Understanding and Using the Equine Veterinary Technician: the Key to a High-Performance Equine Practice

Through this presentation the audience will have a better understanding and appreciation of the terminology, the requirements, the regulations, the education, and the equine veterinary technician profession as a whole, and assist the equine practitioner to be able to more fully utilize their veterinary technicians and assistants to enhance their practice.

1. Introduction

Today's role of the equine veterinary assistant or technician has evolved greatly from the days of the single practitioner serving the dairy farmer. The term veterinary technician came from the technician in the milk laboratory, who often had to assist the veterinarian because there was no one else to help. Today, a veterinary technician's position in an equine practice is, and should be, a nurse, a laboratory technician, an assistant, an anesthetist and surgical nurse, a medical transcriber, a manager and supervisor, a trainer, a resource, and a business assistant. An equine practice or veterinarian that is not using veterinary technicians in these areas is missing opportunities for profit, growth, and more free time.

The term veterinary technician encompasses a variety of terminology and experience. An approximation of the number of technicians is at the least equal to the 8500 members of the American Association of Equine Practitioners (AAEP). Many of these technicians and assistants have acquired their knowledge and areas of expertise while working alongside a veterinarian or in a laboratory for many years, but they do not have formal education or certification in these areas. There are technicians who have obtained a formal education and accreditation in veterinary technology and are certified, licensed, or registered in various states and recognized nationally. As of July 2005, the American Association of Equine Veterinary Technicians (AAEVT) had over 750 members. One-half of the members have credentials. Whether you are a licensed veterinary technician (LVT), registered veterinary technician (RVT), or certified veterinary technician (CVT), the term used is mandated by the technician's state of residence. Below are definitions of the three terms, which may help differentiate their use.

Certification is the recognition by the private sector of voluntarily achieved standards. Certification is usually given by a private sector, non-profit, professional association, or independent board to individuals who achieve specified standards. Certification is different from licensure, because it is generally non-governmental and voluntary. Confusion can result when the title certified is used for a licensed profession, such as Certified Public Accountant.

Registration refers to the keeping of lists of practitioners by a governmental agency. It can be equivalent to licensure but may also be distinguished from licensure in that criteria for registration may not exist and registration may not be required for practice.

Licensure/licensing is understood as the permission to do something as given by an authority, with the implication that one would not be permitted to do this activity without permission. To be licensed is more than a statement of qualification, as certification is. It is a statement of qualification, and it is the right to do an activity otherwise not permitted by a given authority.

Both certification and licensure, however, carry the connotation of trust, belief, and confidence; without these attributes, the certification or the license would have little worth.

Multiple titles can be very confusing for the public. To simplify the terminology, the National Association of Veterinary Technicians of America (NAVTA) and the American Veterinary Medical Association (AVMA) now recommend the use of the term credentialed veterinary technician. A certified, licensed, or registered veterinary technician is a graduate from a 2-yr AVMA-accredited program from a community college, college, or university. A veterinary technologist has graduated from an AVMA-accredited bachelor-degree program. Almost every state requires a veterinary technician/technologist to take and pass a credentialing exam. Passing this exam ensures the public that the veterinary technician has entry-level knowledge of the duties they are asked to perform in the veterinary clinic or hospital. The terms veterinary technician, assistant, and nurse are often interchanged; however, all of these terms describe the role of the veterinary technician in the practice.

To meet the technical demands of an expanding veterinary profession and a more mobile population, formal academic programs began in the 1960s. Today, there are over 100 veterinary technology programs in the United States that graduate veterinary technicians. To maintain a standard of excellence, these programs are accredited by the AVMA Committee on Veterinary Technician Education and Activities (CVTEA). The course of study is at least 2 yr, leading to an Associate of Science or equivalent degree; 4-yr Bachelor of Science degrees are available at some institutions. A typical 2-yr program has studies in veterinary medical terminology, anatomy and physiology, chemistry and biology, radiology, laboratory procedures, pharmacology, surgery, surgical assistance and anesthesia, animal care, animal breeds, animal diseases (including laboratory animals), clinical pathology, and work experience. However, the emphasis is on small animals, and most programs only concentrate a portion of a semester on equine studies. As of May 9, 2005, there were 116 AVMA accredited veterinary-technician programs in the United States. Of those, 5 offer distance learning venues, and 15 offer a 4-yr Bachelor degree option. Furthermore, 11 new programs have recently applied for accreditation.

In ~40 states and provinces, veterinary technicians are certified, registered, or licensed. Candidates are tested for competency through an examination, which may include oral, written, and practical portions. This process is regulated by a State Board of Veterinary Examiners or the appropriate state agency. Veterinary Practice acts, legislated by states and provinces, often define the responsibilities of the veterinary technician. These responsibilities and duties are dependent in part on the type of employment the individual chooses.

