reference library

Personal appearance professionals in the United States — such as barbers, cosmetologists, and manicurists — must typically be licensed. These licensing requirements vary from state to state, and they are…
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The COVID‐19 pandemic wreaked havoc on the world economy as shelter‐in‐place regulations forced individuals to stay at and work from home. Brick and mortar testing centers, whether run as part…
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Occupational licensing laws have been relaxed in a large number of U.S. states to give nurse practitioners the ability to perform more tasks without the supervision of medical doctors. We…
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All PAs must practice with a collaborating physician; however, state laws dictate the extent of that relationship. This interactive guide provides an overview of PA scope of practice laws by…
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In 2005 the United States spent $6,401 per capita on health care-more than double the per capita spending in the median Organization for Economic Cooperation and Development (OECD) country. Between…
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The Department of Veterans Affairs (VA) is amending its medical regulations to permit full practice authority of three roles of VA advanced practice registered nurses (APRN) when they are acting…
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” Pew Health Professions Commission endorses the need to reform the regulatory system, the general vision articulated by the Taskforce on the future of the system, and the invitation to…
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“The Federation of State Medical Boards (the Federation) is a national non-profit association whose membership includes all medical licensing and disciplinary boards in the United States, and the U.S. territories….
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“Despite research indicating that health, cost, and quality of care outcomes in midwife-led maternity care are comparable with and in some case preferable to those for patients with physician-led care,…
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Wisconsin issues four different types of credentials, which are: licenses, certificates, registrations, and permits. All types collectively are commonly referred to as credentials. For the purposes of this report, the…
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The objective of this report is to detail the health, safety and economic contributions of the professional beauty industry and the critical role professional beauty licensing plays in protecting those…
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Arkansas policy makers are aware of their state’s high criminal recidivism rates (the percentage of released prisoners that reoffend). The criminal justice reforms in Arkansas have also indicated that policy…
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The American Association of Nurse Practitioners® (AANP) released both the new national nurse practitioner (NP) count and findings from its 2018 National Nurse Practitioner Sample Survey. As of January, a…
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In A Fair Chance: Simple steps to strengthen and diversify the teacher workforce, NCTQ analysis reveals both astonishingly high numbers of elementary teacher candidates failing their professional licensing tests each…
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Our aim in conducting the State Medical Boards Awareness Study was to measure national awareness of state medical boards, as well as gain insights on Americans’ experiences with, and responses…
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Political leadership from the governor was one of the strongest factors influencing whether or not licensing was reformed. Governors accomplished this in a myriad of ways. Both Michigan Governor Rick…
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Little information exists on U.S. physicians who have been disciplined with licensure or restriction-of-clinical-privileges actions or have had malpractice payments because of sexual misconduct. Our objectives were to: (1) determine…
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“This project explored the effects of nurse practitioner (NP) scope of practice (SOP) legislation on the distribution and practice patterns of NPs as well as their billing practices. The goal…
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Many states allow nurse practitioners (NPs) to practice and prescribe drugs without physician oversight, increasing the number of autonomous primary care providers. We estimate the causal impact of NP independence…
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Nurse practitioners (NPs) and physician assistants (PAs) now outnumber family practice doctors in the United States and are the principal providers of primary care to many communities. Recent growth of…
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It is widely recognized that there is significant state-level variation in scope-of-practice regulations (SSoPRs) for nurse practitioners (NPs). This study was designed to examine whether SSoPRs influence labor markets for…
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Nurse practitioners have become an increasingly important part of the US medical workforce as they have gained greater practice authority through state-level regulatory changes. This study investigates one labor market…
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There has been a dramatic increase in the authority granted to nurse practitioners (NP) and physician assistants (PA). This “expanded” authority has changed who can provide health‐care services and has…
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Strengthening health care overall is essential to the health of our nation and promoting access to health care as well as controlling health care costs in a quality cost-effective manner….
