Legislative Testimony for LB205: Adopt the Surgical Technologist Registration Act
A Nebraska hospital with a job posting for a surgical technologist position proposes the following in their job summary: “The Surgical Technician follows established protocols for cleaning, decontaminating, preparing and packaging, disinfecting or sterilizing, and storing medical and surgical supplies and equipment.”
In researching the duties of surgical technologists, common themes are that they are members of operating room teams, which include the surgeon(s), anesthesiologist and nurse(s). Surgical technologists work under the authority and supervision of the surgeon unless prohibited by state law or hospital policy.
In the 1950’s, 1 in 20 occupations in the country required a government permission slip, also known as an occupational license, to work. Fast forward to today, and now 1 in 3 occupations in the country require this government permission slip to work. This national trend holds true in Nebraska.
Last year, the Nebraska Legislature passed LB299 which establishes a legislative review process to examine the state’s nearly 200 occupational licenses to assess for overly burdensome regulation. If LB205 advances and ultimately passes, this will add one more occupation to this review process.
I’d like to provide insight for the committee using the LB299 framework. LB299 was modeled after the Institute for Justice’s “Inverted Pyramid” and suggests lesser restrictive methods for regulating professions.
One such lesser restrictive method is registration. With registration, the government does not mandate any personal credentials or qualifications, but providers must notify officials of their name, address and the services they provide before they can work. The basic requirement to register with the state may be sufficient in and of itself to deter a potential questionable worker. Registration gives consumers access to a list of service providers.
A second potential option is voluntarily certification from a non-governmental organization. Similar to licensing, voluntary certification sends a signal to consumers that a provider has a certain level of training and experience. Volunteer certification allows employers (not the government) to choose whether they wish to require private certification as a condition of employment. Voluntary certification therefore provides the presumptive benefits of occupational licensing without the costs.
Third, insurance is an option to consider. Insurers will pay damages for harm that is the result of a provider’s malpractice. Hospitals and outpatient medical care centers often require physicians to carry malpractice insurance. Having to carry malpractice insurance incentivizes safety. Like car insurance, fewer payouts results in lower provider premiums and ultimately lower consumer costs. This sends a signal to consumers that the provider cares about safety and quality. Dr. Edward Timmons, a Professor of Economics and Director of the Knee Center for the Study of Occupational Regulation at Saint Francis University who is a leading scholar in the occupational licensing arena reported in his April 2018 Harvard Business Review article that 1) If licensing were improving the quality of optician services, we’d expect to observe lower malpractice insurance premiums in licensed states. We found no evidence of higher premiums in unlicensed states; and 2) when health care professions are licensed, these fees may increase wages but do so at the expense of consumers.
Why don’t we let potential workers and hospitals decide? Why don’t we allow the potential surgical technologist decide if they’d like to pursue voluntary certification to increase their chances for hire? Why don’t we allow hospitals to decide if they are ok hiring a worker and providing on the job training, or if they prefer to hire those who have pursued voluntary certification?
In 2016, the Surgical Technologist credential went through the 407 Review Process. In reviewing the Board of Health and Director’s reports, it was made clear that they recommended against licensure.
LB205 may be titled the “Adopt the Surgical Technologist Registration Act,” but in reviewing the details of this bill, it is not creating a database of demographic information or a list of who is practicing as a surgical technologist in the state as would be expected for a registry. It instead mandates the completion of an application, and it mandates the completion of post-secondary educational requirements (section 6). Along with these requirements, Section 7 proposes statute to spell out a surgical technologist’s scope of practice. LB205 creates a job license.
When discussing a variety of policy issues in this legislature, we often ask, “How does Nebraska compare?” and “What about our neighboring states?” Currently, only 11 states regulate surgical technologists. Of those 11 states, only 1 of our neighbors, Colorado, regulates this profession. Currently, Nebraska falls in line with most of the country, therefore we are competitive as of today. LB 205 would reverse this status.
The Platte Institute opposes the creation of new occupational licenses when there are other ways to assure the safety of the public. We view LB205 as an increased burden to those wanting to work as a surgical technologist. I ask that committee members do not advance LB205 out of committee.