Certifiably Successful

Luckily for you, allied health professionals are in great demand. Unluckily for you, getting and keeping the certification you need can be a challenge. Between ever-changing educational requirements, certification exams, continuing education requirements and the confusion surrounding certification versus registration versus licensure, it’s no wonder that your head spins when you think about becoming certified in your field.

Help is at hand. We spoke with execs at allied health organizations and members of certification boards to clearly map out the route to becoming certified in several fields.

Please note, however, this is only a brief sampling of allied health careers. If we were to cover all the important areas of allied health, we’d wind up writing a book! If you don’t see your specialty covered here, it doesn’t mean Diversity: Allied Health Careers is ignoring your profession. A terrific source of information is your allied health discipline’s professional association Web site.

Speech-language-hearing pathologist

You can call yourself a speech-language pathologist as soon as you have your degree. However, to be certified you must go through the American Speech-Language-Hearing Association (ASHA). “ASHA certification is a voluntary process, but it gives individuals mobility, a standing with employers they might not have with just licensure and rights to bill for Medicare and Medicaid,” says Georgia McMann, director of certification administration at ASHA. “In some positions, certification is what employers look at when they’re deciding on salary increases or promotions.”

Forty-eight states have licensure laws, and most of them are very similar to ASHA’s certification requirements. “State licensure boards will accept verification of ASHA certification and will not require that an individual present all of the documentation and go through what can be a very lengthy process for licensure,” says McMann.

Requirements: To be certified, you need a master’s degree. This involves 75 hours of coursework, of which 36 are graduate hours, and 350 hours of practicum, of which 250 are in speech and language disorders. ASHA’s code of ethics also requires students to sign a basic ethics statement.

The Exam: The exam is a two-hour, multiple choice test with 150 questions. The pass rate is approximately 87%. Many students take the exam during their last semester. The exam is given six times per year and can be taken at major universities across the U.S. For dates and locations, contact ASHA by phone or online, or visit the Educational Testing Service at www.ETS.org. You must pass the exam within three years of your academic coursework being approved for ASHA certification.

Help: ETS publishes two study guides: one for speech and one for audiology.

Continuing Education: In audiology, continuing education requirements start this year. For speech-language pathologists, the requirements will start in 2005. Certified members will have three years in which to complete three Continuing Education Units or 30 contact hours. Check the ASHA Web site for more information.

Advice: “Our certification standards are changing, so for individuals who are enrolled in a graduate program, apply as soon as you get the degree so you won’t face the situation where you were trained under earlier standards and now new standards are in effect,” says McMann.

Radiologic Technologist

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) generally requires technologists to be registered as well as certified. The American Registry of Radiologic Technologists (ARRT) annually registers the certificates of individuals who agree to comply with the ARRT Rules and Regulations, continue to comply with the ARRT Standards of Ethics and meet the Continuing Education Requirements. Whether you need to be certified and/or registered depends on your state. To find out, call your state department of health, or check out the list of state contacts on the ARRT Web site.

About 35 states require a license as well as a certificate. “In all states that require a license, if you are ARRT-registered you can get the license without a problem,” says Ginny Haselhuhn, B.S., R.T.(R), assistant executive director of the ARRT. While right now the states are in charge of whether to require licensure, the American Society of Radiologic Technologists (ASRT) is working with other groups to create a federal minimum requirements licensure program. This is called the CARE bill, for Consumer Assurance of Radiologic Excellence, and it’s just been introduced in the House of Representatives. This bill would require all states to have strong laws regarding licensure and certification.

Requirements: How much education you need for certification depends on your modality. The primary modalities—radiography, nuclear medicine technology and radiation therapy—have accredited programs. Most radiography programs are two years long, but some last four years. Nuclear medicine technology and radiation therapy most often require an additional year beyond radiography.

To become certified as a radiologic technologist, you must also uphold the ethical standards of the ARRT. “You can’t have been convicted of a felony or a misdemeanor,” says Haselhuhn. “You also can’t have lied on your application or something of that nature. We don’t want people who have been convicted of murder or rape or assault to be working with patients.”

The Exam: The exam is a computer-based, multiple choice test with 200 questions and takes about three hours. The exams are scheduled at the student’s convenience at multiple test centers across the U.S. You can take the exam up to three times in three years. If you aren’t successful after three tries, you have to go back and do remedial activities such as independent study to retake the test one last time, within a year.

