Before the Bedside Manner

An increasing share of Americans hold jobs requiring a license of some sort. In 2018, the U.S. Bureau of Labor Statistics reported that 24.1 percent of workers in the United States hold a government license, privately issued certification, or both.

Health care is one of the most regulated industries in the United States. Governments regulate health care to protect their citizens’ lives and health by ensuring that citizens receive health care and advice from qualified professionals. Not all forms of professional accreditation in the field, however, come from government entities.

Licensing involves a regulatory agency or body formally recognizing that an individual possesses all qualifications to practice a profession within a state. These requirements often include “some combination of education, training and examination to demonstrate competency.”

In addition to regulations from agencies or accrediting bodies, certification frequently concerns a national professional board providing a practitioner a credential “in addition to their primary qualifying degree and examination.”

Health care practitioners must navigate this range of approving bodies and comply with professional requirements while also caring for patients and adapting to their needs. Commentators recognize a potential tension between innovation in the industry and compliance with regulations, but most attention focuses on just one side of this possible tension—either new treatment and technology—instead of the current governing mandates underscoring health care practice today.

This seminar highlights selected scholarship on how the health care industry grapples with regulations affecting occupational licensing for health care providers, as well as the field’s push for innovation.

• Regulatory authorities governing medicine, nursing, and pharmacy should “exercise thoughtful, deliberate decision making” when establishing board policies and regulations and should balance “market-driven decisions” with “accountability and responsiveness to the public interest,” argue David C. Benton, Carmen A. Catizone, and Humayun Chaudhry. Their article in the Journal of Medical Regulation also highlights health care regulators’ need to accommodate new health care delivery technologies and treatments “without abandoning their core responsibility to regulate with the best interests of the public in mind.”
• A 2018 Texas state law prevents hospitals from using maintenance of certification (MOC), a program intended to ensure physicians are up to date on medical knowledge, as the sole factor they consider when differentiating between doctors.David Johnson, a physician at UT Southwestern Medical Center, argues in the Journal of the American Medical Association that “although criticism of recertification programs and MOC is not unprecedented, seeking legislative reprieve from state governments” is unusual and “may have unintended consequences.” Johnson asserts that, because medical boards normally self-regulate physicians and physician licensing, this law could lead to unwanted future state “intervention into the practice of medicine.”
• In a recent paper published in Academic Medicine, the journal of the Association of American Medical Colleges, Humayun Chaudhry, Darrell G. Kirch, Thomas J. Nasca, and their co-authors explain how they and other leaders of the national organizations responsible for self-regulation in medicine have come together as the Coalition for Physician Accountability. Members of the coalition “recognize that self-regulation is an earned privilege, bestowed upon the medical profession in return for service to the public, and that it involves major shared responsibilities.” They also acknowledge that achieving the “quadruple aim of enhancing patient experience and improving population health while lowering costs and improving the work life of clinicians and staff is becoming more challenging” in the United States. To address the increasing challenges, these leaders of the organizations responsible for accreditation, assessment, licensure, and certification formed the coalition, so that they could collaborate and develop effective solutions.  
• “An evolving healthcare system requires evolving professional regulation to keep pace with system growth and chang,” write Elizabeth Wenghofer and Sophia M. Kam of Laurentian University in a 2017 paper. They argue that advancing the health care profession to keep pace with its changing landscape may require efforts to “un-silo” health profession regulators. Wenghofer and Kam assert that interprofessional regulation is crucial in systems requiring “collective and additive competence” such as the health care industry.
• Do professional regulations benefit the public or burden professionals? In a recent paper in the Journal of Research in Nursing, Elaine Maxwell explores a debate between two professionals about the proper role of regulation in health care. Maxwell explains that the Chief Executive Officer of the Nursing and Midwifery Council, Jackie Smith, argues that, instead of mainly focusing on “fitness to practice,” regulators should “be a force for development and improvement.” Maxwell also highlights Peter Carter’s counter-argument that “regulation is not a panacea that prevents organizational or system-wide failures.” Maxwell concludes by explaining that many people support moving away from focusing on private practitioners in isolation and, instead, scrutinizing “the context in which they practice, providing support for continuous development and helping individuals adjust to changing circumstances.”