Dr. David Haworth joins Dr. Andy Roark to unpack one of the most talked-about shifts in veterinary medicine: the rise of mid-level practitioners. In this episode of the Cone of Shame Podcast, they dive into the connection between regulation and innovation—yes, you read that right—and how smart, clear guidelines can actually fuel progress. The conversation then shifts to Colorado’s landmark ballot initiative, paving the way for mid-level roles in vet med. Dr. Haworth shares his perspective on what thoughtful implementation could look like, why engagement from veterinarians is critical, and how we can build a future where access to care improves without compromising quality. If you’re curious about technician utilization, veterinary policy, and what this all means for the profession, this episode is for you. Let’s get into it!
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ABOUT OUR GUEST
David Haworth, DVM, PhD is an Executive Vice-President at Embark Veterinary, responsible for Research & Development, Business Development and Corporate Strategy, as well as a highly sought-after advisor and consultant to some of the largest and smallest organizations in the animal health and wellness space. He serves on numerous boards including DOG TV and Chairs the Scientific Working Group of the Human-Animal Bond Research Institute (HABRI). Prior to Embark, he was the co-founder and president of Vidium Animal Health, a genomic diagnostics company, and helped lead it to a successful acquisition. He is also a former President of PetSmart Charities in the US and Canada, where he managed the largest strategic grant-making organization in animal welfare as well as the former President & CEO of Morris Animal Foundation, providing millions of dollars in grants for veterinary medical research. Prior to his work in non-profits, he served in multiple positions at Pfizer Animal Health (now Zoetis, Inc.), the largest producer of veterinary pharmaceuticals and vaccines in the world, ending as the Director of Global Alliances within the Business Development group and before that a Director in Pfizer Animal Health’s Research & Development division. Prior to joining Pfizer Animal Health, he was an associate veterinarian at a small animal and emergency clinic in Washington State. Dr. Haworth received his bachelor of science in biology from the College of William & Mary and his doctor of veterinary medicine and doctorate of philosophy from Colorado State University. He also completed a postdoctoral fellowship at Colorado State University’s Animal Cancer Center. He has two adult children and splits his time between Denver, Colorado and Bozeman, Montana with his wife of over 30 years and their Golden Retrievers, Bridger and Breckenridge.
EPISODE TRANSCRIPT
Dr. Andy Roark: Welcome everybody to the Cone of Shame Veterinary podcast. I am your host, Dr. Andy Roark. Guys, I’m here with my friend Dr. David Haworth and we’re talking about, it’s a, we, I’m, I promise this is going someplace good. We’re talking about regulations. And what impact regulation and good regulation has on innovation.
And then, and this is about, hmm, a third of the way through the episode, we transition into the mid-level practitioner, and we’re talking about Colorado and we are talking about the ballot initiative that makes possible a mid-level practitioner in vet medicine in that state. And then the back half of the episode is all about what does this look like and what are the regulations we’d be thinking about? And what are the concerns that we have and what are the steps that we should take or should be taking to get this implemented in a way that’s got some good guardrails, right? Some good boundaries. Everybody knows what is inbounds and what’s out of bounds and what we’re doing and what we’re not doing and things like that.
And so it’s a really good conversation. This is the best conversation I’ve had so far to help me take this landmark, you know, vote in Colorado and think about what, what comes next, like brass tacks, nuts and bolts. What is this doing here and how we go forward and what’s gonna happen. And so anyway, it’s a good episode in that regard.
David is a funny guy. He’s really neat to talk to. He’s just, he’s had such an incredible career. You hear me gush about his just super cool career at the very beginning. But he has got a really neat perspective and I really appreciate him speaking very candidly about where he thinks it’s going and, and what he thinks the future’s gonna be like.
So anyway, let’s get into this episode.
Kelsey Beth Carpenter: This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to the Cone of Shame with Dr. Andy Roark.
Dr. Andy Roark: Welcome to the podcast, Dr. David Haworth. How are ya?
Dr. David Haworth: Ah, I’m awesome. Andy, how are you?
Dr. Andy Roark: Man, I’m fantastic. Thank you so much for being here. You are someone that I have known you, you and I have gone back, we go back way, way back.
