Colorado voters

Photos courtesy of subjects

These and other Colorado voters talked to the VIN News Service about a state proposition to create a midlevel veterinary practitioner. Clockwise from upper left are Chelsea Hopkins, Jeremy Rietmann, Jody Travis, Vicki Kerr, Stephen Ramsey and Carly Rietmann (center).

In a big test of an idea that's causing consternation among many veterinarians, voters in Colorado are being asked to decide whether to create, for the first time in the United States, a role called a veterinary professional associate, or VPA.

The question is encompassed in Proposition 129, one of 14 ballot measures being decided by Coloradans, who began receiving ballots by mail on or around Oct. 12. All votes must be cast by Nov. 5.

The VPA's role is generally envisioned to include tasks that have been restricted to veterinarians, such as diagnosing conditions, performing minor surgeries and providing prognoses — albeit under a veterinarian's supervision. It is often compared to nurse practitioners or physician associates in human medicine.

Supporters say VPAs will take pressure off overburdened veterinarians, who can delegate more tasks and, as a result, provide more access to care. Critics say delegating veterinarians' tasks to less educated and experienced individuals will put animals at risk and devalue the role of veterinarians.

The concept of creating a midlevel practitioner in veterinary medicine has been around for decades. However, the recent development of master's degree programs to educate future midlevel professionals and a failed bill to create a VPA in Florida have added vigor to the formerly hypothetical discussion.

In human medicine, advanced practice providers were defined in state laws through legislative and regulatory wrangling beginning in the 1960s. Putting a professional credential to a direct public vote is unusual — possibly unprecedented.

What do people with no professional or financial stake in veterinary medicine think about whether to fundamentally reshape clinical care teams?

To find out, the VIN News Service communicated this month with 13 Colorado voters with no direct connection to the profession. They offered their impressions of Prop. 129 as ballots were arriving in their homes.

Most of the voters in VIN News' sample didn't know about the proposition until they were approached for an interview. The majority read up on the measure before being interviewed or answering email questions.

The access to care argument

In an election cycle famous for the blizzard of campaign ads, only one person reported seeing Prop. 129 promotional materials anywhere.

Vicki Kerr, a 59-year-old photographer, received an email urging a "yes" vote from the Dumb Friends League, the local shelter organization that is the lead sponsor of the measure.

Kerr said the organization's pitch that a VPA would allow practices "to provide more services for people who are unable to afford them" was persuasive.

Living in the Denver metro area, she said she's never had difficulty getting a veterinary appointment. "But I can see how it might be a problem in other places," she said. "I would hope something like this would become helpful."

She planned to vote "yes" on the measure, though she expressed concern about possible impacts on veterinarians. "People need to be paid properly for all their credentials," she said. "I hope this wouldn't lessen the profession."

That's one of the concerns motivating Carly Rietmann, 42, to vote against the measure. "I would oppose this because I think it devalues the expertise and years of hard work that go into becoming a DVM," she wrote in an email to VIN News.

Rietmann, the senior services manager for a county public health department in the mountain town of Eagle, has a couple of close friends who are veterinarians. "I wouldn't want this diluting their profession and undermine the years of hard work they spent obtaining their skills and expertise."

She added that she doesn't believe a "lack of vets" is an issue in the state.

Denver resident Chelsea Hopkins, 32, is leaning toward yes "after going back and forth on this for a while."

"To me, the access to affordable veterinary care is the most important aspect here," she said in an email. One factor in her decision was what she called an "alarming" finding in a 2023 study by Colorado State University's Animal-Human Policy Center. In response to a survey, 71% of practice owners or managers reported that they had to divert clients weekly or more often "because they can't fit them into their schedule or address their condition in a reasonable time frame."

(CSU's College of Veterinary Medicine and Biomedical Sciences began nearly 10 years ago developing a master's degree that would qualify graduates for what has come to be known as the VPA.)

