I'm a bit disturbed and/or upset about the way licensing issues in the US are often covered. Typically you see an article like this, in a news outlet that's aiming for financially motivated and/or well-off individuals, complaining about licensing for beauticians and doing a hand-wavy thing about medical professionals. The argument is "beauticians don't need licenses but all this other stuff is fine."

The problem with this is while it's true that beauticians don't cause the same damage as a medical provider (usually), they also don't have the same financial impact on the US economy as a whole. We don't hear people complaining about haircut costs, we hear people complaining about healthcare and higher education costs.

When it does get discussed, it seems like those discussions are always targeting those who threaten the status quo, and there's very little discussion of underlying issues.

So for example, you have pieces complaining about NP or PAs replacing doctors in clinics, ignoring the fact that it's not the NP or PA degrees necessarily, it's that you're taking people out of a 2 year program and putting them directly into practice with no residency or training program. Similar things play out with other provider types, where there's a lot of FUD and playing on stereotypes without discussing actual training backgrounds encountered within degrees, or the requirements that are actually necessary to complete tasks.

If you look at current MD programs, many of them are pushing hard to go to a 1.5 year coursework, 2.5 year clinical training model, followed by residency. Compare that to a PA program that is what? 1.5 years of coursework followed by clinical training. Many PA programs now also require licensed healthcare practice before you even enter the program too. So it's really hard for me to accept the argument that PAs + 6 years of supervised training aren't similar to an MD + 4 years of supervised training.

You can extend this to all sorts of aspects of the medical system. Many medications that are now prescribed really don't actually require prescriptions, especially some of those that someone has been taking for years. Others could be overseen by a pharmacist (probably better in many cases than a physician), or a psychologist, dentist, or optometrist with the right additional training.

The idea that provider skills in a given area are only ever possibly obtained by the MD degree model is preposterous to me. Sure, there are probably some domains where this is currently true, but there's a lot of domains where it's not. These discussions need to stop treating healthcare as if licensing is a totally different issue there — although it is probably in terms of risks but also in terms of costs, the fundamental problems are the same.

I could go on and on. Even among MDs, the specialty and subspecialty accreditation requirements can be grossly excessive and unnecessary. Conversely, there's also the fact that MDs sometimes are making decisions that they're not actually trained to deal with because their degree gives them a kind of blanket legal authority.

Everyone has anecdotes about poor care, but I can say the same just about any type of provider I've had contact with. I can think of grossly irresponsible care that I've had from physicians, where we've been saved in a sense by PAs, RNs, or NPs. I can also think of cases where the MDs were great, and the PAs, RNs, and NPs didn't know what they were talking about.

Healthcare licensing is a complete mess and it is a major unrecognized source of increased healthcare costs. Even with all of the push to deregulate, I don't see it being addressed effectively anytime soon because the discussion gets so distorted and because it often feels like the way it bubbles up into public consciousness is through bad actors leveraging deregulation for undesirable reasons.