Are You Licensed?

WangThe value of certification for biomedical equipment technicians (BMETs) and clinical engineers (CEs) is often debated on BiomedTalk listserv, at trade shows and in industry publications. Instead of certification, I think we need to have a longer and broader vision and start discussing licensure. Don’t get me wrong: I am not against certification, as I am a certified CE. However, I think certification is reaching the limit of its usefulness, and we need something more powerful to protect the safety of the public and, at the same time, the interest of the professionals in this field.

For example, if you seek care in a hospital, you will be seen by a licensed doctor, cared for by a licensed nurse, treated by a licensed physical therapist or a licensed respiratory therapist (if needed). If you need medication, it will be dispensed by a licensed pharmacist. (Actually, there are dozens of regulated professions, such as accountants, beauticians, dental hygienist, dieticians, emergency medical technicians, etc.) I think most of the BMETs and CEs would agree that the work we do is just as serious and challenging as that performed by those licensed professionals. If not properly serviced by a qualified person, defective medical equipment can injure and kill patients just as easily as erroneous diagnosis or treatment. So why are we NOT licensed as most other healthcare professionals?

If you think it is because we work for a state-licensed or nationally accredited institution that is responsible for what we do, think again. First, the doctors and the nurses in these institutions are required to be licensed. Second, BMETs and CEs more often are employed by independent contractors that the hospital barely controls or supervises. Finally, as patients are being aggressively moved out of hospitals, so is the medical equipment they need. The people who service the equipment used in subacute facilities and homes are not supervised by any government agency or professional entity. Today, anyone can acquire some tools and call him/herself a BMET or even an “engineer.”

The need for qualified — licensed, in my opinion — BMETs and CEs in healthcare organizations and related businesses has never been so critical. The ever-growing influx of sophisticated technologies and pressure to reduce costs are making healthcare organizations progressively dependent on technology. Users are increasingly unable to detect serious equipment problems and avoid “user” errors, and thus need equipment “experts” to provide continuous training and monitoring in addition to maintenance and management. Moreover, manufacturers and accreditation organizations are perpetually adding maintenance and management requirements with little or no regard to the resource limitations — and often without justification or clear guidance.

Not surprisingly, several countries are already looking into or working on a licensing scheme for BMETs and CEs. Apparently Ireland, Japan, South Africa and Brazil are among them, but I would not be surprised if some European countries already have strict controls in place, as they typically rely heavily on regulations.

Unlike certification, licensure is mandatory. Only those who are licensed may practice in this field. Hospitals and service companies will no longer be able to hire the cheapest labor they can find. Newcomers will be required to have appropriate educational background and practical experience before qualifying for licensure. After obtaining a license, these professionals will have to provide proof of continuous learning and professional improvement in order to keep their licenses. This process will assure a minimum level of safety and quality for the public and encourage continuous improvement and growth of the profession.

Some colleagues oppose licensure for various reasons. For example, they want to remain “free,” they are skeptical that a licensure process can truly measure competency, or they are concerned about the possible costly license fees. As with airplane pilots, I do not think we will be able to remain barnstorming “Red Barons” forever because public safety will outweigh our individual freedoms — eventually. The certification experience has taught us that it will be difficult to develop a perfect licensure process; however, if more people were to contribute, we would likely find a process that is acceptable to most. Licensure fees may well be significant because state agencies have to be self-sustainable. On the other hand, the foreseeable decrease in the available (licensed) labor pool and its consequent increase in wages will more than offset the license fee; it’s feasible that many employers would cover it as part of their recruitment incentive anyway.

Having stated my case for licensing, how do I suggest we proceed? Look for my take on ways to accomplish licensing in the July issue.

Binseng Wang, Sc.D., CCE, is vice president, Quality Assurance & Regulatory Affairs, for MEDIQ in Pennsauken, N.J. E-mail him at