The Veterinary Mid-Level Practitioner Debate

The veterinary profession has been arguing about the mid-level practitioner for the better part of a decade, and we’ve made almost no progress. In November 2024, Colorado voters passed Proposition 129 by ballot initiative, creating the veterinary professional associate — bypassing the American Veterinary Medical Association, American Animal Hospital Association, and Colorado Veterinary Medical Association, all of which opposed it.

The National Association of Veterinary Technicians in America held a formal listening session in March 2026 and officially declared that they do not support the current VPA/MLP model. AAHA’s October 2024 position statement called it a threat to patient safety. Every major veterinary organization has lined up against it, and yet the problem the role was supposed to solve — companion animal access to care, especially in rural communities — hasn’t gone anywhere.

We’re Asking the Wrong Question

I want to suggest that the debate is stuck because we’re asking the wrong question.

For the past 10 years, the mid-level practitioner conversation has been framed as a clinical scope question. “Should someone who isn’t a veterinarian diagnose, prescribe, and perform surgery?” Every time that question is asked, the answer from the profession is the same: No. And the answer is defensible. Patient safety matters. Scope of practice laws exist for good reasons. Veterinarians spent eight years earning the credentials that entitle them to clinical decision-making authority, and that authority should not be given away lightly.

But what if the mid-level practitioner role isn’t clinical at all?

I spent 25 years as a credentialed veterinary technician across multiple hospitals and three years running a communal cat adoption space in Northern California called Chico Cat Café. I am currently completing my Master Shelter Care Specialist credential through the UC Davis Koret Shelter Medicine Program. Throughout my years of experience, I have watched:

• Rural families drive two hours to vaccinate their cats
• Under-resourced shelters euthanize animals that could have been saved by basic preventive care
• The veterinary workforce shortage worsen year over year without a meaningful solution emerging from inside the profession

Here is what I’ve come to believe: The real gap in veterinary access isn’t clinical scope expansion. It’s community presence.

Rural communities don’t need someone who can do the same work a veterinarian does, just faster and cheaper. They need someone who can be there consistently for prevention, education, behavioral assessment, referral coordination, and the ongoing welfare monitoring that traditional clinic-based medicine simply cannot provide at the distances these communities face. They need what human medicine calls a public health nurse.

The Infrastructure Question

The “public health nurse” role already fits within the existing credentialed veterinary technician scope. Vaccines, parasite prevention, nutrition counseling, wellness screening, behavioral assessment, client education, documentation, triage, and warm referrals — every one of these activities can be performed by a credentialed veterinary technician today, in any state, under veterinary supervision. With modern telemedicine, supervision can be remote. No scope of practice change required. No ballot initiative. No opposition to overcome.

What’s missing isn’t the legal authority. What’s missing is the infrastructure.

Consider the community-based animal health worker model. Used in more than 25 countries and recognized by the World Organisation for Animal Health, community-based animal health workers provide basic animal health services in remote areas with veterinary oversight. In the countries where they operate, they have dramatically improved livestock health outcomes in communities that would otherwise have no access at all. The model works. It just hasn’t been adapted for U.S. companion animals.

Consider James Rodgers’ Mission Pawsible in British Columbia, where prefabricated veterinary hubs ship to rural and Indigenous communities and assemble into kennels, exam rooms, and supply depots. Consider the Asheville Humane Society mobile vet care research published in 2021, which showed that positive first experiences led owners to seek future veterinary care independently. Consider that 72% of nonprofit veterinary organizations report being short-staffed for both veterinarians and support staff, and 51% face client wait times of two months or longer.

The pieces of the solution exist, but no one has assembled them.

This is where the mid-level practitioner debate could move forward if we let it. We shouldn’t be asking, “Can non-veterinarians practice clinically?” Instead, we should be asking, “What infrastructure do underserved communities need, and who is the workforce that staffs it?”

So, what infrastructure do underserved communities need? They need permanent, community-embedded veterinary health posts — fixed sites in small towns and mobile units in dispersed rural areas — that provide prevention, education, behavioral assessment, and triage under veterinary supervision. Call it a veterinary outpost. Call it a community animal health center. Call it whatever makes sense for the setting. The label is less important than the function.

And, who should staff these posts? Credentialed veterinary technicians with additional training in community health, supervised by veterinarians with public health credentials who provide remote oversight across multiple sites. This workforce already exists in embryonic form. What it needs is a credential that recognizes the additional competencies required for community-embedded work — something along the lines of a certified community animal health professional, deliverable through existing credentialing infrastructure like the Association for Animal Welfare Advancement.

A Model That Sidesteps the Current Debate

This model sidesteps every objection raised against the current MLP proposal. It requires no state practice act changes. It doesn’t threaten veterinarians’ scope or revenue. It doesn’t put non-veterinarians in positions requiring clinical judgment they aren’t trained for. And it creates referrals to private practice veterinarians rather than competition with them — relieving them of routine preventive work they’re drowning in, so they can focus on the intensive medicine they went to vet school for.

The Georgia VMA listed five barriers to the MLP:

1. U.S. Food and Drug Administration prescribing authority
2. U.S. Department of Agriculture accreditation
3. State practice acts
4. Competency evaluation
5. Salary projections

The community health veterinary practitioner model triggers zero of these barriers.

Rethinking the Problem

We need to change how we think about the problem. It’s not a scope problem; it’s a public health problem. It’s not a credentialing fight; it’s an infrastructure investment. It’s not a threat to the profession; it’s an expansion of the profession’s reach.

I don’t know what organization or coalition will take this up first. What I do know is that the mid-level practitioner debate, as currently framed, has failed the communities it was supposed to serve. After arguing about clinical scope for 10 years, we still haven’t put a single new veterinary professional into an underserved rural county.

Maybe it’s time to ask a different question and start making progress.

BY THE NUMBERS

• 72% of nonprofit veterinary organizations report being short of veterinarians and support staff.
• 51% face client wait times of two months or more.
• 118,000+ credentialed veterinary technicians currently practice in the United States.
• 25+ countries operate community-based animal health worker programs recognized by the World Organisation for Animal Health.