Freestyle healthcare enters the marketplace

December 1, 2008

Like most radiology groups, mine is a diverse collection. This is good. It allows us to hear a wide range of approaches to any given problem, some of which are novel and some stupid.

Like most radiology groups, mine is a diverse collection. This is good. It allows us to hear a wide range of approaches to any given problem, some of which are novel and some stupid. Mine are always novel.

On most issues, I have partners to the left and right of me. One of the more conservative subscribes to publications from the Cato Institute. Judging from those he shares with me, the institute's output falls somewhere between the John Birch Society and Attila the Hun.

The latest policy analysis from Cato he passed on is by Shirley Svorny, Ph.D., chair of the economics department at California State University, Northridge, entitled Medical Licensing: An Obstacle to Affordable, Quality Care. Definitely a different approach.

Prof. Svorny states, "Consumers would benefit were states to eliminate professional licensing in medicine and leave education, credentialing, and scope- of-practice decisions entirely to the private sector and the courts."

She argues that specialty boards, hospitals, insurers, and trial attorneys would do a better job of deciding who is qualified for a given aspect of medical care. Consumers, who are of course the best determinant of good care, would have a wider range of choices. Market forces will make everyone do better for less, and we will have better, cheaper healthcare. Uh huh.

While it's true that the politics of licensure often revolve around limiting competition, the practice also establishes a minimum level of performance, and then seen other specialty boards umbrella their members into the field with ridiculously low standards.

Hospitals look very hard at these changes, if the preempting specialty wants to do the exams somewhere else. When the exams are staying in house, and numbers will go up thanks to self-referral, the review seems a little less critical. We all know the reason cardiologists now do 75% of the cardiac nuclear imaging studies is because they read them so much better.

I'm sure when a board-certified internist does an ultrasound scan, savvy consumers know the competence and 'Licensure at least establishes a defines a scope of minimum level of competence training. Take the and defines a scope of training.' difference between our years of training and the "Certificate of Merit in Ultrasound"Joe Doc got from the Magic Mini-Ultrasound Co. when he attended its weekend course.

And, of course, insurers, those mighty defenders of patients' access to quality medical care, would never use the abolishment of licensing laws to their own benefit. All the money they saved outsourcing medical imaging, lab tests, and surgery to unlicensed practitioners in Bangladesh would be put right back into consumers' pockets.

I think Professor Svorny has a brilliant idea. Let's deregulate the entire process and give control to private enterprise and the free markets. Look how well it worked for the banking and mortgage industries.