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Pros and Cons of Veterinary Technician Licensure in MN Julia Wilson, DVM, DACVIM Minnesota Board of Veterinary Medicine.

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Presentation on theme: "Pros and Cons of Veterinary Technician Licensure in MN Julia Wilson, DVM, DACVIM Minnesota Board of Veterinary Medicine."— Presentation transcript:

1 Pros and Cons of Veterinary Technician Licensure in MN Julia Wilson, DVM, DACVIM Minnesota Board of Veterinary Medicine

2 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!

3 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

4 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

5 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)

6 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)

7 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

8 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. passing score on the VTNE 2. graduate of an accredited veterinary technician program 3. continuing education (10 CE credits/2 years)

9  Cannot practice veterinary medicine as defined in MS 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 Current Technician Status in MN Continued

10 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 (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

11 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

12 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: 1. veterinary technician licensing 2. review of Vet Practice Act & Rules On indefinite hold pending MVMA decision

13 Model Practice Acts & Other States

14 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

15 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.

16 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

17 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

18 Direct or Indirect Supervision  MN – currently only allows direct supervision  AVMA 1. direct supervision = DVM is on the premises and has assumed responsibility for patient care by a person working under her or his direction 2. 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

19 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

20 NAVTA Model Practice Act Tasks by Level of Supervision Continued  Indirect Supervision Tasks :  Treatments: drugs, medications, immunological agents  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

21 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 policymay add to cost  License fees may become technician’s responsibility

22 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

23 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

24  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 Cont.

25 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.

26  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

27  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, followedby all current licensees) Total is about $370 - $420 Costs of Licensure if Same

28  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 Parallel Costs of License Renewal q 2 year for Other MN Health Professions

29 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?

30 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

31  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? Minimum Standards Who Defines Skill Levels?

32 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

33 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

34 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

35 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)

36 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)

37 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. Minnesota’s Criteria for Regulation § Subdivision 2

38  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 Potential Legislative Considerations to Support Licensure

39 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

40 Survey Results Part 1

41 Survey Results Part 2

42 Survey Results Part 3

43 What about Continuing Education costs? License Defense Insurance? Survey Results Part 4

44 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

45 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.

46 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.

47 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

48 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

49 How Do We Go Forward?


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