Dr. David Haworth: I think there was one of those archetypal bus rides at NAVC back when we had to go between the Marriott and the Gaylord that I first remember talking to you at any kind of depth.
Dr. Andy Roark: Yeah, well, you, you have, I have admired your career from afar for a long time. We met early on. You were always doing these just interesting things and you were doing, you were at Pfizer before it was Zoetis and you, you just had this, this cool projects going on and I was like, oh man, that guy’s doing, I don’t know what he’s doing, but it seems very important and innovative.
And then you moved on from Zoetis and then you were, right now you are the former president and CEO at Morris Animal Foundation. It’s an enormous organization, David. And then also you’ve been– you’re a past president of the PetSmart ch, PetSmart Charities for the United States and Canada.
These are a huge deal of these philanthropic organizations. And now you’re the executive vice president at Embark Veterinary. You’re doing really cool work with genomics. And so you’ve just, you’ve always had these, these things going on.
Dr. David Haworth: I think there’s this, you’re also trying to say, Andy, that I can’t keep a job.
Dr. Andy Roark: No, it’s just, you’re really, seems like you lack commitment and follow through, is what I’m
Dr. David Haworth: I really do. I just have to a little stick to it. As my grandfather said, there’s a lot of quit in that boy.
Dr. Andy Roark: So yeah, well it’s I started seeing you writing recently, and so you write for the Fountain Report, which I really enjoy. So anyone who’s not getting the Fountain Report definitely take a look at it and check out it. It’s sort of a, jam packed newsletter of industry thought, perspective, and news. And so, David, you went for there.
You had this article that came out recently that I really liked because it pressed me to think in a way I haven’t thought before. And the article that you wrote, you were making the case that good regulation of an industry or a company drives innovation. And I have, I’ll be honest and always say, I have always felt like, I’m not saying all innovation is good, I’m not saying regulation is bad, but I’ve always thought that regulation was anti innovation.
Why don’t you just lay out at the high level, that, sort of, your position and why you try to make that point.
Dr. David Haworth: Absolutely. To start with, I’m the child of two economics professors at Florida State University. So, to say that I’d be these were very free market oriented people. So I could never be claimed to be pro regulation, but it has occurred to me, when I was working in the highly regulated industry of pharmaceuticals and especially research and development, as we were trying to get new drugs developed there. It’s a real two sided
sword there with regulation. On the one hand, you really do want to be safe and efficacious. You want these drugs give to our animals and to our patients and to ourselves to be safe and efficacious. On the other hand, you don’t want it so burdensome that only the biggest companies in the world can afford to go through the process.
And so where good regulation comes is to find the middle ground. To ensure the well being of the public and also at the same time allow for a lot of room in there to meet those standards to and that’s where innovation comes from it. I think where innovation fails. So the antithesis of this point is if the regulation is just capricious and it’s because I said so then there’s no way to be very good and innovative about it.
If on the other hand, it’s it’s just no hold bars. Well, then that’s, there’s very little innovation that’s necessary to get through there.
Dr. Andy Roark: Can you think of an example, ideally in vet medicine, but is there something you’ve seen in your career where you felt like the stage was set very nicely for innovation? So there was a regulatory framework around it and you were like, that’s, that, that was set up well and we benefited from it.
Dr. David Haworth: I would say the accreditation process for veterinary schools during the last 20 years or so and I, and I say it really specifically because in veterinary schools, we had this blast of state schools, you know, the great land grant schools that I attended, you attended and that had large teaching hospitals and had good research programs and moved stuff through.
And then we kind of stopped. And the regulations didn’t change. The 11 standards of accreditation didn’t change, but for some reason we couldn’t get a new school. And a couple of them tried. And then, in the early two thousands, we remember that there was this big push where the starting of the consolidators were saying, Hey guys, the NVA’s and the VCA’s were going, guys, I can’t get enough veterinarians
to fill the spots that I have, no matter what I want to pay them, they’re just not there. And in the back of JAVMA you know, we’d have 40 pages of one ads for new veterinarians. There wouldn’t be any new schools. Well, I think we kind of broke through that and the accreditation standards became, okay, so here are the things that you need to do in order to qualify as a veterinary, as a, as an accredited veterinary school.
