Colorado voters are deciding whether to authorize a new category of veterinary care professionals, but the proposal includes some noticeably controversial aspects.
Proposition 129 would create a middle-level veterinary position known as a veterinary professional associate. Those who do the job would be required to hold a master’s degree and work for a veterinarian.
The American Society for Prevention of Cruelty to Animals, an advocate of Proposition 129, argues that it aims to expand access to veterinary care.
“Colorado’s severe and worsening veterinarian shortage has made it challenging and expensive to access care,” an ASPCA website says. “When people cannot access or are forced to forgo preventive vet care, medical conditions may go untreated, leading to increased suffering, more expensive treatment plans and even death.”
The new veterinary care associates, or “vet PAs,” as ASPCA calls them in an allusion to the physician assistants that aid humans, might “drive down the cost of care for common conditions and preventive medicine and increase appointment availability.”
According to a Colorado Public Radio report in May, there are approximately 3,800 practicing veterinarians in the state. But many of those veterinarians may be overworked. The Animal-Human Policy Center at Colorado State University’s Warner College of Natural Resources found in 2023 that about 70% of Colorado veterinarians refuse service to injured or sick companion animals each week because they cannot accommodate them.
Centennial State veterinarians not only care for 2.5 million cats and dogs, they likely face the highest per capita demand for companion animal care of any state.
Logistical considerations are not the only possible barriers to veterinary care in Colorado. Economic obstacles appear to exist, too. One 2018 study published in the Journal of the American Veterinary Association documented a significant jump in the proportion of cats and dogs who do not receive veterinary care.
The Access to Veterinary Care Coalition concluded in 2018 that, nationwide, “millions of pets do not receive adequate veterinary care because the costs are beyond the family’s ability to pay.” “This may be the most significant animal welfare crisis affecting owned pets in the United States,” the report continued. That perspective squares with a study published this year in Frontiers in Veterinary Science. “Between the 1990’s and the 2010’s, the cost of veterinary medical care rose faster than both human health care and inflation, with a corresponding increase in the number of pets not receiving care,” that paper concluded.
Many Colorado veterinary professionals appear to believe that this is a colossal problem for this state’s pet population.
In many cases, according to AHPC, veterinary care that could be made available cannot be afforded by clients. More than half of veterinarians and/or veterinary technicians “reported that[,] on average, they had to decline veterinary care for patients because the caretaker cannot afford to pay for treatment at least once a week.” And more than 70% told AHPC “that their veterinary team has had to euthanize an animal in the past year because the owner couldn’t afford the treatment they recommended and a different decision would have been made if the client had sufficient financial resources.”
In general, veterinarians and veterinary technicians do not see that these challenges are being addressed by the state’s corps of veterinary technicians because they perceive a shortage of those professionals. More than three-fourths of AHPC’s survey respondents “somewhat or strongly agreed with the statement that registered veterinary technicians and certified veterinary technicians are difficult to find,” while more than three-fourths of veterinarians said, “they sometimes or often perform duties that RVTs/CVTs could perform.”
Then there is the challenge inherent in assuring that farm animals receive needed medical attention. Most of the Eastern Plains have been designated by the U.S. Department of Agriculture as being a “Veterinary Services Shortage Situation,” as has Delta, La Plata, Montezuma, Montrose, and San Juan counties on the Western Slope. Sue VandeWoude, a professor at, and the dean of, CSU’s College of Veterinary Medicine and Biomedical Sciences, told state legislators in Sept. 2023 that, in rural areas of the state, there is “a crisis when it comes to the availability of veterinarians.”
Rep. Karen McCormick, D-Fort Collins, pushed two bills into law during this year’s General Assembly session that took aim at Colorado’s veterinary care crisis. HB 24-1047, signed into law in March, allowed a new veterinary professional associate position, while HB 24-1048, which Gov. Jared Polis approved in April, authorized the use of telecare services for both pets and farm animals.
The telehealth law requires that veterinarians see an animal in person before providing that variant of care. “[W]hat’s important about the bill and what we are doing is to bring what has always been in the Colorado Veterinary Board of Medicine statute and rules, in order to be able to practice telemedicine,” McCormick told Colorado Public Radio in March. “It’s critically important that a person have a veterinarian-client-patient relationship established.” Under HB 24-1048 only a licensed veterinarian would be able to prescribe medication based on a telehealth examination of an animal.
The veterinary professional associate legislation set forth specific tasks that VPAs could undertake. “[Under the law, veterinary technicians are allowed to assist with surgical procedures and place abdominal, thoracic, esophagostomy, or percutaneous endoscopic gastrostomy tubes under immediate supervision,” according to the American Veterinary Medical Association. “Under direct supervision, they may perform dental procedures and treat minor medical conditions under certain circumstances.”
McCormick believes Proposition 129 will undermine both of those new laws by weakening the protection of animal wellbeing they provide. The ballot initiative, she wrote in a June essay for the Denver Post, threatens to open the door to VPAs that are “not licensed to practice medicine” and that have “not gone through an accredited veterinary education program,” “not passed a national exam,” and “will not have sufficient liability protections.”
McCormick added that the VPAs that Proposition 129 would sanction could not “prescribe medicines because of federal law” and “will be under-trained through primarily an online master’s program.”
