Those of us who have been fighting for occupational licensing reform and other forms of deregulation have been astonished at how quickly many of the same stubborn, unnecessary regulations we’ve fought against for years have now been paused during this pandemic. To be frank, it has proven that we’ve been right all along.
Dubious concerns about health and safety have long been leveled at professions as benign as hair braiders  and florists . However, the accusations that reformers and advocates don’t care about “health” or “safety” because we want to unburden people of needless, cost-intensive licensing requirements have quieted during the current pandemic. Instead, innumerable executive orders across the states have reduced medical regulations, not only to help professionals maintain an income during this economic downturn, but also to expand access to care.
Consider that many nurses and doctors have been fighting for years over “scope of practice” — the duties they may perform and whether nurses’ should be allowed to provide care outside the purview of a physician. The American Medical Association has long voiced  concern that it is “dangerous” to allow nurses to practice independently or perform more duties.
But evidence continues to mount that expanding scope of practice for advanced practice registered nurses, physician assistants, and pharmacists lowers medical costs  and improves access to care . It is no wonder that, in the face of the coronavirus, many states such as Alabama , Louisiana , Kentucky , and Massachusetts  have expanded scope of practice for various medical professionals.
One can only wonder why these states did not make this change long ago and in a lasting way. If it was truly dangerous to allow nurses to perform more duties, it is unlikely that we would have seen such expansions during a time of crisis — let alone so many so quickly.
Similarly, doctors who have immigrated  to the United States must go through a licensing process that can last more than a decade . As Perrie Briskin reports in Vox , “The process of certification for a foreign-trained doctor is the same process an American who just finished medical school must go through — take the boards and enter into a three- to seven-year residency program.”
Furthermore, American residency programs have more applicants than spots and favor Americans. “In 2018, 56 percent of foreign doctors who applied were ‘matched’ with a residency program compared to 94 percent of US medical students,” writes  Briskin.
While it is reasonable to make sure these doctors have the requisite skills, our current process is unduly burdensome. Once again, were it so dangerous to allow immigrant doctors and medical school graduates to more easily get to work, why would New York , New Jersey , and Massachusetts  allow them to work to varying degrees in this time of crisis?
Burdensome regulations in our public health system do not just apply to practitioners, either.
Certificate of need laws, or CON laws for short, require that, before adding hospital beds, opening a new medical facility, or buying new medical devices, individuals seek approval from competitors. While proponents  tout this practice as necessary to improve access to care and lower costs, these “competitor’s vetoes ” are continuously shown  to stymie competition, reduce access, and increase costs.
Indeed, over a dozen  states have swiftly paused their CON laws in order to expand access to care. If they were truly about protecting consumers, or access to care, in particular, we would hardly expect this to be the case. And while we’re unlikely to see the full benefit of their suspensions realized, as it takes time for new providers to step in following their suspension, surely the benefit of pausing them in order to expand access to hospital beds ought to be a lesson for states.
We have also witnessed a rapid increase in the use of telemedicine, remote healthcare via the internet, video conferencing, or over the phone. This allows people to seek medical care while social distancing, and it has great potential in good times as well. However, some optometrists don’t like the idea of online  eye exams  — eyecare has been rife with economic protectionism  thinly veiled as “safety” concerns for decades. Other doctors have resisted  the opportunity of telemedicine for reasons that include building relationships with patients.
Many of these restrictions have  been  loosened  in reaction to the current pandemic. Telehealth visits are booming . Clearly, this was an obvious way to expand access to care without worry of significant detriments. Here, too, we see that modest reforms increase access to care, and there’s no reason this shouldn’t be true even in normal times.
We should take the coronavirus as a lesson to always be wary of regulatory calls appealing to “health” or “safety” not backed by evidence. Otherwise, access to medical care will suffer.
Image credit: joshimerbin
- “hair braiders”: https://www.forbes.com/sites/instituteforjustice/2018/03/13/tennessee-has-fined-residents-nearly-100000-just-for-braiding-hair/#5ac75dac174c
- “florists”: https://reason.com/2013/10/19/how-to-fix-the-supreme-court/
- “voiced”: https://www.ama-assn.org/practice-management/payment-delivery-models/ama-successfully-fights-scope-practice-expansions
- “lowers medical costs”: https://thehill.com/opinion/healthcare/484023-the-us-has-a-primary-care-shortage-scope-of-practice-reform-can-help
- “improves access to care”: https://www.forbes.com/sites/adammillsap/2018/06/19/its-time-to-expand-scope-of-practice-laws/#1674456c2c64
- “Alabama”: https://www.abn.alabama.gov/wp-content/uploads/2020/04/2020-04-02-Fifth-Supplemental-SOE_COVID-19.pdf
- “Louisiana”: http://www.lsbn.state.la.us/Portals/1/Documents/news/govproclamation.pdf
- “Kentucky”: https://kbn.ky.gov/Documents/Order%20_KBN_APRNs.pdf
- “Massachusetts”: https://www.mass.gov/doc/march-26-2020-advanced-practice-registered-nurses-order/download
- “immigrated”: https://www.acf.hhs.gov/orr/resource/u-s-medical-licensing-process
- “decade”: https://www.nytimes.com/2013/08/12/business/economy/long-slog-for-foreign-doctors-to-practice-in-us.html
- “Vox”: https://www.vox.com/first-person/2019/8/7/20757511/universal-health-care-doctor-physician-shortage-burnout
- “writes”: https://www.vox.com/first-person/2019/8/7/20757511/universal-health-care-doctor-physician-shortage-burnout
- “New York”: https://www.vox.com/2020/3/30/21190971/foreign-immigrant-doctor-nurse-coronavirus
- “New Jersey”: https://www.nj.gov/governor/news/news/562020/20200401b.shtml
- “Massachusetts”: https://commonwealthmagazine.org/health-care/baker-allows-foreign-doctors-to-practice-here/
- “proponents”: https://www.ncsl.org/research/health/con-certificate-of-need-state-laws.aspx
- ““competitor’s vetoes”: https://regproject.org/paper/competitors-veto-state-certificate-of-need-laws-violate-state-prohibitions-on-monopolies/
- “shown”: https://www.mercatus.org/publications/corporate-welfare/certificate-need-laws-how-con-laws-affect-spending-access-and-quality
- “dozen”: https://pacificlegal.org/certificate-of-need-laws-covid-19/
- “online”: https://www.rstreet.org/2016/04/20/optometrists-push-for-state-laws-blocking-online-eye-exams/
- “exams”: https://www.nkytribune.com/2018/02/julie-metzger-optometrists-support-hb-191-because-patients-deserved-a-high-level-of-care-and-safety/
- “protectionism”: https://ij.org/center-for-judicial-engagement/programs/victims-of-abdication/williamson-v-lee-optical-1955/
- “resisted”: https://www.nytimes.com/2010/01/07/health/07chen.html
- “have”: https://azgovernor.gov/governor/news/2020/03/governor-ducey-expands-telemedicine-coverage-arizonans
- “been”: https://www.gov.ca.gov/2020/04/03/governor-newsom-issues-executive-order-to-expand-telehealth-services/
- “loosened”: https://www.mackinac.org/mackinac-center-applauds-gov-whitmers-loosening-of-health-care-regulations
- “booming”: https://www.cnbc.com/2020/04/03/telehealth-visits-could-top-1-billion-in-2020-amid-the-coronavirus-crisis.html