Let’s dive into two issues facing veterinary medicine in the United States. The first is telemedicine (not a newcomer, of course), and the second is the acute shortage of veterinary faculty and its impact on school accreditation (making a first-time appearance here). The only connection between these two topics is their impact on access to veterinary care.
As many readers know, the debate over veterinary telemedicine changed over the past 14 months. In October 2023, California Gov. Gavin Newsom signed a pro-telemedicine VCPR law that unanimously passed the Democrat-controlled Legislature. The law took effect on Jan. 1, 2024. Shortly afterward, in March 2024, the Republican-controlled Florida Legislature unanimously approved a pro-telemedicine law that was signed later by Gov. Ron DeSantis.
California and Florida don’t agree on much, if anything, so they drew attention when lawmakers supported their respective bills without a single “no” vote. The legislators made clear that telemedicine is not a partisan issue. The rationale in California and Florida boiled down to these two arguments:
- Telemedicine works for people and will work for pets, plain and simple.
- We face serious challenges over access to care due to shortages of veterinary professionals.
The state lawmakers rejected an argument from veterinary trade associations that no care is better than care provided through live video by a licensed veterinarian. Regardless of whether in-person care is better than virtual care in certain people’s minds, some care by a licensed veterinarian beats no care. Human health care faced similar issues as telemedicine worked its way across the 50 states. The pro-telemedicine arguments ultimately prevailed.
Meanwhile, in Texas
Significant news in the world of telemedicine also came in October 2024 with the 5th Circuit Court of Appeals’ Hines ruling. As a lawyer who has tried many cases in trial and appellate courts, I was shocked (pleasantly) by the force and blunt nature of the Hines opinion. It left nothing to the imagination.
In short, the decision overturned the Texas Veterinary Practice Act’s ban on an electronic (telemedicine) VCPR and enforcement by the Texas Board of Veterinary Medical Examiners.
A little history: Dr. Ronald Hines provided email advice to Texas clients without establishing an in-person
veterinarian-client-patient relationship. He was sanctioned by the state board, and the case went back and forth between a federal district court and the 5th Circuit Court of Appeals. Finally, the appellate judges ruled in Dr. Hines’ favor after reviewing each argument made by the Texas board and the state VMA.
The 5th Circuit held that Texas violated Dr. Hines’ freedom of speech rights. You might not know that the First Amendment protects both commercial and personal speech. The court established that advice and medical directions made by a veterinarian (whether in writing or orally) are protected speech.
The judges rejected the state’s claim that a telemedicine VCPR could be banned simply because the veterinary board views in-person visits as better. Such an argument did not overcome the First Amendment.
Stop With the Speculation and Fear
The appellate court also concluded that the state could not justify its actions based on fears or conjectures that a telemedicine appointment might harm animals. No evidence was provided of any such harm, and again, the court held that First Amendment rights may not be denied due to speculation or fears.
Speculation or prediction of harm to animals has been the central argument advanced in states to oppose a telemedicine VCPR. Canada’s Ontario province, with 16 million people, has allowed a telemedicine VCPR for over eight years without receiving a single complaint of harm to a pet. No jurisdiction has come forward in America to say otherwise. The same predictions and fears fell short in the human health care debate over telemedicine.
While the 5th Circuit’s opinion governs only Texas, Louisiana and Mississippi, the ruling reaches beyond the three Southern states. Other courts will study the opinion and respect the fact that a federal circuit generally viewed as conservative reached the conclusion it did. All this leads to the question of where the U.S. Food and Drug Administration will land if asked to reconsider its decades-old requirement of an in-person VCPR when a veterinarian prescribes an extra-label drug.
Stay tuned. The Hines ruling is new, but I predict federal authorities will take notice.
Help Wanted
The second issue — faculty shortages at our 33 accredited U.S. veterinary schools — receives too little attention. Data from the American Association of Veterinary Medical Colleges shows a shortage of more than 4,000 faculty positions. Conservative number adjustments place it at over 2,000.
No one questions that faculty shortages exist, and, of course, the pressure only increases at veterinary colleges as private practices respond to clinician shortages with more generous compensation packages.
The concern is heightened because of a matter that popped up over the past few months at our veterinary accreditor, the AVMA Council on Education, regarding remote and distance learning. All veterinary colleges utilize some form of it. A typical example is an academic expert’s lecture or demonstration in one location being shared electronically with students somewhere else. You can appreciate that the need for distance learning expanded dramatically during the pandemic and persists with the shortage of academic specialists.
Peer Pressure
For every existing and proposed veterinary college, the question is whether the Council on Education may accredit them if their curricula offer remote or distance learning. Unlike over 20 other professional program accreditors in the United States, the COE has never requested authority from the U.S. Department of Education to evaluate schools’ distance learning programs. The predicament has delayed or reshaped accreditation site visits for new programs and caused concerns for existing schools that need remote learning tools to deliver their curricula.
It’s inconceivable that the Department of Education will forbid veterinary schools from using the same tools employed by peer professional schools, especially virtual tools with best practices and successful track records.
The COE is slowly determining when and how to request authority from the Department of Education. All the while, the schools remain in limbo.
The outcome is certain. The COE will gain the privilege of evaluating distance or remote learning in veterinary programs and will follow the best practices of fellow professional programs and college accreditors.
The clock is ticking for veterinary medicine. Time is of the essence.
DID YOU KNOW?
The American Veterinary Medical Association established the Committee on Intelligence and Education in 1890. Sixteen years later, the committee took steps to initiate college evaluations. A replacement group, the accreditation-granting Council on Education, was formed in 1946.