So how do you better use a veterinary technician in your practice? First, determine what your needs and priorities are both personally and professionally. To help determine what role a technician could take, ask your technician as well as yourself and other veterinarians where the technician could assist you; then, support the technician in overseeing or taking over those areas. Tools are available to assist you in assessing not only the skill sets of your staff, but their personalities as well. These can help outline job descriptions and areas of responsibility based on staff interest, personality traits, and skill. For instance, someone who does not enjoy interacting with people and does not have an outgoing, friendly personality may not be the best person to greet your clients or answer the phones. This person may enjoy working in his or her own realm, such as the laboratory area or in data entry. If your practice has an organizational need, find a staff member who enjoys organizing and creating processes and encourage them to oversee those areas. Examining a staff member's past employment can also give insight as to skill sets and areas of expertise that could be used in your practice, such as regulatory training, accounts receivable, or computers and information technology.

Cross-training of staff and sharing of information in areas of expertise is critical in the use of technicians and support staff. If a staff member is isolated from other areas of the clinic and the associated procedures, the clinic and your daily flow could be severely hampered by an employee calling in sick or leaving the practice. Supervisory technicians in each area of the practice should train the other staff members. Have the front office staff write down their procedures and share them with the technician staff. Cross-training also helps build a team structure. Everyone begins to have an appreciation of the other staff member's or technician's job and area of responsibility. When a technician goes to a seminar or continuing education (CE) course, have them present the important points of what they learned to the rest of the staff. Allowing staff to conduct seminars plus cross-training of individuals also builds a sense of importance in staff. They have an opportunity to be the expert in an area as well as a mentor and a trainer, which gives them a sense of value to the practice. They are able to contribute to the growth and knowledge base of the practice and the support staff.

The areas in which a veterinary technician can support the veterinarian are:

• Obtaining a brief history and making sure the client and patient information is correct as well as performing physical exams (TPR) and recording results in medical charts.
• Obtaining samples, performing laboratory tests, and reporting all results.
• Educating and communicating with clients.
• Anticipating your needs and having all equipment, medications, and supplies ready and available as well as maintaining equipment and restocking supply areas and trucks.
• Preparing patients for surgery, performing/monitoring anesthesia, assisting in surgery, and observing the patient in recovery.
• Maintaining and recording all medical logs, controlled drug logs, data entry, and medical records.
• Managing and controlling inventory, which also includes interacting with pharmaceutical representatives and suppliers.
• Preparing estimates and discharge instructions, having dispensed items properly labeled and ready to go, communicating instructions to the client, and calling clients to check on cases or discharged patients.
• Taking and developing X-rays, performing ultrasounds and shock-wave therapy, assisting with lameness exams, applying bandages, performing treatments, monitoring the intensive care unit, and performing rehabilitation therapy.
• Preparing invoices and collecting money, especially for ambulatory clinicians.
• Supervising and training other assistants and technicians.

Consider what your day as an equine veterinarian would be like if your technician was allowed to do all of these tasks for you so that you don't have to do it all. You arrive at 9:00 a.m., and all of your hospitalized patients have been examined; their treatments (per your instructions) have been completed, their records were updated, and an overview of their status is ready for your review. You order the laboratory work and the diagnostic procedures; while you are making phone calls and checking the appointment book, the procedures are carried out. Your appointments arrive, and your technicians make sure the client paperwork is correct, having anticipated your needs for equipment, medications, and supplies. You visit with the client while the technician performs the physical exam and takes a brief history. The technician takes the X-rays and assists with the lameness exams or the ultrasounds. You are free to visit with the client further or start your next appointment. You then have your first surgery, and the technician has prepared the patient for surgery. All records and X-rays are ready for your review, the pre-surgical laboratory work has been done, the surgical packs and anesthesia equipment are ready and the horse is on the table ready for you to perform your surgery. On completion, you leave to talk to the client, and the horse is bandaged, recovered, and monitored. For your farm call, the technician drives so that you can make calls and review records. At the farm, the technician gets all the medications and equipment ready, assists you, puts everything back in its place, and then prepares the invoice and collects the bill. On the way home, the technician enters all the data into the medical records or on your day log, updates your appointment book, and schedules recalls. Back at the clinic, the technician develops the X-rays and restocks the truck for the next call. At 4:00 p.m., you check on all the hospitalized cases, and you leave for the day, knowing that the technician will take care of the treatments, monitor the status of the surgery patient, call you with an update, and prepare for the next day.

Now imagine what your day would be like if you did not have a technician who was doing all or most of these tasks for you.

