Licensure

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Home Births: Feminists vs. OB/GYNs

April 20, 2012 in Licensure, Nonphysician Clinicians, Regulation | No comments

Why aren’t physicians more supportive of home births and midwifery?  The answer is that it eats into their market share and reduces their income.

“[In the 1970s] feminists argued that medical care needed to be demystified and women’s lives demedicalized.  They maintained that childbirth was not a disease and normal deliveries did not require hospitalization and the supervision of an obsterician.

The conflict over home birth proved to be one of the most bitter between the medical profession and the women’s movement.  While no state forbade home birth, the American College of Obstetricians and Gynecologists actively discouraged it as unconscionably risky.  Doctors who participated in home births by offering backup in emergencies were threatened with loss of hospital privileges and even their medical licenses.  Midwives in California were prosecuted for practicing medicine without a license.”

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In Support of a Fake Doctor

December 14, 2010 in Licensure, Physician Compensation | 5 comments

Recently, MSNBC reported that respected cardiologist and United Airlines captain Dr. William Hamman is in fact not a doctor at all.  ”The AP found he had no medical residency, fellowship, doctoral degree or the 15 years of clinical experience he claimed. He attended medical school for a few years but withdrew and didn’t graduate.”  As a result, “Journals that printed articles listing Hamman with M.D. and Ph.D. degrees are being contacted in case they want to correct the work. Beaumont removed him from a U.S. Department of Defense medical simulation contract that a physician at the hospital had obtained.”

Dr. Hamman lied.  He lied about his credentials and should be punished for that.

What news articles are not covering, however, is the quality of work Dr. Hamman did.  If Dr. Hamman conducted heart surgery without the proper training, then that is a serious issue.  According to the news report, however, “There is no indication Hamman ever treated a patient.”

Instead, Dr. Hamman’s training sessions used an operations research framework from his background as a pilot in order to help Doctor’s improve quality.  His training was typically titled, “This is Your Captain Speaking: What can we learn about patient safety from the airlines?”  They were so successful, that ”Even after learning of Hamman’s deception, the American Medical Association was going to let him lead a seminar that had been in the works, altering his biography and switching his title from ‘Dr.’ to ‘Captain’ on course materials. It was canceled after top officials found out.”

It is possible that the only way for Dr. Hamman to gain the respect of his peers or even gain entry into the world of medicine is with an MD.  Nevertheless, this does not mean that Dr. Hamman could not have conducting high quality training seminars to maximize physician teamwork.

One of my friend’s who is a physician actually worked with Hamman.  The physician said that Hamman seemed legitimate.  He never talked about clinical issues, only simulation and teamwork issues.

On the personal level, this story is about a man who lied and lacked integrity.  On a system level, this story may actually tell more about physicians’ efforts to prohibit non-physicians from providing any services even remotely related to medical care–such as Mr. Hamman’s teamwork training.  Physician efforts to protect their turf is legendary…this may be the real story.

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Why are coffins cheaper in California

November 16, 2010 in Regulation | 2 comments

How occupational licensing affects the cost of goods and services:

“After Hurricane Katrina leveled the pine forest that had been their sole source of income, Benedictine monks in Louisiana  wanted to support themselves by making and selling coffins. Unfortunately for the monks, in Louisiana only a licensed undertaker can sell coffins. It’s the law, enforced by the State Board of Embalmers and Funeral Directors, which is dominated by funeral industry members who no doubt benefit from the lack of competition.

In California, there is no such law and no regulatory board for the funeral industry to dominate. Instead, it is regulated by the State Department of Consumer Affairs. Coffins are available here through retailers, even online, moderating their prices.”

From KQED’s Perspectives Series, Marsha Cohen, UC Hastings Law School Professor

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Is licensing tax preparers a good idea?

January 7, 2010 in Regulation, Taxes | 3 comments

The USA Today writes that “the IRS has proposed a broad initiative that would require hundreds of thousands of tax preparers to register with the government, pass a competency exam and adhere to ethical standards.”  This sounds like a good idea as it will safeguard individuals from unscrupulous tax preparers.  But who will this truly benefit?

If you want a high quality tax preparer, there are many reputable companies that can prepare your taxes.  These tax preparers will be well trained and you’ll pay more for them.  Firms have an incentive to maintain this quality so their customers continue to require their services.  If quality is above average over the long run, they can build a reputation and charge higher prices.  Thus, for individuals who already have high quality tax preparation, there is no benefit.  In fact, there could be an increase in cost to these individuals if the government standards require additional training that does little to improve quality.

This idea will most certainly hurt poor immigrants.  When I was in college, I spent my Saturdays in the spring doing tax preparation for immigrant farm workers in Kennett Square, PA.  I worked for a non-profit legal firm.  I receive training on the basics of tax preparation.  Because most of these migrant workers had little assets and no mortgage, doing their taxes was simple.  If an individual had a more complex tax return (e.g., if they had a mortgage), I would refer them to the supervising lawyer.  The migrant workers received their tax preparation for free since we were volunteers.  However, this practice may not continue into the future.

If the government requires everyone who prepares taxes to pass through an onerous training program, fewer volunteers will decide to participate in free tax clinics.  Many non-English speaking Americans may not fill out their taxes themselves.  Further, the non-profit’s scope of their program will likely decrease if they have to pay for additional training for all their staff. 

Also, how will the government guarantee people will act ethically?  Will they give them a test of what is ethical?  Will they ask nicely ask people not to do a bad job?  

In short, licensing tax preparers is a bad idea.

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