PVMA Statements

Statements

PVMA has been hard at work to provide our Members with policy statements and position statements. We recently published two statements regarding Telehealth and the Veterinary Nursing Initiative. As PVMA adds more policies and statements to its library, Members can access them at bit.ly/PVMAstatements.

Policy Statement on Veterinary Telehealth

Background and Context:

In recent times, our profession has experienced unforeseeable challenges in delivering veterinary services. The problem is complex and multifaceted. Many veterinary nurses / CVTs dropped out of the workforce due to family obligations and other financial considerations. Other support staff members have had to juggle these same challenges. In addition to diminished capacity for patient care, veterinary practices have had to cope with decreased efficiency. Operating hours, in many cases, have necessarily been reduced to meet the challenge of staffing shortages. Concurrently, reliance on referral hospitals has resulted in longer waits for much needed emergent and specialty care. [“Are we in a veterinary workforce crisis?” JAVMA News, Sept. 15, 2020, AVMA.org.]

These issues overlay an already existing problem in the adequacy of delivery of veterinary services to underserved communities. In many rural areas, veterinarians are few and far between. Those veterinary hospitals that exist are overtaxed and worn thin. Specialty care, in the cases of referral or emergency, may necessitate driving several hours. A veterinary shortage that began prior to the 2020 COVID pandemic has become increasingly problematic. Complicating this stress, veterinarians who are struggling with high educational debt-to-income ratios must be able to competently and efficiently manage the demand for optimal veterinary care while balancing the expectations of clients experiencing their own financial strains. Studies have proven that veterinary professional and personal wellness is diminishing and burnout is expanding. [“Merck-AVMA Veterinary Wellbeing Studies” 2018, 2020, 2022]

At the same time, veterinarians and CVTs are concerned professionals who strive to provide exceptional care for clients and patients, whenever feasible. We truly accept the lifelong obligation to continually improve our professional knowledge and competence affirmed in our oath. Therefore, we work cooperatively with specialists to give relief and to ease the pain of our patients. We seek out continuing educational opportunities that add value to our ability to improve the health and longevity of our patients.

Defining Telehealth and the Veterinary-Client-Patient Relationship (VCPR):

For decades, our profession has used telehealth as an aid in delivering veterinary services, starting with phone triage, expanding to digital images that are texted or emailed, and extending to AI platforms. Smart devices, electronic records, and digital imaging platforms have revolutionized the ease and speed of our ability to communicate with clients and with our colleagues, allowing information, advice, and education to flow into and out of a patient’s treatment plan. We recognize that these technologies are improving by the moment and embrace how they may augment the practice of veterinary medicine now and in the future.

At the PVMA, we support technologies that aid in improving the quality and quantity of veterinary care. However, there is no substitute for a thorough, hands-on physical exam. Equally as important is the one-on-one discussion with the client. These are integral aspects of the art of the practice of veterinary medicine. They ensure optimum patient and client safety. The delivery of veterinary services, whether it is prescribing medication, performing advanced imaging, or making treatment recommendations through the formulation of a treatment plan, must be predicated upon this solid foundation.

Furthermore, the Pennsylvania Practice Act requires a VCPR for a veterinarian to diagnose, prescribe medication, or otherwise treat an animal. [63 P.S. Sec 485.3(15)] Under the VCPR, the veterinarian assumes responsibility for making medical judgments and ensures that he or she has sufficient knowledge of the patient to initiate at least a general or preliminary diagnosis. In addition, the VCPR establishes that the veterinarian is available to follow up or make further recommendations regarding the patient’s continued care based on examination of the animal or medically appropriate and timely visits to the premises where the animal is kept.

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Policy Position:

PVMA supports a balanced approach to telehealth, that:

1. supports technological advancement while stressing the importance and necessity of the veterinarian/client/ patient/relationship, and that

2. promotes the position that telehealth should only be conducted within an existing and valid Veterinarian-

Client-Patient Relationship (VCPR)

Additionally, PVMA promotes the following ancillary concepts:

• The Pennsylvania Veterinary Medical Association opposes telehealth services that are offered directly to the client/ public when the intent or outcome is to diagnose or to treat the patient in the absence of an established VCPR.

