Licensure of Work
Our
licensing laws are directly responsible for the wastage of precious
human and capital resources in the preparation of various professionals.
This manifests itself in the high cost and scarcity of professional care. Instead of
merely testing for competence, our laws mandate a
tortuous and expensive path to becoming a clinician/accountant/hair dresser - you name it. Allow me to first offer you critiques of the current professionallicensing system and then suggest that disposing of it is better than
the amending of it.
1) We are missing the point! - If the point of licensing is to make available competent professional/practitioner, it is helpful to compare our current occupational licensing laws with those of motor vehicle operation licensing. If you need a motor vehicle driver's license, you demonstrate your competence to drive and you get a license to drive. But where do you go to demonstrate your competence to mend sewage pipes, cut hair or do brain surgery? There is no governmental testing for cataract removal, plumbing, or hair dressing prior to issuance of licenses that allow practice of these interventions. Nor is there any testing prior to renewing the licenses in most states. Therefore, to the extent we think that bearing of license by a particular person proves that they are competent to provide the professional service we need, we are entirely wrong - the licensing of occupations is useless in this regard. The truth is that we rely on other 'indicators' to decide who would be best suited to provide a service we need - these include years in practice, appointment in prestigious companies, referrals & reviews, a robust civil & criminal justice system and the backing of a malpractice insurance career.
2) It is highly inefficient - Instead of merely testing for competence, as discussed above, our laws mandate a tortuous and expensive path to starting a profession. Consider this report by the New York Times regarding need to finish 2,100 hours of education prior to granting of a hair dressers license in Iowa! While extraneous knowledge gained is indeed desirable and occasionally useful, it was not cost (or time) effective. The net result of this is the relative poverty of the consumer (who is deprived of cost effective hair dressers). Indeed, the requirement for specified hours of training prior to grant of a license only demonstrates that governments are woefully unable to check actual competence of a professional and instead hope that if you slog through 2100 hours of training you would be an OK hair dresser.
3) It limits our right to avail inferior care. - you read that correctly - right to inferior care. Licensing laws are not about making a available a competent crop of professionals. Their bigger impact is eliminating practicing professionals, from the market, who are supposedly sub-par. And why should we, as consumers, object to that? For one, a sub-par provider may still be more suitable to us after considering price and availability. Barring an inferior hairdresser/plumber/lawyer does not magically make competent professionals more abundant and cheap. Secondly, my opinion of what is sub-par may differ from the state's opinion (no, that does not mean that I am stupid). Consider the case of Nurse Practioners, Physician Assistants and Clinical Registered Nurse anesthetist. These groups are pushing states to allow them to practice medicine independently in their respective fields. The claim is that, after decades of working in their field and continued medical education, they are as competent or more than any fresh graduate from the state listed schools. If you find this claim convincing, should you not be free to engage their services without fear and retribution?
It is hoped that the above demonstrated for you that our licensing laws do vastly more harm than good to the cause of provision of cost effective quality professional services. This leads to a logical question about how we may reform these laws, or should we just abolish them? Allow me to talk about reform first.
If we are going to have occupational licenses, modelling the laws after driving licenses is a good idea. Their are no minimum supervised training hours at an accredited university that you need complete to apply for a driver's license. Similarly, at a minimum, all requirements for how a person trains to be a physician/lawyer/hairdresser/plumber need abolition. The licensing process need focus solely on testing the competence of an applicant regardless of how the training was done. In addition, given the vast amount of contemporary medical knowledge and techniques, issuance of a general license to 'Practice Medicine' or 'cosmetology' or 'plumbing' to any one person is dangerous - since no one person can master it all. Further, it discourages a student who wants to focus only on cutting hair from ever doing that because he/she is mandated to learn a slew of extraneous stuff. This would be akin to granting a person a license to operate all motor vehicles (such as boat, train, plane, etc.) without first testing the person on each one of those. Clearly, that would be absurd. In fact there are numerous qualifiers on your driver's license (such as need for eye glasses while driving). It follows that licenses to practice each profession need a similar narrower scope of practice based on each demonstrated competence.
While I suggest above that granting a general license to 'Practice Medicine' is dangerous (given that no one person can master the entirety of medicine), we do not see these dangers manifested in reality. We do not have instances of dermatologists doing brain surgeries on people (although they indeed have the license to do so). Why? For the very reasons that are elucidated in the beginning of our discussion - people do not really rely on medical licenses before they retain a physician for a job. They rely on other 'indicators' to decide who would be best suited to provide a service they need - these include review of their years in practice, appointment in prestigious hospitals, referrals & reviews, a robust civil & criminal justice system and the backing of a malpractice insurance career.
Consider hospitals for an example. Do you think that hospitals will retain anyone to be a surgeon on their staff if they present a medical license? Absolutely not! Hospitals have an extensive credentialing processes whereby the training, exact work history and references are verified. Even when the 'privileges' to work in a hospital are granted, each privilege is very narrow in scope and tailored according to verifiable history. Example of privileges that one clinician may have include ability to interpret EKG, vent management, doing a medical consult or even admitting a patient to the hospital. Usually, each clinician's privileges to work in a hospital are unique to them - given their unique demonstrated expertise (their is certainly overlap in privileges as well). For example, a cardiologist may not, in some cases, have the privilege to even admit a patient to the hospital.
