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If state licensing

titioners seek certification from the American

Clinic, offer first-line health care, are staffed by

Nurses Credentialing Center. The ANCC offers

nurse practitioners, and are opening up in

were eliminated

nursing certification in 26 different specialties.

CVS, Target, and Wal-Mart stores across the

tomorrow,

According to that organization, more than

United States. These organizations have enor-

consumers would

75,000 advanced practice nurses are currently

mous incentives to maintain quality to protect

certified.88 Other organizations that certify

their reputations. For example, Minute Clinic

continue to be

nurse practitioners include the National Cer-

boasts of its adherence to evidence-based med-

protected.

icine guidelines.92 Wal-Mart has bet on brand

tification Board of Pediatric Nurse Practition-

names as a proxy for quality in promoting its

ers and Nurses, the National Certification

retail clinics. "The Clinic at Wal-Mart" brand

Corporation for the Obstetric, Gynecologic and

will partner with local hospitals in "co-brand-

Neonatal Nursing Specialties, the American

ed" walk-in clinics, relying on local hospitals'

Academy of Nurse Practitioners, and the

reputations to bring in consumers.93 Without

National Association of Nurse Practitioners in

Women's Health.89 These organizations are

state licensing, brand names and reputation

known in the medical community and serve as

would play an even greater role in health care

a guide in hiring nurses.

markets, such as by offering guidance to

If state licensing were eliminated tomor-

patients considering treatment in freestand-

row, consumers would continue to be pro-

ing outpatient surgery centers.

tected by this sophisticated network of well-

known private organizations that accredit

Conclusion

health care facilities and credential medical

professionals.

Medical licensure fails to meet expecta-

tions in the area of discipline and consumer

Brand Names: Would Additional

protection. State medical boards' disciplinary

Protections Arise without Licensing?

efforts can arguably be said to protect clini-

In many industries, markets assure quality

through brand names and reputation.90 Con-

cians more than consumers. Many actions

sumers rely on brand names as a quality signal

against clinicians are settled privately and

in markets for restaurants, clothing, automo-

after extended periods of time. Clinicians

biles, computers, and air travel. Thanks to

who have faced disciplinary actions often

brand names, a hungry traveler in a strange city

continue to practice, with no public disclo-

knows exactly the quality of cuisine he will get if

sure of the reasons for the sanction. The per-

he walks into a McDonald's versus a Chili's or a

sistent difference between the promise of

P.F. Chang's China Bistro.

licensing and its actual performance is sum-

Brand names have played a smaller role in

marized by one long-time observer of New

health care than in other industries, perhaps

York's licensing laws, who describes that

because of preemption by licensing boards

state's statutory authority as "exemplary" but

the state's use of that authority "shameful."94

and the perception of quality assurance asso-

Reforms that fail to appreciate the

ciated with licensure. However, brand name

propensity of licensing authorities to place

and reputation are growing as a basis for qual-

physician protection ahead of patient protec-

ity assurance in health care markets. Health

tion seem destined to repeat the failures of

plans that combine insurance and health care

licensing. Drs. Lucian Leape and John

delivery under one roof, such as Kaiser

Fromson call for sweeping changes to exist-

Permanente, stake their reputations on the

ing quality assurance measures, including

quality of their providers. The Cleveland

"explicit [national] performance standards of

Clinic, the Mayo Clinic, and other facilities

behavior and competence" for physicians.

have national reputations and are putting

them to use in telemedicine.91 Brand-name

While those standards would be based, as it

retail clinics, such as RediClinic and Minute

happens, on the voluntary Maintenance of

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