Should HTM be licensed? Weighing the pros and cons

Teachers do it. Psychologists do it. Lawyers do it. Even doctors do it. They are all part of a profession, and they all must be licensed to practice it. There are licensing requirements that a long list of professionals must meet before they can hang out their shingle. Did you know that nearly a third of all occupations in the U.S. require a license? Auctioneers in more than half the states in the country are not excluded. So why not HTM professionals?

A license or a required certification can publicly state that a person is competent to practice their profession. Many employers even pay extra to BMETs who are certified. Some require certification for employment. And certification can lead to advancement to a senior BMET position. On the flip side, some voices in the profession feel that there are too many disparities in work environments to depend on a standardized test. Others question the need if their employer doesn’t require it.

For those tasked with working on medical equipment, the certified biomedical equipment technician (CBET), certified radiology equipment specialist (CRES) and certified laboratory equipment specialist (CLES) are certifications that attest to a certain knowledge level related to medical equipment, radiology equipment and laboratory equipment.

The three certifications come from the International Certification Commission for Clinical Engineering and Biomedical Technology (ICC). AAMI states that certification provides recognition “that individuals have demonstrated excellence in theoretical as well as practical knowledge of the principles of biomedical equipment technology.”

AAMI also points out another component of certification. It demonstrates to an employer a certain commitment to an employee’s career along with a level of competence. That commitment to career and knowledge level is further reflected in the continuing education or practice activities required to maintain certification.

There is one thing abundantly clear about the CBET exam or any other; it requires the test-taker to study for the test. That requirement means that the prospective CBET has taken the time to review information important to their profession. If a BMET needs to beef up their knowledge of anatomy and physiology or safety issues, the process of study requires them to review this information.

The CBET exam is ever evolving. It is developed andrevised by the U.S. BMET Board of Examiners, an 18-member AAMI committee. The committee also develops the CLES and the CRES exams. The group also oversees the International Certification Commission’s certification renewal program (those points are tracked in a continuing practice journal).

Continuing education allows those certified to renew their certification every three years. That renewal requires an accumulation of 15 points. Not only does the process of accumulating those 15 points contribute to continued professional development, but it allows the HTM professional to continue to enhance their knowledge and stature as a professional. This process of continued learning aids in competence and also makes a statement to management.

There are eligibility requirements for certification. According to AAMI, those requirements are: an “associate’s degree in (a) biomedical academic program and two years’ full-time BMET work experience; or completion of a U.S. military biomedical equipment technology program and two years’ full-time BMET work experience; or (an) associate’s degree in electronics technology and three years’ full-time BMET work experience: or four years’ full-time BMET work experience.”

YEA OR NAY?

It is easy to come up with some anecdotal examples that one great biomed that someone knows isn’t certified or another mediocre one is. Knowledge and competence come from several sources and certification is just one. There are many variables that can exist with every example of a good or bad biomed.’There could be few more passionate advocates for certification than someone who has been close to the topic for some time. Dave Scott has run the well-regarded CABMET CBET study group for some time. He has lived the process.

“The question is — should the profession be licensed? Yes (an emphatic yes). My mom is a beautician; I have a friend that is a massage therapist. Plumbers, electricians, other trades have it. All of those that I listed have to be licensedto practice their trade. Why wouldn’t we have something like this? Right now there is no regulation over biomed at all. CMS has put some mandates on us recently, and it is currently being argued. Do you think it would be as much of an argument if we were more united as a profession?”

“ Why aren’t we,” Scott asks? “What is holding us back? Licensing would go a long way on this front, I think. Every driver of a car in the U.S. is supposed to be licensed to be able to drive. They have to know what the road signs are and (the) rules of the road, then pass a test both written and hands-on, then renew every few years.”
Scott draws the distinction between licensure and certification and addresses the question of mandatory certification. “I think maybe. The reason I say maybe is if we are licensed then maybe not as much need to be certified. Maybe certified is more of a senior level? Kind of like a master license for an electrician. I think it has its place, but maybe not as much for an entry-level person. I could see having a license and being certified.”

When asked the question of experienced BMETs requiring certificationthose with 20 or 30 years on the jobScott speaks as a member of that group. He has heard many from this group oppose certification. Scott sees certification as going a long way to establishing HTM’s credentials as a profession. “I have always strived to make my profession, HTM, better. When I leave the profession, I want it to be better than when I came into it — maybe because of something I did or helped with, or maybe joining in with others for a good cause or backing others efforts to make a difference.”

Larry Carr, CBET, believes that certification should be a requirement. “I believe, however, that it should also be used as a tool to encourage those that are not certified to become certified. With this in mind, I think that a BMET1 should be allowed to retain their job. A carrot of BMET 2, with a raise and greater responsibilities dangled in front of them, should be an incentive to them.”

