Combating COVID-19 With Emergency Occupational Licensing Reform

The threat of COVID-19 overwhelming the health care system and its ability to provide care for patients has forced states to respond by temporarily waiving regulations. Many state policymakers should be commended for acting swiftly to address this crisis. Idaho, Maine, Maryland and Missouri, in particular, have led the way with reforms to help expand access and alleviate shortages.

As more states implement social distancing measures to slow the spread of COVID-19, the number of U.S. deaths continues to grow. Testing has not been widespread enough to estimate an accurate figure, but the number of infected is large and growing. Health care facilities are already being stretched to their limits as hospital beds are filling with COVID-19 patients.

Our health care system is strained by regulations that limit our capacity, causing shortages even under normal conditions. Our shortage of physicians will soon be met by the looming shortage of nurses. Occupational licensing laws are a major contributor to the lack of flexibility in response to sudden increases in demand.

The purpose of licensing laws is to ensure quality professionals, but the evidence is mixed that this purpose is fulfilled. Because substandard health care poses a serious risk, 44 percent of health care and education workers require a license to be able to practice.

While ensuring competence for health care providers is essential, this comes at a cost. Licensing laws reduce the supply of professionals by up to 20 percent. Requirements such as education, training and exams are set in stone and inflexible, meaning that the health care workforce cannot rapidly grow when crises hit.

Scope of practice laws, which accompany occupational licensing laws in health care, dictate specific tasks professions may perform. Because the American Medical Association has outsized influence over scope of practice laws, many health care professions do not practice to the full extent of their education and training. As a result, we have competent, fully trained professionals forced to sit on the sidelines.

During a pandemic, when we need all hands on deck, limiting the supply of health care professionals can have grave consequences.

Fortunately, some states have responded, implementing temporary waivers that will help expand the supply of health care workers when we need them most. In a recent policy brief, we summarize and rank the effectiveness of these measures.

Recognizing the seriousness of the emergency, Maryland has granted all health care professionals the authority to work beyond their current scope of practice. As hospitals run the risk of being overwhelmed by patients, we may need health professionals to take on new tasks caring for patients, or we will be forced to leave patients without care.

Idaho, Maine and Missouri have all granted their governors broad authority to waive licensing requirements for health care professionals to serve unmet needs that will only grow as COVID-19 spreads. Waivers like these allow students in their final weeks of training to practice like fully licensed professionals, without waiting to take the licensing exams that have been delayed and disrupted because of the virus. Other workers potentially will be able to receive training in limited areas to provide new care to patients.

Other reforms that states have implemented have been a step in the right direction but do not go far enough to ensure that patients have adequate care. Some states have allowed retired professionals to begin practicing again. Unfortunately, this will not add much capacity, and COVID-19 poses a greater risk for the elderly.

Another reform is granting temporary licenses to out-of-state professionals, allowing them to practice immediately. While this will allow capacity to shift to alleviate strain in “hot spots,” in an epidemic that impacts the entire country, it will not increase the total capacity of the health care system.

Many states have waived fees and continuing education requirements during the state of emergency. This will help professionals maintain their ability to legally practice during the crisis, but it will not expand the health care capacity of any state.

Our current regulatory policies restrict our health care capacity and potentially put patients at risk. The fast spread and high hospitalization rate of COVID-19 can quickly overwhelm health care systems when states do not have the ability to quickly increase the number of health care professionals.

As states consider reforms in the face of COVID-19, they should look to national leaders like Idaho, Maryland, Maine and Missouri. Sweeping reforms initiated in each state will give their health care systems the flexibility to respond to the crisis.


Conor Norris is a research analyst and Edward Timmons is director of the Knee Center for the Study of Occupational Regulation. Edward Timmons is also professor of economics at Saint Francis University in Loretto, Pa.

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