Help: The ARRT’s certification handbook has a content outline of the exam to help you study. You should receive the handbook from your program director when you’re about to finish the program, or you can order it on the ARRT Web site.

Continuing Education: Every technologist must complete 24 hours of continuing education every two years.

Of those 24 hours, a minimum of 12 must be “Category A,” which means that the educational activity has been evaluated by a RCEEM, or Recognized Continuing Education Evaluation Mechanism, such as the ASRT.

Advice: “Clinical experience as well as didactic knowledge—understanding why you do what you do—is really what it’s all about,” says Haselhuhn. “Understanding the ‘whys’ makes all the difference in the world.”

Respiratory therapist

Certification is considered the entry level into practice for respiratory therapists. “Most hospitals want at least a minimally certified credentialed respiratory therapist,” says Pam Bortner, MBA, RRT, president of the National Board for Respiratory Care (NBRC). Forty-four states plus Puerto Rico also require licensure; to gain licensure, you must be certified. To find out what your state requires, check out the NBRC Web site.

Requirements: Anyone enrolled in a program beginning after January 1, 2002, must have a minimum of an associate degree from a respiratory therapy education program supported by the Committee on Accreditation for Respiratory Care (CoARC), or its predecessor, the Joint Review Committee for Respiratory Therapy Education (JRCRTE) or accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP). Individuals enrolled in an education program before January 1, 2002, must have a certificate of completion from a respiratory therapy education program supported by the CoARC or the JRCRTE or accredited by the CAAHEP.

The Exam: The entry-level test is the CRT. The examination is given via computer and consists of 160 multiple-choice questions distributed among three major content areas: clinical data, equipment and therapeutic procedures. Candidates are given three hours to complete the CRT exam. The exams are given Monday through Friday, and there are testing centers in every state. The test is given at AMP Assessment Centers, many of which are located within select H&R Block tax offices. You can take the exam as many times as you need to, and there’s no time limit.

Help: An overview of the test is available in a book that you can order through the NBRC Web site. You can also take self-assessment exams on the site; one version is free, and there are also secured exams that require a fee.

Continuing Education: A mandatory competency program went into effect in July 2002; every five years you must either take a specialty exam, take a self-assessment exam or complete continuing education credits. “It might sound like a lot, but it’s really not,” says Bortner. “Most of the states that have licensure have a mandatory requirement to maintain between 12 and 18 continuing education credits in two years. So if you maintain your licensure competency, you would automatically keep your credential competency.”

Advice: “If you complete the requirements of the program fairly satisfactorily, you should not have too much problem with the examination,” says Bortner. “We spend a lot of time with the educational people as far as making up examinations. When we look at the requirements for an examination, we share that with the educational programs, so their curriculum is very much professionally based.”

Physician Assistant

Physician assistants are licensed in all 50 states, and certification is required for licensure. The requirements for initial licensure are fairly consistent in all states. “What varies are the requirements for relicensure or licensure renewal,” says Ragan Morrow, director of governance and communication for the National Commission on Certification of Physician Assistants (NCCPA). “Nineteen states require certification for licensure renewal, and three others link certification to prescriptive privileges.”

Requirements: Candidates must graduate from a physician assistant program that’s accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). Most programs take two years on top of a bachelor’s degree.

The Exam: The initial certification exam is called the Physician Assistant National Certifying Examination (PANCE). The computer-based test has 300 multiple choice questions and takes six hours. It’s offered 50 weeks out of the year at over 300 Prometric centers across the country. You must pass the exam within six years of graduation or within six attempts, whichever comes first. “In the entire history of the organization, less than one-tenth of one percent of PAs did not pass within their first six attempts,” says Morrow.

Help: The American Academy of Physician Assistants(AAPA) offers a list of exam review courses at www.aapa.org/cme/review-cert.html. There are also several study guides, including A Comprehensive Review for the Certification and Recertification Examinations for Physician Assistants, which includes a CD ROM with a practice test (AAPA members: $32.95; Non-members: $37.95; Contact: API: 800-708-7581). An updated version of this book is now available.

