If you are living in Puerto Rico, you may have reason to worry. The BBC reports (“PR seizes fake docs“) that “arrest warrants were issued for at least 88 doctors whom officials allege gained their credentials through fraud or bribery…The arrests are linked to allegations that members of Puerto Rico’s medical licensing board took bribes of as much as $6,000 (£2,900) to raise the marks on exam papers so candidates would pass.”
As a person who generally favors less licensing and more certification, the key for either strategy to work is for the patient/consumer to have faith in the licensing or certification process. If there are multiple certifying agencies, each agency has an incentive not to allow fraud or bribery since the value of their certification would plummet if fraud was found. With licensing–where a monopoly such as the government or professional board–there is less incentive to guard against fraud since there is no competition against which reputation matters. From the doctors point of view, if they can practice without a license, there is less incentive for them to commit fraud regarding their qualifications or test scores. Of course, without some sort of certification, they will likely have fewer patients or will have to accept a lower price.
Nevertheless, fraud and bribery can occur in either the licensing or certification case. Hearing of these cases where individuals ‘cheat’ is always disappointing and erodes patients’ faith in their health care system.