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Certification standards developed by the pri-

If there were no state licensing of medical

vate American Board of Medical Specialties,

professionals, consumers would search more

Leape and Fromson propose that reform be

and demand more information, as they do

initiated and ultimately enforced by state

with other goods. Patients could obtain as

medical boards.95 Little in the state boards'

much quality assurance as licensure pro-

decades-long record of failing to protect con-

vides--and more--simply by looking for a

sumers suggests that state boards are well-

board-certified physician. Brand names

suited to this task.

would play an increasing role in assuring

Those who favor replacing state regula-

quality care.

tions with national standards argue that

Additional protections likely would arise

national standards would encourage geo-

beyond the consumer's immediate purview.

graphic mobility of medical professionals. Yet

Credentials verification organizations would

national standards for medical professional

check criminal records and verify clinicians'

licensing would be a mistake for two reasons.

education, training, and performance on

national exams.97 The specific information

First, variations across states let us see what

provided by licensure is not difficult to verify

works and what doesn't, allowing for innova-

privately. Competition among credentials

tion. Second, a shift toward national stan-

Patients have

verification organizations would place such

dards would increase special interest influence

little to lose, but

information, and potentially more, in the

over licensing, leading to greater entry restric-

hands of providers and consumers. As noted

tions and less access. Eliminating licensure

much to gain,

above, the specialty boards already have plans

entirely would increase mobility as well, and

from eliminating

to increase their monitoring of the continu-

would be a better policy option.

medical licensing.

ing competence of board-certified physicians.

Quality assurance in today's medical mar-

When patients are injured by incompetent or

ketplace doesn't come from state medical

negligent physicians--as some inevitably will

boards but from the fear of medical malprac-

be--they will continue to have recourse to the

tice liability and from market mechanisms

courts. The potential for liability, concern

such as malpractice insurers; independent cer-

over reputation and brand name, and evolv-

tification agencies like the Joint Commission,

ing standards of care would put continuous

specialty boards, and credentials verification

pressure on health plans, facilities, and clini-

organizations; consumer guides such as

cians to improve quality.

Consumer Reports, HealthGrades, and Angie's

Without legislatively mandated education

List; and insurers' and providers' interest in

requirements or scope-of-practice restrictions,

protecting their reputations and brand names.

hospitals and other providers could better

A clinician may have a degree from an elite

adjust their workforces when demand shifts,

school, but if he has not kept abreast of the

or when opportunities arise to reduce costs--

medical literature or his skills have deteriorat-

either by making care more convenient or by

ed, his state license does almost nothing to pro-

saving patients money--while maintaining

tect patients. According to Dr. Derek van

quality. Patients have little to lose, but much

Amerongen, Chief Medical Officer of Humana

to gain, from eliminating medical licensing.

Health Plans of Ohio and Indiana: "People and

If eliminating licensing is politically infeasi-

the legislatures read way too much into licens-

ble, some preliminary steps might be generally

es. They are extremely poor proxies for quality

and knowledge."96 Oversight of medical pro-

acceptable. States could immediately increase

fessionals by state medical boards is at best

workforce mobility by recognizing clinician

redundant to those quality protections provid-

licenses issued by other states, or Congress

ed by courts and market processes. Because

could require states to do so. For midlevel clin-

licensing reduces access to care and may give

icians, such as physician assistants, physical

consumers a false sense of security, it may in

therapists, and audiologists, eliminating edu-

fact do more harm than good.

cation requirements beyond an initial degree

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