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It is believed that the strict medical school admissions standards and state licensing procedures for doctors favor the creation of better trained doctors and a medical establishment that is, on average, of higher quality than if we did not have such a restrictive licensing system.

This raises two issues for me. The first is a direct discussion of the claim made above (which will be the subject of today’s post) and the other a discussion of the consequences of such a claim, if true (the subject of tomorrow’s post).

It is far from clear that the restrictive licensing requirements even make the average quality of medical professionals higher than would otherwise be the case. How can that be you might say? If we only let qualified people into the field, wouldn’t the field be stronger than if anyone who wished entered the field? Perhaps. But there are two countervailing forces – one legal and one economic, but they are related.

  1. The strict licensure practiced in the USA makes it nearly impossible for high quality foreign trained doctors and practitioners to work here in the USA. Unless you believe that the US’s population of 309 million contains all of the top quality medical professionals in a world of 6.7 billion people, then by keeping out foreign “competition” we are settling for a much lower average quality medical profession than would otherwise be the case. One need look no further than the average quality of workers in non-licensed professions like computer software and college teaching to see how much better off we would be with foreign competition. Half of the economics programs in the country would have to shut down without top talented foreigners (maybe that would be a good thing!)
  2. Adam Smith, as always, would have much to add here. By practicing restrictive licensing, we don’t simply limit the entry of less talented people into the medical profession, we vastly limit the extent that specialization and the division of labor is permitted to run its course in medicine. Remember that no one is a factory, or at least a good one, unto themselves. As more people enter a market, each of us is able to specialize into what we are relatively good at, but further, such specialization permits us to invest in each of those specializations to a far greater extent and it also enables us to accumulate capital and technology which can make those specialties far more productive than they would otherwise be. So, even if we allowed less talented people into the medical profession, the specialization that their entry would permit would increase the productivity and quality of the more talented practitioners and of themselves. Thus there is no a priori reason to suspect that admitting more “lower quality” people into the medical profession would lower the average quality of the medical profession itself.

3 Responses to “Medical Licensure and the Quality of the Medical Profession”

  1. Speedmaster says:

    Another quick thought on this, and I’m certainly not the first to make this point …

    If we had done the same thing with cars that we have with medical licensure, it would be as though we said that by law no one could buy/own a car cheaper or with fewer frills and quality than a Mercedes. While it’s a nice thought. It really isn’t fair to everyone who can’t afford that level of car.

  2. Harry says:

    Since before all of us were born, the medical profession was professional , exacting its own standards, including the two-year-long he’ll week called residency. Of all professions, Medical Doctors are the most worthy of the title Doctor. Much better than a JD, which lets the practioner sue MDs for medical errors. Ever try to sue a lawyer for incompetence? I have.

    A doctor friiend of mine grumbles under his breath whenever our local educational poobahs are introduced as doctor Smith, as if their dissertation on the effect of acne on teenager ability to integrate with their peers has the same value as noticing that someone has a life-threatening infection.

    An M.D. from any US medical school is great, and to get back ont the question you raised, they do just fine without some pointy-headed bureaucrat selling them a liscence. I will reluctantly agree to having a disinterested panel of doctors certify that the prospective doctor is qualified.

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