In the United States, medical doctors are licensed by state medical boards to practice medicine. That is all that is needed for state medical boards to be able to carry out their statutory mandate to protect the public health, safety, and welfare by assuring that those who practice as physicians have the requisite education and experience to practice medicine. New physicians are examined through the United States Medical Licensing Examination (similar to the PE exam). State medical boards do not license medical specialties, recognizing advanced qualifications in medicine. If a physician wishes to pursue a specialty, say in anesthesiology, they have to gain another four or so years of experience in anesthesiology beyond the initial residency. After that, they can apply to the American Board of Anesthesiology (www.theaba.org, or do a Google search of “American Board of”—you will get pages and pages of them) to take the examinations leading to a specialty certification in anesthesiology. There are many specialty certifications in medicine, each overseen not by state regulatory boards, but rather by professional organizations. When a hospital needs another anesthesiologist, they hire one who is a licensed medical doctor in their state, and, most likely, one who has a specialty certification in anesthesiology from the ABA. The same is true of surgeons, neurosurgeons, radiologists, internists, obstetricians, etc., etc. In medicine, the professional associations determine the advanced qualifications required to practice in medical specialties, not the limited number of board members who are gubernatorial appointees to a state medical board.
The Web site of the American Board of Medical Specialties provides a brief description of medical licensing in the U.S.:
“Physician board certification is a voluntary process that approximately 80 percent of doctors in the U.S. obtain. A physician is licensed by the state to "practice medicine and surgery," and medical board certification is not a requirement for licensure. Licensed physicians may practice in whatever medical disciplines interest them and can legally practice in that field of interest without obtaining a medical residency or fellowship. Board certification, however, means that a physician’s skills and knowledge in the specialty/subspecialty has been examined and meets standardized requirements by an ABMS Member Board. Additionally, some of the surgical specialties require one or more years of experience before physicians can take their board-certifying exams (the number of years varies according to each board).”
Quite frankly, the licensure process in medicine couldn’t work otherwise because the state medical board would need to have too many physicians of all those specialties. And from a regulatory standpoint, it isn’t needed. In our licensing system, we regulate professions state by state essentially to accomplish two objectives: to establish and regulate a minimum threshold of education, experience, and examinations to practice that profession at a minimum level of competence; and to put in place a regulatory system to be able to discipline those who commit professional misconduct in a fashion that may negatively impact the public health, safety, and welfare.
Engineering is no different. We license engineers as professional engineers by establishing a threshold of minimum competence evidenced by appropriate standards of education, experience, and examination, and we establish a regulatory system in each state to assure that all professional engineers practice ethically and responsibly. Disciplinary power is in place to deal appropriately with those who don’t. As in medicine, regulating advanced engineering qualifications at the PE board level isn’t necessary from a regulatory/legal perspective, and it isn’t appropriate.
The American Society of Civil Engineers maintains a post-licensure certification program, for example, providing a Diplomate Water Resources Engineer specialty certification. This certification is for those water resources engineers who demonstrate by advanced education and experience that they have achieved an advanced level of qualification in water resources engineering, including achieving the requisite body of knowledge.
The American Academy of Environmental Engineers maintains a certification program, previously called Diplomate Environmental Engineer (DEE), and now called Board Certified Environmental Engineer (BCEE), which involves documentation of advanced education and experience and written and/or oral examinations showing advanced qualifications in environmental engineering.
These, and other, engineering certifications can play the same role in engineering as do the certification programs in medicine.
Structural engineers, through the ASCE Structural Engineering Institute, and through the National Council of Structural Engineering Associations, have been advocating that PE boards in the U.S. initiate separate licensure, after the PE, for structural engineers (read "Debating the Structure of Licensing"). The structural engineers mean well, but they are barking up the wrong tree. This initiative has two fatal flaws.
1. This initiative would need to be as applicable in the future to nuclear engineers, or hazardous waste engineers, et al, as it is to structural engineers. Many structural engineers believe that structural engineering uniquely imperils the public health, safety, and welfare, and this contention simply isn’t valid. The discussion is without merit. In the long run, having the state regulate multiple engineering disciplines won’t work.
2. From a legal and regulatory standpoint, the regulation of advanced qualifications isn’t necessary. It isn’t necessary in the medical profession, and it isn’t necessary in the engineering profession. Licensure followed by specialty certification works well in protecting the public health, safety, and welfare in anesthesiology and neurosurgery; it can work as well in engineering.
Engineers of all disciplines should together recognize that technology is expanding, and will continue to expand, and that engineering practice in all disciplines that impact the public health, safety, and welfare will continue to become more complex and more demanding in terms of both technical and professional practice skill sets. The appropriate method of recognizing the advanced qualifications required is: 1) through expanding specialty certification to many more disciplines; 2) ensuring that those certifications have an appropriate level of rigor, and; 3) educating owners and others who employ engineers that these specialty certifications are desirable and necessary to reflect the advanced qualifications required for complex engineering assignments.
It works in medicine; it always has. It can work the same way in engineering, and engineers should be working together to make it work well, the same way it works in medicine. If it works for neurosurgeons, it will work for structural engineers.
Editorial input provided by Bernard R. Berson, P.E., F.NSPE and L. Robert Smith, P.E., F.NSPE.
