Carolyn Henry, DVM, MS, DACVIM (oncology)

Dr. Carolyn Henry is a professor of oncology at the University of Missouri College of Veterinary Medicine and director of the Research Center for Human-Animal Interaction. She served as dean from 2018 to 2023 and sits on the board of the Kansas City Animal Health Corridor, as well as the Veterinary Technology Advisory Committee for Moberly Area Community College. Dr. Henry is a past president of the ACVIM Specialty of Oncology. The views expressed in this article are her own.

I came up through the “old school” system of veterinary medicine, which shaped my perspective in a particular way. I tend to enter conversations as a bit of a naysayer—but with an open mind. That’s exactly how I approached the concept of veterinary professional associates (VPAs) when I was asked to participate in a deans’ advisory group that explored the subject in 2022 and 2023. Full disclosure: they may have appointed me specifically because they wanted some healthy skepticism at the table.

But here’s the thing about polarizing topics in veterinary medicine: they deserve more than knee-jerk reactions. They deserve conversation.

What are we afraid of?

Panel discussions about midlevel practitioners often feature passionate voices from both sides. The AVMA feels strongly about its position. Corporate practice representatives have their views. Independent practice owners worry about their future. And somewhere in this cacophony of concern, two fundamental questions get lost: What problem are we trying to solve? And what are we afraid of?

Until there’s agreement on these basic issues, finding a solution remains elusive.

The fear seems at least partially rooted in the growing tension between corporate practice and privately owned practices. A sort of conspiracy theory has emerged that this is simply a move by corporate America to hire less expensive veterinary care providers and generate higher profit margins. Would a midlevel practitioner accomplish that? Yes, in many regards.

But in my experience, that’s not the main impetus for these discussions. The conversations began with genuine concerns about access to veterinary care. While the reasons pets don’t receive the care they need are multifaceted, the initial intent behind the VPA role is likely purer than it’s been portrayed.

A shortage of evidence

At the core of the debate lies the question of whether there is or isn’t a shortage of veterinarians. The profession simply can’t agree. Studies funded by Mars suggest a shortage is coming.¹ Studies funded by the AVMA insist otherwise.² A study commissioned by the AAVMC points to “a severe and growing unmet need for veterinarians in coming years.”³ While these organizations all used independent researchers, questions of bias are still inevitable. And then there are those who focus on the differences between “shortage” and “scarcity” and the implications for veterinary wages.

As the debate continues, the solution isn’t to retreat to our respective corners. At some point, the profession needs to come together, sit down, and genuinely work toward solutions. Because regardless of where one stands on midlevel practitioners, several crises demand attention:

• Technicians don’t stay in their jobs, much less in veterinary medicine, for long.
• Certain geographical areas truly have shortages of veterinarians.
• Access to care remains a significant issue in many communities.

The bigger picture

As animal health professionals, our focus should be on what’s best for animals: ensuring they’re vaccinated, meeting their basic needs, and providing appropriate spay and neuter services to address overpopulation. These are the questions that should drive the conversation—not squabbling over pieces of an increasingly shrinking pie.

With veterinary visits declining and costs rising, perhaps the question isn’t whether VPAs will take business away from veterinarians. Perhaps there’s a whole population of pet owners not currently seeking veterinary care who might be more likely to do so if there was an entry-level point with a midlevel professional. In fact, the recent PetSmart Charities and Gallup study showed that >50% of pets receive no veterinary care.⁴

Is the answer to churn out more small animal veterinarians? Probably not, although the studies have focused on shortages of veterinarians serving companion animals. A more tactical approach would examine where the shortages are most acute—rural medicine, food animal medicine and other underserved sectors—and create educational pathways that address those specific needs.

Let’s not forget that while the veterinary profession debates, states are making their own decisions. Colorado and Arkansas have already launched a midlevel practice role to be written into their practice acts. It doesn’t matter what we think as veterinarians if legislators or public initiatives decide they want these changes.

Preparing the next generation

In veterinary education, there’s a growing emphasis on teaching students to effectively utilize the entire veterinary team. This includes ensuring technicians are appropriately recognized for their training and skills. In many practices, the term “veterinary technician” is applied to individuals without formal training, which can be frustrating to those who have completed rigorous education and credentialing programs.

The profession needs to codify what these titles mean and how they’re applied across the country. And if VPAs become a reality, questions about certifying boards and skill differentiation from registered vet techs or vet tech specialists must be addressed.

