State Licensure requirements for PFT Testing

There has been a fair amount of confusion about PFT lab staff licensure requirements. This information is not available on the AARC website, nor on any of the AARC state society websites. A month or so ago I reached out to all of the AARC state societies but received responses from only a handful of them. I was recently able to complete this research however, by visiting the websites of the remaining state licensing boards and state legislatures.

It turns out that the majority of states require licensure of PFT Lab staff, most often by requiring CRT or RRT credentials, occasionally by allowing CPFT and RPFT credentials and in a couple of cases, a state licensure exam. There were also a couple of cases where the regulations were so vaguely written that it wasn’t clear whether pulmonary function testing fell under the Respiratory Care practitioner scope of practice or not.

Anyway, based on state society feedback and my best interpretation of the relevant laws and regulations, the following list should be a reasonably accurate look at the licensure requirements for each state.

State: Requires Licensure: Credentials: Source:
Alabama Yes CRT, RRT Link
Alaska No
Arizona Yes CPFT, RPFT, CRT, RRT Link
Arkansas No Link
California Yes State licensure exam Link
Colorado Yes CPFT, RPFT, CRT, RRT Link
Connecticut Yes CRT, RRT Link
Delaware Yes CRT, RRT Link
Florida Yes CRT, RRT Link
Georgia Yes CPFT, RPFT Link
Hawaii Yes CRT, RRT Link
Idaho No Email
Illinois Yes CPFT, RPFT, CRT, RRT Link
Indiana Yes CRT, RRT Email
Iowa Yes CPFT, RPFT, CRT, RRT Link
Kansas No Link
Kentucky No Link
Louisiana Yes CRT, RRT Link
Maine No Email
Massachusetts No Link
Maryland/DC Maybe Link, Link
Michigan Yes CPFT, RPFT Link
Minnesota No Email
Mississippi Yes CRT, RTT Email
Missouri Yes CRT, RRT Link
Montana Yes CPFT, RPFT, CRT, RRT Link
Nebraska Yes CRT, RRT Link
New Hampshire Yes CRT, RRT Link
New Jersey Yes CRT, RRT Link
New Mexico Yes CRT, RRT Link
New York Yes CRT, RRT Email
Nevada Yes CRT, RRT Link
North Carolina Yes CRT, RRT Email
North Dakota Yes CRT, RRT Email
Ohio Yes CRT, RRT Link
Oklahoma Yes CRT, RRT Link
Oregon No Link
Pennsylvania Yes CRT, RRT Link
Rhode Island Probably Not Link
South Carolina Yes CRT, RRT Link
South Dakota Yes CRT, RRT Link
Tennessee Yes CRT, RRT Link
Texas Yes CRT, RRT Link
Utah Yes CRT, RRT Link
Vermont Yes CRT, RRT Link
Virginia Maybe Link
Washington Yes State licensure exam Link
West Virginia Yes CRT, RRT Link
Wisconsin Yes Up to hospital Email
Wyoming Yes CRT, RRT Link

I have mixed feelings on the subject of licensure. On the one hand my concerns about the level of professionalism in pulmonary function testing (discussed previously) has caused my views to evolve substantially over the last couple of years. I now believe that licensure can and should be a step towards improving the quality of PFT lab staff and testing. Having said that I am extremely disappointed by how few states recognize CPFT and RPFT certification as the most appropriate requirement.

I noticed that the respiratory therapist scope of practice from many different states had mostly the same statements. The AARC has been the state (and national) level advocate for the profession and is likely responsible for this. I’m not necessarily going to blame the AARC, instead I am going to say that it appears that pulmonary function lab staff are remarkably poor advocates for our field.

There’s a lot that needs to fixed in the field of pulmonary function testing if it is going to in any way remain relevant. Going forward I’d like to suggest that even though it isn’t a requirement, all PFT labs should require their staff to obtain, at a minimum, CPFT certification. I’d also like to suggest that we all need to contact our AARC state-level political advocates and lobby for language in the respiratory therapy scope of practice statements that acknowledges the need for CPFT and RPFT certification for performing pulmonary function testing. The reality is that we can’t expect others to fix this for us. We need to advocate for ourselves.

Finally, kudos to the AARC state societies that responded to my questions and knew whether or not licensure was required (or at least acknowledged that they didn’t know). Dingbats to those that didn’t.

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PFT Blog by Richard Johnston is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

11 thoughts on “State Licensure requirements for PFT Testing

  1. I work for a pediatric pulmonigist in the state of Florida and do PFTs I’m not a CMA or even a RMA I was trained by another non CMA to do the PFTs and honestly have never felt comfortable with the amount of responsibility it in tails So should I be doing this or not ?I feel your current blog is telling me NO

    • Carmen –

      It depends on what tests you are performing. If you are just performing peak flows or spirometry you are probably okay since these tests usually completely unregulated and almost anybody is allowed to perform them (no state will force a doctor’s office or clinic to hire a respiratory therapist just to perform peak flows or spirometry). If you are doing more than that (lung volumes, DLCO, oscillometry, exaled NO), particularly if you are performing pre- and post-bronchodilator spirometry and most particularly if you are administering the bronchodilator, then you are probably within your state’s respiratory therapist’s scope of practice and shouldn’t be doing it.

