As the COVID-19 pandemic unfolded in 2020, veterinary teams across the nation quickly pivoted to remote workflows, and telemedicine appeared to be on the brink of a breakthrough. New companies emerged almost weekly to cater to a surge in demand, yet nearly five years later, the question remains: Has veterinary telemedicine fulfilled its promise?
The integration of technology in healthcare is not a novel concept; after all, the necessity of telephones and computers for client communication is widely accepted. The crux of the debate surrounding telemedicine in veterinary practice, however, hinges on a pivotal issue: Should veterinarians be allowed to establish a virtual veterinary-client-patient relationship (VCPR) without an initial in-person examination? If so, what safeguards should be implemented to protect the well-being of pets?
Confusion Over VCPR Laws
The answer to this question is far from straightforward. Veterinary medicine is regulated by a complex mix of federal and state laws that vary significantly, often leaving even seasoned professionals bewildered. With legislative changes sweeping across the country, keeping abreast of these developments poses a challenge for all but the most vigilant stakeholders.
At the heart of this issue lies the lack of a uniform definition for establishing a valid VCPR. While some states provide explicit guidelines, others leave their regulations vague or open to interpretation.
According to the Veterinary Virtual Care Association’s recent analysis of VCPR laws by state:
Nineteen states explicitly prohibit establishing a VCPR through virtual examinations.
New York has no mention of VCPR in its practice act, thereby lacking any governing rules.
Twenty-two states require veterinarians to have “seen” or “become acquainted” with the patient prior to establishing a VCPR, with ambiguity surrounding whether a virtual examination suffices.
Eight states explicitly permit the establishment of a virtual VCPR.
In addition to these state variations, veterinarians must navigate federal regulations concerning medication prescriptions under the FDA. In these instances, the FDA asserts that “a valid VCPR cannot be established solely through telemedicine.” Moreover, any extralabel drug use necessitates an in-person exam.
Proponents of Virtual VCPR
Supporters of a virtual VCPR, including Mark Cushing, JD, president of the Animal Policy Group and cofounder of the Veterinary Virtual Care Association, advocate for its inclusion in veterinary state practice acts. He highlights the challenges faced by pet owners, particularly those with limited mobility.
Cushing shares a compelling scenario: “A woman in her 80s living in an apartment with two cats won’t be ‘reaching under the bed, pulling her cats out, putting them both in carriers, carrying them down to the street, getting an Uber or taxi and trying to find a vet.’” He argues that rejecting telemedicine care in such circumstances is misguided, stating, “No care is preferable to virtual care is absurd.”
Cushing and his collaborators, including various shelters and humane societies, have campaigned for virtual VCPRs, emphasizing that many pet owners struggle to access in-person veterinary care due to financial, transportation, or situational constraints. “Telemedicine is used in all 50 states for people…why not for pets?” he asks, pointing out the safeguards like informed owner consent that exist in various states.
Opponents of Virtual VCPR
Conversely, the American Veterinary Medical Association (AVMA) and some state veterinary associations strongly oppose virtual VCPRs. Gail Golab, PhD, DVM, and AVMA’s Associate Executive Vice President, asserts that extensive research demonstrates the necessity of in-person examinations for accurate pet diagnoses and to foster trust with pet owners.
According to Golab, the feedback from telemedicine services aimed at underserved communities underscores that a hybrid care model—combining in-person visits with telehealth—is superior. “Some care isn’t better than no care when it’s the wrong care or when it removes the incentive to physically deliver care where it’s needed,” she cautions.
Evolving Legislation in Veterinary Telehealth
State laws regarding telemedicine are evolving rapidly as advocates on both sides of the debate push their agendas. Recent changes in various states highlight this trend:
Florida: As of July 1, 2024, Florida’s amended Veterinary Practice Act will allow veterinarians to establish a virtual VCPR through live video consultations.
District of Columbia: Effective July 19, 2024, the Health Occupations Revision General Amendment Act allows veterinarians to form a practitioner-client relationship via telehealth.
Ohio: A pending Senate Bill would enable VCPRs to be established through in-person or live video consultations.
California: A recent amendment permits virtual VCPRs with restrictions on prescription durations.
Michigan: A proposed bill would allow VCPRs through real-time electronic technology for companion animals.
Looking Ahead
Despite the divide over virtual VCPRs, both sides acknowledge the value of technology in enhancing veterinary care and increasing access, particularly in underserved areas. With ongoing legislative efforts and growing interest in telehealth, the future of veterinary telemedicine looks promising.
What the landscape of veterinary telemedicine will resemble in 2025, 2030, and beyond remains uncertain, but the discourse surrounding it is far from over.
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