The Less-Regulation Movement: Why Certification Is a Viable Option for Professional Regulation

Having studied the economic and legal arguments for and against the less-regulation movement (LRM) and written about this topic on multiple occasions, I believe that incorporating private-sector certification into state law is a viable option for protecting the public from substandard professional services.

In the September/October 2022 Public Affairs article, “The Less-Regulation Movement: Why Certification Is a Viable Option for Professional Regulation,” I outline the rationale behind my stance. Read the article to learn about relevant definitions, my fundamental economic principle for determining the optimal stringency of a credentialing examination and its eligibility requirements, the advantages of certification, and more. The full article is available via the “Public Affairs Articles” webpage.  

Certification and the CMA (AAMA) Credential

The Misuse of Medical Assisting Credentials May Have Legal Consequences

The roles of medical assistants have expanded and diversified during the last 10 years. So too have the number and types of medical assisting credentials. In this blog post, I will explain basic facts about medical assisting credentials and the potential legal consequences of misusing them.

Licensing and Certification

A license is a mandatory credential, usually issued by a state, without which an individual is not permitted by law to practice a profession. A certification is most frequently a voluntary credential, usually issued by a private-sector body, that provides evidence of an individual’s knowledge and competence in a profession. A license is required by law; a certification is (with limited exceptions) not required by law.

Examples of medical assisting licenses are the “medical assistant-certified (MA-C)” and the “medical assistant-registered (MA-R)” issued by the Washington State Department of Health.

Accreditation of Certification Programs

There are two accreditations available to U.S. certification programs:

  • Accreditation by the National Commission for Certifying Agencies (NCCA) under its Standards for the Accreditation of Certification Programs
  • Accreditation under International Standard ISO/IEC 17024:2012, Conformity Assessment—General Requirements for Bodies Operating Certification of Persons (ISO 17024)

Accreditation of the CMA (AAMA) Certification Program

The CMA (AAMA)® is a medical assisting certification issued by the Certifying Board of the American Association of Medical Assistants® (AAMA). The CMA (AAMA) certification program is the only medical assisting certification program that is accredited both by the NCCA and under ISO 17024.

Permissible Use of the CMA (AAMA) Credential

The only medical assistants permitted to use the CMA (AAMA) designation in connection with employment or seeking employment are those medical assistants who have achieved certification through the Certifying Board of the American Association of Medical Assistants (AAMA) and whose CMA (AAMA) credential is current. A medical assistant who never held the CMA (AAMA) or who formerly held the CMA (AAMA) but whose CMA (AAMA) is not current is forbidden from using the CMA (AAMA) credential. A medical assistant who violates this policy is in jeopardy of sanctions by the Certifying Board of the AAMA and sanctions under federal trademark law.

Registration of the CMA (AAMA)

The AAMA registered the “CMA (AAMA)” designation/initialism with the United States Patent and Trademark Office (USPTO) as a certification mark. This registration gives the AAMA intellectual property rights in this designation. A certification mark “is a type of trademark that is used to show consumers that particular goods and/or services, or their providers, have met certain standards,” according to the USPTO.

Registration of the “Certified Medical Assistant” Phrase

The three-word phrase “certified medical assistant” has also been registered by the AAMA with the USPTO. Consequently, this three-word phrase should not be used as a generic reference to all medical assistants. This phrase should also not be used as a generic reference to all medical assistants who hold a credential. “Certified medical assistant” should only be used when referring to medical assistants who hold a current CMA (AAMA).

The Legal Status of the “CMA” Initialism

The “CMA” initialism is not registered with the USPTO. This is because the official designation of the credential awarded by the Certifying Board of the AAMA was changed from “CMA” to “CMA (AAMA),” effective January 1, 2008. However, the AAMA retains common law rights in the initialism “CMA.” For example, if the initialism “CMA” were used in a way that would likely confuse employers or other parties into thinking that the reference to “CMA” was a reference to “CMA (AAMA),” the AAMA would likely have a cause of action against the misusing party.

