Arnold Kling  

Physician Licensing

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Physician licensing is one of those issues where economics and ordinary intuition conflict. Most people believe that licensing serves to protect consumers from incompetent doctors. Economists worry that licensing is a form of supply restriction and rent-seeking. EconJournalWatch, a publication recommended by Alex Tabarrok, looks at the economics literature on the topic.


many economists view licensing as a significant barrier to effective, cost efficient health care. State licensing arrangements have limited innovations in physician education and practice patterns of health professionals...
Consumers would benefit from a regulatory environment in which health care provider organizations and hospitals are free to employ health manpower in flexible ways and medical training is offered in a variety of forms.

For Discussion. Could the same be said for the Ph.D "license" and the tenure "license" in economics?


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TRACKBACKS (3 to date)
TrackBack URL: http://econlog.econlib.org/mt/mt-tb.cgi/100
The author at Ashish's Niti in a related article titled Problem of antibiotic resistance writes:
    The case of antibiotics over-prescription merits Govt. regulation because of antibiotic resistance problem. [Tracked on August 3, 2004 10:00 AM]
COMMENTS (8 to date)
Bernard Yomtov writes:

No.

It is not illegal for non-Ph.D's to teach at the university level. Indeed, many do. So the degree can hadly be considered a "license" on a par with a medical license, without which practicing medicine is a crime.

Lawrance George Lux writes:

I have only a Masters of Education, and therefore, take great license anytime I write on Economics. Do I take umbrage at Ph.D and tenure? Only to the degree no one offers me an honorary one. lgl

Jason Ligon writes:

It is inefficient, though. The people that administer a great quantity of care do not need full M.D. training, but we have to pay for it anyway.

I mean, really. Why does removing a plantar wart or some such procedure have to cost so much?

Mark L. Jackson writes:
So the degree can hadly be considered a "license" on a par with a medical license

Neither can an MD. It is not a license either. As for needing an MD to practice, that is not true. Ask any nurse.

Bernard Yomtov writes:

It is worth noting that the market is a bit more complex than the article describes. There is a fair amount of certification that augments the licensure process.

In most or all medical specialties there is a "board-certification" procedure, by which the relevant board certifies that a physician has met certain requirements to practice a specialty. This typically includespassing an exam, and participating in some lvel of continuing education. Not all physicians are board-certified, even in their own specialties.

Less well-known is the matter of hospital privileges. Hospitals are not required to permit any physician to practice in their facilities. They normally require proof of qualification - a completed residency in the specialty for starters - before letting a physician "on staff."

While it may be technically legal, as the cited article claims, for an ophthamologist to perform heart surgery, it is wildly unlikely that any hospital would permit this in its operating rooms.

Alex writes:

Medical field (and attorneys) need healthy competition. (Medical training needs to be opened up to alternate ways to learn the material and for varied skills. Won't bore you with some ideas here.) Think peer reviews should be kept honest and patient reviews used. Has been too much covering up of gross errors and negligence. Need to get insur. attorneys and pers.injury attorneys profiteering out of health care. Also, think need tort reform.

And, am not alone in saying will reject outright and to face of some quota as know the scores and grades [ res. of four med. schools showed 3500 much higher qualified were denied ]

As far as Ph.Ds. and licensing? Sorry, but think univ/. system is archaic, outdated. Also,am not alone in thinking that staff should be part-time.

Alex writes:

As in, can you read, think, and apply? Which to many of us wipes out the need for Ph.Ds. (outside of for genuine sc. res.& a new discovery) or years of indoctrination to the too young, too inexperienced, and clueless.

Same applies to legal field monopoly on civil law side. There are other ways to function as consultant/ coach to solve matters for much smaller fees and costs. [esp. in a dev. society] There are ways to reduce costs, paper, time, and emotional upheavals of what basically amounts to attorney thugs fighting with each other and hemorrhaging people and the econ.

Another archaic system handed down and a King's court system. Where are those pruning the laws on the books... or those ensuring the laws are written in bus. English? I for one do not want some modern type jury make-up deciding my fate. Or allowing people to repr. others if they want them to based on their reputation and own knowledge of law, etc. [I have many ideas as to how changes should be made in the legal system]

jaime writes:

1. It is convenient to have a responsible professional to have control over the sale of drugs, hormones, etc.
2. A professional with diploma may be compared to a branded commodity: an accepted brand provides some guaranty of quality.
3. The customer of medical services is unable to distinguish between a serious professional and the charlatan. Frequently, the charlatan is more convincing and credible.
4. It is convenient for society to have a dedicated corps of selected people in charge of vital functions: medicine, military, religion, university education, law enforcement, justice, diplomacy, etc.

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