      If you like performing tests on children however, and are any good at it then consider this an opportunity for you to seek more advanced education (many community colleges have respiratory therapy courses), and get your CRT or RRT certification (CPFT or RPFT too). There is always a demand for good pediatric pulmonary function technicians.

      – Richard

      • Yes Richard I am doing lung volumes and dlco and pre and post bronchodilator spriometry and administering the bronchodilator What should I do now that I know this I know about the certification I’ve mentioned it to the doctor I work with but was told it’s really not necessary. This is a large practice with multiple offices and all the MAs are doing it.

        • Carmen –

          Tough call because your decision is putting your job on the line. I think that the scope of practice for respiratory therapists in Florida is fairly clear but I am not not an expert. If you want to be sure you could try reaching out to the Florida Society for Respiratory Care in some anonymous fashion and get their opinion.

          It is possible that the pediatric physicians you work for may honestly not be aware of the requirements and to be realistic even if this situation came to the attention of the medical authorities in Florida any legal or regulatory action would most likely to be focused on the physicians responsible for the pulmonary lab and not you. You might still be out of a job, but it is unlikely that any legal action would be taken against you personally. I am more concerned however, that you have already stated that you are uncomfortable with the amount of responsibility you’ve been given, particularly since you the only training you received was from another medical assistant. Maybe I am reading too much between the lines, but I am concerned that your training isn’t sufficient to be doing accurate testing and I think you are too. If this is the case then I would be concerned about the ethics of the practice group you are working for.

          At a conference about ten years or so ago I met a pulmonary technician that worked for a pulmonary practice group. He was constantly being given very unrealistic times to perform testing and if there was any difficulty getting the patient to perform the tests and the appointment time was up then it was tough luck for the patient. All the physicians cared about was whether there were results, not whether they were accurate. In this case the practice group was ordering and billing for tests they knew were of marginal accuracy but this continued (at least according to what he said) because the tests and their interpretation brought in revenue. In his case, he also had limited training and had been unable to find a job at a hospital-based PFT lab. He needed his job so he didn’t feel he could walk away from the situation, but he was nevertheless quite unhappy and dreaded going to work each day. I’d like to say that I’d walk away from a situation like this (and since I am semi-retired and only work on things that interest me right now I can) but there have been times in the past when for any number of reasons (although not because the people I worked for were ethically challenged in any way) I’d like to have left the job I had at the time but I also had responsibilities and couldn’t easily walk away.

          You’ve brought this issue to the attention of the physicians you work for and it is clear they aren’t interested in your questioning the job requirements. You probably have a good idea whether your situation is ethically challenged or not. If it is and your work is leaving a bad taste in your mouth and you don’t look forward to going to work then it’s time to look for a new job. Life is too short to be that unhappy with what you’re doing. If it isn’t this way however, and you like what you’re doing then dig into the job and learn how to be the best pediatric pulmonary technician you can be. There are a number of good textbooks on pediatric pulmonary function testing (get them used on AbeBooks.com) and study them. Regardless of which course you choose you should also think about going back to school to get the proper certifications so that you don’t end up trapped in a job you don’t like.

          Best wishes, Richard

  2. Hello.

    The information for Pennsylvania on this website stating that one must be a CRT or RRT to work in a PFT lab in the state is incorrect. The link provided on the site for the state takes you to the Pennsylvania Code for RT licensure.

    Read through the code and you won’t see ANYTHING that states one must hold the CRT or RRT credential to work in a PFT lab. What it says is that in order for you to call yourself a respiratory therapist and be licensed as one, you need to meet the requirements in the code.

    Pennsylvania licensure of RTs is not exclusive – meaning that another license that has a scope of practice that includes traditional RT activities is able to perform them. For example, an RN can legally perform nearly all of the responsibilities that are in the RT scope of practice because their scope of practice includes those responsibilities. They do not need to hold the CRT or RRT credential in order to do so – their RN covers it. Right or wrong, that’s what the law states.

    There is absolutely nothing in the PA Code that refers to individuals working in a pulmonary function lab. It only addresses those who are licensed as an RT, their requirements, and the legality of calling yourself an RT.

    In reality, there is no legislation that specifically addresses who can and who cannot work in a PFT lab. For this reason, I know of a physician office where the office SECRETARY performs spirometry and other tests. She has no education other then what was provided by the sales rep (which, fortunately, was VERY good and she does a good job!).

