Screenshot from public hearing
Erin Spencer, a veterinary technician in Massachusetts, recently testified before lawmakers that state credentialing is needed to protect pets and owners, and that greater oversight will result in better working conditions.
A few months into her first job as a veterinary assistant in Massachusetts, Erin Spencer was assigned to monitor anesthetized patients, substituting for a more experienced staff member who was unexpectedly out for the day. At the time, Spencer had no formal veterinary training or education.
Swallowing her panic, she tracked patients' heart rates and counted respirations during surgery. She relayed the numbers to the surgeon. She didn't know how to interpret the numbers, she said, or more importantly, how to recognize trends that would indicate the patient was in distress and when to alert the surgeon to trouble.
During a spay, a cat stopped breathing. Spencer remembered feeling helpless as the surgeon and a veterinary technician supervisor tried and failed to revive the patient. She determined then and there that she didn't want to be in that position again. "I was in vet tech school that fall," she said.
Twenty years later, Spencer is a multi-credentialed veterinary technician and director of veterinary nursing education for a group of emergency practices. She described her experience to a committee of the Massachusetts Legislature last week during testimony in support of House Bill 406, which would regulate the practice and require licensing of veterinary technicians for the first time in the commonwealth.
"On-the-job training can mean that someone with absolutely no experience is doing jobs that they're not qualified to do," Spencer told the Committee on Consumer Protection and Professional Licensure. "We have no rules in place, so things like that have happened and continue to happen."
Massachusetts is one of 10 states that do not license, register, establish minimum education criteria for or define a scope of practice for veterinary technicians. The others are Colorado, Connecticut, Florida, Minnesota, New Hampshire, New Jersey, Rhode Island, Vermont and Wyoming, according to research by the American Association of Veterinary State Boards.
In states with no requirements or protections, veterinarians can hire untrained, uncertified and unlicensed assistants and call them "technicians." Many in the profession say this creates frustration among those with credentials, drives down pay in the occupation and hurts morale.
Veterinary technicians list low wages, lack of respect from employers and burnout as the top reasons for leaving the field, according to a 2016 survey by the National Association of Veterinary Technicians of America.
"Effective, proper utilization has been a problem that has plagued our profession for a long time," said NAVTA President Ed Carlson, who is a certified veterinary technician in Massachusetts. His certification was conferred by the state veterinary technician association, which is not a regulatory body. He is the director of veterinary nursing education for a continuing education company.
Bills pass, more in pipeline
Recent efforts to raise professional standards through regulation have been successful. Utah amended its veterinary practice act to recognize state-certified veterinary technicians last year. In May, Montana's governor signed a bill establishing licensure for technicians in the state.
Similar legislation has a toehold in at least two more states, in addition to Massachusetts.
A bill introduced in April in Minnesota calls for creating a path to licensure for veterinary technicians. The current draft establishes qualifications that include graduating from a veterinary technology program accredited by the national veterinary medical associations in Canada or the U.S., receiving passing scores on the Veterinary Technician National Examination (VTNE) and a state jurisprudence exam, and undergoing a criminal background check.
Dr. Allen Balay, a semi-retired veterinarian and veterinary technology educator in Minnesota, is a leading advocate for the bill. "We believe if we recognize and empower [veterinary technicians] in the profession, we'll keep them," he said.
While the bill did not pass before the recess this year, it remains in play because Minnesota legislative sessions span two years. During the break, Balay and fellow proponents are working to identify and win over any naysayers before the session resumes in 2022.
First model scope of practice
Veterinary technicians are not permitted to diagnose disease, prescribe medications or perform surgery.
AAVSB secretary and executive director James Penrod said the task list and supervision guidelines in the scope are based on a job analysis of 5,000 technicians for the Veterinary Technicians National Exam, which is administered by the association. "We were able to see what tasks they were actually doing," he said.
As a result, the scope serves not only as a model for regulators, he said, but also communicates to veterinarians the range of technicians' skills, which could improve how veterinarians use these team members and help elevate their role.
The National Association of Veterinary Technicians endorsed the guidelines in May. Association president Ed Carlson said the model scope is already helping to frame constructive discussions.
He sits in on veterinary medical board meetings in New Hampshire and Massachusetts, neither of which regulates technicians. "Listening to the conversations, it has been very evident that in some people's minds, everything on this list makes total sense," he said. "For other people, it's kind of opening their eyes like, 'Oh, I never thought about asking a technician to do that.' That could help with utilization."
To allay concerns that experienced technicians who never attended an accredited program and/or never took the VTNE could be disqualified from using the title, the bill proposes alternative pathways to licensing for two years after it goes into effect. These include having more than 4,000 hours engaged in the practice of veterinary technology within the previous five years and a letter of recommendation from a licensed veterinarian.
Balay calls this "a fairly liberal grandfather clause," and it's designed to support technicians working in practices in remote communities where qualified technicians are in especially short supply.
Meanwhile, Colorado is in the early phase of a regulation push. The Colorado Association of Certified Veterinary Technicians submitted a request to the Office of Policy, Research and Regulatory Reform for something called a "sunrise review."
