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An ethicist's commentary on veterinary "nurse practitioners".

Throughout the history of this column, I have strongly expressed the opinion that technicians may perform procedures on animals only when supervised by veterinarians. I have taken “supervised” fairly literally to mean that the veterinarian should be close enough during the procedure to jump in if something unexpected goes awry. 
 
This issue came up most recently regarding on-farm procedures at night or under blizzard or other arduous weather conditions. I reiterated my position, but later heard some relevant new information from a number of veterinarians. Apparently a generation ago, such unpleasant tasks devolved upon the most junior member of a practice. Today, I am told, that culture has changed, and junior veterinarians won't willingly undertake such work. 
 
If that is indeed the case — but only if that is indeed the case — we are dealing with a new playing field. If veterinarians who are willing to do such work cannot be found, other arrangements must be made, and we must be willing to flex. 
 
The concept of the nurse practitioner is an interesting one, and seems to be working well in human medicine, particularly in rural areas that are underserved medically. Such a person is trained to perform some of the tasks usually done by a physician, and thus brings a certain amount of professional health care to a venue that might well otherwise do without any medical care at all. 
 
Could such a compromise work in veterinary medicine? It would depend on the training undergone by such a person, on a high degree of quality control, and on rigorous certification, but it could be done. Would it serve veterinary medicine well? Certainly, if indeed veterinary practitioners are unwilling to perform such tasks. I personally believe that it would be better if they did, rather than to create a whole new layer of professional designation, but this is unlikely to happen. So we need to think about “supertechs.” The most fundamental question, of course, is what sort of education they would receive. If their training in surgical procedures was merely rote, they could not respond to emergencies. On the other hand, it is hard to see how they could get adequate surgical training to cope with emergencies when there is trouble in training veterinary students in this area! I would like to look at a putative curriculum, but would do so with healthy skepticism. Let us also remember that nurse practitioners do not remove testicles and these “tech practitioners” would. 
 
The question before us reminds me of a suggestion made to me by a friend who is a veterinary school dean. Given the acute shortage of human medical professionals in rural areas, why could not veterinarians be trained to back up physicians, much in the manner of a nurse practitioner? Except for liability issues, this strikes me as a good idea, since both veterinarians and physicians are similarly educated. In fact, the first 2 years of medical and veterinary school are virtually the same. Veterinarians could certainly deal with wounds, lacerations, abrasions, contusions, and fractures — tissue is tissue. Both understand (or are presumed to understand) the biology behind medicine in a more significant way than a technician would. 
 
I applaud the interim report recently issued by task force of the Council of the College of Veterinarians of Ontario, which task force stresses the need for proper certification and training and also suggests limits on what such paraprofessionals may do. This should initiate a healthy dialogue in the veterinary community. 
 
I am grateful to Tim Blackwell DVM for dialogue.