And smart people could look at those. Find ways to meet all those standards. So we saw some really innovation in the distributed model, you know, and now we’ve had Western University with a very committed distributed model for over two decades. And fantastic clinicians coming out of there, you know, you could argue that the Caribbean schools it’s had similarly and but now you’ve got this whole stream of new schools coming online.
And, you know, I know veterinarians have certain feelings about that, but there that feels to me like a place where the rules were set. There are ways to meet those standards. Now, if you don’t like them. Well, that’s why we can change standards. I mean, I was going to cop out and say that the best example that I know of is the U. S. Constitution, because it’s very, they’re very clear guidelines. You know, Article 1 is the legislative branch. Article 2 is the executive branch. Article 3 is the judicial branch, on and on. And then it has ways to amend it. And we, you know, got the 25 25 amendments to the U. S. Constitution that has allowed us to say, Hey, you know, we didn’t say all that we needed to say that first time through.
And yeah, I think those are all those to me are examples of good regulation. Good good guidelines that both protect the public trust, but then have flexibility on how you meet Those conditions
Dr. Andy Roark: yeah, I, I very much liked, I think what spoke to me a lot was the idea of this clear expectations of these are, this is what’s in, and this is, you know, as long as you stay within these parameters go nuts as far as finding new ways to do this. I just, I like that a lot. Are there examples in your mind of areas that are nebulous now, where you feel like there’s not clear guidelines or, Hey, I mean, I guess I’m even sort of thinking back to your days in, pharma, even for, as an example of where there are times when you were saying, we don’t have clarity on what regulations, what’s going to be inbounds and out of bounds.
And as a result, it’s holding back our ability to innovate.
Dr. David Haworth: Yeah, 100%. So every time you see a new mechanism of action, stem cells right now are good are in my mind. A good example. The FDA doesn’t know how to regulate stem cells because they’re used to having small molecules that go into the body or maybe a vaccine that goes into the body and lets the body react.
But you can measure those or 40 years ago, you might not have been able to measure, but since then we figured out ways to do so. And so everyone’s very comfortable with, you know, if a new NSAID wanted to come onto the market, for instance, we have all the essays to say you have to have a, you know, Cyclooxygenase to inhibit inhibition of this level and it has to be as good or better than this straight But stem cells, know, there’s sort of a there’s sort of magic in a way and it’s hard to regulate magic and so as a result the process to get those regulation to get it to get to meet a regulation level is going to take some both innovation, but also take money and time, and that’s what we see.
A lot of small companies don’t have money and therefore the time to be able to walk the FDA or any of the regulatory bodies through that.
Dr. Andy Roark: Yeah, that totally makes sense. It’s funny, I hadn’t thought about that as again, it totally makes sense. It takes time to go through the process, and also, we’re paying payroll and development costs the whole time we’re doing that, and it breaks little companies. That makes sense.
Dr. Andy Roark: When you think about this spectrum from you know, the last 20 years, vet schools you know, the, guidelines are clearly laid out.
Regulations are clearly stated. Over to stem cells where, you know, how do we regulate magic? Where do you see our, profession sitting currently in regards to the mid level practitioner sort of, ballot initiative in Colorado? So that was another part you sort of talked about in your article. You were like, sort of laid out this, idea of, what’s good regulation, what’s bad regulation, and then where are we when we start talking about mid level practitioners?
And I’ll just start with this by saying, this is an area I’m intensely interested in. I’ve always been an advocate for technicians and support staff being able to do more, things like that. I’m very aware of the cost of care for pet owners and, and, you know, I am a vet to my bones. I want to do the work and I want to have a good lifestyle.
And also, but my, this care to be affordable because I want people to have to have pets and I believe in the human animal bond. And so anyway, I started looking at this and you were the first one I sort of, who started to kind of speak in any clear way around what it might take to move this initiative forward.
And so let me sort of stop talking here and say, when you’re looking at this issue, sort of wait, what do you see?
Dr. David Haworth: Yeah, and that’s, that’s very kind of you to say first of all, but this is an area that I’m intensely passionate about. You and I share, I think, a lot of parallels. When I was at PetSmart Charities you know, it’s a 75 million a year grants to primarily shelters and rescues, and a lot of those shelters and rescuers are like, look, man, we don’t need rabies vaccines.
