Hi, this is Mark Cushing and welcome to the fifth episode of Mark Five: Policy Off Leash, where I try to go through the basics about the issues, policies and questions people have regarding telemedicine in the United States. What you can do, what you can’t do and where it may be going.
In the last episode we talked about Ontario, Canada which has legalized VCPRs through telemedicine and we’ve got the benefit now of the Ontario VMAs summary of what’s happened in two years up there. We put that on our website VVCA.org and I hope you have looked at that. Today we take on a topic that has been the subject of a lot of conversation and some webinars in the US: What role can a veterinary technician play? What are they allowed to do or not do when it comes to telemedicine?
Let’s start with Veterinary Practice Acts. Everyone watching who’s a vet tech or a veterinarian knows that every state has a different Veterinary Practice Act and it regulates how you get to be a vet tech or a veterinarian what you can or can’t do. The main thing about Veterinary Practice Acts, when it comes to vet techs or vet nurses across the country, are what I call the 3 No’s: the three things vet techs cannot do. You cannot perform surgery, you cannot prescribe medications, and you cannot diagnose or offer a prognosis of a condition for an animal, in particular a pet. Nothing with respect to those three no’s is changed by telemedicine.
The other thing that a Veterinary Practice Act does when it comes to vet techs is it looks at the relationship between veterinarians and vet techs. I’ll talk a little bit more about the relationship between veterinarians and vet techs at the end of this video, but practice acts don’t describe everything that tech is allowed to do or not throughout the day. They simply say in the world of medicine specifically, here’s what you can’t do with respect to a veterinarian and here’s what you can do.
There is an infinitely wide world of advice, guidance, and questions to be answered that a vet tech or a vet nurse can provide through telemedicine on almost an unlimited range of topics. Because they have been a vet tech and have been trained in schools as well as trained in practice and they obviously love animals, this makes them a great resource to answer pet owners’ questions. From new pet owners to behavior and the list goes on. There is nothing in a practice act that restricts the vet tech from providing valuable guidance to the pet owner.
It’s important that vet techs and vet nurses know – and it’s equally important that veterinarians understand as well – that if the vet is not using their vet techs and vet nurses to provide that kind of advice, they’re frankly making a mistake. They’re not using their staff to the level of knowledge and skill they have and they are denying pet owners a valuable resource that they would appreciate; as long as you don’t cross the line regarding surgery, prescribing medications, or a diagnosis or prognosis.
Let me finish with one aspect of practice acts that has a connection to the relationship between veterinarians and vet techs. This has to do with supervision. The word supervision is used in virtually every veterinary practice act; it describes across the country with no real difference in definitions three levels of supervision a veterinarian can or should provide over a certified vet tech. Number one is indirect supervision, number two is direct supervision and three is immediate supervision.
Indirect supervision means the veterinarian is not required to even be on the premises for whatever the vet tech is doing with a patient, with a pet or an animal. The veterinarian could be fishing in Alaska but if they are reachable by phone, vet techs can do what they need to do with the patient in the clinic. Those indirect supervision circumstances in some states, like the state of Washington, are spelled out in great detail. The veterinarian can be visible on a screen or visible via phone and that’s adequate for telemedicine circumstances.
Direct supervision means the veterinarian is on the premises. One may ask, is the purpose of being on the premises so that the vet tech can ask questions and get the advice of the veterinarian? Or is it because there may be something occurring to the pet that is life-threatening, and you want the veterinarian to be in the room? If you see it the latter way, telemedicine doesn’t fit. If being present could mean live video, would that satisfy the test of direct supervision? This could be tested in the next few years; no one’s ever been asked at a state board level to answer that question as of right now.
The third category, immediate supervision, means what it sounds like. The veterinarian is in the room. This circumstance often involves surgery where there’s anesthetic procedures going on and the veterinarian needs to be right there. Telemedicine doesn’t fit in that circumstance obviously.
So, what did we learn? Practice acts define and limit, but they do not cover everything that vet techs can do. Vet techs have knowledge and can provide guidance on a range of topics to pet owners and it should be encouraged. Pet owners will not only welcome it, but they will also pay the practice to have that service. Lastly, the levels of supervision may be able to involve telemedicine except for the case of immediate supervision and in some circumstances, direct supervision.
I hope this has been helpful we’ll see you next week on Policy Off Leash, this is Mark Cushing.
If you want more information or even more fun to engage in an extended conversation with your colleagues about these issues, go to the veterinary virtual care association or VVCA.org website where our 3,600-member strong organization is engaging on all topics that concern telemedicine and virtual care for veterinary practices. Not just limited to the policies I’m discussing but how do you use it best, how do you implement it, how do you train your staff, what are the proper roles for all the staff members, and actually how pet owners have reacted to it. We’ll see you next week, thanks.