they don’t have enough AVMA members in their ranks. While bylaws amendment 6 lowers requirements for current allied groups to retain their seat in the House, bylaws amendment 7 requires a two-thirds vote by delegates to admit new groups. 
• Bylaws amendment 8, submitted by 10 allied groups, also focuses on House representation. It grandfathers any organization that’s been in the House during the past 10 years, citing the entity’s "necessary and historical representation." "There is no requirement for state organizations to satisfy a percentage of their members to be AVMA members," the amendment says. "Enforcing this requirement on allied organizations imposes an undue burden" on groups with fewer members. 
• Bylaws amendment 9 alters the composition of the Council on Public Health and Regulatory Veterinary Medicine to expand the eligibility of volunteers to the group, which typically attracts government employees. The revision clarifies that any veterinarian "with relevant experience in animal and/or public health (to include private practice, academia, and industry) is welcome and eligible to apply."

Update: The AVMA House of Delegates passed the dues increase but not the telemedicine resolution. Delegates referred it to a working group to further study the issue.