The other day I got a letter from my doctor telling me that he was moving on to another position. The bottom line is that he can no longer be my physician, so it is up to me to pick another doctor at my primary care clinic. He included a list of seven of his colleagues who can be my new doctor. The letter, which is printed on the clinic stationery, says, “Below are the names of my very capable colleagues at the Clinic who will be able to provide you care. I would heartily endorse all of them.”
If I’ve ever heard Clinic-speak baloney, that’s it. I don’t know any of the seven people listed. The sole information with which I’ve been provided is the name and medical title of each doctor. That’s exactly how my clinic and the medical establishment want it. They’re all licensed, they’re all doctors, so heck, they’re all equally good, right? WRONG! Do you know what they call the person who graduates first in his class from Medical School? Do you know what they call the dumbest, stupidest guy (last in his class) who just barely graduates from medical school???? They both have the same title…Doctor! Now how in the heck am I supposed to rank those seven names at the bottom of the letter I’ve received?
The problem here is occupational licensure, where government intervenes to allow only those with a “license” to practice a profession. Doctors, lawyers, electricians, plumbers, even barbers, must be licensed in most states. The primary effect of licensure isn’t to ensure consumer protection (there are horrific doctors, lawyers, and plumbers out there) but to limit the supply of those practicing the profession, thereby increasing the income of those allowed to practice the profession.
I could go on and on about how occupational licensure costs consumers billions of unnecessary dollars every year, but in this blog I want to concentrate on the “information void” that licensure creates. Because practitioners, whether they are electricians or medical doctors, all fall under the same title (licensed electrician, doctor, lawyer, etc.) consumers are supposed to assume that a high degree of quality exists with all licensed practitioners. In short, the occupational licensure information void leaves consumers without the relevant facts they need to make a wise decision.
In a world of de-regulated medicine there wouldn’t be an information void. I could just pull out my copy of the medical issue of consumer reports where every physician, surgeon, nurse practitioner, and physician’s assistant would be ranked according to various criteria. The surgical survival rate, the patient satisfaction rate, the referral rate, the bedside manner ranking, and other important indicators would all be available to me.
Licensure isn’t needed to insure quality. Quality can be approached just as well with certification, which refers to the passing of a privately controlled exam to demonstrate knowledge. For example, accountants are not licensed. Any guy on the corner can hang a sign and do your taxes if you agree. However, the certified public accountant (CPA) takes a rigorous exam to differentiate himself from others who practice accounting. I prefer certification to licensure, because the government isn’t involved in certification and the consumer is free to shop a larger number of providers by hiring non-certified practitioners.
It’s ironic that we have more information available to us in the purchase of a dishwasher or an automobile than in choice of our healthcare provider. Without a medical issue of consumer reports, I’m stuck with using informal networks to choose my next provider. I’ll talk to a few doctors and try to get their opinions “off the record.” I’ll ask around and get all of the information I can possibly get. This information gathering process is time-consuming and imperfect, but until we can loosen up on occupational licensing I’m pretty much shopping blind for a new doctor.