Governors who recently suspended state licensing laws to address the COVID-19 pandemic tacitly conceded through this action that these regulations limit the free flow of health care services and contribute to shortages. States should learn from this moment and, as explained in a new policy analysis from the Cato Institute, consider replacing licensing with certification to remove barriers that block qualified people from entering health professions and traveling to places where they are needed.
A good place for reform-minded public health policymakers to start is to consider how licensure works in the architecture profession. Based on a hybrid of licensing and certification, it enables architects to practice in 54 states and territories plus the District of Columbia. The certification even lets them practice in Canada, Mexico, New Zealand, and Australia. Architects, who often work on multiple projects in different regions of the country or the world, would be stymied if there was no way around licensing obstacles. The solution they developed points a way for other professions.
The way the architecture industry handles the matter is through the National Council of Architectural Registration Boards, a private non-profit organization that credentials and certifies training, competency, and work quality of architects. The NCARB was founded in 1919 to encourage state architecture licensing boards to establish uniform standards across the country. Today, licensing boards in all 55 U.S. jurisdictions grant a license to any applicant who is NCARB-certified.
An architect needs only to pay state licensing fees as well as a certificate transmittal fee to the NCARB. Canada, Mexico, New Zealand, and Australia recognize NCARB certification as well. NCARB is working to seek recognition by other Asian-Pacific countries. The NCARB also offers two “alternative paths” to certification for applicants who have substantial work experience in architecture but have not graduated from accredited architectural programs. Architects may apply directly to state licensing boards and jump through all the hoops necessary to obtain a state license. But once an architect is NCARB-certified, the obstacles get removed from the road.
While the architecture model is markedly better than that used for health professionals, it could be better. Architects must still go through the hassle of getting a state architecture license when an NCARB certificate is all they really need. The licensing boards are redundant. They only add bureaucracy and cost to the process. The certification process should completely replace licensure. States should end licensing boards and allow architects maintaining NCARB certification to automatically set up practice. They should also permit architects who are certified by other accredited organizations that may arise to compete with NCARB.
Still, when state lawmakers take a critical look at how health care licensing laws stand in the way of getting health care to their constituents, they can learn much from the architecture example. A move toward certification as an alternative to licensure would allow more individuals to enter the pool of health care providers based upon skill and experience. Nurse practitioners and physician assistants, for example, would be able to offer more services to patients by demonstrating proficiency to the certification organization. This would increase patients’ access and broaden their choices.
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Source:: Los Angeles Daily News