Who Really Benefits From the Healthcare License Regulations in Your State?

Regulations are ubiquitous in health care, giving some patients a welcome sense of security. Legislators—and industry insiders lobbying them—present their laws as safeguards against substandard care. 

Certainly, many people pushing these standards have patient well-being in mind. But experts in a field are typically the same people who benefit from keeping that field restricted. What lobbyists sell as barriers to harm are sometimes just unnecessary barriers to competition. And the same state lawmakers that allowed existing flower arrangers to legislate their competitors out of business with “quality standards” are also responsible for determining who can and can’t administer your health care.

How is your state “protecting” your health care?

Creating Nursing Shortages

Desperation for nurses is the norm, and the COVID-19 pandemic exacerbated the persistent crisis. A projected 193,100 new registered nurses are needed per year, but fewer than that are expected to enter the field over the entire upcoming decade. 

Patients cannot afford to have their state legislators make the nursing licensure process unnecessarily cumbersome. Individual states maintain their own licensing rules, and some legislators demand excessive fees and implement other rules that have nothing to do with care. 

Consider the process to obtain registered nursing licensure in New York. Given the exam required to become a nurse (the NCLEX) is a national test, one might think a nurse could easily practice across multiple states. But New York is one of nine states not participating in the Nurse Licensure Compact (NLC), which streamlines practicing across state lines. The time it takes to obtain licensure also depends on whether the candidates attended school in New York or another state. 

Regardless of where they went to school, nursing candidates in New York must pay a $143 application fee in addition to the universal $200 NCLEX exam fee. They must also renew their licenses every three years by paying a $73 fee. No new education or testing is involved, and this is purely a financial hoop. 

Nobody can fairly claim licensing is the sole reason, but New York has fewer than 10 nurses per 1,000 residents (compared to South Dakota’s high of almost 16 per 1,000). Surely the state would benefit from placing fewer obstacles in the way of nursing candidates.

Limiting Reasonable Scope Of Practice

Healthcare professionals with the same qualifications and titles have different allowed scopes of practice in different states. A nurse practitioner (NP), for example, functions much like a doctor in some states but is severely limited in others.

In a “full practice” state, an NP “can evaluate patients; diagnose, order and interpret diagnostic tests; and initiate and manage treatments, including prescribing medications and controlled substances, under the exclusive licensure authority of the state board of nursing.” This broad scope lightens the load of providers, gives patients more time with them, and lowers costs. Furthermore, some patients prefer an NP to a physician, due to the more holistic approach and specialized experience with patient care.

In other states, physician-led organizations such as the American Medical Association (AMA) seriously restricted the scope of NP practice. They refer to broader NP rights as “scope creep” or “inappropriate scope expansion,” clearly implying danger in using an NP without direct MD oversight. However, numerous studies indicate an NP is at least as effective as an MD for many procedures. Legislation aimed at restricting them in areas where they are competent is both costly and counterproductive. It only benefits physicians, preventing them from worrying about more competition. 

Restricting Telehealth

During the COVID-19 pandemic, every state lifted restrictions on telehealth. Due largely to concerns about viral spread, patients were encouraged to stay home. To facilitate this protocol, telehealth licensing procedures were simplified, and doctors could freely practice virtually across state lines. 

This served not only to insulate patients from disease (which is surely desirable whether or not a pandemic is raging) but to give them access to far more care options. Patients separated geographically and legally from their favorite doctors could see them again. Patients in a hurry for an appointment in a busy state could make a sooner appointment elsewhere. 

Unfortunately, in thirty states, medical boards and legislatures reverted to their pre-pandemic, protectionist ways. More options for patients equals more competition for providers, and telehealth equals more options. 

As in the case of nursing and scope of practice restrictions, telehealth licensing rules serve incumbent professionals rather than patients. Occupational licensing in general benefits large businesses rather than customers. This is an irritant in the field of floral arrangement; it’s outright dangerous when preventing patients from accessing health care.