Draft:Workforce Development in Veterinary Medicine

• Comment: WP:NOTHOWTO McMatter ^(talk)/_(contrib) 23:31, 30 December 2023 (UTC)

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Veterinary Professional Practice Associate (VPPA)

Description

Animal Heatlth has evolved with the Veterinary Professional Practice Associate (VPPA). The Veterinary Professional Practice Associate is an advanced practice animal healthcare provider with an accredited master’s degree who supports the veterinarian and the animal healthcare team in providing veterinary medical care across specialties. Access to quality veterinary care is essential for the well-being of pets and pet owners, and the VPPA fills those essential needs. The industry also faces a lack of access to care for many reasons.

A Lack Of Access to Care

1. Geographic Barriers: Geographic barriers play a significant role in limiting access to veterinary care. In rural and remote areas, the nearest veterinary clinic may be several hours away, making it challenging for pet owners to access routine care or emergency services. And let’s not forget the geographic barriers also include urban care deserts.

2. Economic Factors: Financial constraints can prevent individuals from seeking veterinary care. The high cost of veterinary services, including diagnostics, surgeries, and medications, can be prohibitive for many pet owners, especially those with limited income or resources.

3. Insurance Gaps: Unlike human healthcare, pet insurance is less widespread, leaving many pet owners to bear the total cost of medical care. This lack of insurance coverage can lead to delayed or limited access to necessary treatments.

4. Workforce Shortages: The need for more veterinary professionals, including veterinarians, technicians, and support staff, limits the capacity of veterinary clinics to serve their communities effectively. This workforce shortage contributes to extended wait times for appointments and reduced access.

5. Cultural and Social Factors: Cultural and social factors can also influence access to veterinary care. Some communities may have beliefs or attitudes that discourage seeking medical care for animals, while others may lack awareness of available services.

Leading Solutions for Access To Care?

1. Telemedicine: Telemedicine in Veterinary Care allows pet owners to consult with veterinarians remotely, providing timely advice and reducing the need for in-person visits. Telemedicine with a full virtual VCPR is particularly beneficial for those in rural and care desert areas and individuals with limited transportation or mobility.

2. Increase Veterinary University Class Size: Increasing veterinary university class sizes across 32 plus locations can assist in serving communities and their populace by graduating more veterinarians. Reference US number of veterinary universities:..

3. Build New Veterinary Universities: The Construction of twenty new veterinary universities in the United States will help alleviate professional shortages in the next twenty years.

4. Veterinary Professional Practice Associate: Solves existing and future veterinary provider needs and shortages while ensuring growth opportunities for certified veterinary technicians and veterinary university applicants not accepted to veterinary colleges, Veterinary Professional Practice Associates is a permanent solution that closes the Access to Care gap.

5. Licensed Veterinary Technicians: To utilize certified veterinary technicians to the fullest of their licensure. To develop a long-term career path through education, responsibilities, additional certifications, or upscale and upskill to a Veterinary Professional Practice Associate.

6. Financial Assistance Programs: Establishing financial assistance programs and low-cost clinics can make Veterinary Care more affordable for low-income pet owners. These programs can include subsidies, sliding-scale fees, or partnerships with local animal welfare organizations. A national program such as Petacaid is also a viable solution.

7. Educational Outreach: Raising awareness about the importance of regular veterinary care through educational campaigns can encourage pet owners to seek preventative care and early interventions.

8. Workforce Development: Initiatives to increase the number of veterinary professionals, including greatly enhanced scholarships, loan forgiveness programs, and expanded veterinary education programs, can help address the workforce shortage. Visa restrictions for foreign veterinary graduates and practicing veterinarians must be addressed and modified.

9. Legislation and Regulation: Implementing regulations and legislation to promote telemedicine, ensure fair and progressive wages, and improve access to Veterinary Care can significantly impact addressing the issue

SCOPE

The scope of a Veterinary Professional Practice Associate is similar to that of the familiar human health Physician Associate or Nurse Practitioner. A Veterinary Professional Practice Associate is an advanced practice animal health care provider nationally certified (VPPA-c) by a board exam and practices under their own license within a defined scope of practice. Healthcare services and privileges depend on the laws in the jurisdiction in which they practice. They may work in a structured collaboration or with the supervision/delegation of a veterinarian with an active veterinary medicine license. The Veterinary Professional Practice Associate may practice within all US jurisdictions, federal and state government entities, uniformed services, and US armed forces.