• PVMA asserts that the VCPR cannot be established through telemedicine.

• PVMA agrees with the American Veterinary Medical

Association that emergency teletriage, including poison control services and emergency triage, are an acceptable exception, as these are potentially fatal circumstances where time is of the essence.

• PVMA supports telehealth efforts that result in the delivery of specialty services that would otherwise not be available to the patient. A Pennsylvania veterinarian with a valid

VCPR should have the professional discretion to consult with specialists and/or to conduct three-way consultation with the client, primary veterinarian, and the consultant.

In this case, the veterinarian with the PA license is determined to have the VCPR with client and the patient.

While the specialist or consultant may not hold a license in PA, he or she must be legally authorized to practice veterinary medicine in another state.

• PVMA recognizes that telesupervision of other credentialed veterinary professionals, such as veterinary nurses / CVTs, may be useful in underserved areas, particularly in the agricultural realm. This improves the utilization of education, knowledge, and experience of the entire veterinary team.

• Clients should be informed of the teleprovider’s identity, location, and state licensure status, and made aware of privacy and security issues involved in accessing veterinary services through telemedicine.

• The PA licensed veterinarian should obtain the client’s owner consent and be aware of any underlying legal liabilities. Additionally, platforms for communicating and sharing medical information must be secure thereby safeguarding privacy.

• Issues pertaining to enhancing license portability should be addressed as permitted, within the PA Veterinary Practice

Act and the Veterinary Regulations.

• Reflected in PVMA’s requested changes to the Rules of

Professional Conduct for Veterinarians, submitted to the

Pennsylvania Board of Veterinary Medicine, September 2021, which are as follows: Telehealth – given the surge of veterinary corporate medicine’s efforts to market and sell veterinary products, including pharmaceuticals, without an established veterinarian/client/patient relationship (VCPR), the following language additions are proposed.

(a) “Consultation” definition in 31.1 – added language is in bold.

“Consultation – a deliberation, in person or electronically, between two or more licensed veterinarians or a licensed veterinarian and other licensed professional concerning the diagnosis of an animal’s condition, the care to be provided and the proper management of the case. The veterinarian

seeking consultation is licensed and under jurisdiction of the Board, pursuant to the Act (63 P.S.) and maintains the valid VCPR and the practice of veterinary medicine occurs where the patient is located at the time of the consultation.”

(b) Addition of Veterinarian/Client/Patient Relationship (VCPR) to 31.1 Definitions sections, as it is specifically referenced in 31.21 Rule of Professional Conduct for Veterinarians, Principle 7.

“Veterinarian/Client/Patient Relationship – also known as VCPR, as defined by the Act (63 P.S. 485.3) and that a valid examination must be physical and in person in order to establish the VCPR. A VCPR is not established solely through veterinary teleconsultation.”

(c) For consistency, the following changes to “Indirect veterinary supervision” in 31.1 is also proposed (in bold):

“Indirect veterinary supervision – A veterinarian is not on the premises but is acquainted with the keeping and care of the animal by virtue of a physical and in person examination of the animal or medically appropriate and timely visits to the premises where the animal is kept and has given written or oral instructions to the certified veterinary technician/registered veterinary nurse for treatment of the animal patient.”

Position Statement on Veterinary Nursing

Background and Context:

In 2017, NAVTA launched the Veterinary Nurse Initiative in part to address the ongoing credentialed veterinary technician shortage present in Pennsylvania and the rest of the country. NAVTA’s leadership proposes that standardizing the title to “veterinary nurse” enhances public awareness about the role of the CVT/RVT/LVT, as well as providing clarity about the role within the profession.

One of the significant issues with the title “veterinary technician” is that over the past several decades, it has been used to refer to virtually any employee of the veterinary practice, who is not the veterinarian, with no regard for that person’s education or licensing. This has been detrimental in the following ways:

• CVTs have not been utilized to the extent of their education/training.

