Policy issues — more precisely, political issues — take up a lot of media reports and conversations around pet health care nowadays. The issues are all tied to change, which is always a difficult topic for veterinarians. I will attempt now to frame the discussions and suggest ways to lower the temperature by treating change as less of a threat.
Reciprocity and Licensing
The first one is easy: license reciprocity for veterinarians and eased multistate licensing. Some readers might argue the extent of veterinarian shortages — I don’t need convincing — but all jurisdictions should welcome the solution embraced by 18 state practice acts. It’s the rule that veterinarians practicing in the United States should be able to move from one state to another without retaking the North American Veterinary Licensing Examination, following the model of most professions.
If they meet the following conditions, why would we punish veterinarians for exercising their free choice to relocate?
- Graduate of an accredited veterinary medicine school
- Passed the NAVLE
- Good licensure standing in their current state
- Passed (if required) each state’s jurisprudence exam
Regardless of whether a veterinarian moves next door, north to south or east to west, why should a state veterinary practice act make it difficult, if not impossible, to do so? If thousands of pet owners move from one region to another, doesn’t it make sense that the demand for veterinary services will increase in the new state? The same rationale applies to veterinarians wanting to provide medical services in multiple states.
Here’s a breakdown of license reciprocity:
- Eighteen states grant the freedom: Arkansas, Colorado, Delaware, Georgia, Illinois, Massachusetts, Michigan, Montana, North Dakota, New Hampshire, Ohio, Rhode Island, South Carolina, South Dakota, Texas, Vermont, Washington and West Virginia.
- 21 states and the District of Columbia impose a range of continuous prior service requirements, or else a NAVLE exam must be retaken: Alabama, Alaska, Connecticut, Hawaii, Indiana, Iowa, Maine, Mississippi, Missouri, Nebraska, New Jersey, New Mexico, North Carolina, Oklahoma, Oregon, Pennsylvania, Tennessee, Utah, Virginia, Wisconsin and Wyoming.
- 11 states offer exceptions to the continuous service requirement but fall short of full reciprocity: Arizona, California, Florida, Idaho, Kansas, Kentucky, Louisiana, Maryland, Minnesota, Nevada and New York.
We have no data to suggest that public health or animal welfare is at risk when licensees seek additional licenses. Recent graduates of accredited veterinary colleges may take the
NAVLE and be licensed without prior experience, as they should be. But why are experienced veterinarians who seek an additional license required to retake the NAVLE unless they practiced continuously for an arbitrary number of years? In other words, a one-year break in such states (regardless of the reason) disqualifies them from pursuing licensure in a new state unless they pass another NAVLE. These anti-competitive, restrictive policies have outlived their original purpose, particularly in today’s era of veterinarian shortages.
Managing, let alone dictating, the number of practicing veterinarians in a state isn’t the job of veterinary medical boards. And if the rule is somehow justified as quality control, wouldn’t the boards need to retest every veterinarian who takes a personal leave or extended vacation? Of course, no one suggests that policy. Continuing education requirements continue to apply, ensuring that veterinarians stay current.
A concerted effort will launch soon to modernize the laws in the restrictive states. Here’s to hoping the veterinary community shows its support.
Federal Interest in Veterinary Telemedicine
The Texas Veterinary Practice Act bans establishing a veterinarian-client-patient relationship through telemedicine, but that’s about to change. In September 2024, the federal 5th Circuit Court of Appeals overruled the Texas ban as an unlawful infringement of commercial free speech under the U.S. Constitution. The case involving plaintiff Dr. Ronald Hines went back and forth between trial and appellate courts for years, but now it’s settled for Texas and the two other states (Louisiana and Mississippi) overseen by the 5th Circuit.
What’s interesting is the court’s emphasis on Texas’ inability to justify why telemedicine works for people but not pets. Opinions about telemedicine or preferences for in-person examinations are not enough to deny the free-speech rights of a licensed veterinarian utilizing telemedicine.
The ruling came at a time when many veterinarians and clinics were advised that the U.S. Food and Drug Administration “banned” telemedicine nationwide. That didn’t happen, of course, so nothing’s changed in the decades since the FDA required in-person examinations before a veterinarian prescribes off-label medications.
We will see how federal agencies view veterinary telemedicine in the wake of the 5th Circuit’s opinion in the Hines case.
Colorado’s Proposition 129
The Colorado State University College of Veterinary Medicine and Biomedical Sciences has spent the past three years developing a master’s program for a new role: veterinary professional associate. The American Veterinary Medical Association and the Colorado VMA opposed the idea and successfully lobbied the state Legislature to prevent VPA licensing. However, supporters (led by Dumb Friends League and others) gathered sufficient voter signatures to place the issue on the November 2024 ballot. Opponents spent $2.4 million fighting the measure, which passed by a five-point margin.
As is often the case with political campaigns, rumors and dire predictions swirled around the veterinary industry and inside Colorado. Wildly false claims were leveled against Proposition 129, the very idea of VPAs and Colorado State.
Now that the law is settled, let’s stick to the facts about midlevel practitioners. (They have served human medicine well for over 60 years.) Colorado will serve as a VPA pilot, and we can all exhale and see how things work out.
Voter support of an initiative in one state often opens the door in other states, particularly when consumer-friendly policies are involved. Colorado’s administrative agency will initiate rulemaking to implement Proposition 129, but opponents might pursue other options to restrain the rollout. However, Proposition 129 is now the law.
Still to be determined is whether the VPA role becomes a national battle. The intensity of the Colorado campaign suggests we are in for a serious contest across the country involving major players on both sides.
The issue is a financial and “good of the industry” one. Be prepared for VPAs to replace telemedicine and veterinarian shortages as the topic of the day, week and year.
When the debate moves from the political arena to actual boots on the ground in veterinary clinics, we can explore how various categories of professionals and skills mesh to build health care teams serving pets and people.
DID YOU KNOW?
Veterinarian candidates may take the North American Veterinary Licensing Examination up to five times, including incomplete attempts. According to the International Council for Veterinary Assessment, “Candidates may appeal to the ICVA board of directors for approval to take the NAVLE more than five times.”