Pros and Cons of Veterinary Technician Licensure in Minnesota PowerPoint - Dr. Julia Wilson
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Transcript Pros and Cons of Veterinary Technician Licensure in Minnesota PowerPoint - Dr. Julia Wilson
Pros and Cons of Veterinary
Technician Licensure in MN
Julia Wilson, DVM, DACVIM
Minnesota Board of Veterinary
Medicine
Objectives
Provide an overview of key points pertaining to
veterinary technician licensing and regulation
Describe the efforts of MVMA, MAVT, and BVM
to develop criteria for licensure & any changes in
scope of practice
Outline the requisite legislative steps to
accomplish licensing IF a majority of all
constituent groups agree licensure is needed
Educate and stimulate discussion!
CVT versus LVT
CVT means certified veterinary technician is
the current option via MVMA
LVT means licensed veterinary technician has a
status regulated by a Board of Vet Med.
Requirement for all personnel to work as a
veterinary technician
criteria
for licensure likely same as CVT, plus state
jurisprudence examination
different medico-legal connotations
could potentially exclude those trained on the job
versus a 2 year program +VTNE
Veterinary Technician
National Exam (VTNE)
3 hour examination
Multiple choice questions
Offered 3 times a year
State or province must confirm eligibility to take
examination
Current MVMA requirement to become a
certified veterinary technician
Only eligible if graduated from an accredited
program
Accredited Veterinary Technician
Programs (12/14)
244
total active programs
18 in Canada
12
in Minnesota
Probation = 6
New = 72
Distance Learning or on-line = 4
Closing = 6
(Closed = 12)
National Perspective
16 U.S. jurisdictions that do not currently regulate
veterinary technicians (license/register)
10/16 have a voluntary credential process, like MN
3 Model Practice Acts: Suggest criteria for
licensing, responsibilities, CE requirements
American Association of Veterinary State Boards
(AAVSB)
AVMA
National Association of Veterinary Technicians in
America (NAVTA)
NAVTA Survey 2012
About 2,500 respondents, 95% female
Averages: age = 40, years in profession = 12.8
Both veterinary technicians (86%) and veterinary
assistants took part
Half of technician respondents are suburban
All 50 states and Canada represented
Credentialed participating technicians:
1/3 licensed, 1/3 registered, 1/3 certified
75% associate’s degree, 11% bachelor’s degree
15% trained on the job
38% work part time for $16.80/hour
Current Technician Status in MN
Voluntary certification program through the MVMA
and CVT
CVT can join Minnesota Association of Veterinary
Technicians (MAVT) as a full member (otherwise
only associate member)
Requirements:
1.
2.
3.
passing score on the VTNE
graduate of an accredited veterinary technician
program
continuing education (10 CE credits/2 years)
Current Technician Status in MN
Continued
Cannot practice veterinary medicine as defined in
MS. 156.12 of the Veterinary Practice Act
No legal definition or distinction from persons
trained on the job or those not passing the VTNE
but technician program graduate
May only work under direct supervision
Supervising veterinarian assumes all
responsibility for an employee’s professional
performance
Certified Veterinary Technicians in
Minnesota (as of 12/18/14)
2772 CVT’s versus about 2,700 DVM’s with active licenses
equal about 1:1 ratio
AAVSB data:
Average = 2.55 DVM per technician
Range = 1.11 (ND) to 12.46 (SD)
Suggests that large majority eligible are already certified
CVT Costs: Application = $60; Biennial renewal = $60
Continuing education requirement = 10 hours q 2 earscan
include on the job training hours
Very few CE programs need MVMA approval, as most are
either RACE approved or MN Board of Veterinary Medicine
approved
Choosing Licensure
Decision should be grounded in an increased need
for public protection
Requires opening the Veterinary Practice Act and
new Board of Veterinary Medicine Rules
Pro: Would be an opportunity to remove outdated
or murky language in other parts of the VPA
Con: Risk of other, potentially negative changes if
legislators so choose
History of Effort to License
MN Veterinary Technicians
2003 MVMA Veterinary Practice Act Task Force is led by Dr.
Sharon Hurley & Kim Horne, CVTbut is in hiatus since 2013
2006 MVMA & MAVT convention flyers, ongoing discussion
at MAVT since
2013 draft language was discussed with the Revisor’s
Office, but no bill introduced
2014 Joint Task Force of MN Board of Veterinary Medicine
& MVMA
Two components:
veterinary technician licensing
review of Vet Practice Act & Rules
1.
