Midlevel Practitioners: Current Status and Clinical Impact

This article originally appeared in the Summer 2026 issue of EquiManagement. Sign up here for a FREE subscription to EquiManagement’s quarterly digital or print magazine and any special issues.

The veterinary professional associate (VPA), or midlevel practitioner, is a new role analogous to a physician assistant in human medicine. Proponents describe this role as filling a gap between veterinarians and veterinary technicians and helping address a national shortage of veterinary care, particularly in rural areas.

The idea of a midlevel practitioner arose years ago at the Colorado State University (CSU) College of Veterinary Medicine and was recognized by some veterinary industry stakeholders as a solution to providing veterinary care in the face of rising costs, increased demand, and difficulty retaining professional staff, especially within welfare organizations and shelters. The funding for marketing the initiative to voters came mostly from corporate veterinary firms, with strong support from some shelter groups.  

In November 2024, Colorado voters narrowly passed Proposition 129 with just 52.8% of the vote. The proposition established the role of the VPA and, starting on Jan. 1, 2026, permitted these individuals to practice veterinary medicine under certain circumstances in Colorado. The AVMA and Colorado VMA had come out strongly against the proposition, saying the proposed training of the midlevel practitioner was inadequate to safely perform the clinical skills included, such as surgery. They also felt VMAs would receive insufficient laboratory and clinical exposure, putting the health and welfare of Colorado’s pets and other animals at risk. More than 200 national and local veterinary, humane, and breeders’ organizations; veterinary clinics; veterinarians; veterinary technicians; and pet owners also spoke out against the measure.

Governor Jared Polis signed House Bill 25-1285 into law on May 30, 2025, modifying the requirements to practice veterinary medicine and establishing the veterinary professional associate. The Colorado State Board of Veterinary Medicine is expected to oversee the examination, qualification, and registration for these professionals, with frameworks anticipated by early 2027. 

In Colorado, to qualify for registration as a VPA, an individual must be at least 18 years of age and hold a master’s in veterinary clinical care or the equivalent, as determined by the State Board of Veterinary Medicine. In addition, a VPA must have passed a national credentialing exam (still in development) to demonstrate entry-level competency to practice. An individual can also qualify to register as a VPA if they are registered as a veterinary technician with a designation as a veterinary technician specialist; have met the requirements of an equivalent pathway established by the board; and have passed the same national credentialing exam to demonstrate entry-level competency to practice as a VPA. 

The wording of the guidance in Colorado indicates that VPAs must work under the supervision of a veterinarian and are trained to work only on canine and feline patients to diagnose medical concerns, perform routine surgeries, and order and perform tests and procedures. The supervising veterinarian will be liable for their work. Because federal law dictates that only veterinarians can prescribe medications, a licensed veterinarian must approve any pharmaceutical treatments midlevel practitioners prescribe.  

In Colorado, to delegate tasks to a VPA, a veterinarian must have a signed agreement with the VPA, ensure their compliance with the Veterinary Practice Act, and be located at the same veterinary premises, unless the VPA meets indirect supervision requirements. These include requisite clinical benchmarks, such as practicing veterinary medicine under the direct supervision of a licensed veterinarian for a specified number of hours. The licensed veterinarian may supervise no more than three VPAs at one time. 

Opposition Against VPAs

As a guest on EquiManagement’s The Business of Practice podcast in August 2025, Jim Zeliff, DVM, MBA, explained that once the ballot initiative passed in Colorado, the state Veterinary Practice Act automatically had to be amended to allow this new law. In many other states, the legislatures would need to create a similar law, so veterinarians could have power to influence their state legislators if they are not in favor of midlevel practitioners. Zeliff encouraged veterinarians to get involved in their state veterinary medical associations to increase advocacy for equine and all other sectors of veterinary medicine. He said individuals can contact their state representatives and senators “to let them know where you stand.” Being involved with organized veterinary associations is more important than ever for supporting the profession’s future. Zeliff concluded that increasing utilization of licensed veterinary technicians is an important part of keeping VPAs out of equine veterinary medicine.  

