Michigan’s largest hospital system, Beaumont Health, alone has 500 nurses who have tested positive for COVID-19. Health providers all across the state are stepping up to fight the virus, with many prepared to make the ultimate sacrifice.
Because of this emergency, Michigan law gives the governor almost unilateral power. One of the ways Gov. Gretchen Whitmer has used it is to remove a host of regulatory burdens in order to better fight the virus.
This includes lifting “certificate of need” laws that force health providers to go through a bureaucratic process to expand facilities and add equipment. The governor also will allow medical professionals to skip part of their certification mandates and expand the “scope of practice” for nurses.
All of this is certainly useful. But the evidence shows that these regulations should be permanently eliminated when the crisis is over.
In 21 states, nurse practitioners (highly trained registered nurses) can operate independent of doctors — overseeing patients, prescribing medicine and running facilities. In 17 states, they can operate a “reduced practice,” working with a lot of independence, subject to some restrictions. In only 12 states, including Michigan, nurses operate under a “restricted” regime. That is, they can only work under the supervision of a doctor and generally cannot prescribe medicine.
According to Thomas Hemphill of the University of Michigan-Flint, decades of research shows no difference in health outcomes between patients treated by nurse practitioners and those treated by doctors. Insurers also don’t care, either; there is no measurable premium difference among states that can be attributed to their licensing requirements.
“Nurse practitioners are a highly competent, cost-effective yet underutilized health care professional,” Hemphill said. “Full practice legislation would go a long way toward solving [many] health problems.”
Unfortunately, Michigan’s scope-of-practice rules prevent nurses from fully contributing to our health care. As Michigan confronts a shortage in medical providers, particularly in rural areas, it makes sense to roll back licensing requirements and bureaucratic rules that don’t serve to protect the public.
But how do we determine which licensing rules are necessary for public safety and which simply stand in the way of people working, for no reason? That’s the subject of a new report I wrote with Professor Hemphill, “How to Analyze Occupational Licensing Laws: A Model Review Process.”
Several states have recently passed laws requiring regular reviews of their occupational licensing laws — the fees, education and training requirements, testing mandates and other regulations workers are subject to. Michigan has a bill introduced to do the same, Senate Bill 40, though it has not yet passed.
Our report provides a model for what to consider in order in determining if a license makes sense, or whether other, less burdensome regulatory options are better. The model includes:
- Providing a legal definition of an occupation, including the scope of work
- Determining how many people are licensed in the occupation and if the requirement is enforced
- Looking at how many other states license this occupation and comparing the requirements
- Tracking how many complaints are filed about workers in this field and whether they relate to public health and safety
- Comparing regulations (or lack thereof) between similar occupations
- Determining if liability insurance rates are different and related to how highly regulated an occupation is
Most people are aware of silly government rules that don’t make sense, or regulations that don’t work in the real world. The state should not be imposing laws that serve no purpose, and having an independent body regularly analyze these rules is good for everyone.