Not all technicians are qualified or experienced in all of these areas, and you need to be aware of state regulations and veterinary practice acts regarding the use and supervision level of certified and non-certified assistants. Several resources that list various state statutes and accredited schools of veterinary technology are the NAVTA (www.navta.net) [1] the American Association of Equine Veterinary Technicians (AAEVT; www.aaevt.org), and the various state technician associations. Encourage your technicians to seek out professional associations, attend continuing education seminars and wet laboratories, and take courses online. Share with them articles of interest or new developments in the industry. There are courses offered online from Veterinary Support Personnel Network (www.vspn.org) that are very reasonable in cost and vary from receptionist skills to basic equine knowledge. The AAEVT offers regional CE meetings and wet laboratories three to four times a year as well as 2 - 3 days of technician-oriented CE at the annual AAEP conference. Several Colleges of Veterinary Medicine (such as Texas A&M and University of California at Davis) and various State Technician Associations also offer technician CE seminars. The AAEVT web site has a page listing upcoming CE.

Your technician staff can take on the responsibility of ensuring they are contributing to the practice as well. As in most successful operations, it is a two-way street. Some areas where a technician can aid the practice are:

• Seeking out CE and advanced training and education in a specific area.
• Sharing the information with other staff members, technicians, and doctors.
• Taking charge of client education in the practice.
• Marketing the practice to the community.
• Taking on the title of business assistant and learning aspects of accounting, business tools, budgeting, and cash flow.
• Being proactive by anticipating the needs of the doctor and the practice and finding a means to fulfill them.
• Having a positive attitude.
• Showing creativity in approaching problems or challenges.
• Synergism: forming superior skills in time management and competency.
• Adaptability: being flexible and open to new ideas, techniques, and products.
• Participation: establishing worth by contributing and looking for ways to improve on a process, a technique, or a system.
• Treating the job as a professional career choice and participating in professional associations and the community (such as speaking at high school career days), visiting technician schools, and attending local, state, and national veterinary conferences.

As technology becomes more important in the medical service that we offer in equine practice, the role of the veterinary technician will be more valuable. The veterinarian will need to rely more on their support staff to understand and implement new equipment, new software, and new diagnostic tools and technology. Digital radiology and ultrasound and the ability to archive digital images on the web or into medical records is becoming a standard of care. The days of the solo equine veterinarian doing it all are becoming a tradition of the past. Clients are more educated and aware of new medical advances, and they are demanding that their horses receive the very best medical care available; this includes a knowledgeable and competent staff. The veterinary technician plays an important role in an equine practice being able to offer that quality of care and medical expertise to their clients.

The veterinary technician in an equine practice is a valuable investment. Technicians can save you time, which saves you money; they can perform laboratory and other diagnostic procedures, which can increase income centers, they allow you to concentrate on the aspects of veterinary medicine that you enjoy and should focus on, such as diagnosing, prescribing, performing surgery, and communicating with clients, to eliminate burnout, and they can be your teammate, your support system, your veterinary assistant, your nurse, and your technician. It may take investing some time, money, guidance, and professional mentoring, yet the rewards and the possibilities are many. You may ask, where do I find a technician who has all of these qualities?You may only need to cultivate and encourage one of your present support staff, or you may need to search outside your practice for a technician who is qualified in the areas your practice needs.

There is a lack of certified technicians in the equine field because of the lack of professional recognition and the lack of emphasis on equine studies in accredited veterinary-technician schools. In many of the AVMA-accredited programs, the equine courses are optional or encompass only a portion of a semester. For some technicians, it is not economically viable to quit working in an equine practice to attend a technician school for 2 yr where they will probably not learn any more than they already know from their hands-on equine experience. Additionally, there is no guarantee of an increase in salary. For a technician who has pursued certification, the lack of recognition and pay in the equine practice is often a professional disappointment. They have pursued 2 yr of veterinary technology training, and they have received a degree and have passed state and national board examinations. It is difficult to justify that commitment to a profession or a career that often deems your worth to the practice as a few dollars above minimum wage. There is also the lack of trust from the equine veterinary community that the technician schools will teach or train their assistants better than they can do in their own practice. Fortunately, many schools are beginning to expand the training in equine studies.

Technicians have chosen to work in an equine practice, because they love what they do, just as you have chosen to be a veterinarian. For some, it is just a job. Most technicians, however, view their role as a career and a profession and are willing to make the commitment to view the position as more than a job and to be a team player. Often, all it takes to turn a job into a career is for the veterinarian to recognize the importance of the technician, allowing them to do what they were trained to do. By acknowledging that they are valuable members of the team and that the practice has shown profit and growth because of their contribution, you will benefit both personally and professionally.