• Unlicensed people have been permitted to perform procedures for which they are not adequately trained or supervised.

• The public has been confused and misled by the random use of “vet tech.”

• CVTs continue to leave the profession in large numbers citing low wages, lack of public recognition, underutilization, lack of opportunity for advancement, and compassion fatigue.

• Based on information and statistics provided by the

Center for American Progress and the Bureau of Labor and Statistics, high turnover rates and job satisfaction issues for CVTs are likely increasing the costs for delivery of veterinary care.

• Employers continue to increase the number of advertised positions for veterinary nurses across the country in response to increased numbers of applicants for these positions. NAVTA strongly recommends that the title “veterinary nurse” only be used by those who hold credentials as a CVT, RVT, LVT, or LVMT. (NAVTA |

NAVTA: The Job Title of “Veterinary Nurse” Should Be

Reserved For Credentialed Technicians)

A 2016 NAVTA survey showed that over half (56.7%) of the respondents had changed their place of employment within the first five years. According to the AAHA’s Compensation and Benefits, the current rate of turnover for veterinary technicians is 23% annually. The Center for American Progress calculates the cost of turnover to be about 20% of each employee’s annual salary for workers earning less than $50,000.

PVMA’s Position and Professional Support in the Commonwealth:

In 2020, the Pennsylvania Veterinary Medical Association surveyed membership and found that 96% of respondents supported the Veterinary Nurse Initiative (VNI) and favored PVMA making a statement of support of the VNI. [PVMA Keystone Veterinarian Spring 2020 [32 - 33] (nxtbook.com).] PVMA supports the VNI, and the goals of NAVTA for the change in title to lead to greater job satisfaction for veterinary nurses/ CVTs, increased longevity in the field, and greater public awareness of the high level of care vet nurses provide to their patients. PVMA also recognizes that the title of “registered veterinary nurse” (RVN) assists in improving public awareness of the role that CVTs provide in the delivery of veterinary services, and that improving the title may help to retain much needed CVTs/RVNs within the profession.

Furthermore, this shift toward “veterinary nurse” is seen across the state in credentialed educational programs. Over the past three years, three of the seven Pennsylvania programs fully accredited by the AVMA, transitioned from veterinary technology programs to “veterinary nursing” programs1 . A significant number of CVTs entering the workforce in Pennsylvania each year are graduating with degrees in “veterinary nursing,” and want to be recognized as such in the workplace. On the national level, in addition to NAVTA, the AVMA also recognizes the term “veterinary nurse.” The AVMA Board of Directors released the following position statement on terminology regarding veterinary technicians/nurses:

Add your voice to the conversation by donating to our Political Action Committee today!

Contributions can be sent to: Pennsylvania Veterinary Political Action Committee (PVPAC) 8574 Paxton Street | Hummelstown, PA 17036

Corporate checks are not permitted by Pennsylvania law. PVPAC may only accept voluntary donations from individuals. Please make your personal check out to PVPAC.

The AVMA recognizes efforts by the National Association of Veterinary Technicians in America (NAVTA) and others to use the term “veterinary nurse” in place of veterinary technician within the profession and in criteria for credentialing purposes. The AVMA further recognizes ongoing efforts to promote adoption of the term “nurse” in state practice acts. The AVMA will continue to use the term veterinary technician in its polices and communications; however, will recognize credentialed veterinary nurses as being equivalent to credentialed veterinary technicians.

PVMA requests the recognition of the title “veterinary nurse” in addition to “certified veterinary technician” within the Veterinary Regulations. Just as the Board of Veterinary Medicine recently updated the Regulations to include the use of the title “veterinary assistant” to replace the previously used “non-certified employee,” PVMA asks that language be added, clarifying the title “registered veterinary nurse (RVN)” as equivalent to “certified veterinary technician (CVT).” [See recently submitted request, September 2021.]

References:

1 Harcum College - Veterinary Nursing Degree Veterinary Nursing - Johnson College of Technology Veterinary Nursing | Wilson Edu