Licensure in medicine originated in London when a small group of physicians led by the scholar Thomas Linacre petitioned King Henry VIII to establish a college of physicians on September 23, 1518. An Act of Parliament extended its powers from London to the whole of England in 1523.¹ The aim was to protect the public by ensuring that only qualified professionals were allowed to practice medicine. Likewise, licensing today of medical and other professionals exists to protect the public from unqualified practitioners and journeymen.

In this month’s issue of the Journal, Johnson et al.² provide a detailed background of the development of the perfusion profession, a description of the expanding scope of perfusion practice, and the nature of the education and requirement to become and maintain certification as a certified clinical perfusionist (CCP), a story of the birth and evolution of an important allied health specialty. The authors review the 30-year history and landscape of licensure of perfusionists in the United States and distinguish between “registration,” “titling,” and “certification.” An important finding of the review is the lack of professional recognition, regulation, and licensure in most states, a finding that needs to be addressed.

The development and introduction of the heart-lung machine (HLM) for cardiopulmonary bypass (CPB) to permit open-heart cardiac surgery are considered some of the greatest advances in cardiac medicine. However, the introduction of the complex, novel, and “temperamental” new devices (e.g., pumps, oxygenators, reservoirs, heat-exchangers, filters, tubing, etc.) required dedicated and informed persons to run these new machines. In the early days, these were managed by thoracic surgeons, anesthesiologists, residents, and laboratory technicians who learned to assemble, prime, operate, troubleshoot, and clean these HLMs during laboratory research on animals. They then managed CPB during human applications in addition to their other responsibilities. In the early years, mortality rates associated with CPB were significant. It became apparent that this new powerful technology required specialized expertise. Gradually, people from other fields (e.g., nursing, pulmonary therapy, surgical technicians) began to perform these duties as their primary responsibility after on-the-job training. This led to the term “perfusionist” (v “pump tech”), which was recognized by the American Medical Association in 1977. Formal hospital-based training was initiated in 1963 (Cleveland Clinic) and at universities in 1968 (Ohio State University). In 1968, perfusionists established the American Society of Extracorporeal Technology; in 1973, the American Board of Cardiovascular Perfusion. The designation of CCP was identified in 1973, and the first examination was administered in 1974.

The collaborative efforts of surgeons, anesthesiologists, and perfusionists to improve safety, conduct clinical research, and continuously improve practice are numerous and unprecedented and have been critical to the refinement of cardiopulmonary bypass. For example, The Accreditation Committee–Perfusion Education (AC-PE) is a committee of the Commission on Accreditation of Allied Health Education Programs. The mission of the AC-PE is to cooperate with the Commission on Accreditation of Allied Health Education Programs to establish, maintain, and promote appropriate standards of quality for educational programs in perfusion and to provide recognition for educational programs that meet or exceed the minimum standards outlined in the accreditation Standards and Guidelines for the Accreditation of Educational Programs in Perfusion. The AC-PE is composed of surgeons, anesthesiologists, and perfusionists, consisting of two representatives appointed by each sponsoring organization (American Academy of Cardiovascular Perfusion, American Association for Thoracic Surgery, American Board of Cardiovascular Perfusion, American Society of Extracorporeal Technology, Perfusion Program Directors’ Council, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons). The committee has developed a world-class accreditation program for perfusion schools. In the United States, all training must be affiliated with an educational institution and leads to at least a bachelor’s degree. It includes both basic education and practical experience (at least 75 CPB cases). Some programs offer a master’s or doctorate degree. To be certified as a CCP, a candidate must pass a two-part examination and have performed 40 clinical CPB procedures postgraduation. To maintain annual certification, CCPs must perform at least 40 clinical procedures each year and receive 45 continuing education units every 3 years.