2.
•
On indefinite hold pending MVMA decision
Model Practice Acts & Other
States
AAVSB Model Practice Act
Minimum age of 18
Good moral character
Accredited school and passing score on VTNE or
equivalent exam within last 5 years
CE requirement for license renewal
+/- State examination (jurisprudence)
Technician may not do surgery, diagnose,
prognose, or prescribe drugs, medicine and
appliances
State Practice Act should define what animal
health care tasks a technician can do and
appropriate degree of supervision
AVMA Model Practice Act 1/13
AVMA accredits veterinary technician schools and
colleges
Veterinary technician = graduate of a 2 to 3 year
accredited program in veterinary technology
No age restriction
National examination requirement
CE requirement for renewal
Technicians may not diagnose, prognose,
prescribe or perform surgery.
NAVTA Model Practice Act 1/09
Legislative Intent and Purpose: The practice of
veterinary technology is a privilege granted by legislative authority to
maintain public health, safety and welfare and to protect the public from
being misled by unauthorized individuals.
Definitions: criteria for title equals similar
levels
of supervision: immediate, direct & indirect
veterinary assistant
Tasks Restricted to Vet Tech or Veterinarian
Legislative Process Advice
Scope of Practice for Techs
Must be defined in any proposed legislation
Might preclude others from fully assisting veterinarians
even if very well trained
Level of supervision should be explicit
NAVTA Model Practice Act
Immediate supervision – DVM within eyesight & hearing
range
Direct supervision – DVM on premises and readily
available
Indirect supervision – DVM not on premises BUT tech is
able to perform the duties of a DVM by maintaining direct
communication
Direct or Indirect Supervision
MN – currently only allows direct supervision
AVMA
1.
2.
•
direct supervision = DVM is on the premises and
has assumed responsibility for patient care by a
person working under her or his direction
indirect = DVM need not be on the premises but
has given instructions for treatment of the
patient AND is readily available for immediate
communication. *DVM still has responsibility
for patient care*
AAVSB – direct supervision = similar
NAVTA Model Practice Act
Tasks by Level of Supervision
Immediate Supervision: DVM within direct
eyesight and
hearing range
- Induction of anesthesia
- Surgical assistance to the DVM
- Dental extraction not requiring tooth or bone resection
Direct Supervision: DVM is on premises and readily available
- Euthanasia
- Blood collection, preparation & administration
- Application of splints and slings
- Dental procedures (Example: Removal of calculus, plaque,
polishing, equine tooth floating)
Indirect Supervision: DVM is not on the premises but tech is able
to perform the duties of a DVM by maintaining
direct
communication
NAVTA Model Practice Act
Tasks by Level of Supervision Continued
Indirect Supervision Tasks:
Initiation of parenteral fluid administration
IV catheterization
Radiography
Collection of blood and urine (including cystocentesis &
catherization)
Collection of tissue samples and cultures
Routine laboratory procedures
Supervision of handling of biohazardous waste
Emergencies: life-saving aid & treatment: hemorrhage
control, drug administration post DVM communication,
resuscitation, splints, wound dressings, external supportive
treatment in heat prostration cases
Treatments: drugs, medications, immunological agents
CVT versus LVT in Minnesota
Will the public know the difference?
Will a change to LVT enhance public protection?
Liability for technician mistakes may still be the
employer’s responsibility OR LVT may be liable for
mistakes
Liability insurance and license defense policy may
add to cost
License fees may become technician’s
responsibility
MVMA/MAVT
Proposed Legal Language
Veterinary Technology is the science and art of
providing all aspects of professional medical care
and treatment for animals as determined by board
regulation, under the appropriate supervision of a
licensed veterinarian, with the exception of
diagnosis, prognosis, surgery, and prescription.
