Only a small number of studies examine the effect occupational licensing has on public health or safety. The limited evidence suggests that these state-imposed mandates do little to protect the public.
A study from the Obama administration reported:
“Stricter licensing was associated with quality improvements in only 2 out of the 12 studies reviewed. There is also evidence that many licensing boards are not diligent in monitoring licensed practitioners, which contributes to a lack of quality improvement under licensing.”
If licensing fails to show clear benefits in the quality of services provided, it is unlikely to provide meaningful health and safety benefits.
Positive health and safety effects should be easy to find in dangerous occupations or the health care industry. Existing research generally fails to find a correlation between licensing and improved outcomes in these areas, however. In some cases, the research suggests the opposite: that licensing laws negatively affect health-related outcomes.
Electricians work in a relatively dangerous profession, with a much higher death and injury rate than the average occupation. A study from the Bureau of Labor Statistics examined the licensing of electricians from 1992 to 2007. It focused on states that began licensing electricians over this period, analyzed the strictness of these regulations and compared worker injury and death rates across states. The report showed that “the impact of occupational regulation on deaths and injuries is statistically insignificant or indeterminate.”
The bulk of studies looking at the licensing requirements of nurses suggest that these rules harm, rather than help, the public. One example is nurse practitioners, who are nurses with advanced medical degrees and extra training. Licensing and scope of practice rules vary among the states, with 22 permitting nurse practitioners to operate independently. Other states, including Michigan, restrict these medical professionals from providing certain services and require them to operate under the direct supervision of a physician. The graphic below shows the various types of scope of practice laws across the country. It was created by the School of Nursing at Simmons University and based on information provided by the American Association of Nurse Practitioners.
Research shows restrictions on the scope of practice of nurse practitioners is associated with lower wages, an increased likelihood of nurses relocating and worse health outcomes for some populations. One study found that health insurers had to pay between 3% and 16% more for well-child visits in states with restrictive licensing laws for nurse practitioners. It also found “no evidence that the changes in regulatory policy are reflected in outcomes that might be connected to the quality and safety of health services.” Another study found nurse practitioners were far more likely to move to full practice states than restricted practice states. A 2022 study found that parents rated their children’s health better in states that allow nurse practitioners to practice independently.