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“The use of nurse practitioners (NPs) is one way to address the shortage of physician primary care providers. NP training programs and the number of practicing NPs have increased in…
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Community health centers are at the forefront of ambulatory care practices in their use of nonphysician clinicians and team-based primary care. We examined medical staffing patterns, the contributions of different…
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Occupational licensing laws have been relaxed in a large number of US states to give nurse practitioners the ability to perform more tasks without the super-vision of medical doctors. We…
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This paper considers how the decision to enter advanced practice nursing (e.g., the occupations of nurse practitioner, certified nurse-midwife, nurse anesthetist, and clinical nurse specialist) is affected by State laws…
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“Little is known about the geographic distribution of the overall primary care workforce that includes both physician and nonphysician clinicians–particularly in areas with restrictive nurse practitioner scope-of-practice laws and where…
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“Policymakers and clinicians are concerned that future growth in demand for health care services will exceed current provider supply. One potential solution to meeting this demand is expanding the number…
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“Access to quality primary care is challenging for rural populations and individuals residing in primary care health professional shortage areas (HPSAs). The ability of nurse practitioners (NPs) to provide full…
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The provision of health care to low-income Americans remains an ongoing policy challenge. In this paper, I examine how important changes to occupational licensing laws for nurse practitioners and physician…
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Nurse practitioners (NPs) and physician assistants (PAs) now outnumber family practice doctors in the United States and are the principal providers of primary care to many communities. Recent growth of…
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This analysis draws upon data from the Organization for Economic Cooperation and Development and other cross-national analyses to compare health care spending, supply, utilization, prices, and health outcomes across 13…
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The summary goes here Douglas W Roblin, David H Howard, Edmund R Becker, E Kathleen Adams, and Melissa H Roberts Health Services Research June 2004 External Link

State scope of practice (SoP) laws impose significant restrictions on the services that a nurse practitioner (NP) may provide in some states, yet evidence about SoP limitations on the quality…
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Patients can hold physicians directly or vicariously liable for the malpractice of nurse practitioners under their supervision. Restrictive scope-of-practice laws governing nurse practitioners can ease patients’ legal burdens in establishing…
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Public choice theory has long been the dominant lens through which economists and other scholars have viewed occupational licensing. According to the public choice account, practitioners favor licensing because they…
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The increased use of nurse practitioners (NPs) and physician assistants (PAs) represents an important option for increasing access to healthcare. I explore the effect of two types of laws on…
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The demand for health care and healthcare professionals is predicted to grow significantly over the next decade. Securing an adequate health care workforce is of primary importance to ensure the…
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Higher health care prices in the United States are a key reason that the nation’s health spending is so much higher than that of other countries. Our study compared physicians’…
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This policy paper builds on FTC staff competition advocacy comments that focus on proposed state-level changes to statutes and rules governing the “scope of practice” of Advanced Practice Registered Nurses…
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The issue of occupational regulation has been of academic interest from Adam Smith to Milton Friedman (Friedman 1962; Smith 1937). In Western democracies, the number of workers who are required…
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In this issue of JAMA, Papanicolas and colleagues compared health care spending in the United States with health care spending in a select group of 10 of the highest-income countries…
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Retail clinics are largely staffed by nurse practitioners (NPs) and are a popular destination for nonemergent care. We examined if there was a relationship between NP practice regulations and retail…
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One proposed strategy to expand primary care capacity is to use nurse practitioners (NPs) more effectively in health care delivery. However, the ability of NPs to provide care to the…
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The costs of primary care have been rising and access to it may become limited because of a possible shortage in primary care physicians. Some state governments have addressed this…
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Licensing of the health professions is an issue of public policy which has been under fire for years. Economists argue that licensing stifles competition and increases health care costs. Manpower…
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This note measures the effect on migration patterns of current state occupational licensing. The alternative system against which the existing system is measured is one in which persons who are…
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Despite the inherent advantages of peer review, the record of self-enforcement among physicians has been poor. Failures have been attributed to plausible factors, including protective self-interest, a misdirected sense of…
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State Medical Boards that license and discipline physicians play an important and insufficiently studied role in medical quality assurance. Only Boards can limit or remove a physician’s license to practice,…
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Both the Federation [of State Medical Boards] and the American Medical Association offer guidelines on how to deal with ethical behavior issues, but no one entity oversees or mandates how…
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In the United States, state level boards dictate rules for physician licensure and discipline. Would-be physicians must complete an approved medical training program and pass a standardized test. Scope of-practice…
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Board certification was associated with a lower risk of discipline ([odds ratio] OR, 0.45; P

As recently as the late 1960s, most licensure boards were composed of individuals appointed or nominated by medical societies. Only slowly did judicial supervision and legislative control transform licensure boards…
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Disciplined physicians were more likely to practice in psychiatry, child psychiatry, obstetrics and gynecology, and family and general practice than nondisciplined physicians and were older than the national physician population,…
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State medical boards discipline several thousand physicians each year. Although certain subgroups, such as those disciplined for malpractice, substance use, or sexual abuse, have been studied, little is known about…
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Current statutes grant broad, near-exclusive scopes of practice to a few professions and “carved-out” scopes for the remaining professions. These laws erect unreasonable barriers to high-quality and affordable care.The need…
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This study explores the effects of public licensing board members on legislative regulatory reforms. It represents the first such study that looks across states and across occupations. Public members were…
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The generally stated purpose for licensing and the primary justification for this use of the police power of the state is to ensure quality in services offered to the public….
