43 states still require an in-person exam to establish a vet-patient relationship — blocking telemedicine from reaching the 245 federal veterinary shortage areas

In 43 states and Washington D.C., a veterinarian cannot legally prescribe medication, diagnose a condition, or provide medical advice to a pet owner via video call unless they have first examined that specific animal in person. This in-person requirement — called the Veterinary-Client-Patient Relationship (VCPR) — means that a pet owner in rural Montana with a sick dog cannot video-call a veterinarian in Billings for help unless that vet has physically touched the dog at some prior appointment. If the nearest vet is 100 miles away and has a three-week wait, the dog either suffers until the appointment or gets no care at all. This matters because the USDA has designated 245 veterinary shortage areas across 47 states in 2025 — the highest number ever recorded. Only 3.4% of the total U.S. veterinary workforce practices food animal medicine, and just a few hundred large-animal vets serve vast swaths of agricultural America. Telemedicine is the obvious force multiplier: a single veterinarian could triage dozens of cases per day across a multi-county shortage area, prescribing antibiotics for straightforward infections, guiding farmers through calving complications on video, and reserving in-person visits for cases that genuinely require hands-on examination. Instead, the VCPR requirement forces every interaction through the bottleneck of a physical visit, which is precisely the resource that does not exist in these areas. The structural reason is regulatory capture by state veterinary boards, which are composed primarily of practicing veterinarians who view telemedicine as a competitive threat to brick-and-mortar practice. The AVMA itself only updated its telemedicine policy in 2024, and the FDA continues to require in-person VCPR establishment for prescribing certain medications. Only seven states — including Florida, Arizona, Ohio, and California (all in 2024) — have passed laws allowing virtual VCPR establishment, and even those have significant restrictions (Arizona limits prescriptions to 14 days, California only recently reversed its position). A federal preemption or uniform model regulation could unlock telemedicine for veterinary care overnight, but the profession's decentralized regulatory structure — 50 state boards, each with its own practice act — makes coordinated reform nearly impossible.