“Does certification make you a better technician? Does it help you interact with medical staff and assist in troubleshooting complex medical systems? I don’t believe it does,” says Walter Barrionuevo, director of Clinical Engineering Services at BayCare Health System, a department we recently profiled. “All the certification demonstrates is that a technician has the drive and ability to study and pass a test in their field. We do however, encourage our clinical engineering technicians to become certified, but certification is not a requirement for getting hired or being promoted.”

“I certainly believe in it and I think all BMETs should get it,” says Roger Bowles. “As for making it mandatory, I wouldn’t have a problem with that, but I think it would take a while to make that happen as each state would probably have to mandate it. I’ll have to think on that a bit.”

“I expect with Obamacare tightening the belts of healthcare providers, we will see our work load increase and pay rates affected. One way to insure that ‘profession’ is kept in the HTM professional is to require certification,” says Larry Rochowicz, CBET, CRES, who works for biomedical imaging services for The Reading Hospital and Medical Center.

“I would even go so far as supporting licensure. If you look at how our job performance can affect a patient’s outcome, why would you want anything other?

There are details to be considered like entry level and close to retirement situations, but I feel this would benefit the HTM professional – I vote yes.”

“I’m personally disappointed in the lack of support the HTM professional gets from local, state and federal entities,” Rochowicz says. “Everyone understands how medical equipment is used to diagnose and treat patients, but very few people realize the connection between that equipment and the professional men and women which insure the equipment is safe, calibrated and serviced on a regular basis. In order for the HTM profession to get this support, we need regulations on the skills, certifications and licensing of personnel. Most of this is already in place, but what is missing is the local, state and federal laws to support it.”

“If you want to raise the bar and standardize it across the profession there are some issues,” says Kevin Melvin, CBET, from Legacy Health. “This would have to be enacted at the federal level for it to be standardized in every state. Is the profession sure it wants to go there? In my humble opinion there would have to be a grandfather clause for those who are working in the profession but do not hold the certification.”

“There needs to be a lower standard provisional certification for those fresh out of college programs, as a part of the certification test requires experience in the field. Without that experience, passing the exam becomes a very high bar indeed,” Melvin says.

“The profession would need to ensure that there are enough people being educated in the profession to meet the needs of the industry if it becomes a mandatory requirement. Not all hospitals reward certification. What would be done to raise the compensation bar as the profession raises the competency bar? Who would pay for that?”

WHEN THE EMPLOYER TAKES THE INITIATIVE

Certification is not available to those who have just graduated from a biomed program. Should there be a requirement for licensure or certification for those people before entering the profession?

“What happens when somebody comes out of school? In a lot of trades, people are actually apprentices or they have different names for them before they become a fully-fledged [professional],” says David Braeutigam, MBA, CBET, director of biomedical engineering at Baylor Health Care System.

“I feel strongly that we need to take another step in certification, whether its licensing the profession or mandating certification. If I was going to try to map out something, typically, you would want to take baby-steps. You can’t just immediately, starting September 1, 2013, say everybody has to be licensed because you have to get people up to it.”

Braeutigam suggests that there is no reason for the HTM profession to dive in head first. He suggests that a logical step would be to look at all the other professions who have chartered a course through required licensure or certification already. “You find out what other people did. What did nursing do when they finally decided to make it mandatory; what did respiratory do or what did some other healthcare field do in the interim? I’m assuming what they did was that everybody existing was grandfathered. Somehow, starting this day forward, then some type of certification or licensure was required.”

“Another baby-step you can do, which we did at Baylor, I think around 2003, was that we looked at our job descriptions and we actually decided to simplify our job descriptions. Instead of having a BMET I, II, III and IV, we came up with a BMET and a senior BMET. Typically, the differentiator is experience. And so, what we did is that the senior BMET wassomebody who had five or more years of experience, an associate’s degree [and] showed leadership ability. But you also had to have active certification with AAMI-mandatory, with no options,” Braeutigam says.

He says that when the requirements were started, his department had three senior BMETs who were not certified. Those BMET’s were given two years to complete certification. If they did not complete the certification, they would be dropped to a BMET. “Anytime we had an opening in the future for a senior BMET, the requirements are that you be certified. So, what we did, we set up an incentive plan to a certain extent, so that if someone wanted to become a senior BMET, which means typically, when you think about peer-to-peer — more respect, when you think about money in your pocket, you’re getting promoted into a higher pay range, so it’s money in your pocket.”

“What you would do, you would go out and get certification before you actually had to have it. Like getting a job, you have to get the degree before you get the job. You don’t get it afterwards. For us, if you want to be a senior BMET, you have to be certified.”
Managers also need to be certified in Braeutigam’s program. They need to set the example. “Too many of us look for somebody to mandate it as opposed to us, meaning at your local hospital, taking charge of it and running with it there. I’m not going to wait for the group, because we have been talking about this for a long time,” he says.