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Skilled technicians are being asked to perform more patient services than they may be comfortable with or legally permitted to do
Editor’s note: All names and businesses in this dilemma case are fictitious, but the scenario is based on real occurrences.
Hope Veterinary Hospital was very busy. The COVID-19 pandemic added to this, but the facility attempted to care for patients in the most efficient way possible.
Capable technicians, use of an online pharmacy, and telemedicine all maximized efficiency and production. It was not unusual to see as many scheduled technician appointments as there were appointments with the veterinarians. These appointments consisted of follow-up vaccinations, laboratory tests, and bandage changes. Additionally, there were postsurgical wound treatments such as cold laser therapy and suture removals. All these procedures were ordered and supervised by a veterinarian on duty.
The Hope Veterinary Hospital veterinary technicians were highly skilled. In many cases, they were essentially acting as nurse practitioners. This hospital was in a state where the role of the veterinary technician was largely defined by the licensed veterinarian’s supervision and discretion. The technicians were prohibited from practicing veterinary medicine, which required a license and a veterinary degree. However, they could perform many medical tasks under the direct supervision of a veterinarian. This led to excellent pet care, yet some felt they might be pushing the envelope.
Recently, 2 staff technicians asked to meet with the hospital director. They wanted to speak about the scope of their responsibilities as technicians. These technicians had observed, as the clinic got busier, that they were doing more medical care. They felt this was drifting into the area of practicing veterinary medicine as opposed to technically assisting the medical staff. The hospital director asked for specific examples. One of the technicians remarked that it was not unusual while they were polishing teeth during a dentistry appointment to be asked to remove a tooth that was loose and ready to fall out. The veterinarian had authorized this, but they were not comfortable with the extraction. The other technician noted that all vaccinations in their state, except rabies, had to be administered by a licensed veterinarian. Nevertheless, to save time, technicians were told to give the other vaccines along with the rabies vaccination. Finally, a technician saw what she felt was a classic hot spot on the outside of a dog’s rear leg. She described it to the veterinarian. He instructed her to clip it, clean it, and prescribe a 7-day course of amoxicillin and clavulanate potassium tablets (Clavamox; Zoetis).
The hospital director took the technicians’ comments very seriously. Directives for the practice of veterinary medicine in their state gave licensed veterinarians broad latitude. Veterinary technicians did not have individual state licenses but rather worked under the direct supervision of a licensed veterinarian. As a result, the consequences of any actions taken by a veterinary technician were directly attributed to the supervising veterinarian. However, the definition and practice of veterinary medicine was delineated in the state’s practice act. Examples mentioned by these technicians clearly came under the category of a “slippery slope.”
The hospital director had a meeting with the veterinary staff and described the technicians’ issues. The doctors were a bit defensive. They felt, as licensed veterinarians with the right to supervise their veterinary staff, they were not in violation of any practice act dictates, but if any technician felt uncomfortable performing a supervised treatment, they could decline without fear of consequence. The hospital director felt that this was an acceptable compromise. In the end, if necessary, the ultimate arbiter would be the state board.
Do you feel the veterinarians were overstepping their supervisory duties by allowing the technicians to engage in these “medical procedures?” We would like to know.
In a modern, progressive practice, skilled technicians are essentially nurse practitioners. Some states license veterinary technicians, whereas others do not. Nevertheless, a licensed veterinarian must oversee all medical care, and see that all patients are conscientiously cared for. A practice being busy is not a reason to have care that should be rendered by a veterinarian shifted to a technician. The veterinarian and the technician are a team. The state’s practice act outlines its responsibilities. If the team then acts in the best interest of the patient, they are ethically meeting their responsibilities.
Marc Rosenberg, VMD, is director of Voorhees Veterinary Center in Voorhees, New Jersey. Although many of the scenarios Rosenberg describes in his column are based on real-life events, the veterinary practices, doctors, and employees described are fictional.