Creating a career ladder matters too. In my view, one promising model involves partnerships between veterinary teaching hospitals and community colleges to provide clinical training for veterinary technician students in associate degree programs. Once credentialed, these technicians could transfer credits toward an online bachelor’s degree completion program—ideally with support like tuition discounts for those working in teaching settings. This kind of pathway can open doors to master’s programs and even teaching opportunities, giving technicians clear avenues for growth rather than professional dead ends. A VPA role could further expand those career options.

Finding the guardrails

During discussions about potential VPA responsibilities, two areas have prompted extensive debate: establishing the veterinarian-client-patient relationship (VCPR) and performing surgeries.

The VCPR has “veterinary” right in the name, which in my view suggests it should be established by a veterinarian. As for surgeries, it’s been proposed that VPAs can perform “uncomplicated spays”—but an uncomplicated spay can quickly become complicated, leaving a midlevel practitioner potentially unqualified to handle the situation.

Could a VPA be trained to perform spays in a shelter medicine setting with a veterinarian present? Yes, and that might efficiently address overpopulation issues. But the fear centers on independent practice—if midlevel practitioners can establish VCPRs, prescribe medications and perform surgeries, what distinguishes them from veterinarians?

It’s worth noting that proposed models require VPA supervision by a veterinarian, with the veterinarian ultimately liable for anything that goes wrong. If that responsibility seems too burdensome, a practice owner can simply choose not to hire VPAs. And if a corporate practice decides to employ three VPAs for every veterinarian, making the veterinarian responsible for all outcomes, perhaps that’s not the right setting for that veterinarian.

The human medical profession offers cautionary tales. Recent lawsuits have highlighted instances of nurse practitioners and physician assistants working beyond their capabilities, creating patient safety concerns.^5,6 If veterinary medicine pursues this path, examining these warnings and crafting appropriate guardrails becomes essential.

While veterinary medicine often looks to human medicine as the “older sibling” to emulate, human healthcare faces its own unresolved challenges—from insurance complexities to access issues and determining appropriate expertise levels. Perhaps this presents an opportunity for veterinary medicine to lead rather than follow.

The path forward

During my deanship, I hardly recall a week when I didn’t get calls from alumni struggling to hire veterinarians. In many practices, efficiency could improve dramatically with a system recognizing the skillsets of credentialed veterinary technicians, veterinary technician specialists, VPAs and other team members, with everyone understanding their role and how to collaborate effectively.

The profession would benefit tremendously if advocates from both sides could simply sit at the table and have a civil conversation. Success doesn’t necessarily mean changing minds but fostering understanding through respectful dialogue. The polarization helps no one—not veterinarians, not technicians, and certainly not the animals in our care.

The path forward requires moving beyond fear, beyond territorialism, and toward a collaborative approach that acknowledges legitimate concerns while focusing on the ultimate goal: providing the best possible care to animals in a sustainable veterinary ecosystem. In the end, validation of VPAs will rest on whether they are hired and retained.

References

¹J.W. Lloyd, “Pet Healthcare in the U.S.: Another Look at the Veterinarian Workforce,” Mars Veterinary Health, 2023, www.marsveterinary.com/media/uploads/2023/08/Characterizing-the-Need.pdf.

²Malinda Larkin, “No Dire Shortage of Veterinarians Anticipated in Coming Years,” AVMA News, October 4, 2024, www.avma.org/news/no-dire-shortage-veterinarians-anticipated-coming-years.

³Robert J. Gitter and Joseph A. Meek, “Demand for and Supply of Veterinarians in the U.S. to 2032,” AAVMC, June 2, 2024, www.aavmc.org/resources/demand-for-and-supply-of-veterinarians-in-the-u-s-to-2032.

⁴Gallup and PetSmart Charities, “State of Pet Care Study: Pet Parents’ Assessment of American Veterinary Care,” 2025, www.gallup.com/analytics/659123/gallup-petsmart-charities.aspx.

⁵Monica Ludwick, “Supervision Under Scrutiny: Navigating Physician Assistant Accountability,” Cooperative of American Physicians, November 26, 2024, www.capphysicians.com/articles/supervision-under-scrutiny-navigating-physician-assistant-accountability.

⁶Stephanie Srakocic, “Jury Awards $1.4 Million Verdict Against Philadelphia Nurse Practitioner Who Failed to Treat Hyperthyroidism,” MDLinx, August 30, 2023, www.mdlinx.com/article/jury-awards-1-4-million-verdict-against-philadelphia-nurse-practitioner-who-failed-to-treat/5JRnJUQRtuGTvFuRIZGyiz.