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My opinion that nobody asked for...MLP edition

There is buzz about a mid-level practitioner (MLP) role in veterinary medicine. It's in the forefront for me because I'm a member of NAVTA, and also a co-founder and current president of the Arizona Veterinary Technician Association. My personal and public opinions on things might not always align, but in this case they do. We aren't ready for a mid-level practitioner. I know we aren't, even though there will be plenty of technicians who disagree with me. The reasons may not make sense to everyone, so hear me out.


I think the primary reason it's a "nay" from me is there are no guarantees with this idea; pay, scope of practice, reciprocity. Techs may take on more schooling with no promises as to if they can use it anywhere in the country, and a formal program for it already doesn't seem fair. I am 100% one of those people who would be an overachiever that wanted to do this something like this. I did go as far as a VTS (Dentistry), but there are problems with this idea.


My primary concern since I've taken up vet med politics has been defining and recognizing the role we play in a practice. The efforts for vet med to standardize title (whatever title that may be) and define scope of practice are so few and far between that the thought of trying to add another title to a practice act seems impossible. Open the practice acts to delineate which team members do what, what they're called, and create transparency for consumers (the pet owners) and then we'll talk.


If you compare it to human medicine, and that's barely possible, an RN has to go through about 6-8 years of schooling including their BS in nursing to be a nurse practitioner. To be a physician's assistant, there are undergraduate degrees and then a post-graduate program as well. This amount of school is similar to and very close to a DVM. If we wanted to be veterinarians, we probably would have walked that path long ago.


So, having said that, a "veterinary nurse practitioner" should be a master's level degree to be qualified. It should (no, let's say must) be a a previously certified/registered/licensed veterinary technician and all that implies. A BS in veterinary technology, then a Master's degree to attain a mid-level role is the only way this could work in my mind. I'd love to say that any animal science degree would be a good pre-requisite but I won't entertain that. This role, if it ever actually happens before I die, needs to be filled by an experienced technician. The skills that come from a practicing technician would be invaluable knowing that there isn't going to be any more staff for them in this role than there is now.


I also can't see how these intractable practice acts can grant additional duties to a technician when they haven't done so for a Veterinary Technician Specialist (VTS). The majority of the additional duties in this role would fall under surgery, prescribing, diagnosis, and prognosis. To be useful, a they would need skills that a VTS might possess, for example. A neuro technician could absolutely perform a neuro exam, but the doctor would have to potentially repeat it to reach a diagnosis (which is more like triage). An emergency tech could unblock a cat, but not diagnose a urinary obstruction before doing so. Not involving a DVM in a physical exam is triage, and great technicians are doing that already. To make a VTS in ECC utilized to the absolute maximum (which they were 100% trained to do) would be to have the scope of practice specifically allow them to do a chest tap on a dyspneic patient, ligate a hemorrhage, or stabilize a hypoglycemic diabetic. Until a practice act spells that out, and there is reciprocity from other states, I wouldn't want to bet my license that I would get support from anyone if something went wrong. The DVM is most often going to be responsible for it, and I'm not ok with that on their behalf.


Coming from a dental technician, you know where I was going with this. The most obvious example for us would be extractions. You'd expect a VTS in dentistry to be allowed to perform extractions after being trained as a subject expert. I know how to perform a surgical extraction. I've studied it, I've assisted the doctor countless times, and I can even guide a DVM student in a pinch until the doctor is available. I have never performed one myself, and I'm ok with that. I know the AVDT's stance on technicians doing extractions is unpopular. I've seen plenty of people condemn it on social media. There are states with some ambiguous language about it, and others that specifically allow extractions by technicians. To them, I ask how performing exodontic therapy, a permanent alteration of an animal, isn't surgery. To perform an extraction on ~60% of a dog's dentition, a gingival flap and alveolectomy is required. Can you remove a tooth without doing that? Possibly, but that would be going down the path of subpar medicine. A gingival flap is soft tissue surgery, an alveolectomy is orthopedic surgery, and the complications associated with doing them improperly can cause severe adverse events for a patient. These are events up to and including hemorrhage, nerve damage, fractured mandible, ruptured globe, fistulation, and the list goes on.


Then there is the issue of a fair wage for these skills. How many technicians will want to go into more student loan debt not knowing what they will be paid? While we're talking about pay, where will this professional fall? If you're producing revenue for a clinic that is comparable to a DVM doing wellness appointments, and allowing the DVM to create revenue through other channels like surgery, the salary would have to reflect that. Seeing as there is rarely a technician salary that provides a living wage, how can we expect that to change? If it does change, what does that say about the value of a technician with a bachelor's degree who only makes another $1 per hour?


This whole MLP idea needs to be meant to enrich the careers of the people who have been holding up vet med on their shoulders for years; the technicians! If not enough of them are willing, it will be because we didn't treat them well up to this point.


If you've read this far, you care a lot about vet med. You might just be someone dedicated enough to take this on someday...



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