    Thanks

    Thomas Lamphere BS, RRT-ACCS, RPFT, FAARC
    PSRC Executive Director

    • Thomas –

      In the PA RT scope of practice it states that functions of a respiratory therapist includes:

      (11) Measurement of ventilatory flows, volumes and pressures.
      (12) Analysis of ventilatory gases and blood gases.

      This language is similar to the RT scope of practice in other states and I took it to mean that pulmonary function testing was limited to RT’s. Usually when pulmonary function testing can be performed by CPFTs, RPFTs or those without any particular qualifications then that is often included in the legislative statement. Nice to hear that I was wrong.

      There’s no reason that RN’s (and physicians) couldn’t perform pulmonary function testing anywhere but it probably isn’t terribly cost-effective. Scopes of practice are almost always directed at hospitals and do not cover private physician offices or clinics. Please note that the PA RT scope of practice includes the statement “(b) Under section 13.1(d) of the act, a respiratory therapist may perform the activities listed in subsection (a) only upon prescription or referral by a physician, certified registered nurse practitioner or physician assistant, or while under medical direction consistent with standing orders or protocols in an institution or health care facility.” There are secretaries and medical assistants performing spirometry (often quite poorly) as well as many other tests (also often quite poorly) across the country without any oversight.

      Regards, Richard

      • Believe me when I tell you that the law SHOULD regulate who performs pulmonary function testing. Unfortunately, Pennsylvania lawmakers do not like to restrict practice….even when it makes sense to do so!

        The fact that these tests often help in determining a patient’s diagnosis AND treatment underlines the importance of the tests being done correctly. The same could be said for the quality control in PFT labs which is severely lacking in many labs across the country! I was just discussing this very topic at the AARC Congress in Indianapolis last week.

        Thanks!

        Tom Lamphere BS, RRT-ACCS, RPFT, FAARC
        PSRC Executive Director

        • Tom –

          You’re preaching to the choir. We also need to think about lab licensure as well, not just the staff. I speak to technologists workings in PFT labs all over the country and I think that most of us try to do our jobs well but we are often undercut by a lack of support from the hospital administration and indifference by medical staff. Lab licensure (with documentation and inspections) would set minimum standards for PFT lab operations that would in turn mandate a higher level of support (and perhaps respect) than we currently receive.

          Regards, Richard

  3. If I am reading all the comments correctly, it would seem that a Registered Nurse could administer a PFT. Does that also apply to a Paramedic? In a First Aid clinic on a construction site attended by a RN or LPN or Paramedic – which of these individuals would be allowed to administer a PFT?

    • Carolyn –

      In most state regulations pulmonary function testing is considered part of the Respiratory Therapy scope of practice. Occasionally there is additional language allowing CPFTs and RPFTs to perform pulmonary function tests. In a few states there are no restrictions whatsoever about who can perform PFT’s. In all states however, it is common practice for medical assistants and even clerical staff to perform spirometry in clinics and physician offices. Moreover, I know of some group pulmonary physician practices that have their own PFT lab in states where RT or PFT credentials are required but because they are a private practice they don’t consider that state regulations apply to them (and this is because the regulations for the RT scope of practice usually includes some language that implies that they only apply to hospitals and medical centers). So, depending on which state you’re in, what test you’re performing and where you’re performing it there’s no question that RNs, LPNs and EMTs can perform pulmonary function testing.

      I’d also say that it’s somewhat universally accepted that RNs, LPNs and EMTs are “higher” up the totem pole than Respiratory Therapists (and CPFTs and RPFTs) and for this reason it is probably legally permissible for RNs, LPNs and EMTs to perform PFTs anywhere, regardless of whether or not PFT testing is mentioned in the RN, LPN or EMT scopes of practice. However, whether it is economically feasible to have RNs, LPNs or EMTs perform PFTs is another matter. The pay scale for these professions is usually noticeably above those for CRTs, RRTs, CPFTs and RPFTs, and this being the case, why would you hire an RN, LPN or EMT for this kind of work?

      In addition, simply because you have RN, LPN or EMT credentials doesn’t mean you have the knowledge to perform PFTs. There is a common perception among physicians, nurses and allied professionals who have never worked in a PFT lab that it is simple, easy work that anyone can do. This is far from the case since quality pulmonary function testing requires both experience and a knowledge of physiology, pathophysiology, physics, technology and psychology. True, almost anybody can go through the motions and get a computerized test system to get some kind of test results from a patient, but they probably won’t be meaningful and clinically useful results.

      Regards, Richard

  4. Hello,
    It was good to read your BLOG.
    I have been doing PFT’s for over 20 years. I was frustrated to see clerical persons at pulmonary offices being trained to do complete PFT’s.
    After being a CRTT for years I became a CPFT then
    RPFT and love this job. No regrets, but I want all labs to put out ATS acceptable data. I guess that is expecting too much.
    Keep up the good work,
    Patricia Clark
    Coordinator Pulmonary Function Lab
    Trios Hospital
    Kennewick Wa

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