Presentation on theme: "Pros and Cons of Veterinary Technician Licensure in MN"— Presentation transcript:
1 Pros and Cons of Veterinary Technician Licensure in MN Julia Wilson, DVM, DACVIMMinnesota Board of Veterinary Medicine
2 ObjectivesProvide an overview of key points pertaining to veterinary technician licensing and regulationDescribe the efforts of MVMA, MAVT, and BVM to develop criteria for licensure & any changes in scope of practiceOutline the requisite legislative steps to accomplish licensing IF a majority of all constituent groups agree licensure is neededEducate and stimulate discussion!
3 CVT versus LVTCVT means certified veterinary technician is the current option via MVMALVT means licensed veterinary technician has a status regulated by a Board of Vet Med. Requirement for all personnel to work as a veterinary techniciancriteria for licensure likely same as CVT, plus state jurisprudence examinationdifferent medico-legal connotationscould potentially exclude those trained on the job versus a 2 year program +VTNE
4 Veterinary Technician National Exam (VTNE) 3 hour examinationMultiple choice questionsOffered 3 times a yearState or province must confirm eligibility to take examinationCurrent MVMA requirement to become a certified veterinary technicianOnly eligible if graduated from an accredited program
5 Accredited Veterinary Technician Programs (12/14) 244 total active programs18 in Canada12 in MinnesotaProbation = 6New = 72Distance Learning or on-line = 4Closing = 6(Closed = 12)
6 National Perspective16 U.S. jurisdictions that do not currently regulate veterinary technicians (license/register)10/16 have a voluntary credential process, like MN3 Model Practice Acts: Suggest criteria for licensing, responsibilities, CE requirementsAmerican Association of Veterinary State Boards (AAVSB)AVMANational Association of Veterinary Technicians in America (NAVTA)
7 NAVTA Survey 2012 About 2,500 respondents, 95% female Averages: age = 40, years in profession = 12.8Both veterinary technicians (86%) and veterinary assistants took partHalf of technician respondents are suburbanAll 50 states and Canada representedCredentialed participating technicians: 1/3 licensed, 1/3 registered, 1/3 certified75% associate’s degree, 11% bachelor’s degree15% trained on the job38% work part time for $16.80/hour
8 Current Technician Status in MN Voluntary certification program through the MVMA and CVTCVT can join Minnesota Association of Veterinary Technicians (MAVT) as a full member (otherwise only associate member)Requirements:passing score on the VTNEgraduate of an accredited veterinary technician programcontinuing education (10 CE credits/2 years)
9 Current Technician Status in MN Continued Cannot practice veterinary medicine as defined in MS of the Veterinary Practice ActNo legal definition or distinction from persons trained on the job or those not passing the VTNE but technician program graduateMay only work under direct supervisionSupervising veterinarian assumes all responsibility for an employee’s professional performance
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 ratioAAVSB data:Average = 2.55 DVM per technicianRange = 1.11 (ND) to (SD)Suggests that large majority eligible are already certifiedCVT Costs: Application = $60; Biennial renewal = $60Continuing education requirement = 10 hours q 2 ears can include on the job training hoursVery few CE programs need MVMA approval, as most are either RACE approved or MN Board of Veterinary Medicine approved
11 Choosing LicensureDecision should be grounded in an increased need for public protectionRequires opening the Veterinary Practice Act and new Board of Veterinary Medicine RulesPro: Would be an opportunity to remove outdated or murky language in other parts of the VPACon: 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, CVT but is in hiatus since 20132006 MVMA & MAVT convention flyers, ongoing discussion at MAVT since2013 draft language was discussed with the Revisor’s Office, but no bill introduced2014 Joint Task Force of MN Board of Veterinary Medicine & MVMATwo components:veterinary technician licensingreview of Vet Practice Act & RulesOn indefinite hold pending MVMA decision
14 AAVSB Model Practice Act Minimum age of 18Good moral characterAccredited school and passing score on VTNE or equivalent exam within last 5 yearsCE requirement for license renewal+/- State examination (jurisprudence)Technician may not do surgery, diagnose, prognose, or prescribe drugs, medicine and appliancesState 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 collegesVeterinary technician = graduate of a 2 to 3 year accredited program in veterinary technologyNo age restrictionNational examination requirementCE requirement for renewalTechnicians 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 similarlevels of supervision: immediate, direct & indirectveterinary assistantTasks Restricted to Vet Tech or VeterinarianLegislative Process Advice
17 Scope of Practice for Techs Must be defined in any proposed legislationMight preclude others from fully assisting veterinarians even if very well trainedLevel of supervision should be explicitNAVTA Model Practice ActImmediate supervision – DVM within eyesight & hearing rangeDirect supervision – DVM on premises and readily availableIndirect 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 supervisionAVMAdirect supervision = DVM is on the premises and has assumed responsibility for patient care by a person working under her or his directionindirect = 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 resectionDirect 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 agentsInitiation of parenteral fluid administrationIV catheterizationRadiographyCollection of blood and urine (including cystocentesis & catherization)Collection of tissue samples and culturesRoutine laboratory proceduresSupervision of handling of biohazardous wasteEmergencies: 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 mistakesLiability insurance and license defense policy may add to costLicense 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:has graduated from a veterinary tech program that is accredited by the AVMA or CVMA, andhas 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 siteNon-licensed employees would NOT be allowed to perform current tasks without a veterinarian or veterinary technician on siteAllows technicians to provide medical care without a veterinarian on site with DVM permissionVeterinarian still assumes responsibility
24 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.
