Should more flexible health care professional licensing continue after COVID-19?

Shirley Svorny and Michael Cannon of the Cato Institute have a long history (see here) of criticizing government licensing of physicians and other health care providers (e.g., nurse practitioners [NPs], nurses). Their proposed alternative has been to allow private entities to certify the competence of practitioners. They claim that private entities would increase competition by allowing an increase in supply, allow for more cross-specialty competition, permit more flexible certification categories, and reduce the chance for incumbent control of government licensing boards that restrict supply. Those would favor government licensing would argue that the government may be able to better uphold quality standards than private-sector entities with a potential profit motive or conflict of interest. To generalize, the pro-certification camp (e.g., Svorny and Cannon) typically is more concerned with cost of care, efficiency and value; the pro-government licensing camp typically is more concerned with minimum quality standards independent of cost.

A recent white paper by Svorny and Cannon, however, argues that the cost of the lack of flexibility in government licensing has truly been highlighted by the recent COVID-19 pandemic. As there has been a surge in need for care of COVID patients, cross-specialty support is needed to care for the surge in COVID-19 patients.

State governments have not been entirely passive, however. There has been some loosening of government licensing restrictions during the pandemic by most states. Some examples:

New York expanded scopes of practice to let nurse anesthetists, physician assistants, and specialist assistants practice independently; to let pharmacy technicians help pharmacists compound, prepare, label, and dispense drugs for home infusion providers; and to increase the number of providers who can supervise emergency medical services personnel.63 Alabama expanded scopes of practice for NPs, nurse midwives, nurse anesthetists, physician assistants, and anesthesia assistants, freeing them to “practice to the full scope of their practice as determined by their education, training, and current national certification(s).”64 Colorado expanded scopes of practice for a host of health professionals…as well as (unlicensed) nursing students and medical assistants by allowing NPs and nurse anesthetists to delegate tasks to them.65 States including California, Maryland, and North Dakota allowed pharmacists to order and collect specimens for COVID-19 tests… Most states—including New Jersey and New York—suspended prohibitions on clinicians in other states providing care to their residents, whether in person or via telemedicine, either outright or by way of conditional waivers that require registration or an emergency license.72 Several states removed barriers to clinicians providing care after they retired or otherwise allowed their licenses to lapse.

Yet, not all states were so flexible and COVID-19 reveals that incumbents still wield significant power.

[In California, the]…state’s Department of Consumer Affairs refused to allow NPs to practice independently and instead increased the number of NPs each physician could supervise

Allowing for a more flexible credentialing program as Svorny and Cannon propose would certainly reduce cost and increase patient access to care. If done right, quality may not suffer. If credentialing is implemented in less robust way, however, there is a risk of quality reductions. Nevertheless, the Cato researchers make some compelling points that allowing for health care professionals to have more flexibility in how they practice medicine would be a net positive for society.

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