The argument seems simple enough. If cosmetologists, stenographers and sports agents must be licensed by the state, why don’t the people who control radiation for a living?

That’s an argument made by radiologic technologists — sometimes called radiographers, rad techs or RTs — who want to regulate and self-police their profession.

The rad techs, under the banner of the Idaho Society of Radiologic Technologists, will join an ever-increasing roster of professionals who have asked the state to legally define who they are, what they can do and to whom they must answer.

Groups like that don’t come to the Capitol with identical motives. Some want recognition of their legitimacy. Some want legal privileges and a defined standard of care. Some want the certainty of rules and formal complaint processes.

And some are taking pre-emptive action: “Let’s do it before someone else does it to us” is the theme.

Idaho licenses many professions, though the Legislature has been more reluctant to do so than the rest of the country. Conservatives and free-market minds have resisted or fought against the rad techs’ push for years. Proponents hope 2013 will be their breakthrough year.

LICENSING IN IDAHO

The Idaho Bureau of Occupational Licenses has about 54,000 licenses in almost 30 professions under its purview. Cosmetologists and contractors make up more than half of them. Massage therapists will join the list July 1, 2013.

With revenue from license fees, the bureau does the back-office work for professional boards that oversee and discipline each profession. The bureau also helps each board with legal issues and complaint investigations.

But the bureau doesn’t oversee all professions. There are separate Idaho licensing bodies for doctors, nurses, pharmacists, dentists, lawyers, veterinarians, engineers and land surveyors, electricians, plumbers, insurance agents, zip line tour guides and hunting outfitters.

MASSAGING THE MESSAGE

Massage therapists won such a victory in this year’s session. Their licensure bill passed 28 to 6 in the Senate and 39 to 29 in the House.

As massage therapy gained more respect as a medical treatment — not a pampering ritual — the practitioners rallied more support, both within their profession and from consumers.

Massage therapists work on the body’s soft-tissue muscles to relieve pain and stress, rehabilitate injuries and help clients’ overall well-being. If prescribed by a doctor, massage therapy may qualify as a tax-deductible medical expense. Practitioners generally train and study for 500 hours or more, according to the Bureau of Labor Statistics.

Idaho massage therapists don’t want to be confused with people in the massage-parlor business, says Suzanne Budge, who lobbied for the massage therapists. The licensure advocates “wanted to distinguish themselves from the, perhaps, more unsavory side of the business,” Budge says.

Their bill had been in the works for decades. “We had a couple practitioners around the state who were involved in this in the ‘90s,” Budge says. But it took time to build energy within the profession and to reach a tipping-point in public perception, she says. Several prostitution busts in Idaho massage parlors, including four women arrested in Boise in 2010, helped push the bill along.

Massage therapists argued that consumers wanted a guarantee that, when they walk into an office and disrobe, they’ll be greeted by a professional, not a lay person with an LLC after her name. Customers want someone who knows physiology, can treat sports-medicine patients and has scruples, Budge says.

And a patchwork of different municipal rules — Boise, Meridian and Garden City each have their own licenses for massage therapists — made it hard to practice in the Treasure Valley, says Suzie Lindberg, a Boise massage therapist.

The therapists also wanted a complaint process and a way to discipline people who posed as massage therapists but provided illegal or unethical services.

The consumer-protection angle was key to the Legislature’s support, Budge says. As with rad-techs, most people who visited massage therapists already assumed they were licensed, she says.

Lawmakers will ask professionals in their home districts if they support licensure, Budge says. So the “first and most important level of support that a lawmaker wants to know — and that you have to be able to substantiate as you move through — is that the professional community is in support” of the bill.

The next mountain to climb is getting other stakeholders on board. That’s where turf wars and philosophical debates erupt.

THE MIDWIFERY PUSH

Take midwives. For about 25 years, midwives kicked around the idea of licensure, says Barbara Rawlings, a Bonners Ferry midwife and chairwoman of the state board. “We just thought, oh, we’ll go and get this done,” she says with a laugh.

Then a kindly legislator warned them “it would take three to five years.”

Professional midwifery became a licensed occupation in 2009, three years after the first attempt at a bill.

The idea gained traction several years ago, as Idaho midwives watched other states imposing rules on the midwifery industry. So they drafted an opt-in, voluntary licensure bill.

“We were wildly unsuccessful,” Rawlings says.

The reason: Midwives won consumer and intra-profession support but had “no support from the medical community.”

