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Steering a Middle Course

Lincoln Memorial’s pilot program for midlevel professionals is a crucial response to chronic shortages of veterinarians and technicians.

Steering a Middle Course
The creation of a midlevel professional is a growing debate in veterinary medicine.

Two major challenges confront U.S. veterinary medicine in the face of unprecedented demand for pet health care. The first is the acute shortage of veterinarians. The second is the acute turnover issues involving credentialed veterinary technicians/nurses, who are chronically underpaid by practices and have few pet-related alternatives. Both challenges have a single solution: Follow human medicine’s 50-year path of creating midlevel professionals. Human health care has faced shortages for decades, and they would have been catastrophic, even unimaginable in scope, if midlevel professionals had not arrived on the scene to relieve MDs and RNs.

PAs and NPs

Consider the human precedent as we debate the value of taking the first step, in 2022, of creating a veterinary midlevel professional. In the mid-1960s, physicians and educators recognized a shortage of primary care physicians. Dr. Eugene A. Stead Jr. of the Duke University Medical Center put together the first class of physician assistants in 1965, and they graduated two years later. Today, the United States has over 140,000 indispensable physician assistants. They often serve as the senior professional at rural hospitals, where without PAs, there would be no care.

Also in 1965, the nation’s first nurse practitioner program was created by Loretta Ford and Henry Silver at the University of Colorado. Today, more than 325,000 NPs are licensed in the United States, and more than 36,000 completed their academic programs in 2019-2020.

If you are reading this article, you embrace the human health care delivery model because you have seen these professionals. They take care of you and your loved ones. How often does someone complain that a friend or colleague had to see a PA or NP?

Did MDs resist efforts to add PAs and NPs to America’s health care rosters? MDs opposed osteopathic physicians when they arrived, but the anti-competitive opposition was overcome, thank goodness. Can you imagine where we’d be if the early MD resistance had prevailed?

Veterinary medicine has the opportunity now to answer this question: Should we resist the creation of midlevel professionals at the urging of some veterinarians, or do we provide credentialed veterinary technicians/nurses with an attractive career ladder by developing medically trained professionals to work with veterinarians and ameliorate the effects of chronic shortages?

Pet owners are crying for veterinary care, yet practices have reached or exceeded their capacity. Team-based care is embraced in every health profession, yet veterinarians seem reluctant to empower all team members with more trust, responsibility, power and skills. If they did, pets would win, and the veterinary team would get home earlier for dinner. Still, large organizations dismiss the idea of a midlevel professional as unnecessary. Let’s explore.

Sink or Swim

While COVID-19 arrived like a hurricane in driving demand for veterinary care, waves were building over the past decade. Baby-boomer veterinarians began to retire, the culture of pet nation took hold, and pet owners wanted more from the veterinary health care system, including more visits and elevated standards of care. In addition, they were willing to pay for it. Meanwhile, veterinary practices struggled with veterinary technician/nurse turnover and stubbornly refused to address compensation and skill-utilization issues. We were headed toward a perfect storm.

The veterinary system has held fast to a two-tiered professional track. DVMs generally complete eight years after high school. For veterinary technicians/nurses, some 200-plus programs, often through community colleges, award two-year associate degrees. A handful of colleges offer four-year veterinary technician degrees to a small cohort of students.

Put simply, we have credentialed veterinary technicians/nurses and veterinarians and very little in between, unlike human health care.

Coming Soon to LMU

In 2019, the Veterinary Innovation Council (VIC) turned its attention to the possibility of master’s degree programs at veterinary medical schools that would create a veterinary version of the physician assistant or nurse practitioner. Acknowledging the political challenges of creating another licensed professional, such as a veterinary nurse practitioner, VIC urged the development of pilot programs.

At the same time, the Lincoln Memorial University College of Veterinary Medicine, under then-dean Dr. Jason Johnson, outlined a new program that has morphed under the current dean, Dr. Stacy Anderson, into the initial pilot for a master’s in veterinary clinical care — the sort envisioned by VIC. The program will launch in 2022 and is expected to attract high-performing credentialed veterinary technicians/nurses whose tuition would be funded by veterinary practices and organizations. LMU anticipates a one-year, three-semester program costing $25,000 and conducted online so that students can continue working and do clinical training at their practices.

Fortunately, veterinary colleges do not face accreditation barriers to offering such master’s degrees, provided the university’s accreditation authorizes them. Nor will veterinary practice acts and veterinary medical board regulations serve as barriers. All this is an opportunity for the marketplace to embrace and help co-create a value-added provider to the veterinary profession.

An Opportunity to Specialize

Holders of the master’s in veterinary clinical care will deliver at least two things of high value to their practices:

  • Manage the overall care delivery system and non-veterinarian team, allowing veterinarians to practice medicine as they are trained to do.
  • Work up cases in smaller practices, shortening the time a veterinarian usually needs to treat a patient.

Smaller practices have difficulty matching the starting salaries of new veterinarians, so master’s degree holders will be useful instantly. Students enrolled in the LMU program will take gross anatomy, physiology and pharmacology alongside veterinary students. A small core curriculum will allow master’s students to track in their areas of interest, such as:

  • Small animal general practice
  • Small animal specialty/surgery
  • Small animal emergency
  • Shelter medicine
  • Diagnostic, nutrition and pharmaceutical industry medicine
  • Equine
  • Food animal

They also will log other skills and competencies. Additional courses will highlight communication, leadership and management. Most of the graduates could smoothly step into more senior roles at their practice or organization.

The pet health care industry is in the mainstream news daily. It’s poised to grow, but shortages threaten our future. Nearly 60 years of the midlevel professional “experiment” in human health care surely has proven its value, so let’s hope the veterinary establishment doesn’t stand in the way of pilot programs.

Politics & Policy columnist Mark Cushing is a political strategist, lawyer, founding partner of the Animal Policy Group and founding member of the Veterinary Virtual Care Association. Since 2004, he has specialized in animal health, animal welfare, and veterinary educational issues and accreditation. He is the author of “Pet Nation: The Inside Story of How Companion Animals Are Transforming Our Homes, Culture and Economy.”


In 2020, the median annual pay for physician assistants was $115,390, according to the U.S. Bureau of Labor Statistics. That compares with $117,670 for nurse practitioners.