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No. 621

September 17, 2008

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Medical Licensing

An Obstacle to Affordable, Quality Care

by Shirley Svorny

Executive Summary

In the United States, the authority to regulate

Consumers would benefit were states to elim-

medical professionals lies with the states. To prac-

inate professional licensing in medicine and leave

tice within a state, clinicians must obtain a license

education, credentialing, and scope-of-practice

from that state's government. State statutes dic-

decisions entirely to the private sector and the

tate standards for licensing and disciplining med-

courts.

ical professionals. They also list tasks clinicians are

If eliminating licensing is politically infeasible,

allowed to perform. One view is that state licens-

some preliminary steps might be generally accept-

ing of medical professionals assures quality.

able. States could increase workforce mobility by

In contrast, I argue here that licensure not

recognizing licenses issued by other states. For

only fails to protect consumers from incompe-

mid-level clinicians, eliminating education re-

tent physicians, but, by raising barriers to entry,

quirements beyond an initial degree would allow

makes health care more expensive and less acces-

employers and consumers to select the appropri-

sible. Institutional oversight and a sophisticated

ate level of expertise. At the very least, state legisla-

network of private accrediting and certification

tors should be alert to the self-interest of medical

organizations, all motivated by the need to pro-

professional organizations that may lie behind the

tect reputations and avoid legal liability, offer

licensing proposals brought to the legislature for

whatever consumer protections exist today.

approval.

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Shirley Svorny is professor of economics and chair of the Department of Economics at California State University,

Northridge, and an adjunct scholar at the Cato Institute.