The version of VPA created by Proposition 129 would not limit the tasks that a VPA could perform under supervision, leaving the task of doing so to state regulators, and would permit VPAs to order tests, perform surgeries.
“We all know that surgery isn’t routine until it’s done, the animal is awake, and there weren’t any complications,” Jen Bolser, the chief veterinarian at the Humane Society of Boulder, told AVMA. “So, to think we can pick and choose the routine spay and neuter surgery for an individual with less training to perform is really unrealistic.”
As for veterinary telehealth access, McCormick said she thinks Proposition 129 would “eliminate the need for a doctor to ever see your animal in person.” “The ballot question essentially eliminates the most important tools your veterinarian has to get to the bottom of what is going — their hands, eyes, ears and nose,” the Larimer County legislator added.
McCormick referred, in her Denver Post essay, to two separate earlier ballot initiative proposals that sought to enact different telehealth and VPA statutes; one of them that addressed both later qualified for this autumn’s election ballot.
One unclear implication of Proposition 129 is the extent of education that the VPAs it authorizes would receive and when that education would be available. CSU is in the process of developing a master’s degree program in veterinary clinical care, but exactly what the curriculum will be and when it will be available is unknown.
“Skilled veterinary technicians are already more qualified than this contemplated VPA,” McCormick wrote in her Denver Post essay. “They have comprehensive training, take a national exam and are regulated by the state.”
Melanie Marsden, a Colorado Springs-based veterinarian, echoed that perspective. “In recent conversations, CSU says they will go ahead with [the] program regardless of [the ballot initiative’s] outcome,” she told the AVMA for a publication by that organization. “How is creating a new profession with new schools, new tests, new accreditation, all that—how does it make sense when we already have veterinary technicians?”
Katie Redd, a former Denver Dumb Friends League veterinarian now in practice in Washington, argued in a recent commentary that Proposition 129 does not mandate that the education VPAs would receive is effective. “[U]nder this measure, someone with as little as three semesters of fully online lecture with no laboratory, a fourth semester of truncated basic clinical skills training, and a short internship could be entrusted with [the] critical responsibilities [of providing clinical veterinary care],” she wrote for the Colorado Sun on Oct. 17. “No rigorous, supervised training akin to what veterinarians must undergo.”
Veterinary technicians are not required to hold a master’s degree or even a bachelor’s degree. Instead, they must obtain an associate’s degree. Veterinarians must graduate from a four-year advanced degree program leading to a Doctor of Veterinary Medicine degree and then pass a national licensing examination before engaging in the practice of that profession.
DDFL president Apryl Steele, a veterinarian, defended DDFL’s support of Proposition 129 in a recent open letter to the state’s veterinarian community. She argued that debate over the proposal has been contaminated with “intentional misinformation” and that the measure is a “thoughtful, logical, and supportive way to increase access to veterinary care and decrease mental and emotional pressures on veterinary teams.”
“The VPA role is not the only solution to these issues, but it is a great opportunity to positively impact our profession,” Steele wrote. “Imagine a highly trained, capable professional who works under the supervision of a veterinarian as directed by the DVM. Imagine that this person has graduated from an accredited VPA school with a master’s degree in veterinary clinical care and has passed a national competency exam. This VPA has liability insurance and is fully covered by the veterinarian’s liability insurance.”
The pet rescue organization leader also attacked criticism of the VPA educational requirement included in Proposition 129. “The Master’s in Veterinary Clinical Care degree program under review at Colorado State University’s College of Veterinary Medicine and Biological Science is a 65-credit hour program focused only on cats and dogs,” Steele wrote. “Future graduates of this program would be able to serve in shelter medicine regardless of the success of this legislation . . . “
Physician assistant programs generally require about 130 credit hours, which have to be completed primarily in-person, and a residency, whereas the proposed VPA degree program may allow aspirants to mostly do their learning online and would not apparently require any residency.
“It is hard to believe someone can argue with a straight face that a three-semester, 65-credit program—conducted mostly online—is remotely sufficient training to diagnose, prescribe drugs or perform abdominal surgery,” wrote Eric Fish, a Florida-based veterinary scientist and frequent commentator on veterinary medicine issues, in a recent Substack post.
Steele also asserted that Proposition 129 VPAs would receive “pre-clinical surgical training” in an amount similar to veterinarians, that accreditation would be likely, and that graduates of the CSU master’s degree program would have to pass an appropriate licensing examination. “With the work of the CVPA, these goals are expected to be accomplished within a couple of years,” she wrote. “To oppose the VPA movement because these steps cannot yet happen is short-[sighted] and manipulative.”
Many professional organizations for veterinarians oppose Proposition 129. They include the American Association of Bovine Practitioners, American Association of Equine Practitioners, American Associations of Swine Veterinarians, American Association of Veterinary State Boards, American Veterinary Dental College, AVMA, Colorado Association of Certified Veterinary Technicians, Colorado Veterinary Medical Association, and Independent Veterinary Practitioners Association.
Proponents include the ASPCA, DDFL, Independence Institute, The Interfaith Alliance of Colorado, and a political action committee known as All Pets Deserve Vet Care. The Colorado Sun reported earlier this month that All Pets Deserve Vet Care received more than $1.2 million in donations as of Sept. 11, nearly all of it from DDFL.