The AVMA, AAEP, American Animal Hospital Association (AAHA), American Association of Veterinary State Boards, North American Veterinary Technicians Association, and many other veterinary associations remain strongly opposed and believe midlevel practitioners will harm the stature of already often underutilized licensed veterinary technicians.

The AAHA took a firm stance against the midlevel practitioner (MLP) role, outlining its concerns about the potential risks associated with this new tier of veterinary care and citing issues related to patient safety, quality of care, and the devaluation of existing veterinary roles. The organization believes the introduction of MLPs could have unintended consequences that would compromise patient safety and disrupt the veterinary team structure.

The AAEP strongly opposes the creation of an MLP or VPA, arguing it does not serve the best interests of patients, clients, or the profession. The AAEP believes essential clinical functions, such as diagnosing, prescribing, and surgery, must be restricted to veterinarians to ensure quality care.

Prerequisites and Curriculum

The VPA program’s 65 credit hours would cost more than $34,000 for in-state students and more than $77,000 for out-of-state students, based on Colorado State University’s tuition and fees for graduate programs. To be admitted, applicants must have a bachelor’s degree and completed 20 courses in the sciences very similar to veterinary school prerequisites. The VPA curriculum is five semesters long, with the first three semesters virtual and no hands-on laboratories, even in such subjects as clinical anatomy and principles of surgery. Considering some DVM programs have shortened to three years, it is questionable why one would pursue a VPA degree instead of a DVM.

In a piece on his Substack channel All Science Great and Small, Eric Fish, DVM, expressed doubt that VPAs will provide care to underserved areas. While more than 500 counties in the U.S. are designated as veterinary shortage areas, he said the need is for mixed and large animal veterinarians, not for exclusively small animal, which is what VPAs are being trained to serve. He opined that these rural shortages persist because of low earning potential and most young people’s preference to live in more urban areas. 

On The Veterinary Roundtable podcast, Sue VandeWoude, DVM, DACLAM, dean of CSU’s veterinary college, clarified that “the VPA curriculum focuses on primary care for dogs and cats and does not provide training in large animal medicine.” Her statement undermines one of the original arguments for the VPA, that “Many Coloradans struggle to get veterinary care for their animals, especially in rural and agricultural communities,” which strongly implied that approving the MLP position would help mitigate the problem of large animal veterinary care.

Other states are also considering legislation to create midlevel practitioners. According to the AVMA, “Florida legislators introduced S652/HB729, which would create a VPA position in which the person is authorized to perform veterinary services delegated by a supervising veterinarian.” In Tennessee, Lincoln Memorial University already offers a Master of Veterinary Clinical Care, which provides similar training as that required for a VPA but is designed for credentialed veterinary technicians seeking to advance in the field. Tuition before other costs is about $12,000.

Take-Home Message

According to the AAEP, “While discussions about addressing veterinary workforce shortages continue, many veterinary associations advocate for alternative solutions, such as enhancing the utilization and education of licensed veterinary technicians. The situation continues to evolve as stakeholders assess the implications of introducing this new category of veterinary professional.”

As veterinarians, practices, and veterinary organizations grapple with the introduction of midlevel practitioners, some strategies have emerged for the transition. Equine veterinarians should be members of their state VMA and be engaged in leadership. Veterinary technicians should be encouraged to work to the top of their skill level while remaining within their state regulations. Potential midlevel practitioner graduate students should consider the cost-benefit ratio of VPA programs and whether veterinary school would be a better choice. All should keep an open mind and listen to the debates that are sure to occur. 

Editor’s Note: As the discussion surrounding veterinary professional associates continues to develop, new regulations and professional guidance might have emerged since this article was written. The article reflects the information available at the time of publication.

Related Reading

• The Business of Practice: Emergence of the Midlevel Practitioner
• Staying Ahead of the Curve: Navigating Legislation Affecting the Veterinary Profession
• Colorado Lawmakers Fall Short in Effort to Limit Midlevel Role

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