Seven Questions for AVMA President-Elect Candidates
The TVMA Executive Committee will be voting in June for the AVMA President-Elect. TVMA posed seven questions to each candidate, and their responses are below. If you have comments regarding the candidates that you would like the Executive Committee to take into consideration prior to voting, please email info@tvma.org.
Learn more about the candidates online:
Dr. Grace Bransford: https://graceforavma.com/meet-grace
Dr. Rena Carlson: https://www.renacarlson4avma.com/
1) What are your views on the mid-level health provider in veterinary medicine?
Grace Bransford:
For the students in the current mid-level veterinary health provider program, unfortunately, they seem to be on a ship that has nowhere to sail. There is currently no licensure in any state for their credential. The bigger issue is that we are currently under-utilizing the wonderful, committed veterinary assistants and technicians (RVTs/CVTs) in our profession.
We must first ensure that we are giving veterinary assistants and RVTs/CVTs the work they are allowed to do to the full extent of the regulations of their given state.
We have to look long and hard at how we distribute and manage the work flow in our practices. We have the resources in our people to increase the capacity and quality of the work we do in practice. Until we first give veterinary assistants and RVTs/CVTs the permission and tools to maximize their work tasks in the practice to the full extent of the capabilities their certification or licensure allows them, we are underusing a very valuable resource.
That said, I do not support the mid-level veterinary health care provider until the time it may be truly needed. That means we must examine the workflow optimization issue very carefully and put it to use. The end result should be that our veterinary staff are working at their highest ability allowed by their state, and feeling fulfilled and happy with their careers.
Rena Carlson:
The workforce challenge that our profession is experiencing remains complex and multifactorial. The idea of a mid-level veterinary provider is a response to reduce the workload on veterinarians. Adding a midlevel veterinary provider without a comprehensive analysis of an “ideal veterinary health care team” is ill conceived. It is important to learn from stakeholders about different perspectives on mid-level providers as well as improved utilization of technicians in veterinary practices.
Efficient care delivery, high staff turnover, high veterinary technician turnover, and the many reasons technicians leave the profession have all been identified as significant causes of work force issues. Simply adding another level with no infrastructure to support the position will unlikely resolve the root causes of workforce challenge and negatively impact the profession at this point in time.
While many veterinary companies and clinics are working at an efficient and productive level, the profession has room for increased efficiency and productivity. Sixty percent of technicians report on survey’s they are not performing the tasks they are trained to do. Leveraging the expertise of our technicians, offloading duties from the veterinarian to other skilled staff, providing professional development opportunities, and improving job satisfaction are critical for decreasing staff turnover and improving our efficiency, level of care, and ease the burden on veterinarians.
The workforce challenge needs to result in concrete steps that engage stakeholders at many levels to discuss prevalent workforce and veterinary practice needs. If elected AVMA President Elect, I would work to identify the ideal veterinary health care team, advocate for resources to help veterinarians with immediate solutions to improve efficiency and ease the heavy workload.
2) Please explain your views on Diversity, Equity, and Inclusion (DEI).
Grace Bransford:
When I think about DEI, I obviously consider race, ethnicity, gender, economic background, LBGT, and the many other segments that are part of DEI, but I also consider DEI providing diversity of thought and opinion.
As I said in my presentation to the TVMA Executive and Board of Directors in early March, my leadership vision ensures that everyone has a seat at the leadership table. No one should be kept away due to their particular race, gender, background, etc. We need to make sure the AVMA avoids “groupthink” and that our representation includes diversity of thought and opinion and that is given the full degree of respect that it deserves.
My other thought on DEI as it relates to leadership is that must also ensure competence over constituency. Meaning that our AVMA leaders must be competent in their responsibilities rather than just filling a chair because of their gender, race, age, religion, LGBT status, socioeconomic background, etc. We must find and encourage the best and the brightest who are motivated to be leaders. We must give all who desire to be AVMA leaders the training they need to be successful in leadership roles.