Continuing Education: The initial certification is good for two years, after which certificate holders must log 100 hours of continuing medical education (CME) every two years. After six years, you must take a recertification exam. Four organizations either provide the CME or approve other organizations to provide the CME; one of the biggest providers is the AAPA. PAs can also go to any CME that’s accredited for physicians.

Advice: “People who do well in their PA program are generally going to do very well on the certification exam,” says Morrow. “Put in the hours when you’re in your program, and certification should just be one last step to a great career.”

Occupational Therapist

Forty-seven states require licensure to work as an occupational therapist, and certification is part of the licensure requirements. NBCOT offers two types of certification: the Occupational Therapist Registered and the Certified Occupational Therapy Assistant.

Requirements: To become an Occupational Therapist Registered, you must be a graduate of an accredited occupational therapy program and complete fieldwork. Some programs are at the bachelor’s level, but most are at the master’s level. Becoming a Certified Occupational Therapy Assistant requires a two-year technical degree from a community college or technical school plus fieldwork. All candidates must sign a code of conduct; every three years, you must reattest to the standards.

The Exam: The exam, which is administered by computer, consists of 200 multiple-choice questions and lasts about four and a half hours. The exam is given at the candidate’s convenience at more than 300 Prometric Test Centers throughout North America, including Puerto Rico and the Virgin Islands. If you fail the test, there’s a waiting period of 90 days to retake it. You can take the exam as many times as you need to, and there’s no time limit.

Help: Some companies, such as F. A. Davis Company, offer study guides for the NBCOT exam. Search the Internet with the keywords “study guide” and “NBCOT” to find others.

Continuing Education: Every three years, you must attain 36 hours of professional development activities, which may include taking college classes, attending workshops, authoring a book and lecturing at a seminar. “The opportunities are very cost-effective and attainable,” says Paul Grace , MS , executive director of NBCOT.

Advice: “A quality certification exam needs to measure what you do in practice,” says Grace. “Where students put that to task is in their fieldwork experience. So besides going to a fine school and getting a degree, their fieldwork should offer them a variety of experiences so they can truly experience the breadth of the profession. When they see questions on the exam about particular scenarios, they’ll have their fieldwork experience to draw from.”

A Day in the Life of a Respiratory Therapist

Name: Tonie Perez

education: Kettering College of Medical Arts
title: Respiratory therapist
workplace: Cincinnati Children’s Hospital’s Regional Center Neonatal Intensive Care Unit (RCNIC)
location: Cincinnati, Oh.


Every eight seconds in the United States a new baby is born. Each newborn begins their lives as independent humans with their very first breath. Throughout our lives, how often we breathe and how much we breathe is often taken for granted. For some children, however, this simple function is not so effortless.

The science of respiration or breathing leads us to the profession of respiratory therapy. Respiratory therapy is utilized in all hospital settings, nursing homes and even home health care. Some respiratory therapists choose to become instructors in the world of education, while others work within the hospital environment where there are various levels of care.

Meet Tonie Perez, a respiratory therapist at Cincinnati Children’s Hospital Medical Center. Perez has been a respiratory therapist for 17 years. She graduated from Kettering College of Medical Arts in Kettering Ohio in 1987. “I chose Kettering because they are state-of-the-art, and I knew I would get a good education,” she says.

At the Cincinnati Children’s Hospital Perez works in the newborn intensive care unitÑthe Regional Center Neonatal Intensive Care Unit (RCNIC)Ñwhere she is involved with the intensive care aspects of respiratory therapy.

The population of the RCNIC varies from pre-term (24-weeks gestation) to post term (greater than 40 weeks). The role of the respiratory therapist in this critical care environment is to work with pre-term infants prior to 40-weeks gestation or a term pregnancy, which requires constant monitoring of respiratory status. The infant’s lungs are not fully mature until 34-weeks gestation, so birth prior to 40 weeks brings potential problems. For example, during the lung development a substance called Surfactant, which is critical for normal lung function, isn’t readily available.

Being born early not only requires more ventilator support, it also necessitates the need to give Surfactant artificially. Oxygen given to the infants must be monitored continuously because of potential detrimental side effects to their eyes and lungs. It’s like that old adage, too much of a good thing is bad.