We need some way to not have this dog that’s very chronically ill leave the loving home that it’s lived in. And they, give it to us, not because. They’re heartbroken. They can’t afford the care. And so access to veterinary care is a strong passion of mine. I don’t know what the answer is. But I do, I do feel that whatever we’re doing now isn’t addressing the need.
So that’s kind of point, point number one. Point number two, veterinarians, 85 percent of our profession practices. And when I talk to practicing veterinarians, there’s a little bit of I don’t have, you know, I don’t know what the problem is. I still have open appointments on my books, so there must not be a need.
And I always think to myself, yeah, but what about the mom with two kids? The single mom with two kids who has to work two jobs and just wants to take care of their cat. I mean, of course she got an appointment open at 3 30. She’s just trying to, she’s on the city bus trying to get to her second job at 3 30 and she can’t take the cat with her.
So, I do worry a lot about this. I’m also, I also live in Colorado, in Denver now, and so I was right in the smack of all those conversations around the mid level practitioner. I think this is a very good example of the public is going to go find the care that it needs, with or without us.
Now, I love this profession deeply. You know, I, I, I am very proud to be a veterinarian, but I do think sometimes we can be guilty of operating from a spirit of scarcity as opposed to a mindset of abundance, and I firmly believe that there is so much care that can happen. That we, you know, shame on us if we can’t live a find a good living for for ourselves and our families with what we have now currently.
We’re, the, the general point that I tried to make in the article is the voters spoke. You can wring your hands and be angry about it. You can write any kind of letters that you want and you’re going to hold any kind of town hall that you want amongst like minded people. The voters still voted for it.
And so now is the time for informed individuals to lean in. and help decide what does it take to have a mid level practitioner. And of course, the analogies are there to nurse practitioners and physician’s assistants. That’s what we say. And I’ve heard some veterinary technician friends of mine, nurses who say, Hey, you know, David, we’re not using the technicians we have to the greatest ability, no argument whatsoever.
I do think that’s a little bit of a conflating of two different situations, but also when the nurse practitioners and the physicians assistants first came in, it probably wasn’t the physicians who were benefiting the most from that. It was probably the techs. It was probably the, the techs and the nurses initially who kind of came into that space.
So a lot of that is to say, I do think veterinarians have a really important role to play in this conversation around, okay, get used to it. We’ve got a middle level practitioner. It’s legal in one state. At least it’ll probably be legal in some others. Cause the argument is pretty, it’s pretty good to the voters. How are we going to measure, how are we going to allow that? person to practice to a level which actually adds benefit to our practices as opposed to wringing our hands and worrying that they’re going to take over cause I don’t believe it. I don’t think the numbers work that way.
Dr. Andy Roark: Yeah. As far as like a tech mid level practitioner putting all the veterinarians out of business. Is that what you mean? The numbers don’t work well?
Dr. David Haworth: Yeah, sorry. I probably didn’t articulate that well. That is the general tone that I have heard from those. Parts of the organ, parts of the profession who, I mean, let’s face it. They’ve got a pretty loud, we’ve got a pretty big stage to operate on because it’s the American Veterinary Medical Association and they’re saying, you know.
This is going to be a terrible thing for pets. It’s going to be a terrible thing for veterinarians. And I just don’t, I don’t see it. I don’t see that’s where we, the spirit of the people behind this really wanted to take it. Now, if they do, and we somehow. By veterinarians sitting on the sidelines and not getting engaged with what’s it going to take, what are the standards that have to be met, and then we do have people performing complicated surgeries and doing complicated sets of diagnosis with no supervision.
I mean, shame on us. Shame on us for not getting engaged.
Dr. Andy Roark: Yeah, so I very much like your push towards engagement. I always say, you know, I try to I’m a pragmatist in my nature and I have to deal in realities and like this is the reality. So whether this should be or shouldn’t be that horse is out of the barn, you know, like that’s let’s but let’s start to think about where this goes.
And I agree with you. I am a perpetual optimist where I say, I’m not convinced this can’t this can’t work. I also think that this is where it’s going. I mean, you’re talking to a guy who took his kid, you know, three days ago to a nurse practitioner. I couldn’t get her in to see a doctor. That was not available.