Ultimately, a dermatologist contemplating doing brain surgery on his patient is not really scared that he will be held liable for the unlicensed practice of medicine. He is scared of being jailed for false advertising, fraud, battery and murder. Indeed, no harm should come from abolition of occupational licenses, because they currently do no good.
1) We are missing the point! - If the point of licensing is to make available competent professional/practitioner, it is helpful to compare our current occupational licensing laws with those of motor vehicle operation licensing. If you need a motor vehicle driver's license, you demonstrate your competence to drive and you get a license to drive. But where do you go to demonstrate your competence to mend sewage pipes, cut hair or do brain surgery? There is no governmental testing for cataract removal, plumbing, or hair dressing prior to issuance of licenses that allow practice of these interventions. Nor is there any testing prior to renewing the licenses in most states. Therefore, to the extent we think that bearing of license by a particular person proves that they are competent to provide the professional service we need, we are entirely wrong - the licensing of occupations is useless in this regard. The truth is that we rely on other 'indicators' to decide who would be best suited to provide a service we need - these include years in practice, appointment in prestigious companies, referrals & reviews, a robust civil & criminal justice system and the backing of a malpractice insurance career.
2) It is highly inefficient - Instead of merely testing for competence, as discussed above, our laws mandate a tortuous and expensive path to starting a profession. Consider this report by the New York Times regarding need to finish 2,100 hours of education prior to granting of a hair dressers license in Iowa! While extraneous knowledge gained is indeed desirable and occasionally useful, it was not cost (or time) effective. The net result of this is the relative poverty of the consumer (who is deprived of cost effective hair dressers). Indeed, the requirement for specified hours of training prior to grant of a license only demonstrates that governments are woefully unable to check actual competence of a professional and instead hope that if you slog through 2100 hours of training you would be an OK hair dresser.
3) It limits our right to avail inferior care. - you read that correctly - right to inferior care. Licensing laws are not about making a available a competent crop of professionals. Their bigger impact is eliminating practicing professionals, from the market, who are supposedly sub-par. And why should we, as consumers, object to that? For one, a sub-par provider may still be more suitable to us after considering price and availability. Barring an inferior hairdresser/plumber/lawyer does not magically make competent professionals more abundant and cheap. Secondly, my opinion of what is sub-par may differ from the state's opinion (no, that does not mean that I am stupid). Consider the case of Nurse Practioners, Physician Assistants and Clinical Registered Nurse anesthetist. These groups are pushing states to allow them to practice medicine independently in their respective fields. The claim is that, after decades of working in their field and continued medical education, they are as competent or more than any fresh graduate from the state listed schools. If you find this claim convincing, should you not be free to engage their services without fear and retribution?
It is hoped that the above demonstrated for you that our licensing laws do vastly more harm than good to the cause of provision of cost effective quality professional services. This leads to a logical question about how we may reform these laws, or should we just abolish them? Allow me to talk about reform first.
If we are going to have occupational licenses, modelling the laws after driving licenses is a good idea. Their are no minimum supervised training hours at an accredited university that you need complete to apply for a driver's license. Similarly, at a minimum, all requirements for how a person trains to be a physician/lawyer/hairdresser/plumber need abolition. The licensing process need focus solely on testing the competence of an applicant regardless of how the training was done. In addition, given the vast amount of contemporary medical knowledge and techniques, issuance of a general license to 'Practice Medicine' or 'cosmetology' or 'plumbing' to any one person is dangerous - since no one person can master it all. Further, it discourages a student who wants to focus only on cutting hair from ever doing that because he/she is mandated to learn a slew of extraneous stuff. This would be akin to granting a person a license to operate all motor vehicles (such as boat, train, plane, etc.) without first testing the person on each one of those. Clearly, that would be absurd. In fact there are numerous qualifiers on your driver's license (such as need for eye glasses while driving). It follows that licenses to practice each profession need a similar narrower scope of practice based on each demonstrated competence.
While I suggest above that granting a general license to 'Practice Medicine' is dangerous (given that no one person can master the entirety of medicine), we do not see these dangers manifested in reality. We do not have instances of dermatologists doing brain surgeries on people (although they indeed have the license to do so). Why? For the very reasons that are elucidated in the beginning of our discussion - people do not really rely on medical licenses before they retain a physician for a job. They rely on other 'indicators' to decide who would be best suited to provide a service they need - these include review of their years in practice, appointment in prestigious hospitals, referrals & reviews, a robust civil & criminal justice system and the backing of a malpractice insurance career.
Consider hospitals for an example. Do you think that hospitals will retain anyone to be a surgeon on their staff if they present a medical license? Absolutely not! Hospitals have an extensive credentialing processes whereby the training, exact work history and references are verified. Even when the 'privileges' to work in a hospital are granted, each privilege is very narrow in scope and tailored according to verifiable history. Example of privileges that one clinician may have include ability to interpret EKG, vent management, doing a medical consult or even admitting a patient to the hospital. Usually, each clinician's privileges to work in a hospital are unique to them - given their unique demonstrated expertise (their is certainly overlap in privileges as well). For example, a cardiologist may not, in some cases, have the privilege to even admit a patient to the hospital.
Ultimately, a dermatologist contemplating doing brain surgery on his patient is not really scared that he will be held liable for the unlicensed practice of medicine. He is scared of being jailed for false advertising, fraud, battery and murder. Indeed, no harm should come from abolition of occupational licenses, because they currently do no good.
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