"If this new role opens up the ability to serve more clients in a timely manner, I believe that would be overall beneficial to pet owners in Colorado," said Hopkins, who has two cats and plans to get a dog soon.

The idea of improving access to and the affordability of veterinary services carried the day for most of the "yes" voters who talked to VIN News.

Jody Travis, 58, who lives in Grand Junction, had another reason for supporting the measure. She believes the additional tier could open more possibilities for young people interested in veterinary medicine but not ready to jump into veterinary school.

"It's nice when there are levels," she said. "It gives people a way that might allow them to proceed gradually."

Travis, who works in land acquisition for the state transportation department, made clear she was offering personal opinions. At the time of the interview, she had just started her research. "I read through the pros and cons," she said. "There didn't seem to be any cons."

Next, she'll go through the state's ballot booklet with her husband and talk to friends. She'll also ring up her stepfather, a retired veterinarian. "I'm interested in what he has to say," she added.

CO_Info_booklet

Photo by Hailey Van Wormer

Colorado's 2024 state ballot information booklet began arriving in homes in early October. The 110-page guide covers 14 measures, including a constitutional right to abortion, a prohibition on bobcat, lynx and mountain lion hunting, and the creation of a midlevel professional role on veterinary care teams.

Why is this a citizen initiative?

Stephen Ramsey, 72, a commercial photographer and videographer in Denver, said he usually starts his voting research looking "at who's for it and who's against it." From Ramsey's perspective, the fact that Gov. Jared Polis, whom he respects and calls "a common sense guy," endorsed the measure is a point in its favor.

The idea of a VPA reminds Ramsey of nurse practitioners. "I generally think that's a good idea," he said. "I think they are typically well qualified to diagnose and understand less complex and less severe [conditions]. At first blush, that seemed like that might be a good thing for animal owners, as well."

He added that he understands the opposing point of view that VPAs "don't have the depth of training as a doctor of veterinary medicine, and they might miss something."

He also pondered the uniqueness of the proposition, saying, "I don't know if I've ever seen a proposition that has so many ramifications for an important profession."

Several voters questioned the idea of reshaping a profession via a direct vote.

"My initial instinct, is I'm going to vote 'no' because this is why we have a state legislature," said Jeremy Rietmann. "They are there to pore through the pros and cons."

Rietmann, 41, is the manager of the mountain town of Gypsum and husband of Carly Rietmann, who is quoted earlier in this article.

"The whole process for something this complicated is wrongheaded," he said. Using the initiative process in cases like this one "often end up with policy that is poorly informed … and then you have to make it make sense on the back side."

Prop. 129 leaves many details to be sorted out by regulators, including adopting rules necessary for the practice and supervision of VPAs. In addition, the measure calls on the state veterinary medical board to approve a nationally recognized credentialing organization and require a national exam, neither of which exist.

The lack of fine-print regulations also concerns Christina Baker, 61. A nurse, Baker rattled off a list of questions about how VPAs will be trained and regulated. She had already voted "no" when she talked to VIN News on Oct. 20.

"There needs to be clear boundaries about what they can and cannot do," she said, adding that it likely means a lengthy legislative process.

"I realize it's frustrating, but it's set up for a reason," she explained. "Advanced practice providers in human medicine work because they are heavily regulated."

Another factor facing Colorado voters could be ballot measure fatigue. The 14 state measures up for a vote are just the start. There are more than a dozen local measures plus candidates to be decided. The free voter guide for state ballot measures alone is 110 pages long. That's longer than Penguin Books' Of Mice and Men.

Several sources said they couldn't remember Colorado having this many measures on the ballot.

"It's terrible," said Ann Voshall, 88, a retired teacher and entrepreneur living in Lakewood, a suburb of Denver. "It's too much stuff for a normal person to look at."

Despite the tall order, Voshall said she plans to do her homework, which she started mid-interview by peppering this reporter with questions of her own.