The range of services and privileges granted to the Veterinary Professional Practice Associate may vary from state to state, but they generally support and extend the services of a veterinarian and other animal healthcare professionals. In addition to their formal academic credentials, most Veterinary Professional Practice Associates are trained to take on specific responsibilities, such as developing the Client Patient Veterinary Relationship (CPVR), which includes telemedicine, conducting patient examinations, diagnosing disease, developing treatment plans, prescribing medications, preventative care, and vaccinations, ordering and interpreting diagnostic tests, coordinate referrals for advanced animal healthcare, minor and elective surgical procedures, providing certificates of inspection, attestation thus ensuring that animals receive the best possible care. Veterinary Professional Practice Associates also collaborate on zoonotic health issues with population healthcare providers. Veterinary Professional Practice Associates can also be involved in research and education.

Collaboration is a key component of a Veterinary Professional Practice Associate's role. Driven by evidence-based practice with measured quality outcomes, the Veterinary Professional Practice Associates works closely with a veterinarian (practice owner/chief of staff) who reviews patient care quality. The veterinarian who is licensed and in good standing may delegate appropriate responsibilities within the collaborative or supervised agreement. Veterinary Professional Practice Associates must adhere to national and state regulations to maintain their status as professional animal healthcare providers. These regulations include certification through a national organization by a veterinary practice examination reflecting consistent professional standards across all United States jurisdictions1 and licensed in the state or government entity where they practice.

The CDC’s “One Health” initiative establishes a collaborative, multisectoral, and transdisciplinary approach to health care, working at local, regional, national, and global levels- with the goal of achieving optimal health outcomes and recognizing the interconnection between people, animals, plants, and their shared environment. Pets and people have improved outcomes when they are together. The Veterinary Professional Practice Associate will play a vital role in community health goals.

HISTORY

Access to care is one of the driving forces in the development of the Veterinary Professional Practice Associate role. Veterinary colleges are filled to capacity, yet there is still a shortage or maldistribution of veterinary care across all the US jurisdictions. These shortfalls have been acknowledged by the American Veterinary Medical Association (AVMA) as far back as 2009 . AVMA issued a critical issue statement (2006) vowing that the profession must change and AVMA must take advantage of opportunities to foster the growth of veterinary medicine. Measures have been implemented to increase the number of veterinary schools from 28 in 2009 to 30, with the newest school in Arkansas in 2023. Access to Veterinary Care Coalition (AVCC) and Center for Applied Research and Evaluation (CARE), funded by Maddie’s Fund in 2018, research report “Access to Veterinary Care”, outlines the fact that 84.6 million households, 60-70% own a companion animal. That is 47.1 million cat owners and 60.2 million dog owners. There was no mention of reptiles, fish, equine, bovine, or other animals people have adopted as social companions. With expectations of further growth in the pet owner population anticipated, more care providers are needed to provide the access to care required.

Conversations have been ongoing by different professional groups over the past 15 years. The time has come to help our Veterinary colleagues and the public pet owners by fully implementing the role of the Veterinary Professional Practice Associate. While the addition of the Veterinary Professional Practice Associate role is not the only solution to the Veterinary shortage, it is one solution that will improve access to veterinary care.

EDUCATION/TRAINING

The Veterinary Professional Practice Associate is an advanced practice animal healthcare provider with an accredited Master’s degree.

Entry requirements vary, but generally, the preferred master’s candidate would have a bachelor’s or associate degree in veterinary science or technology with significant clinical practice experience.

Applications from cross-disciplines are considered. Examples of these are Pre-Veterinary students, nurses, Nurse Practitioners, Physician Associates, biomedical, and bachelor of science, but all encourage a minimum of veterinary clinical experience for acceptance.

The accredited masters two-year program may be delivered in a traditional in-person on-campus format or with didactic courses taught online with proctored examinations. All programs require clinical courses with specific material and supervised clinical hours at an approved facility under the guidance of a veterinarian. Each clinical course has specific requirements within accreditation standards and their university’s program’s degree/eligibility for graduation/certification. Some of the expected coursework within the master’s program includes advanced anatomy, physiology, pharmacology, pathophysiology, microbiology, behavioral science, public health and zoonotic diseases, radiology, surgery, prevention, and disease management.

