Apryl Steele, DVM, CAWA

Dr. Apryl Steele has been president and CEO of Humane Colorado since 2015. Before that, she served as president of the Colorado Veterinary Medical Association, the Denver Area Veterinary Medical Society, the American Association of Feline Practitioners and the Animal Assistance Foundation. She has nearly two decades of experience in private practice and has also served with the U.S. Army Veterinary Corps and the AVMA House of Delegates.

Before Humane Colorado began campaigning on behalf of a veterinary professional associate (VPA) role in Colorado, we did what all good grassroots organizers do—we polled the public to gauge popular opinion. The results blew us away. Eighty percent of people supported the concept, and our pollsters didn’t want to publish the data because they thought no one would believe it.

This overwhelming support stemmed from pet owners’ ever-increasing difficulty accessing veterinary care: either they couldn’t get an appointment, or they lived in a veterinary desert, or they couldn’t afford it. Less than 10% of respondents directly opposed the idea, with the remainder undecided.

The power of public need

This clear public mandate gave our Veterinary Care Coalition the confidence to move forward with Proposition 129, a ballot initiative asking voters to approve a career pathway for VPAs in our state. Humane Colorado (formerly Dumb Friends League) contributed the majority of campaign resources, but we also had support from the ASPCA, other welfare organizations, and individuals. Most of our funding went toward collecting signatures to secure a place on the ballot—an expensive but necessary investment.

We had been advised that the American Veterinary Medical Association (AVMA) wouldn’t mount a public campaign against us, as it might risk their ability to accredit veterinary schools by appearing to inhibit competition. So we were shocked when they invested over $2 million to oppose the measure, outspending us 8-to-1 with messaging largely based on scare tactics.

Despite the fact that we were dramatically outspent, Proposition 129 passed. What ultimately carried us across the finish line wasn’t clever campaign strategy but a sad reality: the public’s desperate need for accessible pet care. People are struggling to care for their animals, and with few other viable solutions on the horizon, voters saw VPAs as a necessary innovation.

Professional opposition

When I graduated from veterinary school, I naively didn’t understand the difference between veterinary medicine and animal welfare. I’m wiser now, but my belief endures that there shouldn’t be a difference—our true north is to ensure animals receive needed care, and we figure out the rest. So the intensity of the opposition from the profession surprised me. It seemed rooted in protectionism and fear.

I have compassion for the veterinarians and technicians who opposed the measure based on the incomplete and misleading information they received. If I had received that same information, I would have opposed Proposition 129 too. My frustration isn’t with individual practitioners but with the profession’s choice to communicate to the veterinary community in ways that were not transparent.

Correcting persistent myths

Numerous misconceptions about VPAs continue to circulate. One major claim was that VPAs would be uncredentialed, unlicensed, and their programs unaccredited. In reality, all these requirements were explicitly mandated in Proposition 129’s language. The statute clearly requires licensing, credentialing and program accreditation.

Another misconception equates VPA education with technician programs. But the prerequisites for Colorado State University’s Master’s in Veterinary Medical Care are twice what technician programs require. Applicants must have a bachelor’s degree with required courses similar to veterinary school prerequisites—anatomy, chemistry, biochemistry and more. The coursework itself is graduate-level, identical to what veterinary students take, not the 100-200 level courses in associate’s degree programs.

This isn’t meant to diminish veterinary technicians, who are vital to our profession. But technicians are trained to assist veterinarians, while VPA coursework focuses on case management, pharmacology, toxicology and diseases of body systems—subjects that belong in graduate-level education.

The program spans five semesters, with the first three delivered through sophisticated online education—not your basic webinar but interactive, one-on-one live instruction with physical materials sent to students. Online veterinary education isn’t new; many veterinary students across the country already receive asynchronous online instruction. Before clinical training, VPAs complete over 400 hours of in-person labs at CSU’s College of Veterinary Medicine & Biomedical Sciences to develop technical skills.

