This article might surprise readers, but it needs to be written and we don’t have much time to act. A quiet crisis that’s not obvious to practitioners and industry is building within the world of state regulation of veterinary medicine. I observe it only because my Animal Policy Group works with state veterinary medical boards every week. The problem shouldn’t remain a secret.
What’s Wrong
Here’s the problem in a nutshell, and then I’ll examine the causes and solutions.
- State veterinary medical boards are grossly underfunded. In many jurisdictions, the state does not contribute any money, so the boards rely entirely on the regulated professions to cover financial needs. In fact, 27 of 29 boards recently surveyed are self-funded. This is ironic at best because veterinary medical boards exist to protect the public (state taxpayers) and not the professions. Yet veterinarians and veterinary nurses are supposed to carry the heavy load.
- Underfunding means too few staff members are employed to perform the vitally important work we ask of state veterinary medical boards. The first repercussion is that delays grow in the approval of applications and licenses. Second, staffing is insufficient for the management of complaints and new issues, such as opioids and telemedicine.
- Other state boards, specifically resource-rich boards of pharmacy, stand ready to step in. What does this mean? State pharmacy boards will increasingly regulate veterinary practices in the areas of medications and pharmaceutical reporting. Pharmacy boards live mainly in the world of Walgreen, CVS and meganational retail chains. Boards of pharmacy struggle with the veterinary model of small clinics using small locked cabinets to provide medications to pet owners at retail, not wholesale, prices. (Read more about this below.)
Causes and Critical Factors
We are at the early stages of a staggeringly beneficial growth in pet ownership, broad social and cultural acceptance of pets, and millennial demands for human-quality health care for their pets. With this bountiful growth come challenges I’ve written about: shortages of veterinarians and veterinary technicians and nurses, burnouts due to these shortages and insufficient capacity, and a lack of access to pet health care for the above reasons.
Another result of these marketplace gains is an increase in demands upon state veterinary medical boards. Complaints about individual veterinarians increase as pet numbers increase and are exacerbated by a millennial block of clients raised on Yelp, performance reviews and higher expectations of outcomes from veterinary visits. No one is served well if state veterinary medical boards lack the resources to handle these complaints thoroughly and efficiently.
When headlines point to the challenges that veterinary medical boards face in managing investigations, such as in Oregon, California and New York, the pet-owning public grows frustrated and suspicious. That’s not the fault of veterinarians or state boards but rather of a system that chronically underfunds the boards. I’ve attended state board meetings throughout the United States since 2006, and at each stop I hear the same things: more complaints, insufficient staff and an increasingly frustrated citizenry demanding more and better.
Second, the United States faces a crisis over the abuse of opioids and controlled substances, and politicians are taking aim at veterinarians, human health professionals and drug companies. My Animal Policy Group monitors daily all 50 state legislatures, veterinary medical boards and boards of pharmacy. The top four of five veterinary issues in legislatures in 2019 involved opioids in some fashion. That is, reporting to prescription monitoring programs (PMPs), querying PMPs, electronic prescriptions, dosage restrictions, continuing education requirements and the like. While querying the PMP is not a full background check, some practitioners are expected to make a judgment call when controlled substances are required.
Politicians want solutions, and they will not grant the veterinary profession a free pass forever over complaints that we lack the software or staff for compliance, or because pet health care is only a fraction of the problem.
States are implementing comprehensive regulatory schemes with three components:
- Mandatory reporting to state agencies, within tight time frames, of all opioid prescriptions.
- Pre-prescribing “touching base” electronically with state agencies to determine whether a potential patient or client (pet owner) has a drug abuse history.
- Mandatory electronic prescriptions.
The latter component opens the door to further reductions in veterinarians’ market share in pet medications. So, what does this regulatory scheme have to do with a crisis facing state veterinary medical boards? Everything. Please read on.
We’re at a Disadvantage
There is not a state veterinary medical board in America with the budget or staff necessary to manage the reporting, oversight, analytical policymaking or information services envisioned in the comprehensive opioid regulatory schemes. Our veterinary medical boards would like to play the key role, as they have the expertise and knowledge, but they don’t have the resources and often aren’t even at the table with legislators, state health departments and pharmacy boards. This is not fair to veterinary medical boards, nor to veterinarians and the pet-owning public.
The American Association of Veterinary State Boards does an impressive job of providing resources and best-practices suggestions for member boards. But AAVSB cannot fill the funding gap at the heart of this article, although it can serve to rally members to work with stakeholders to find solutions.
Pharmacy boards in 14 states eagerly considered taking control of veterinary pharmaceutical practices by exploring bans on the direct shipment of pet medications by veterinarians to client homes. Fortunately, 12 states backed off and initiatives were defeated in Nevada and Minnesota. The array of opioid-related regulations under consideration is a different matter, and in some cases policies have been implemented by legislatures. State health departments and pharmacy boards will be the natural venues of authority, particularly over reporting requirements.
Veterinary reporting and compliance should be under the jurisdiction of state veterinary medical boards. It’s that simple. However, making it happen, and in a hurry, is anything but simple. Veterinary medical boards are not allowed to lobby, so expecting our boards to lead the fight for state appropriations to oversee veterinary reporting and compliance is unrealistic. The lobbying can only be done by the profession and industry. State VMAs have limited resources, but they can help. Industry has the resources and can step up.
Companies and trade groups are taking more interest in this topic, so stay tuned. And feel free to email me at mark@animalpolicygroup.com if you want more information or are interested in helping.