As health care gets more expensive and Michigan struggles to fill positions, lawmakers have explored different ways to make it easier to work. This includes easing some licensing burdens, expanding scope of practice and creating some sub-categories of licensing.
Not everyone is happy. Bridge Michigan reported recently that “some medical groups warn those efforts endanger patients.”
A “doctor” of nursing? A physician “associate?” A nurse “anesthesiologist?” The ever-expanding terminology and expansion of professional licensing can cause “confusion” for patients who are already navigating a “cloudy environment” in the state’s health care system, said Dr. Tom George, the CEO of the Michigan State Medical Society. “We have a shortage (of physicians) and we recognize the modern practice of health care uses multi-disciplinary teams,” George said. “Patients in Michigan deserve to have a physician available for their care.”
The article notes the abundant evidence that nurse practitioners improve care without endangering patients and shows how most states are safely allowing other medical professionals to practice. But associations of current medical professionals oppose the changes.
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Physician advocates like George, whose organization represents the state’s medical and osteopathic doctors, oppose multiple legislative efforts to grant nurse practitioners full practice authority.
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Nearly a decade ago, the Michigan Dental Association argued against the creation of dental therapists. President Dr. Cheri Newman told Bridge earlier this month it would have better served Michiganders to grow the current workforce of dentists and dental hygienists instead, with better outreach to high school students and expanded mentorships.
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The Michigan Academy of Family Physicians also opposes expanded roles for physicians assistants, arguing that fully-trained medical doctors have “distinctive skills, training and experience.” Likewise, a bill to expand roles for nurse practitioners, it contends, is “dangerous legislation.”
The history of state licensing laws shows that these responses from interest groups are typical. People already working in licensed occupations benefit when the state forces their would-be competitors to get a license before operating legally. The mandates limit competition and reduce the supply of labor, increasing the price for the services provided by those who are licensed.
Regardless of the occupation, almost unanimously the interest groups that benefit from current licensing laws oppose changes that would make it easier for people to compete with an incumbent professional. In recent years, that has been the case for barbers, outdoor guides, dieticians, funeral homes, property managers, therapists, sprinkler installers, food delivery drivers, solar panel installers and most health care professions.
Lawmakers have a role in establishing regulations to protect the public. But they rarely try to determine if these rules do so. That’s why so many of Michigan’s 180 licensed occupations are so random and the thousands of rules regulating these jobs are so arbitrary. These rules come at a cost of hundreds of thousands fewer jobs and thousands of dollars in higher costs for consumers.
So what should the state do about it? It should regularly review all of the licensing laws on the books and ensure they are doing what they are intended to do — protect public health and safety. Many other states have done so, and there’s a model review process for Michigan to do so as well.