Rena Carlson:
Diversity, Equity, and Inclusion is an important aspect of our future as a profession. Our society has become more diverse, and for our profession to serve more effectively in society, we need to resemble society. If we limit ourselves to certain groups of people, we will have limited ideas and perspectives. This restricts our ability to find new and innovative ways to provide veterinary care, increase access to veterinary care, and advance animal health. It is critical that we continue to understand barriers to entering our profession, barriers that limit access to veterinary care and who is being excluded from the veterinary sphere and why. Formulating and implementing strategies to pull down all barriers both real and perceived will support a stronger profession that will fulfill the needs of society.
It is no secret we have become a profession of predominately white females and the professions demographics are imbalanced compared to the US population. Continued and sustained efforts to open opportunities for men, BIPOC, Asian, Latinx groups is critical to insure we are including all perspectives and ideas. While serving as AVMA board chair, we established the DEI Commission and began working closely with affinity groups and our veterinary colleges. This will further advance our efforts to promote our profession to underrepresented youth, bring greater awareness to the opportunities in the profession and support advancement and leadership opportunities to underrepresented segments of our profession.
DEI is also important aspect of our workforce challenges. Creating inclusive and equitable workplaces will decrease staff turnover, improve job satisfaction, and improve our ability to provide best care for animals. AVMA’s work in DEI can help clinics and small businesses avoid unintentionally limiting our opportunities and excluding the talent and skill of many people.
3) What are your thoughts on the value of keeping a strong VCPR?
Grace Bransford:
In my 23 years of professional practice, I have seen the loss of services restricted to the veterinarian such as equine dental floating in nearly 20 states, the current battle over physical rehabilitation, and the change of the VCPR in Ontario, Canada.
The valid VCPR is core to the practice of veterinary medicine. The VCPR ensures that veterinarians, with our knowledge and skill, are the ones to diagnose, prescribe and perform surgery.
From my time on the Council on Veterinary Service, I have an in-depth knowledge of the VCPR and the Model Veterinary Practice Act. These documents, thoroughly reviewed with input from all aspects of our organization, are the trusted source for guidance. I have always supported, and will continue to support, the strong language in the documents to ensure the necessity and legal requirement for the VCPR.
Rena Carlson:
The Veterinary client patient relationship is a cornerstone of committing to quality veterinary care and ethical treatment of animals. Hands-on examination or in person timely visits to the premise are foundational pieces of a strong VCPR. We can only provide best care when the veterinarian knows the patient(s) and has sufficient knowledge and information to make medical judgements, diagnose, treat, and advise an owner concerning care of an individual animal or herd.
As veterinarians we are all acutely aware of the complexity of many diseases and the difficulty sorting through the history, clinical signs reported by an owner. An integral part of making medical judgements is an in person physical exam, including directly observing clinical signs and clues the animal or herd is providing, listening and palpating. While my home state Idaho has never explicitly prohibited a VCPR by electronic means only, examination or visits to the premise are clear in the language. Our practice act clearly states “there is sufficient knowledge of the animal by the veterinarian to initiate at least a general or preliminary diagnosis of the medical condition of the animal. This means the veterinarian has seen the animal within the last twelve (12) months and is personally acquainted with the keeping and care of the animal, either by virtue of an examination, or medically appropriate visits to the premises where the animals are maintained within the last twelve (12) months”.
When a solid VCPR is established which includes an in person physical examination or timely visits to the premise, there is decreased likelihood of misdiagnoses, ineffective treatment, or delayed resolution of medical problems. Weakening the VCPR will lead to increased risk of inaccurate diagnosis resulting in delays in appropriate treatment, animal suffering and distress, as well as client/owner dissatisfaction. Physical examination of the animal(s) remains a foundational piece of providing best veterinary care.
4) What is your position on companies trying to change the VCPR and telemedicine so they can sell veterinary products direct to consumers?
Grace Bransford:
This topic is very important to me. An overseas company (we’ll leave it at that) was given my name as a potential consultant on a veterinary company they hoped to launch in the United States. I was brought on to help recruit veterinarians and consult on operations.
It was not long before it became clear to me that they planned to sell direct to consumer products without a VCPR. I made it clear to them that I would do no further work with them if
that was the case. I cited the strong VCPR regulations in my home state and advised that they would not be able to work with any veterinarians here as it would violate their license to practice.
I have seen many companies gear up for the possibility of the the VCPR requirement being changed as they help lobby for this in numerous states. I am very upset about this as this is yet another critical protection for animal health that could be taken from our profession.
