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Perfusionist (What’s That?) Licensing: Making Heart Surgery More Dangerous


Do you know what a perfusionist is? I didn’t, either, but it’s one of the many occupations that are licensed in the State of Oklahoma. However, we at the 1889 Institute are gradually looking into each licensed occupation to learn if there is justification for forcing people to ask the government’s permission to earn money doing it. So, we got curious about these perfusionists, about which we knew nothing, and why they are licensed (our report).

It came as no surprise that perfusionists use their skills in medicine. Nearly every occupation involved in medicine, other than custodians, especially in Oklahoma, is licensed. Yet, the majority of states do not license perfusionists. Perfusionists do perform an important service. They monitor and operate the machines that regulate blood and air flow of patients having heart surgery.

And perfusionists have accidentally killed people, sometimes due to something as simple as failing to notice a kinked hose.

We have previously reviewed 11 other occupations licensed in Oklahoma, asking two simple questions. First, is it likely people will be significantly harmed if the occupation is not practiced properly? Second, is there some reason markets and civil law fail to protect people? We have answered “No” to both of these questions 11 times. And, only if the answer to both questions is “Yes” would we determine that licensing is justified.

But this time, the answer to the first question is clearly “Yes.” Patients lying on an operating room table, under anesthesia, with a heart stopped and undergoing dissection, are clearly vulnerable if the person charged with keeping the blood flowing and oxygenated neglects that important work.

Nevertheless, the answer to the second question is clearly “No.” If there were some kind of inherent market and/or legal failure, surely all fifty states, rather than a minority, would require individuals to ask permission to be a perfusionist through licensing. Why isn’t this the case?

The answer is that people are already essentially asking permission to act as perfusionists. Surgeons select the perfusionists with whom they work, and surgeons are the ultimate authorities facing potential liability should something go wrong in the operating room. That liability is a much stronger motive for selecting skilled, attentive perfusionists than any motive a licensing board will ever have, since the board faces no consequences at all.

Two facts expose the lie that licensing perfusionists in Oklahoma was ever about public safety. First, the licensing law included a grandfather provision, which made it easy for any bad actor already working as a perfusionist at the time to continue doing so. Second, there are so few perfusionists in Oklahoma and nationwide that they are often in the operating room exhausted and lacking sleep after attending too many surgeries. At least one expert believes the vast majority of perfusionist errors are due to fatigue and stress.

Licensing only makes perfusionists scarcer, especially since the nearest training program to Oklahoma is in Houston, Texas. That artificially limited supply helps to explain why perfusionists, who average more than $120k per year, are worth the money they earn. That scarcity, partly caused by licensing, also explains why patients are at risk from groggy, over-worked perfusionists.

Byron Schlomach is Director of the 1889 Institute and can be reached at bschlomach@1889institute.org.


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