Licensed Veterinary Technician is an individual who:
1. has graduated from a veterinary tech program that
is accredited by the AVMA or CVMA, and
2. has passed the examination requirements as
prescribed by the MN Board of Veterinary Medicine
MVMA/MAVT
Proposed Legal Language Continued
Extends the legal scope of practice if licensed
Licensed technicians would be able to supervise
non-licensed employees if on the same premises
without a DVM on site
Non-licensed employees would NOT be allowed
to perform current tasks without a veterinarian
or veterinary technician on site
Allows technicians to provide medical care
without a veterinarian on site with DVM
permission
Veterinarian still assumes responsibility
MVMA/MAVT
Proposed Legal Language Cont.
Unless authorized to practice veterinary technology
under this act, an individual may not practice
veterinary technology nor use the title "veterinary
technician" or the abbreviation "LVT".
Veterinary Assistant means an employee of a
veterinarian who does not hold licensure as a
veterinary technician and whom the veterinarian
deems competent to administer medication or render
auxiliary or supporting assistance only under direct
veterinary or licensed veterinary technician supervision
or immediate veterinary or licensed veterinary
technician supervision.
MVMA/MAVT Proposed
Legal Language
Immediate Supervision means the supervising
veterinarian or LVT is in the immediate area and within
audible or visual range of the animal patient and the
veterinary assistant treating the patient.
Indirect Supervision of LVT means a veterinarian is
not on the premises but is acquainted with the keeping
and care of the animal by virtue of an 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 licensed veterinary
technician for treatment of the animal patient.
Costs of Licensure
All Board funding comes from license fees,
professional firm registrations, CE approvals, and
mailing list requests
Board of Veterinary Medicine’s work will be
greater than for just veterinarians as there are at
least just as many veterinary technicians
New BVM staff person salary and benefits
New Board members (2 techs likely): would help
handle complaints, interpret minimum standards
for technicians
Costs of Licensure if Same
DVM: Initial Application is $320
Temporary permit is $50
DVM Renewal for 2 years is $200
Other Costs: MN.IT surcharge of $20 (should be
discontinued)
Criminal Background Check is about $50 (one
time beginning with new licensees in 2016 or
2017, followed by all current licensees)
Total is about $370 - $420
Parallel Costs of License Renewal q 2
year for Other
MN Health Professions
Physical Therapy and Physical Therapy Assistant is $120
Physician is $422.40/2 years
Physician Assistant is $253 (Master degree)
Registered Nurse and Licensed Practical Nurse is $85
Nursing Assistants registry by Dept. of Health, trained by RN
more than 2 years experience, or course, written & practical
exam
Dentist is $336; Hygienist is $118; Therapist is $180
Athletic Trainer is $220
Midwife is $220 (3 year training after BA or RN)
Respiratory Therapist is $198
Costs of Licensure Continued
Would the cost of licensing be passed on to
the technician?
Would licensing impact the veterinarian’s
insurance?
Would a licensed technician see a salary
increase?
Would rural veterinarians have to pay
significantly more to attract an LVT if no one
else is allowed to provide veterinary
technology assistance?
Liability for Errors and Unprofessional
Conduct
Licensed technician would be responsible for her
or his actions, and maybe other employees under
tech’s supervision.
License can be revoked, suspended, limited,
conditioned and disciplined.
Agreement for Corrective Action – outcome for
complaints that can be remedied by CE
Veterinarian providing supervision for the
licensed technician may also be legally
accountable
Minimum Standards
Who Defines Skill Levels?
Faculty at veterinary technology college
VTNE
Supervising DVM or employer
Combination
Large Animal vs Small Animal?
Laboratory versus Exotic?
More tasks permitted for Specialty
Technicians?
Other LVT Considerations
LVT will be eligible for Health Professionals Services
Program if chemically, mentally or physically impaired
LVT’s license would be immediately suspended if
reported for failure to pay child support or taxes
LVT could be required to report:
any criminal charges including DWI’s complaint
investigation in any state
unprofessional conduct by DVM, other LVT
unauthorized practice of veterinary medicine or veterinary
technology
controlled substance misuse/diversion
inhumane treatment of animals
Professional Liability
Veterinarian’s liability insurance could exclude
licensed technician’s errors or misconduct
Veterinarian’s liability insurance (AVMA PLIT)
may refuse to cover non-licensed veterinary
assistants if that individual violates the
Veterinary Practice Act
Continuing
Education
Currently required by MVMA for certified
veterinary technicians
Responsibility for monitoring means a shift to BVM
Quantity & type for licensure would need to be
determined
Random audits would be conducted to monitor
compliance
Technician continuing education would need to be
approved by the Board if not already approved by
RACE or Board of Veterinary Medicine fee is
$50/program
Grandfather Provision
for MN Technicians
Minimum of 4160 documented cumulative hours
actively engaged in the practice of veterinary
technology within the last 5 years (about 2.5
years full time)
Letter of recommendation stating competency
from a Licensed Veterinarian who is currently
associated with the individual
Time limit for applying (Example: 3 year window)
(Note: Other states may require them to take an
examination regardless of academic status)
How Often Are Technicians Subject to
Corrective Action or Discipline?