They kind of looked at me like I was crazy and was like I thought she was going to see the doctor. Well, you’ll go to see Megan, the nurse practitioner. And you know what? Megan was fantastic. She was phenomenal. And, and, that is pretty representative of the experience that a lot of people have when they think of nurse practitioner.
I know we’re talking about something different in the vet in the vet world, but I think that that’s the mentality that a lot of, pet owners have because they think about care for themselves. And so I, I think we’re going this way. I’m not going to ask you to tell me how you think this should work because I think that that’s, that’s pretty, challenging question. Maybe you have that answer, but I think what I’m really interested in is, you said, you know, what do we need to, what do we need to figure out in order to take a mid level practitioner and sort of, sort of build these guidelines and start to create a position that, that really benefits the profession and the pets and the pet owners.
And I think that should be the goal. And so what questions do you think for us? We, as veterinarians, or as people who would be leaning in to make this happen, what questions do we need to answer in order to set the stage for success?
Dr. David Haworth: It’s a great question because I think this is one of those that it’s easy to make false comparisons. For instance, you’re a brilliant practitioner, Andy, you, you’ve been doing this for a long time. You’ve seen a lot of things. I was in practice for one year. Yeah. Well, let’s just go on.
let’s go on that assumption. But that would be a terrible comparison to a person on their day one out of vet school. You’re both legally qualified to do the job, but we can’t compare you to the day one practitioner. So maybe the right comparison is, let’s take a day one recent veterinary graduate.
Doesn’t have to be top of the class. Heck, it can probably be the bottom of the class, right? So we have a day one veterinary just a veterinary student yesterday, got their white coat, now they’re a veterinarian. And look at the curriculum that they went through to qualify to be that, and then let’s look at the curriculum that the mid level practitioner program has.
There’s One out there, CSU developed it. Now, can we poke holes in it? Maybe. Let’s just for initial conversation, start there. Say, okay, this is the curriculum that they had to pass. These are the standards that they had to meet. Now, what procedures is this person, this veterinary, this veterinarian, day one, qualified, and I would be comfortable with them doing, versus and what procedures would this person be qualified and I would be comfortable with them doing unsupervised because then it’s apples to apples because, you know, both of us know that as soon as you start your career, there, there are brilliant diagnosticians and there are brilliant surgeons.
And sometimes those are the same person, and oftentimes they are not. I mean, we all take our own paths following initiation. But starting at day one and saying, What are we comfortable with letting a day one veterinarian do? And what would we be comfortable with this curriculum? And what would we be comfortable with a day one mid level practitioner do?
Dr. Andy Roark: Yeah.
Dr. David Haworth: My suspicion is that those day one middle level practitioners are actually going to have five to ten years of veterinary technician experience behind them and probably be able to do a whole lot more than that first year veterinary. But let’s start there. Let’s start with the qualification question and, and then we go and then go from it.
Dr. Andy Roark: So I think this is an interesting mindset, right? You’re not looking at it and saying what does this mid level practitioner need to be able to do? You’re saying what does the veterinarian do beyond what this, the practitioner would be doing? And well, I also think that’s a fascinating way to look at it.
It also frames up the mid level practitioner as probably being much more versatile than a lot of people I think had maybe originally in mind as far as what that, that job would look like. I think it’s it’s interesting to look at it that way. I think one of the questions that’s going to need to be answered is, if we have mid level practitioners and they are doing this suite of services, what is the non overlapping suite of services that the veterinarians are going to be doing?
I think, especially when you have concern about you know, this is going to be the end of veterinarians. I think we need to be able to, we need to be able to look at the Venn diagram of what mid level practitioners can do and vet techs and then what veterinarians do and point to the part of the veterinarian circle that’s not overlapped, you know, and say, all of these things are still here.
Dr. David Haworth: And I think that’s absolutely right. And I also think that there is an escalation question. We, and the interesting thing is we’ve got models. Human health has a very clear model. My son happens to be a paramedic. He works for the fire department in Bozeman, Montana. He’s a super cool guy. But he knows exactly how far he can take a patient because it’s very, that he has certain drugs that he’s allowed to administer under certain conditions.