A sunrise review is a process by which state officials determine whether regulating an unregulated profession or occupation is in the public interest. The year-long process in Colorado includes interviewing stakeholders and researching the regulations in other states. Results of the review are due Oct. 15.
While not required, a positive recommendation is seen as essential to success, said Erin Henninger, executive director of the state technicians group. A sunrise review to regulate technicians failed in 1994. Henninger is hopeful that the pending outcome will be different because many more states regulate technicians today. "It's really just a better time," she said.
Similarly in Massachusetts, efforts to regulate veterinary technicians have been ongoing for years. Spencer and others have worked on legislation for about 10 years. It's not that there is organized or powerful opposition to the bill, they say; it's just challenging to get legislators' attention. That's partly why Spencer told her story — which she recounted publicly only one other time.
"Our consultant shared that these types of bills don't often get traction until there is a horror story attached,” Spencer said. “I, unfortunately, had one, so I was able to share.”
'Veterinary nurse' push loses national profile
A related drive to elevate the occupation through a title change has not yielded fruit to date. The Veterinary Nurse Initiative, launched by NAVTA in 2016, aims to unite the profession under the single title "registered veterinary nurse" in all 50 states. Known as the VNI, the initiative's other stated goals are to standardize credentialing and scope of practice across the country; enact title protection; establish reciprocity among states; and maximize utilization, which means allowing veterinary technicians to perform the full array of tasks they have been trained in.
Fundraising to support the VNI — which is not underwritten by NAVTA member dues — has raised at least $362,510, mostly through corporate sponsorships, according to NAVTA reports published for 2019 and 2020. Of that, $150,540 has been spent on lobbying, and $102,083 has gone to a legislative strategist. NAVTA's Carlson said the association is in the middle of a routine audit and is therefore unable to provide updated income and expense figures.
Early VNI lobbying focused unsuccessfully on getting the "veterinary nurse" title adopted in Georgia, Indiana, Ohio, Oklahoma and Tennessee — all states where veterinary technician licensure is in place. No bills passed, and there is currently no active veterinary nurse legislation in the country.
Since early 2020, fundraising and lobbying for the VNI have been on hold, according to NAVTA's Carlson. "Legislative bodies were mainly focused on COVID-related issues, continuing active lobbying efforts didn’t seem to make sense," he said.
Although the legislative effort so far has gone nowhere, many U.S. practices and veterinary education programs already use the term. Veterinary nurse is also the preferred title in Australia, Ireland, New Zealand and the U.K.
Mark Cushing, a lawyer and founding partner of the consulting firm Animal Policy Group, served as VNI's legislative strategist. Noting that he no longer speaks on behalf of NAVTA, Cushing said the title-change drive has not succeeded to date for two reasons.
First, nursing groups are opposed. "The American Nursing Association and its local affiliates came in so heavy that they overwhelmed the legislature[s], and vet techs had no clout politically," he told VIN News, "although we were close in Ohio, Indiana and Oklahoma." Nurses claim to have some form of title protection or restrictions in 39 states. Early VNI critics predicted that opposition from this quarter would be intense.
Second, the AVMA and some state VMAs did not offer overt support. The AVMA Board of Directors voted early in the VNI campaign to remain neutral on the title-change goal. AVMA's neutrality was viewed by many as opposition and caused veterinarians to stay on the sidelines, Cushing said.
"The professional trade associations weren't behind it, although many companies did support the title change," he said, referring, in part, to several large veterinary hospital groups. "And if that seems to be harsh, sorry."
One sign of organized dissent came in early 2020, when an online petition urging NAVTA to drop the title-change effort garnered 1,116 signatures.
"From an outsider's point of view, the VNI has neither the momentum nor traction necessary for implementing crucial changes to individual states' Veterinary Practice Acts," the petition stated. "The factor that appears to stall legislation is the suggested title change – 'Registered Veterinary Nurse.' While legislators are failing to be swayed by the VNI to create this title, a schism has opened up within the veterinary community in stark contrast to the goal the initiative is meant to achieve: unity."
The petition was never sent to NAVTA, Carlson said, "so the association did not address it. They did, however, post on Facebook that they were aware of the petition and reached out to the individual who started it."
Asked to describe the status of the VNI, Carlson called it "a little bit complex."
He said the initiative helped spur conversation about the role of veterinary technicians, but due to the name of the initiative and the lobbying strategy, some perceived that achieving the "nurse" title was NAVTA's priority. "People started thinking that it was all about the title change, which it wasn't," he said. "All of the components of the VNI are equally important to NAVTA."
Carlson added that while NAVTA is not funding or initiating lobbying efforts in any state, "we will continue to support grassroot efforts in any state interested in working to establish credentialing requirements (including using the term veterinary technician or veterinary nurse), scope of practice, title protection, reciprocity and efforts to improve utilization."
VIN News Service commentaries are opinion pieces presenting insights, personal experiences and/or perspectives on topical issues by members of the veterinary community. To submit a commentary for consideration, email firstname.lastname@example.org.