The dental training VPAs receive is three times what veterinary students get, and their surgical skills training is nearly identical, excluding orthopedics, which falls outside their scope of practice.

When it comes to liability concerns, veterinarians are already liable for veterinary technicians. Most professional liability insurance policies cover delegation of tasks authorized by the practice act. By legally defining the VPA role, we’re actually helping veterinarians reduce liability. Additionally, one insurance company has already committed to offering liability coverage specifically for VPAs—even before the first ones enter practice.

The path forward

A ballot initiative was not our first choice. We would have preferred to follow a legislative pathway because of the collaboration it allows and the opportunity to bring the veterinary community along. But we attempted the legislative route for three years and were blocked each time. The veterinary establishment wields significant influence in state legislatures, while the people and animals needing help lacked a voice. The ballot measure gave them that voice.

Now we’re focused on creating rules and working with the state veterinary board through a public stakeholder process to establish appropriate guardrails. The nation is watching Colorado, and we’re committed to getting this right. No one wants animals to suffer or practitioners to face undue liability.

Key considerations include determining how many VPAs a veterinarian can supervise, defining which procedures fall outside VPA scope (like orthopedics and most body cavity surgeries, with exceptions for spays to address overpopulation), and establishing regulations for continuing education, licensing and discipline. We’re also developing best practices for integrating VPAs into veterinary teams.

Two significant legal questions remain: creating a veterinarian-client-patient relationship (VCPR) and determining authority to prescribe. Regarding prescribing, we contacted the FDA to ask if VPAs can dispense medications if there’s a standing order for a patient. They responded that the FDA doesn’t enforce such matters—it’s a state-level consideration. Just as regulatory organizations adapted their guidelines when physician assistants (PAs) and nurse practitioners (NPs) emerged in human medicine, veterinary regulations will evolve as VPAs become established.

Learning from human healthcare

Speaking of PAs and NPs, the American Medical Association fought against these roles just as vigorously as the AVMA has fought VPAs. Today, approximately half of human healthcare visits are provided by PAs and NPs. Imagine the state of our healthcare system without them.

Interestingly, liability insurance claims are significantly lower for PAs and NPs than for physicians, likely because they handle less complex cases. While some studies suggest varying outcomes with midlevel practitioners, results largely depend on training, supervision levels and the complexity of care provided.

That’s why we’ve emphasized that VPAs will work under veterinarian supervision. In USDA-designated veterinary shortage areas, indirect supervision may be appropriate, but everything must be properly delegated. We’ll need to track outcomes and improvements in access to care before considering any expansion of the model.

Advice for other states

For organizations in other states considering similar initiatives, I recommend first trying the legislative pathway if you have good influence in your legislature and a supportive executive branch. Our governor was instrumental in helping Proposition 129 succeed.

The pet-owning community already supports increased access to care, especially as costs rise dramatically. As people get priced out of veterinary services for their family members, they’ll find alternatives—sometimes turning to individuals with no veterinary training at all. With the need so great, the profession needs to lead this change rather than resist it.

A path to better pet care

When veterinarians and technicians learn more about VPAs, many of them see the benefits. For veterinary technicians, the VPA role creates a career advancement path where previously they faced a hard stop. In fact, CSU has been overwhelmed with interest from technicians wanting to enroll in their VPA program—there have been hundreds of applicants for just 30 seats in the first class.

Critics argue that there’s no proof VPAs will decrease veterinary care costs. My response? Continuing what we’re doing now clearly isn’t reducing costs either. I know of animal welfare organizations across the country that have stopped building subsidized veterinary care facilities because they can’t hire veterinarians to staff them. We have to do something.

If we can move beyond fear and focus on fulfilling our veterinary oath, we can care for more animals while reducing the moral distress veterinarians experience when forced to refuse care or euthanize animals for economic reasons. The status quo isn’t working. It’s time for a new paradigm, and that paradigm is embodied in the veterinary professional associate.