And then he has to escalate that to the terminal or the, care to a physician, to another treatment team. And then there’s also in the same, advanced life support technicians. There’s, you know, they’ve got, we know what you can and cannot do in human medicine, and it’s very, very clear what a nurse practitioner can do and what an MD or DO can do.
And never the twain should meet. But certainly a nurse practitioner is qualified to see your child. I’ll make it up an ear infection or a sore throat and they can do a diagnosis and they can do a strep, they can do the strep test. They can also prescribe antibiotics because this is, again, this isn’t some leap of genius that we all got on our third year of veterinary school.
As we walked into that, you know, that, that secret room, we had to learn it. And I think that we should give that opportunity to other people as well, and other, programs.
Dr. Andy Roark: On a scale of 1 to 10, with 1 being absolute serenity and 10 being pandemonium and chaos, when you look at where we are now, and then you look at the future with these well laid out guidelines where a nurse practitioner knows, or a mid level practitioner knows exactly where their, you know, scope of, services end and where the veterinarian’s begins and things like that.
How much chaos is in between where we are now and a well laid out, nicely regulated future? Is this a ten? Is this gonna, it’s gonna, it’s gonna be screaming mayhem for five years? Or, are you like, no it’s a two. What, what do you think?
Dr. David Haworth: I’ll give you the non answer, and then I’ll give you a prediction. The non answer is it’s up to us.
Dr. Andy Roark: Okay.
Dr. David Haworth: and I guarantee, the longer that we as a profession, and the official spokespeople of our profession, so the AVMA in this case, the longer we fight this, and say it’s bad. It’s bad.
It’s bad. It’s all all we’re doing is building up negative energy against something which is already, as you said, the horse that horse is out of the barn now. And I think it’s also this happens to be I’ll get to the so the longer we do that, the more chaos is going to be involved. So it really is up to us to take the emotionally mature path, which is, I accept that this has happened, I am not happy about it, and, but I’m going to do my best as the most informed people in the conversation to help guide us so that we get very well defined.
So it’s not legislators and lawyers who are saying what’s appropriate in veterinary medicine, it’s veterinarians who are saying what’s appropriate. And I get that, that you know, this is foreign territory to many of us. Like, I’ve lived in corporate world for a really long time.
I’m used to the kind of organized conflict that happens in these meeting rooms. So it’s not, I don’t think it scares me as much as it might intimidate some others. I’m speculating, of course, my prediction is it’s going to be a little bit of a fight until the second or third state passes something. And then we were grudgingly going to go on with it.
You know, I, I, again, I I think we change as a profession, but we change sort of grudgingly and then we accept it, you know, I was, I can remember the conversations in 2011, 2012, where people were like, Oh, you know, actually. Don’t tell anybody I said so, but those Western graduates are really good clinicians.
And you’re like, well, of course, because they’ve seen 400 cases in 50 different hospitals before they actually graduated from vet school, as opposed to, you know, being on that third tier of the hemi pelvic ectomy that that, you know, the only time it was done at the veterinary teaching hospital.
Dr. Andy Roark: Yeah, no, that totally makes sense. David. This has been great I really appreciate you coming on and sharing your insight. Where can people find you online? Where that where can they follow you where they can where can they find your writing?
Dr. David Haworth: so Andy, I write for the fountain report. I usually get to post those as PDF on my LinkedIn profile. It’s David Haworth at LinkedIn page. Always happy to accept new con, new connections there. And then also watch for some of our stuff coming out of Embark Vet. But it’s I think there’s a, we’re kind of turning the corner on just going from a genomics company to something else.
Maybe a trusted advisor for all things to understand your pet better.
Dr. Andy Roark: I’ll put links in the show notes to all those resources. David, thanks for being here. Guys, thanks for tuning in, everybody. Take care of yourselves, gang.
Dr. David Haworth: Thanks, Andy.
Dr. Andy Roark: And that’s what I got for you, gang. Thanks for being here. Thanks to David for being here. Guys, I hope this is a fun episode. I hope it made you think, I hope it gave you some ideas for, innovation and regulation and, you know, what good expectations and guidelines and boundaries look like as we move forward as a society, and specifically how we move forward as a profession.
So anyway, gang, be well. Talk to you later. Bye.