As an ex-advertising professional, I have seen many deceptive practices in play by for-profit companies and worked hard to safeguard against them. I have and will continue to protect the VCPR however I can.
Rena Carlson:
I am opposed to companies attempting to establish a VCPR without an “in person” physical exam or a visit to the premise where the animals are kept. Challenges to the VCPR by companies who wish to sell directly to consumer argue there are barriers to care, these medications will help animals who are unable to receive care and electronic consult is sufficient knowledge to prescribe. Without a VCPR including in person exam or visit to the premise by a veterinarian, there is increased risk of misdiagnosis, inappropriate or ineffective medications, delayed resolution of medical problems and potential for animal suffering. When these complications arise, there is little recourse for an owner to hold accountable those responsible for these issues. In addition, there may not be coordination with a veterinarian for continuity of additional care, “physically” when necessary.
With a strong VCPR the veterinarian is committed to the goal of improving the health and wellbeing of the patient as well as communicating potential outcomes. The motivation and responsibility of the veterinarian is determined by our Veterinary Oath, Principles of Veterinary Medical Ethics, and our veterinary license and state practice act. Unlike large companies, the veterinarian is less motivated by shareholders and profits. When veterinarians provide best care with strong VCPR, profits will follow.
5) What can be done to address the student debt issue in veterinary education?
Grace Bransford:
The $2 billion dollar question. That calculation is done by multiplying the approximate number of veterinary students in schools throughout the U.S. (13,323) by the average debt load of $150,000.
As AVMA’s Vice-President visiting the schools around the U.S., I saw many programs in place to help the debt load. Readily available financial counselors, debt analysis workshops, cost efficient ways of educating the students, and increasing scholarship funds available to students.
Specific debt management apps for veterinary students have been created, financial health information on AVMA’s My Veterinary Life website is available, there are many available resources to assist.
You can lead a horse to water….
I know that when I was accepted and entered veterinary school, I had a “Woo-Hoo” attitude about the tuition money and the loan I was carrying. I would deal with that in the future. Not the right attitude, but I know it is still shared by many students.
We should continue all the very valuable financial management programs available to students but not all will take full advantage of them.
AVMA is doing a good job of continuing keeping legislators apprised of the student debt situation. Veterinarians are critical to the animal, human, and environmental health of our world. Legislators need to know that.
I would like to see students encouraged to purchase their own practices when they are ready. I have seen many colleagues, managing their practices well, be able to pay down their debt and then start to leverage their resources for other important things like homes and their own children’s educational needs.
The importance of financial health is so intricately intertwined with mental health and we need to ensure the first so that we can best help the second.
In my leadership vision, I want to work hard to use my prior advertising and marketing skills to help our key stakeholders – our legislators, our public policy-makers, the American consumer, to be aware of the value of the veterinarian and the many critical contributions our profession makes to the health of all.
Rena Carlson:
The heavy burden of student debt is complex and with many nuances. Many factors remain beyond the direct control of the profession and continue to be societal issues. It is critical AVMA continue to have strong advocacy efforts in responsible and reasonable loan parameters like low rates and repayment options, reducing barriers for loan forgiveness programs, increased funding and access to loan repayment programs both federal and state and ways to reduce the cost of education. AVMA must continue to work with our veterinary colleges to ensure responsible use of available loans.
With many factors beyond the control of our association, the biggest impact AVMA can have is to improve financial wellbeing as students begin their veterinary education and throughout their careers. Students need expanded access to financial advisors who can provide profession specific information that is timely and most likely to be effective prior to admission, and during their entire student experience as well as post-graduation. Access to a pool of financial advisors who understand the profession and are motivated to improve the financial success of veterinarians is critical for wellbeing and financial health.
Providing students and AVMA members with actionable economic and practice management solutions is critical to financial success to pay off student loans. Data shows that practice ownership is a key factor for timely loan payoff and gaining financial stability. For veterinarians interested in ownership, AVMA can provide resources and help reduce barriers to practice ownership. Like many of the diseases we treat as veterinarians, this issue has many nuances and areas to manage as we tackle student debt. In addition to existing projects, collaboration with Veterinary Business Management Association will also support business and financial knowledge for students as they begin their careers.