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Public reports ranking physician competence and quality often yield conflicting results and create confusion. Bivariate Pearson correlation analyses were performed to compare states’ rankings of physician discipline and physician quality,…
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Empowered by the state legislatures and aligned with the profession they oversee, dental licensing boards inhibit competition through restrictive licensing practices. In the manner of a cartel, most boards have…
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State policymakers play an important role in setting licensure policy and are at the heart of many efforts to strike the right balance needed to protect consumers and promote economic…
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Occupational licensing undermines consumer sovereignty and restricts occupational freedom in Alabama. Professional groups use the goal of protecting consumers from unqualified practitioners as cover to restrict access into the profession…
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Health services professionals are confronting the challenge of maintaining and improving competence over the course of lengthy careers in diverse practice specialties. This article reviews the efforts of a selection…
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Self-regulation encompasses a wide range of arrangements, from private ordering without resort to legal rules to state-enforced systems of delegated rules. Transaction cost analysis has been used to explain how…
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The purpose of this article is to examine important elements of the decision of whether and how counselling should be regulated by statute. First, the current status of certification, registration,…
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A recent article in the Federation Bulletin by Shirley Svorny, comparing certification with licensure, suggests that medical licensure does not benefit consumers but, instead, serves the interests of physicians by…
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State medical licensure boards are widely, if dimly, perceived as the keepers of the gate of the medical profession. When patients or their advocates are aggrieved by physicians, they sometimes…
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This paper examines the costs and benefits of occupational regulation. Over 800 occupations arc licensed by at least one of the fifty states. When properly designed and administered, occupational licensing…
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The movement toward increased regulation of the professions continues. As states impose new requirements, legal challenges will follow. This Article advocates that states use caution and restraint in evaluating the…
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State licensing boards perform the important government function of regulating professions, but there is a concern that these boards can be captured by interest groups and pursue private, anticompetitive ends….
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Those concerned with restrictions on innovative technologies and business models often decry the stultifying effects of a ‘Mother, May I?’ approach, whereby the innovator needs government permission to enter a…
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Instead of vetting physicians, the licensing apparatus provides an avenue for professional influence that has been used to restrict entry, limit competition, and preclude innovation in the provision of health…
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An occupational license is essentially a government permission slip to do certain work. In Alabama, before one can become a hair braider, cosmetologist, shampooer, massage therapist, auctioneer, pest control worker,…
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A 2017 study by the Institute for Justice (IJ) examined occupational licensure laws for 102 lower-income occupations and found that Michigan requires a license for 49 of them. Obtaining a…
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The dark side of occupational licensing—its tendency to raise prices to consumers with dubious effects on service quality, its enormous payout to licensees, and its ability to shut many willing…
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The length of time from the implementation of an occupational licensing statute (i.e., licensing duration) may matter in influencing labor market outcomes. Adding to or raising the entry barriers are…
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[T]he purported benefits of occupational licensing requirements — particularly those imposed by active market participants — often fail to come to fruition in practice. This is not entirely surprising, given…
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The authors note that while they may have missed some examples, especially since there is no single authoritative source on de-licensing, it is clear that de-licensing is uncommon, hard to…
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Licensure is not the only or the most effective way to ensure quality. While occupational licensure is intended to protect consumers from harm, there are many other less-burdensome mechanisms to…
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As noted in our introduction, it was often difficult or impossible to obtain data on cases of sexual abuse in medicine. States should make board documents open access. Several states…
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While the United States has long been a top destination for the world’s best and brightest, it has fallen short when it comes to fully tapping the skills and training…
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As a type of occupational regulation, licensure is intended to protect the public by ensuring that practitioners possess the required knowledge and skills to safely perform their craft. Unlike certifications,…
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This monograph presents the results of an Educational Testing Service study, studies by the Council of State Governments, and research by the Department of Labor staff on State occupational license…
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Dental Examiners, moreover, calls for more than a fig leaf of bureaucratic supervision. Superficial reforms will leave states open to considerable legal uncertainty, as the Supreme Court has not clearly…
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It has been a longstanding practice in America for governments to give private entities made up of professionals in an industry the authority to regulate the profession (e.g., state bar…
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We contend that the state action doctrine should not prevent antitrust suits against state licensing boards that are comprised of private competitors deputized to regulate and to outright exclude their…
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Entry into licensed professions requires meeting competency requirements, typically assessed through licensing examinations. This paper explores whether the number of individuals attempting to enter a profession (potential supply) affects the…
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State board sanctions do not appear to be a crucial tool for identifying negligent or incompetent physicians. Medical malpractice underwriters know substantially more about physicians at any point in time…
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The accountabilities and operations of state medical boards can have significant implications for hospitals and health systems in terms of their efforts to ensure quality care and patient safety. This…
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There are many more examples of ways in which public members can strengthen their boards by raising issues and concerns and introducing agenda items that licensee members are unlikely to…
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I argue here that licensure not only fails to protect consumers from incompetent physicians, but, by raising barriers to entry, makes health care more expensive and less accessible. Institutional oversight…
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Thus, allow me to suggest a couple of “second-best” options that may have a better chance of making a more immediate impact.First, conduct periodic occupational licensing reviews. In addition to…
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Only a small segment of the physician population has been formally disciplined. According to a 1999 Institute of Medicine report, those sanctioned are health care professionals who “may be incompetent,…
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