Understanding the veterinary-client-patient relationship
By now, I hope most livestock producers are aware of the impending changes in how feed grade antibiotics are used. After January 1, producers using certain antibiotics in their animals’ feed will first need to obtain a prescription-like Veterinary Feed Directive (VFD) form from a veterinarian before they’re able to purchase and feed those medications.
One implication of these rules that will affect some producers more than others is the stipulation that the VFD forms be obtained through a veterinarian — and not just any veterinarian. The veterinarian writing the VFD form must have what’s termed a “veterinary client patient relationship” (VCPR) with the producer.
A relationship with a veterinarian can take many forms, but the VCPR – which is necessary to obtain a VFD (as well as to use prescription medicines, or injectable or water medications in an extra-label fashion) — is spelled out in regulations. The federal VCPR definition states that a valid VCPR exists when:
• A veterinarian has assumed the responsibility for making medical judgments regarding the health of the animals and the client has agreed to follow the instructions of the veterinarian;
• There is sufficient knowledge of the animals by the veterinarian to initiate at least a general or preliminary diagnosis in the animals; and
• The veterinarian is readily available for follow-up in case of adverse reactions or therapy failure.
The statute also states, “Such a relationship can exist only when the veterinarian has recently seen and is personally acquainted with the keeping and care of the animals by virtue of examination of the animals, and/or by medically appropriate and timely visits to the premises where the animals are kept.”
It’s that last part that creates uncertainty, since it doesn’t specify how frequently a veterinarian must visit an operation. They’re purposefully vague because the rules must apply to all food animal operations. Animal operations vary drastically regarding how often conditions, animals, and management change. A cow-calf operation may have used the same type of cattle and management strategies for years, while in a large dairy, disease problems may change on a weekly basis. A one-size-fits-all solution is not easily attained.
It might be easy to focus on the uncertainties present in the VCPR definition, but I see some aspects as certain:
VFD forms can’t be obtained from a veterinarian that has never seen your animals or operation.
If a veterinarian is familiar with you and your animals, a farm visit to personally examine the animals to be treated may not always be necessary before obtaining every VFD.
Your veterinarian is entitled to determine what “medically appropriate and timely visits” means in the context of their practice and your operation. They’re not obligated to provide you a VFD if they feel a VCPR does not exist – their signature on the line indicates that relationship is present.
A valid VCPR does not mean the veterinarian can authorize uses of feed grade medications that are not on the label (“extra label” use). These are, and will remain, illegal.
Producers with an existing solid relationship with one veterinarian or veterinary clinic will navigate these changes in feed-grade antibiotic use much better than others. For them, all the dust-up about VCPRs is largely irrelevant because that relationship is ingrained in their operation.
Producers who have not had veterinarians on the farm (or not used them at all), will have a harder time adjusting to the VCPR requirement when it comes to obtaining VFD forms. If you’re one of those producers, it’s not too late. Schedule a visit with a veterinarian to go over your current uses of feed grade medications and determine which will require VFD’s. Then discuss what constitutes a VCPR in terms of your operation and the veterinary practice. Coordinating these discussions with your consulting nutritionist is a good idea. In this manner, you’ll be ready for the changes that will occur on January 1, 2017.
Conscientious cattle producers will look at the VCPR requirement not as an opportunity to seek loopholes in the system, rather they will consider it an opportunity for improvement in animal health and profitability through veterinary involvement in their animal’s well-being.
Russ Daly, DVM, is the Extension Veterinarian at South Dakota State University. He can be reached via email at firstname.lastname@example.org or at 605-688-5171.