Some of the patients require medication like bronchodilators to increase the diameter of their airways in order to decrease the work it takes to breathe. Airway management is also needed when patients stop breathing. Immediate intervention is required until the problem is resolved. Respiratory therapists will place a mask over an infant’s face and squeeze a bag that inflates the lungs and breathes for the infant. Depending on the severity of the situation, infants may also be placed on a ventilator. Doctors, nurses and respiratory therapists all work collaboratively for the best care of the child.

Obviously this is challenging and demanding work, but Perez thrives in the environment. She recently received the Zenith Award as an acknowledgement that she has gone above and beyond the call of duty in her position.

Perez originally chose this field of expertise because she felt she could make a profound difference in her parent’s lives. She also enjoys being part of a team that is working together to improve patients’ outcomes.

Perez encourages all students interested in respiratory therapy to learn more about this exciting field. “I can’t stress enough the fact that respiratory therapy is an ever changing and growing field,” she says, “and if you are one who loves new and exciting things and loves people, respiratory [therapy] is for you.”

Read on to discover what a typical day is like for respiratory therapist, Tonie Perez.

7:00 a.m.
Perez’s day starts early; she will work a 12-hour shift, three days a week. Upon arrival to the unit, the night shift gives her a progress report on the patients she is assigned to for the next 12 hours. Once Perez has gotten the report, she checks her orders for the patients.

8:00 a.m.
Perez is in her area making ventilator rounds. She
assesses the patients and their ventilators and makes sure they are working correctly.

9:30 a.m.
The physicians, residents, nurses, dieticians, pharmacists and respiratory therapists go to each bedside and discuss the course of care for that particular patient. Patients on ventilators are assessed and ventilator settings are documented every two hours.

10:00 a.m.
Ventilator rounds are again made, settings are documented, and patients’ lungs are listened to and assessed for secretions or other negative sounds. If needed, corrective intervention is made.

Perez says that this is the predictable element of her job, which makes up about 40%. The other 60%, she says, is not scheduled or predictable because this is a very unstable environment. “Our doors are open 24-hours a day, seven days a week to accommodate the various needs of the infant population,” she says.
11:00 a.m.
A 30-week-old infant is coming in with the transport team from an outside birthing center that was not able to accommodate his breathing needs and possible surgical issues. He is placed in a radiant warmer and connected to a ventilator. The monitors are functional so they are continuously monitoring him. An x-ray is ordered to determine if the ventilator is adequate, and blood is drawn, which will be sent to the lab so that they can access his ventilation.

11:30 a.m.
A half hour has passed while they admit the infant boy. Surgery is called in to assess the need for surgery on a questionable lung mass that was seen on his x-ray. Meanwhile, the staff is doing total supportive care.

With all the activity, the infant in the next bed is becomes sensitive to the increased noise. She starts to show signs of distress; her heart rate drops and she begins to have an apnea episode where she holds her breath and begins to turns blue. Perez attempts to stimulate the infant’s breath by repositioning her and making sure her airway is open. The girl begins to breathe again and her color returns to normal.

1:30 p.m.
Perez begins assessing various ventilator patients. With the new baby boy, she now has four patients to attend to. On any given day Perez can have from two to 12 patients, but she says that she usually has six.

“You’re responsible for those patients’ ventilator assessment every two hours, respiratory medication administration, laboratory blood draws, and constant monitoring of their vitals,” she says.

3:00 p.m.
Surgery returns to the new admit to inform Perez and the nursing staff that surgery is not needed at this time. They continue supportive methods.

4:00 p.m.
Perez is informed that another new admit will be coming in. The mother of the baby girl had no prenatal care and has no idea what the gestation is of the infant.

5:15 p.m.
The infant girl arrives. It was determined by the outside birthing hospital that the infant was approximately 29 weeks old. The birthing hospital was not equipped to take care of her, so she came to RCNIC for supportive care. She’s placed on a nasal cannula so that oxygen can be delivered to her. She’s also placed on monitors and observed. Perez obtains lab values to assess her ventilatory status. Everything appears normal, but the staff will continue to watch her.

6:30 p.m.
Perez makes her last ventilator rounds and takes notes. When 7:00 p.m. arrives she’s prepared to give her progress report on all the patients for that day.

“The average day is very lively but that is what I love the most about my job,” Perez says. She also values her great co-workers and the continuous learning environment.

“There is nowhere else you can get paid to learn,” Perez asserts. “Medicine is always changing and you have to be the kind of individual that accepts change and takes it with open arms.”