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Photo courtesy of Judy Aron

When asked to sponsor a bill creating a conditional license for foreign-trained veterinarians, New Hampshire state Rep. Judy Aron didn't hesitate. Aron, here with husband Michael and their dog Sophie, is eager to find a way to address veterinarian shortages in the state.

Targeting a veterinarian shortage in their state, New Hampshire lawmakers are looking to an untapped resource: foreign-trained veterinarians stuck in an overburdened licensing pipeline.

To practice in the United States, graduates of schools not accredited by the American Veterinary Medical Association can earn an equivalency certificate by completing a four-part program administered by the AVMA.

New Hampshire's new law, taking effect Sept. 17, creates a conditional license for veterinarians who have completed three of four parts in the AVMA's Educational Commission for Foreign Veterinary Graduates (ECFVG) program. To maintain the license, they must practice under the supervision of a licensed veterinarian and complete the remaining part — the Clinical Proficiency Exam — within two years with the possibility of a two-year renewal.

The CPE is a rigorous, three-day, seven-section test that encompasses hands-on procedures, including surgery. In recent years, a post-pandemic surge in applicants has caused a backlog for the CPE. Some applicants have waited more than a year to take it. Moreover, since the majority fail at least one part of the exam, the entire process can take years.

More than 2,000 candidates are enrolled in the ECFVG program; they are at varying stages of completion, and not all are actively progressing through the program, according to the AVMA. In 2024, there were 248 seats for the full seven-section test and more than 300 seats for retakes of individual sections.

Proponents of the conditional license hope it will serve as a model for other states struggling with veterinarian shortages and aid foreign-trained practitioners stuck in ECFVG limbo. In the past few years, Utah has passed two laws to help foreign-trained professionals practice in the state. The Utah Veterinary Medical Association said it is attempting to verify whether provisions in either or both laws apply to veterinarians.

The AVMA told VIN News that it supports states providing a contingent credential under circumstances like those delineated in the New Hampshire law, but prefers calling them "temporary permits" to avoid confusion with licensing. (The organization defines temporary permits in its Model Veterinary Practice Act.)

The AVMA believes licensure of any sort for ECFVG candidates should be restricted to those who complete the certification process, according to a statement provided by AVMA spokesperson Michael San Filippo. "The ECFVG program provides a psychometrically sound, legally defensible educational equivalency certification process developed for a reason; the level of education provided to the graduates of nonaccredited, foreign veterinary colleges is highly variable from country to country and college to college," the statement explains. "Conditional licensure is equivalent to an on-the-job training program for veterinarians with no standardization or oversight."

Dr. Claire Lindo, who owns a small animal practice in the southwestern part of the state, pushed for the conditional licensing law.

"We in New Hampshire are struggling with a grossly inadequate labor pool," she said in an email to VIN News. "In my area … we're still down about half of what we had eight years ago, and even then we were looking for additional vets and support staff."

A listing for an associate veterinarian at her hospital last year yielded just a few good candidates and only one who, in the end, was willing to move to the Granite State — a practitioner in Pakistan.

The experience sent Lindo down an immigration law rabbit hole. Around the same time, she read a VIN News story about the stalled ECFVG process. She determined that carving out a conditional license for veterinarians already in the U.S. could yield quicker results than wading into the complicated and politically charged world of immigrant visas.

Lindo wrote the bill and testified for it. "I'm not looking to have unqualified people making mistakes with my patients and clients," she explained. "I am not looking to subvert the ECFVG process in any way, shape or form."

Veterinarians are eligible for the conditional license if they have passed the state veterinary jurisprudence exam and completed the first three ECFVG requirements (credentials verification, English-language ability and a basic clinical sciences exam). Lindo said she intended that the bill require applicants to pass the North American Veterinary Licensing Exam before qualifying for a conditional license. However, the bill makes no mention of the NAVLE.

Lindo posits that having conditional licensees practice under the supervision of a licensed veterinarian would be a win for the equivalency program.

"A conditional license would allow us to legally mentor these foreign-trained vets to be able to pass the CPE without as many retakes," she said. "It's got to be very difficult to prove physical skills when you have not been able to perform them in years. This mentorship should greatly decrease some of the bottleneck, increasing the supply of ECFVG certificate-holders each time the tests are given [and] increasing the sorely needed supply of new vets."

New Hampshire state Rep. Judy Aron, who takes her dog and two cats to Lindo's hospital, agreed to sponsor the bill. As chair of the Environment and Agriculture Committee, Aron said she was aware of veterinary scarcity in the state and eager to help.

"Everybody was for the idea," Aron said. "Why shouldn't someone who has veterinary background be able to work in the clinic until they can pass their exams? The whole exam thing is so costly and onerous."

Aron added that she hopes the measure will also benefit large animal veterinarians, of which there is a "serious dearth" in the state.

The bill passed without opposition.

Meanwhile, Lindo has adjusted her job listing to invite applications from foreign-trained veterinarians who've already moved to the U.S.