Colorado State University

Lincoln Memorial University

Missouri State University

VETERINARY PROFESSIONAL PRACTICE ASSOCIATE MEDICAL KNOWLEDGE

An overview of medical knowledge includes the synthesis of pathophysiology, patient/pet presentation, differential diagnosis, patient management, surgical principles, health promotion, and disease prevention. Veterinary Professional Practice Associates must demonstrate core knowledge of established and evolving biomedical and clinical sciences and apply this knowledge to patient care in their practice area. In addition, Veterinary Professional Practice Associates are expected to demonstrate an investigative and analytic thinking approach to clinical situations. Examples of the medical knowledge that Veterinary Professional Practice Associates are expected to understand, evaluate, and apply the following to clinical scenarios:

• Establishing a veterinary client-patient relationship.
• Scientific principles related to animal health.
• Eliciting an animal health history, performing a physical exam, and ordering and interpreting diagnostic tests.
• Interventions for the prevention of disease and health promotion/maintenance.
• Etiologies, risk factors, underlying pathologic process, and epidemiology for preventative care and medical conditions.
• Signs and symptoms of medical and surgical conditions.
• Diagnosing, treating, and managing diseases within their scope of practice.
• Prescribing medicines and writing prescriptions under evidence-based medicine guidelines.
• Coordinating referrals for advanced animal health care.
• Providing education in disease prevention as it pertains to animal health.
• Performing specific procedures as determined by the scope of practice and educational preparation.
• Providing a certificate of inspection, vaccination, testing, and attestation as allowed by local, state, and national regulations.

WORK ENVIRONMENT

Veterinary Professional Practice Associates train and work in settings such as companion animal hospitals and clinics, shelter medicine, large animal hospitals and clinics, ambulatory care, food animal care, vaccination clinics and other animal healthcare domains. Veterinary Professional Practice Associates can be found in public health roles, wildlife management, exotic and zoo care, teaching and research as well as hospital administration.

COMPENSATION

Compensation has not been established with this new emerging role, but there is no reason that expectations will be comparable with the PA or NP. As with our colleagues, compensation depends on the practice settings and business locations. An example of the certified and licensed Veterinary Professional Practice Associate compensation would be a base salary and percentage of managed caseload. According to the Bureau of Labor Statistics, in 2020, the median pay for full-time physician assistants was $115,390 per year or $55.48 per hour; the highest 10 percent earned more than $162,470 . Emergency medicine, dermatology, and surgical subspecialty physician assistants may earn up to $200,000 annually. . Nurse Practitioners with a master's or doctoral degree in primary care, urgent care clinics, and hospital inpatient care settings range from $110,000-$139,000, with Certified Nurse Anesthetists being the most compensated at $222,000

JURISDICTION

“Jurisdiction” may refer to any political, administrative, or geographic entity, including a state, territory, country, or government. In these documents, the term is inclusive of the definition of United States as Consistent with the US Department of State, US Department of the Interior, and the CDC, the term United States is defined to include but not limited to all fifty states, the District of Columbia, the Commonwealth of Puerto Rico, the Commonwealth of Northern Mariana Islands, Guam, the Virgin Islands, American Samoa, Wake Island, the Midway Islands, Kingman Reff and Johnston Island, Tribal, Local, and Territorial Public Retrieved 17 September 2021. Physician Assistants" Occupational Outlook Retrieved 5 February 2019.

