Practicing medicine without a license

Not A Doc ShirtIs medical licensure part of the problem with modern health care?  WhiteCoat considers the question:

What would happen if we did away with licensing of medical professionals and certification of medical facilities?

What if we let anyone hang out a shingle and practice medicine out of their garage or their living room? With all the physician extenders performing the tasks that used to be performed solely by physicians, we’re heading down that road already. Get rid of the incremental steps. Jump in head first.

Let my 11 year old forget her paper route and practice medicine – just like Lucy on the Peanuts. She may only make 5 cents per patient, but she would still get paid for her services.

While written somewhat tongue-in-cheek, WhiteCoat seems to think the idea is at least worth debating.  And this is nothing new, either.  A recent Cato Institute paper argued that medical licensure is an obstacle to affordable health care:

[L]icensure not only fails to protect consumers from incompetent physicians, but, by raising barriers to entry, makes health care more expensive and less accessible. Institutional oversight and a sophisticated network of private accrediting and certification organizations, all motivated by the need to protect reputations and avoid legal liability, offer whatever consumer protections exist today.

No less of an authority than the late, great Nobel Prize-winning economist Milton Friedman was critical of medical licensure.  While I wish his writings on economics were required reading in our nation’s high schools and colleges, in my opinion, his arguments against medical licensure are somewhat unpersuasive:

A “faith healer” may be just a quack who is imposing himself on credulous patients, but maybe one in a thousand or in many thousands will produce an important improvement in medicine. There are many different routes to knowledge and learning…

[A] man’s ability to pass an examination twenty or thirty years earlier is hardly assurance of quality now; hence, licensure is not now the main or even a major source of assurance of at least minimum quality.

While the libertarian in me is sympathetic to the basic idea, I doubt too many people will rally to abolish the medical license based on the lucky quack hypothesis.  Also, Friedman seemed to ignore or perhaps was simply unaware of continuing medical education.  In Friedman’s defense, CME and medical board recertification have almost certainly become more rigorous since he penned his words.

I’m open minded about this, but to me, eliminating medical licensure sounds like one of those ideas that look better on paper than in the real world.  Of course, being a licensed physician, I cannot claim to be unbiased.

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