'Clifford Winston of the Brookings Institution argues for eliminating occupational licensing for lawyers entirely and replacing it with a system of voluntary certification. Government has a role to play by collecting information about service quality and making it easily accessible to the public. Databases like the NPDB should be improved and opened for many professions.
The medical profession is unlikely to be delicensed, but as Ms. Allensworth’s book shows, we shouldn’t let the AMA dictate the terms of medical education. Many European countries offer combined undergraduate and medical degree programs that take only six years, compared to the eight or more years required in the U.S.
Advances in artificial intelligence, which Ms. Allensworth doesn’t explore, may also catalyze reform. AI is already transforming fields such as legal research and medical diagnostics, automating tasks once reserved for licensed professionals. As these technologies advance, they can reduce reliance on rigid licensing systems by ensuring quality and safety through innovative tools.'
In many cases, these licencing schemes are put in place by incumbent trade groups, to prevent comeptition.
For example, an association of funeral home owners will lobby their state representative for a law forbidding the sale of coffins by anyone other than a licensed funeral director. Ostensibly this somehow protects the public from unscrupulous coffin-sellers. In actuality, its main effect is to protect the profits of the funeral home oligopoly.
(Lest you think this is a fanciful example, see St. Joseph Abbey v. Castille.)
The AMA education requirements are of essentially the same sort, put in place by a compliant legislature to protect the profits of an incumbent cartel, at great cost to the public.
Advances in artificial intelligence will do nothing, absolutely nothing, to catalyze reform of what is essentially a problem of politics and greed.
> In many cases, these licencing schemes are put in place by incumbent trade groups, to prevent comeptition.
The worst is NAR and Realtors®. There's absolutely no professional instruction involved, just a morality test taken every few years that until the late-1940s early-1950s required that realtors maintain the racial character of neighborhoods (under penalty of disciplinary action.)
They managed to get themselves written into most state and local laws. Only the explosion of aspirational middlemen occasioned by the internet has recently managed to push back on that. Hopefully the recent antitrust case against them is catastrophic, but they spend $100M a year lobbying. Lobbying government is basically all the NAR actually does and all the real value that members are getting.
I would add too that these laws often serve the same interests of white supremacy that they have since the Civil War.
After the end of Reconstruction the Southern states instituted laws now called the “Black Codes”, forbidding blacks from being blacksmiths, or grocers, from owning property, or doing any sort of work other than, effectively, being sharecroppers - essentially slaves of the same white landowners as before.
Consider who is hurt most by laws requiring expensive and onerous licensing for independent hair-braiders. Are a lot of white hair-braiders suffering from this, do you suppose?
Same with minimum wage. Whites were tired of blacks underbidding them, so they just outlawed their jobs by making unskilled labor valued below X illegal.
"Minimum wage legislation emerged at the end of the nineteenth century from the desire to end sweatshops which had developed in the wake of industrialization.[17] Sweatshops employed large numbers of women and young workers, paying them what were considered non-living wages that did not allow workers to afford the necessaries of life." ...
"The earliest minimum wage laws in the United States were state laws focused on women and children.[25] These laws were struck down by the Supreme Court between 1923 and 1937.[25] The first federal minimum wage law, which exempted large parts of the workforce, was enacted in 1938 and set rates that became obsolete during World War II.[25]'
We know your scenario isn't true because there are plenty of white-owned businesses which knowing hire undocumented workers in order to pay them sub-market wages with poor working conditions.
Go back further. Minimums were applied to the railroad in 1909, pulling them up to the prevailing white wage when the Brotherhood of Locomotive Firemen became enraged blacks were working for cheaper.
I don't see anything about a minimum wage. I do see 'the arbitrators did rule that the railroad would be required to pay African American and white firemen the same wage' but nothing about how that minimum was set by law.
Minimums for a union job are not the same as minimum wage, which is the legal minimum set by law.
Union minimums predate the Civil War. For example, the Boston Journeymen Bootmaker's Society had a minimum price per shoe made, back in the 1830s, leading to Commonwealth v. Hunt.