Unknown in Minnesota, as CVT program does
not include either
Veterinary employer has option of firing for
incompetence or unprofessional conduct
AAVSB records of corrective action or
discipline for Techs: 11/38 states
2012 through 2014: Total of 58 reports
Action against license equals 28 in 3 years
(revoke, suspend, probation or discipline)
Minnesota’s Criteria for Regulation
§214.001 Subdivision 2
The legislature declares that no regulation shall be imposed upon any
occupation unless required for the safety and well being of the
citizens of the state. In evaluating whether an occupation shall be
regulated, the following factors shall be considered:
1. whether the unregulated practice of an occupation may harm or
endanger the health, safety and welfare of citizens of the state
and whether the potential for harm is recognizable and not
remote;
2. whether the practice of an occupation requires specialized skill
or training and whether the public needs and will benefit by
assurances of initial and continuing occupational ability;
3. whether the citizens of this state are or may be effectively
protected by other means; and
4. whether the overall cost effectiveness and economic impact
would be positive for citizens of the state.
Potential Legislative Considerations to
Support Licensure
Demonstration of an increased need for public
protection warranting government regulation
Plausible evidence of advantages of licensure to
the public
Plausible evidence that cost of regulation to the
government, animal owners will be minimal
Fair strategy for individuals who are not eligible
for licensure via VTNE
No detrimental impact on rural veterinary
services, particularly large animal veterinary
practice
Ideas to Engage DVM’s in Discussion?
Board of Vet Med newsletter front page asked for response only 4
received
MVMA Survey – results analysis pending
Distributed to:
MVMA-member veterinarians (not all that are licensed)
All technicians for whom MVMA has contact info is CVT’s
Number completed:
Total = 1015
DVM = 312 (<10% of licensed DVM’s)
CVT = 685 (~25%)
non CVT tech = 14
other = 4
Survey Results Part 1
Survey Results Part 2
Survey Results Part 3
Survey Results Part 4
What about Continuing Education
costs?
License Defense Insurance?
Survey Comment Themes
Many said did not know enough about the
issues
More respondents thought cost/benefit
balance did not favor licensure
Lack of job applicants for rural practices
Advocates for licensure stated increase public
respect for technicians and hope for higher
wages
Liability for errors would likely still fall on DVM
Survey Sample Comments
I believe they would be treated with the same
expectation, given the same responsibilities and
accountability that goes with the current designations.
I would support whatever system is less costly and
troublesome. I do not know nor do I care to spend the
time to determine which option that is.
Just another hoop to jump through. We people in rural
MN are working hard to just stay even. Every time the
state gets involved it is just more expensive and a lot
more time consuming.
Survey Sample Comments Continued
We will not be treated any differently and the pay will
not improve.... I feel that our current responsibilities
will remain the same, even if there is a more clearly
defined role. I don't think changing the title and its
requirements is going to actually, in practice, change
much of anything.
I prefer certified techs and will hire one that is not
certified as long as they are taking the exam. I think
that some techs feel they can be under the vet's
liability, I say give the techs something to lose. It is also
a measure of competence, to an extent.
Bottom Line: CVT -> LVT
Accountability & Liability may not change for daily
tasks if supervising veterinarian is still responsible
Regulation would add:
Cost
government judgment of errors
government oversight of CE
risk of license suspension
Obligatory reporting of impairment, diversion, cruelty,
criminal charges, professional misconduct in other
states
Possible job loss for those that cannot be licensed
+/- Negative impact on rural veterinary medicine
Bottom Line: CVT -> LVT Continued
Scope of Practice changes will be controversial
May create the title of veterinary assistant
Indirect supervision – must be shown to be in
the best interest of the public
May not impact salary
How Do We Go Forward?