6) How can you assist in getting AVMA economic data more useable at the state or regional level?
Grace Bransford:
The first question is what would the states or regions like to see and have from AVMA’s vast compilation of economic data?
Clearly, the data has to be presented in digestible bits and have a summary and implications from the data included. I worked very closely with consumer research data in my previous advertising career and am familiar with the summaries and implications derived that were presented to our advertising clients. I wrote many of them myself.
I could see a place on the AVMA website where states could click on the relevant information they need along with legislative activity. These two resources could help state and other entities use that information to send to their members in an easy to digest format. That information could also help those involved in legislative activity have the facts and figures at their fingertips to present to their legislators.
As we further explore the HOD’s engagement with AVMA’s membership, this is an area where our delegates can be a conduit for this information. Potentially, we could provide localized economic data to the caucuses to be brought back to the states and specialty associations.
The economies of large states such as Texas and my home state of California are so very different from that of smaller states. Given the wide variance of our states’ economies, AVMA data has great value.
Rena Carlson:
While on the board and serving as Chair of the Strategy Management Committee (SMC), we supported and approved two key infrastructure components that are critical to disseminate actionable and usable economic information for AVMA members. First, AVMA obtained the capability to compile veterinary economic data by county across the country. The SMC also supported and approved the online learning platform called AXON. With expanded economic data, more regionalized information, and expanded online learning tools, AVMA must work closer with the state associations and at regional meetings to disseminate useable and actionable practice management and economic information.
As President elect, it is critical we support outreach to all state VMA’s and allied groups to provide continuing educational opportunities concerning practice management and veterinary economic information. I would actively promote the current online practice management resources, the AVMA Economic Summit, and the AVMA Practice Pulse Newsletter to the leadership in state and allied associations to help publicize and distribute to all AVMA members. As we learn more about the economics of the profession, we must expand these resources. Like the AVMA Telehealth workshops across the country, economic workshops could be tailored to state and more regional audiences. With the online learning platform, developing toolkits and calculators to allow individual practices to assess their productivity and efficiency, learn more about their own Key Performance Indicators, work with mentors and experts, set goals and improve the financial health of the practice.
7) What do you see our profession’s biggest challenges concerning workforce?
Grace Bransford:
This circles back to Question 1 above. How can we work smarter and not harder. We already work hard enough!
Can we use our veterinary support staff to full advantage and perhaps not need another associate that we can’t find? Let’s make sure we have analyzed our practice’s capacity to perform the necessary work before we add on more staff.
Are we graduating veterinary students who are ready to “hit the road running”, not only in practical skills but in understanding how they contribute to the practice’s financial health? Let’s make sure they know.
Are we recruiting veterinary students in the areas of large animal medicine and public health where veterinarians are needed? Are we identifying the gaps and where appropriate, making sure they are filled?
Are we looking out for our mid-career veterinarians who may be feeling frustrated, not able to buy a practice in their area, or needing a break from the daily grind of clinical practice. How do we help them so we do not see them exit our profession at the rate they are? What programs and services can we help support them with?
In my mind, these are some of the key challenges we face regarding workforce. We need to bring our economists, our educators, and those in the trenches of the workforce along with workforce analysts, to work on this problem. This is exactly the sort of problem that I would like to sink my teeth into.
Thank you for the opportunity to answer these questions. They have helped me review and think deep and hard about these important issues facing our profession. I have enjoyed the experience to ponder and write about the above.
Rena Carlson:
The biggest challenge concerning our workforce issues is to truly understand the root causes of our “busyness” and heavy workload. This is truly complex and multifactorial which has led to a vicious cycle of frustrations. It is easy to have knee jerk simple reactions like adding more veterinarians to the profession or inserting a midlevel professional. While one cannot rule out these actions as valid and perhaps necessary, AVMA has identified many other factors that are putting a strain on our delivery of care. These factors include inefficiency, high staff turnover, misaligned job expectations, and strains on well-being of veterinarians and their support staff. These are weaknesses in our system and must be addressed along with increasing our workforce of new veterinarians and technicians. A systematic comprehensive approach is important to achieve actionable steps that address the underlying root causes leading to workforce issues. As President Elect, I will advocate for research and data that will continue to identify root causes and solutions that truly address those underlying issues.