Well back in the early 20th century I'm afraid that was mostly what was available to discriminated minorities. It's not just theory, it goes back to railroadmen being pissed blacks were undercutting them. They could not just outright outlaw blacks so they just got the minimums set to the prevailing white wage.
Suffrage in the early 20th century applied more to whites than blacks. And having low wage labor be black market without protections can in some cases benefit the upper classes.
It’s hard to compare medical education between countries because some counties will have shorter medical school lengths but longer residency requirements.
And official durations are often different than the amount of time it actually takes students.
In Germany for example med school is 6 years, but the average student completes it in about 7.
A US student with some AP credits from high school and a few summer classes could easy finish university in 3 years and end up taking the same amount of time as the average German medical student.
But even looking at averages at the end of the day doctor’s salaries are a small fraction of overall medical costs so shaving a year off of the average training times isn’t going to make a dent.
The US also doesn’t have a national high school curriculum, so removing general education requirements from the university + medschool pipeline, which is essentially what countries with shorter total training times do, is a harder problem than it is in Europe.
At one point the US did have at least a couple of 6-year undergrad/medical school programs but they were discontinued I believe.
Machine learning has been talked up a lot in medicine especially in the context of radiology. I'm not sure to what degree it's really panned out to date. Legal discovery has been aided by automation of various sort for years.
Not sure what concern you are addressing. I never said to replace radiologists with ChatGPT. My suggestion was to use it as a tool for further information.
That said, note that malpractice is in place for a reason. Everyone makes mistakes. We all have to go in to work even if we have a horrible hangover, doctors and radiologists included.
The trouble with giving doctors complete control over doctor education is that in the US they've used that control to restrict the supply of doctors to keep the price of doctors high.
Right now it’s congress that is restricting the supply of doctors. The AMA’s (which only represents about 15% of doctors btw) current position is that we need more doctors and they have been actively lobbying congress to provide funding for more residency slots.
The AMA lobbied for the freeze in slots in the 90s. Their change of heart today doesn't make them less responsible for creating the mess, in the name of protecting physician salaries, in the first place.
The AMA lobbied for a freeze in slots because the rate of growth had was increasing and extrapolating from that it looked like more physicians would be graduating than there would be jobs for them to fill.
The number of physicians has been growing faster than population growth since the 60s. No one could have predicted that we’d be able to sustain the insane growth in medical spending and demand that allowed this to continue.
Because of the way medical training is funded, number of physicians isn’t not a free market phenomenon. Congress decides how many there are. In the 90s it looked like there were going to be too many. When that changed the AMAs position changed, it was a perfectly reasonable position.
But even if it weren’t a reasonable position. That was 30 years ago. No one who was in a position of power is around today, so it’s unclear to me how exactly the current AMA should bear responsibility.
It would be like if IEEE today called for a temporary freeze on the increase of H-1Bs. Then 30 years later something causes an explosion in demand for engineers and people started blaming these evil engineers.
Excerpted and discussed at https://marginalrevolution.com/marginalrevolution/2025/02/th...
The book site is https://www.hup.harvard.edu/books/9780674295421
'Clifford Winston of the Brookings Institution argues for eliminating occupational licensing for lawyers entirely and replacing it with a system of voluntary certification. Government has a role to play by collecting information about service quality and making it easily accessible to the public. Databases like the NPDB should be improved and opened for many professions.
The medical profession is unlikely to be delicensed, but as Ms. Allensworth’s book shows, we shouldn’t let the AMA dictate the terms of medical education. Many European countries offer combined undergraduate and medical degree programs that take only six years, compared to the eight or more years required in the U.S.
Advances in artificial intelligence, which Ms. Allensworth doesn’t explore, may also catalyze reform. AI is already transforming fields such as legal research and medical diagnostics, automating tasks once reserved for licensed professionals. As these technologies advance, they can reduce reliance on rigid licensing systems by ensuring quality and safety through innovative tools.'