DEFINITIONS, STANDARD LANGUAGE, AND GLOSSARY OF TERMS

Term	Definition
Accreditation	Accreditation is a voluntary process that is engaged in by an organization that sponsor the formal training of the education of the Masters of Science Veterinary Clinical Studies. Accreditation provides programs with the opportunity to demonstrate their compliance with standards and validate the quality of the programs to external stakeholders and prospective advanced practice professionals. Accreditation status is granted to the graduate and postgraduate training programs that meet the predetermined criteria.
Administrative Support (Staff)	An educational institution may offer a waiver of required coursework included in the VPPA curriculum for applicants to the program and/or a waiver of required coursework included in the VPPA curriculum for currently enrolled students in the program which results in the student advancing in the curriculum without completing required curriculum components at the sponsoring institution.
Advanced Placement	Those individuals provide administrative, secretarial, or clerical help to the program. Administrative support staff do not include other staff working in or with the program who are assigned a traditional faculty role or those who function to provide technical assistance for instructional technology or data analysis.
Affiliated Organization	An affiliated organization is an organization distinct from the educational organization with a vested interest in the outcome of the sponsoring organization's MS-VPPA training program.
Analysis	Study of compiled or tabulated data interpreting correlations and trends, with the subsequent understanding and conclusions used to validate current practices or make changes as needed for program improvement.
Coalition for Veterinary Professional Associates-CVPA	The Coalition for the Veterinary Professional Associate (CVPA) is a 501c4 (pending) nonprofit organization born from the need to expand the roles of veterinary professionals to better serve our animal companions and all stakeholders. With solid support from universities, rural settings, shelters, and companion animal environments, this group has come together to lobby for and support the creation of these new mid-tier veterinary providers.
Competencies	The medical knowledge, interpersonal, clinical and technical skills, professional behaviors, and clinical reasoning and problem-solving abilities required for VPPA practice.
Consultant	An individual from within or outside the sponsoring institution who provides advice to the program, but who is not hired by the program to serve as program, principal or instructional faculty or staff.
Distant Campus	A campus geographically separates from the main program at which didactic, preclinical, or clinical instruction occurs for all or some of the students matriculated to that campus.
Distant Education	A formal educational process in which 50% or more of the required content/time/credit hours, excluding supervised clinical practice experiences, may be accrued when the student and instructor/faculty are not in the same physical location at the same time. The interaction may be synchronous or asynchronous.
Diversity	Differences within and between groups of people that contribute to variations in habits, practices, beliefs and/or values. The inclusion of different people (including but not limited to gender and race/ethnicity, age, physical abilities, sexual orientation, socioeconomic status) in a group or organization. Diversity includes all the ways in which people differ, and it encompasses all the different characteristics that make one individual or group different from another.
Elective Rotation	Supervised clinical practice experiences that may differ by student, and which allow students to gain exposure to or deeper understanding of medical specialties related to their clinical or academic areas of interest.
Inclusion	The active, intentional and ongoing engagement with diversity in ways that increase awareness, content knowledge, cognitive sophistication and empathic understanding of the complex ways individuals interact within systems and institutions. The act of creating involvement, environments, and empowerment in which any individual or group can be and feel welcomed, respected, supported, and valued to fully participate.
Observational Experience	VPPA students provide patient care, initially with the exclusive attention of an expert clinical preceptor. Precepted clinic require the time and support of an on-site preceptor for the duration of the session. The preceptor must have sufficient time and availability to be fully available to the graduate trainees for consultation, teaching, and direct assessment of patients. The precepting role changes over time as the learner takes on more progressively independent responsibilities in patient care. There is a general pathway and timeline for this independence, which is individualized based upon the trainees’ progress.
Precepted Clinical Session	VPPA students provide patient care, initially with the exclusive attention of an expert clinical preceptor. Precepted clinic require the time and support of an on-site preceptor for the duration of the session. The preceptor must have sufficient time and availability to be fully available to the graduate trainees for consultation, teaching, and direct assessment of patients. The precepting role changes over time as the learner takes on more progressively independent responsibilities in patient care. There is a general pathway and timeline for this independence, which is individualized based upon the trainees’ progress.
Preceptor	A preceptor is a skilled, experienced, motivated and productive provider who has demonstrated clinical excellence and high-quality care with good outcomes. A preceptor serves as a role model and resource to the VPPA student.
Veterinary Professional Practice Associate	The advanced practice animal healthcare provider supports the veterinarian and the animal healthcare team in providing veterinary medical care across specialties.
United States	The Fifty States, District of Columbia, the Commonwealth of Puerto Rico, the Commonwealth of the Northern Mariana Islands, Guam, the Virgin Islands, American Samoa, Wake, Island, the Midway Islands, Kingman Reef, and Johnston Island. A program may satisfy the requirement of supervised clinical practice experiences the medical facilities located in the United States and through a limited number of medical/veterinary facilities that are accredited by the United States Department of Education operated by the American Government under the signed Status of Forces Agreement with the host nation.

ACRONYMS and ABBREVIATIONS

Acronym	Title Roles / Association
APP	Advanced Practice Provider
AVA	Advanced Veterinary Associate
AVMA	The American Veterinary Medical Association
CPVR	Client Patient Veterinary Relationship
CVA	Certified Veterinary Associate
CVT	Certified Veterinary Technician
CVMA	The Coalition for the Veterinary Professional Associate
DVM	Doctor of Veterinary Medicine
HOD	House of Delegates
LVT	Licensed Veterinary Technician
NAVTA	National Association of Veterinary Technicians in America
RVT	Registered Veterinary Technician
VMD	Veterinary Medical Doctor
VMVA	Veterinary Medicine Veterinary Assistant
VPPA	Veterinary Professional Practice Associate

This new veterinary position is a great asset for pet parents in urban, rural, and desert areas that experience veterinarian and veterinary technician shortages. With highly educated applicants denied to veterinary universities worldwide and for certified veterinary technicians who want to extend their career, The Veterinary Professional Practice Associate is a bright option to pursue, which will only enhance Access to Care for all stakeholders and bridge the gap.