There has long been tension between midwifery and hospital-based medicine. That stems partly from lack of communication, says Rawlings. Some doctors have raised concerns about professional midwives who lack training and who are unwilling to cooperate with physicians.

Proponents had to convince the medical establishment that giving midwives a statutory stamp of approval, letting them use certain medications and allowing them to bill Medicaid was in a patient’s best interest.

So midwives explained how they wanted “to [build a] bridge with the medical community, so that we could have more seamless transfers of care when it became necessary,” such as during labor complications, Rawlings says.

In 2009, “we did hire a lobbyist to carry it over the finish line,” Rawlings says. “We have continued to engage them as our lobbyists” as a 2014 reauthorization approaches.

This spring, the state midwifery board had to use the disciplinary powers Rawlings says she had hoped never to use. When two Meridian midwives, Coleen and Jerusha Goodwin, were accused of malpractice after baby deaths, the board issued its first emergency license suspensions.

Idaho now has more than 30 licensed midwives in good standing.

Rawlings recalls the years of meetings and compromises it took to get a law passed. Was it worth it?

“It’s not perfect. ... There is new territory for us, and there is a learning curve,” she says. “I’ve been a midwife for 35 years, and not having anyone but my midwifery community regulate me. ... Stepping into a strictly regulated status is a challenge — being told what you can and can’t do, and having to live within certain parameters — is something we all have to get used to.”

VOCAL OPPONENTS

Licensure isn’t a popular word in a legislature like Idaho’s, where small government is a mantra, not just a campaign slogan.

The Idaho Freedom Foundation is one of the most outspoken critics of licenses and rules. Executive Director Wayne Hoffman can rattle off a host of ills that he says licensure causes.

Consumers will bear the costs of new license fees. Creativity and innovation will founder under fear of punishment for not following rules. Fewer people will enter the profession.

He sees no benefits to the practice.

“It’s really, really tragic what occupational licensing does to lower- or middle-income people,” he says. “You have somebody that’s working an overnight job as a waitress in a restaurant, and all they want to do is go on to another profession, make more money, and improve their quality of life. [But they’re] confronted with the prospect of going through years of training.”

Lindberg disagrees. She says a massage therapy licensure law may attract more accredited schools to the area.

“This is a short [generally nine-month] technical certification,” she says. “We’re not requiring a four-year degree here.”

Hoffman also argues that licensure curtails market competition. Those already in the profession are “writing the rules that restrict the ability of [their] competition to come in,” he says.

He points to a law that requires driving teachers to first apprentice under existing ones. “How many drivers’ ed programs are going to take in a potential competitor under their wing?” he says.

Instead, Hoffman wants radiologic technologists and others to stick with their status quo. Hoffman says they should let a professional association hand-pick the most qualified practitioners, rely on employers to make good hiring decisions and let the market correct itself.

RAD TECHS ENTER THE FRAY

The radiological technologists say their campaign, like that of massage therapists, is suffering a bad case of public misperception.

All rad-techs interviewed say patients assume a person operating an X-ray machine, MRI or CT scan is licensed, trained and educated. But that’s not the case in many doctors’ offices throughout Idaho, says the Idaho Society of Radiologic Technologists.

The society counts 1,549 members who have met qualifications and taken an exam to be registered with the industry’s national credentialing body. Some radiology practices, such as St. Luke’s Health System, will hire only techs with those qualifications. But many small clinics and doctors’ offices aren’t as picky, the society says.

“I actually had an X-ray taken by someone who had completed a semester of an X-ray program” but nothing beyond that, says Stewart Cathrae, a rad tech at St. Luke’s who has been registered for a year.

“Radiation is not visible; you can’t see it” or its immediate effects, says Joan Truxal, who supervises rad techs at St. Luke’s. “So we need to ... make sure people are getting taken care of.”

Idaho is one of few states without a minimum standard for someone to run an X-ray machine or to put contrast dye in a person’s body to help certain areas show up better in medical images.

Mike Gurr, who is leading the rad techs’ licensure push, says a patient may be under the care of someone who took an afternoon crash course from a medical equipment company.

The public might assume that medical radiation accidents and equipment flubs are reported and tracked, but that’s not true, he says.

Why does any of this matter? “Radiation changes the cells it penetrates,” Gurr says. “It changes DNA.” To let anyone use it is “scary.”

Audrey Dutton: 377-6448