State Law Authorizing the Use of “CMA” as an Abbreviation of “Certified Medication Aide/Assistant”

Statutes or regulations of some states permit or require the initialism “CMA” to be used as the designation for “certified medication aides” or “certified medication assistants.” Such state laws do not infringe the AAMA’s common law rights in the “CMA” initialism because the authority of a government to define an initialism and restrict its use supersedes the authority of a private-sector body—such as a certifying board—to do so. In fact, in some states it is a violation of state law to use “CMAs” to refer to medical assistants rather than medication aides. This is another example of negative legal consequences resulting from the misuse of a credential.

State Law Requiring Words or Initials to Be Used on Medical Assistants’ Name Tags

Some states’ laws require words or initialisms to be on the name tags of medical assistants. These laws must be obeyed. If they are not, legal sanctions may result.

The Display of Medical Assisting Credentials in EHR Platforms

Employers will sometimes tell medical assistants that the electronic health record (EHR) platform of the clinic, practice, or health system will not permit the inclusion of medical assistants’ credentials. This is usually not the case. Most EHR platforms have this capability.

Questions should be directed to me in the comments or via email at DBalasa@aama-ntl.org.

Scope of Practice

North Carolina Medical Assistants in Inpatient Settings

I recently received the following question from a manager at a health care system in North Carolina: 

We are looking at ways to assist nurses in the hospital setting due to the nursing shortage. Can medical assistants practice in a hospital setting without a nursing assistant certification? 

Medical assistants are permitted to meet the requirements and register with the state as certified nursing assistants (CNAs) and medication aides. Short of this, medical assistants are considered unlicensed assistive personnel (UAP) when working under nurse supervision in inpatient settings. 

The North Carolina Board of Nursing has issued some detailed and helpful position statements on what nurses are permitted to delegate to UAP. See the following documents for additional details: 

On the Job

CMA (AAMA) Certification Outside the United States

I received the following question about whether CMA (AAMA)® certification can be used by medical assistants who are interested in working outside the United States:

I am a medical assistant who is certified by the American Association of Medical Assistants®, and I understand that this certification is usable anywhere in the United States. Since I am interested in possibly volunteering outside of the United States as a medical missionary, is my certification usable outside of the United States? If not, what action could I take to remedy this situation?

In addition to CMA (AAMA) certification being usable throughout the United States, the CMA (AAMA) certification program is accredited under ISO 17024—an international standard of the International Organization for Standardization (ISO). ISO standards are recognized throughout the world.

Consequently, CMA (AAMA) certification should be usable in nations other than the United States.

Learn more about ISO 17024 and its significance in the CMA Today July/August 2016 Public Affairs article.


USDE Regulations on Institutional Information

Regulations of the United States Department of Education (USDE) that address the recognition of accrediting agencies (and other matters) went into effect July 1, 2020. The regulations apply to institutions and schools accredited by USDE-recognized accrediting bodies. A school must comply with USDE regulations to be eligible for federal funding, including financial assistance for students under Title IV of the Higher Education Act.

The provisions of the regulations relevant to the medical assisting education community are about education in fields that require completion of a program as a prerequisite for employment. Note the following from the regulations:

(v) If an educational program is designed to meet educational requirements for a specific professional license or certification that is required for employment [emphasis added] in an occupation, or is advertised as meeting such requirements, information regarding whether completion of that program would be sufficient to meet licensure requirements in a State for that occupation [must be provided].

Currently, the following U.S. states require the completion of some sort of medical assisting education program to work as a medical assistant or to be delegated certain tasks while working as a medical assistant:

  • Arizona
  • Massachusetts
  • New Jersey
  • North Dakota
  • South Dakota
  • Washington

Medical assisting program directors and educators who have questions about the impact of the USDE regulations on their programs and schools should email me at dbalasa@aama-ntl.org.