Questions about the differences between licensing and certification, including whether the medical assisting profession should seek state licensure, have increased in recent years. What follows is a definition of key terms and discussion points for different scenarios encountered in the states.

  1. Generally, licensure may be defined as a system of state (on rare occasions, federal) statutes and regulations that requires one or both of the following in order for an individual to practice a profession, or a certain part of a profession:

    A. A certain amount and type of professional education

    B. The attainment of a professional credential

    Additionally, licensure is a system of mandatory, not voluntary, credentialing.
  2. A system of legally required, mandatory education and/or credentialing should be considered licensure, even if it is called something else. For example, the laws of all states mandate that registered nurses (RNs) complete formal nursing education and pass the necessary examination(s) to be licensed as RNs. Similarly, state laws require accountants to meet educational and testing requirements in order to become licensed as certified public accounts (CPAs). Because RNs and CPAs must meet the legally mandated educational and examinational requirements, the systems of state regulation for these two groups of professionals are really licensures, as defined above, even though the words registered and certified appear in the respective professional designations.
  3. Certification may be defined as a legally voluntary system of professional credentialing. Although market forces may make a certification a practical necessity for working, the lack of a state or federal law requiring education and/or credentialing prevents the voluntary professional designation from being considered a license.
  4. It is the position of the American Association of Medical Assistants that potentially patient-jeopardizing procedures—such as phlebotomy; subcutaneous, intramuscular, and intradermal injections; and limited scope radiography—should only be delegable to medical assistants who fulfill the following requirements:

    A. Professionally educated. They have graduated from a medical assisting program accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) or the Accrediting Bureau of Health Education Schools (ABHES).

    B. Suitably credentialed. They hold a current, accredited medical assisting credential of acceptable breadth, depth, and rigor.

    Restricting such procedures to professionally educated and credentialed medical assistants would be considered limited licensure of medical assistants. Such restrictions would not be considered total licensure of medical assistants because nonpotentially patient-jeopardizing tasks could still be delegated to medical assistants who have not received accredited medical assisting education and have not earned an accredited medical assisting credential.
  5. Most medical assistants work under the direct supervision of physicians in ambulatory care delivery settings. Therefore, it is preferable that any type of limited licensure be under the jurisdiction of the state boards of medical examiners.
  6. However, many state boards of medical examiners do not want to interfere with the rights of physicians to delegate procedures to medical assistants, even to those who are not professionally educated and suitably credentialed. Physicians could assert that limited licensure would increase medical assisting salaries and the personnel costs of medical practices and clinics.
  7. On the other hand, in states in which the right of physicians to delegate to medical assistants is not clearly set forth in state law, the boards of medical examiners might support legal recognition and limited licensure of medical assistants.
  8. Some state boards of nursing and nursing organizations are supportive of the delegation of procedures to professionally educated and suitably credentialed medical assistants. Boards of nursing have even supported legislation and/or rules limiting injections to professionally educated and credentialed medical assistants, and have taken the position that boards of medical examiners are undermining public safety by allowing such delegation to medical assistants who are not professionally educated nor credentialed.
  9. The legal environment is uncertain in some states, and there have been disputes between the boards of medical examiners and the boards of nursing over the interpretation of the respective medical practice acts and their regulations, and the nurse practice acts and their regulations. In some instances state attorneys general and courts have been asked to resolve these conflicts. Unfortunately, the right to practice of the medical assisting profession can be threatened by these disputes.
  10. In other states there is cooperation and harmony between the boards of medical examiners and the boards of nursing in regard to medical assisting. For example, South Dakota law provides for joint regulation of medical assisting by the board of medical examiners and the board of nursing. Note the following language from the South Dakota statutes:

    36-9B-3 Registration required. No person may practice as a medical assistant unless that person is registered with the Board of Medical and Osteopathic Examiners pursuant to this chapter.

    36-9B-4 Application for registration—Renewal—Fees. A medical assistant seeking registration under this chapter shall complete an application prescribed by the Board of Medical and Osteopathic Examiners and the Board of Nursing. The application shall be submitted to the Board of Medical and Osteopathic Examiners. A registration fee of 10 dollars shall accompany the application and shall be paid to the Board of Medical and Osteopathic Examiners.

    The registration shall be renewed biennially by payment of a fee of five dollars. A registration not renewed by December 31 of the year of expiration lapses.

    36-9B-5 Registration by Board of Medical and Osteopathic Examiners. The Board of Medical and Osteopathic Examiners shall register a medical assistant following the submission of an application by an applicant for registration who has graduated from an accredited school or a school which meets standards similar to an accredited school and has met other qualifications established by the Board of Medical and Osteopathic Examiners and the Board of Nursing.

    An applicant for registration is exempt from the requirements of this section if the application is received by the Board of Medical and Osteopathic Examiners by January 1, 1992.

Should state medical assisting societies pursue limited licensure? Answering this question is seldom easy because legal and political factors vary greatly from state to state. Above all other considerations, it is imperative that there be unity within the state medical assisting society. Nothing can destroy a public policy initiative more quickly than disunity between members of the profession.

State societies are strongly encouraged to contact AAMA Executive Director Donald A. Balasa, JD, MBA, at dbalasa@aama-ntl.org for assistance in any state public policy efforts.