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 Costs of LicensureAll Board funding comes from license fees, professional firm registrations, CE approvals, and mailing list requestsBoard of Veterinary Medicine’s work will be greater than for just veterinarians as there are at least just as many veterinary techniciansNew BVM staff person salary and benefitsNew Board members (2 techs likely): would help handle complaints, interpret minimum standards for technicians
27 Costs of Licensure if Same DVM: Initial Application is $320Temporary permit is $50DVM Renewal for 2 years is $200Other 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
28 Parallel Costs of License Renewal q 2 year for Other MN Health Professions Physical Therapy and Physical Therapy Assistant is $120Physician is $422.40/2 yearsPhysician Assistant is $253 (Master degree)Registered Nurse and Licensed Practical Nurse is $85Nursing Assistants registry by Dept. of Health, trained by RN more than 2 years experience, or course, written & practical examDentist is $336; Hygienist is $118; Therapist is $180Athletic Trainer is $220Midwife is $220 (3 year training after BA or RN)Respiratory Therapist is $198
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 CEVeterinarian providing supervision for the licensed technician may also be legally accountable
31 Minimum Standards Who Defines Skill Levels? Faculty at veterinary technology collegeVTNESupervising DVM or employerCombinationLarge Animal vs Small Animal?Laboratory versus Exotic?More tasks permitted for Specialty Technicians?
32 Other LVT Considerations LVT will be eligible for Health Professionals Services Program if chemically, mentally or physically impairedLVT’s license would be immediately suspended if reported for failure to pay child support or taxesLVT could be required to report:any criminal charges including DWI’s complaint investigation in any stateunprofessional conduct by DVM, other LVTunauthorized practice of veterinary medicine or veterinary technologycontrolled substance misuse/diversioninhumane treatment of animals
33 Professional Liability Veterinarian’s liability insurance could exclude licensed technician’s errors or misconductVeterinarian’s liability insurance (AVMA PLIT) may refuse to cover non-licensed veterinary assistants if that individual violates the Veterinary Practice Act
34 Continuing EducationCurrently required by MVMA for certified veterinary techniciansResponsibility for monitoring means a shift to BVMQuantity & type for licensure would need to be determinedRandom audits would be conducted to monitor complianceTechnician 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 individualTime 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 eitherVeterinary employer has option of firing for incompetence or unprofessional conductAAVSB records of corrective action or discipline for Techs: 11/38 states2012 through 2014: Total of 58 reportsAction against license equals 28 in 3 years (revoke, suspend, probation or discipline)
37 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: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;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;whether the citizens of this state are or may be effectively protected by other means; andwhether the overall cost effectiveness and economic impact would be positive for citizens of the state.
38 Potential Legislative Considerations to Support Licensure Demonstration of an increased need for public protection warranting government regulationPlausible evidence of advantages of licensure to the publicPlausible evidence that cost of regulation to the government, animal owners will be minimalFair strategy for individuals who are not eligible for licensure via VTNENo detrimental impact on rural veterinary services, particularly large animal veterinary practice
39 Ideas to Engage DVM’s in Discussion? Board of Vet Med newsletter front page asked for response only 4 receivedMVMA Survey – results analysis pendingDistributed to:MVMA-member veterinarians (not all that are licensed)All technicians for whom MVMA has contact info is CVT’sNumber completed:Total = 1015DVM = 312 (<10% of licensed DVM’s)CVT = 685 (~25%)non CVT tech = 14other = 4
43 Survey Results Part 4 What about Continuing Education costs? License Defense Insurance?
44 Survey Comment Themes Many said did not know enough about the issues More respondents thought cost/benefit balance did not favor licensureLack of job applicants for rural practicesAdvocates for licensure stated increase public respect for technicians and hope for higher wagesLiability 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 responsibleRegulation would add:Costgovernment judgment of errorsgovernment oversight of CErisk of license suspensionObligatory reporting of impairment, diversion, cruelty, criminal charges, professional misconduct in other statesPossible 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 controversialMay create the title of veterinary assistantIndirect supervision – must be shown to be in the best interest of the publicMay not impact salary