The Case Against Licensing Health Professionals

Abstract

In the interest of full disclosure, I am a licensed psychologist. Yet I oppose licensing. I remain licensed because I wish to continue to practice my profession. My opposition to both general and specialty licensure is the subject of this paper.To understand my position requires knowing that state governments, under the umbrella of their police powers, grant licensing to a profession to protect the welfare of the public. The licensing act reserves either a title (i.e., psychologist) or a practice (i.e., psychotherapy) to persons who meet particular requirements approved by the state. Doing so creates a monopoly which in turn grants certain economic advantages to licensees. The history of licensure is replete with evidence that economics, not protection of the public, drives licensing. In fact, with rare exceptions (i.e., stockbrokers, detectives), professions have sought licensing-the public has not demanded it.My review of the empirical research shows no substantial relationship between licensing and quality of service measures. Evaluations of the work of licensing agencies also show they do not protect the public (Gross, 1984(Gross, , 1986:(a) Assessment of initial competence relies on invalid criteria, emphasizing credentials and cognitive skills over performance and person over context.(b) Monitoring of ongoing professional competence has not progressed beyond the questionable mandating of continuing education.

Licensing of Psychotherapists in the United States: Evidence of Societal Regression?

“…This is an inevitable result. (p. 372) Twenty-five years later, Gross (1998) agreed with Roger's prediction, saying that licensing had resulted in psychologists achieving acceptability but at the cost of "a decreased tolerance for diversity" and "support for values which work in the marketplace and which replace psychology's traditional research and service values" (p. 258). I see this as evidence of societal regression.…”

“…8). And in an article titled "The Case Against Licensing Health Professionals," Gross (1998) wrote, "My review of the empirical research shows no substantial relationship between licensing and quality of service measures. Evaluations of the work of licensing agencies also show they do not protect the public" (p. 257).…”

“…Hogan (1983) argued that actions taken against unlicensed people are more often aimed at removing competition than incompetence. Gross (1998) suggested that with licensure, "professional psychology has achieved the dream of parity with psychiatry" (p. 258). This is arguable!…”

“…Goodrich reported that the state of Colorado licensing board issued several times more per capita disciplinary actions against licensed than unlicensed practitioners (as cited in Grohol, 1998, para 8). Gross (1998) observed that "some reviews have found licensed therapists to account for at least as much harm to the public as do unlicensed therapists" (p. 258). Rogers (1973) saw a third drawback, which he called "an urge toward professionalism" resulting in a bureaucracy that would become an end unto itself and that would become a "substitute for sound judgment" (p. 352).…”

Psychological assessment, treatment, and outcome with sex offenders

“…Hall (1995) found that community treatment was more eective than institution treatment; thus, where treatment is received may be important. The training, credentials, and experience of the treatment providers, currently a subject of some debate (e.g., Gross, 1998;Jensen & Jewell-Jensen, 1998), may in¯uence treatment eectiveness. It may also be important to consider the gender of the treatment providers (e.g., Langevin et al, 1979).…”