Hello,
Thank you to the Mises Institute for all the great resources.
While listening to some of the podcasts I again heard the libertarian view that we need to do away with licensing of professionals… the specific example was doctors.
First I’d like to say that in some ways that I agree. I am a licensed medical professional in the field of veterinary medicine and I suppose benefit from licensing, however, in other ways it does continually aggravates me.
However, allow me to direct a more pointed discussion. While listening to the podcast (sorry I can’t remember the exact speaker) I found it interesting the apology that was presented against the common “complaint” against doing away with licensing doctors. To paraphrase the complaint is that without licenses there would be more quacks or incompetent practitioners, while the counter argument was that it wouldn’t matter because people would don’t look to licenses when choosing a doctor but instead they ask around and pick one based on recommendations from their friends - presumably that means that the doctor is “good” because they receive a recommendation.
Ok. So based on that I’d like to comment on the counter argument, but only from the limited aspect of the particular apology given not that the idea as a whole does not have merit.
The first fallacy in the rebuttal is that just because someone gives a recommendation that means that the doctor is “good”. This is really painting with a broad stroke. There is a big difference between someone that has seen their doc for a year or two for a sniffle or cough, verses someone that has seen someone all their life, the same doc has attended their whole family, the doc has caught and treated successfully multiple problems and even saved their mother’s life. Now, which recommendation carries more weight?
Secondly, as implied above any recommendation is only good for those problems with which the recommender has had specific experience with that particular doc. What about all the myriad of other problems out there? There is really no way that anyone can give a recommendation that covers all the possible problems that might be encountered no matter how many different patients of a particular doc that one might question.
Aside from the points above we must go deeper. The implication in the answer is that because we can easily go to a friend or colleague now (in the current system) and feel comfortable with their recommendation of a “good” doc, I doubt that this would be the case in a system without at lest some sort of certification. You see, the reason that you can go to a friend and simply say, “hey, who’s your doc? you like him?” and feel comfortable going to that doc is not really because your friend has convinced you that the doc really knows his medicine. The reason that you can take this approach is because you know - subconsciously - that ALL the docs available “should” be on a relatively even playing field in terms of the medical knowledge that they posses for their particular field of study. This is assumed primarily because they have to pass certain tests before given the privilege of practicing medicine. It is these knowledge/skill tests that provide the fundamental basis for confidence. The question to a friend is not really about the skill of the doc, but how well they were treated by the office staff, the nurses, the pricing, how long they had to wait to be seen, the bed side manner of the doc, and lastly if the doc appeared competent (because, really, how does one really know?).
Now, how easy would you really feel making the decision of what doc to use if you had zero idea what they really knew? And really how could you really know for sure unless the doctor has a long successful history of practice? So, what would that mean for young doctors? Probably that they would have to hook up with an old doc and presumably learn from them so that they could acquire that reputation.
But really ,how does one really know the competency of one doc over another? Medicine is only partly science. It is also art. There is an old saying among veterinarians that about 10% of the cases that get better we helped, about 10% of the cases that get better did so in-spite of us,. and about 80% of the case we see would have gotten better without us. In my practical experience this proves true. So, how does one really even know (especially one without any medical knowledge) that they would not have gotten better anyway? Or, quicker without the therapy? The fact is that our experience has a very low sample volume and statistically we can not obtain significant results.
I agree that the current licensing system for professionals is not the least intrusive and free-est/most “liberal” (as in liberty) way to accomplish the goal. If the goal is to make sure that those practicing medicine actually do KNOW the information necessary to do so safely and effectively (because remember this isn’t like going to the garage to get your car fixed - sometime the docs only get ONE CHANCE to get it right) why not simply keep the board tests that lead to licenses/certification but drop the requirements of having to attend a particular AMA certified medical school? Would this not do the same thing? Maybe someone, instead of medical school, apprentices with a doctor? Or maybe they learn from their father (like I’d like to do with my son)? Or maybe there would be an explosion of new online schools or other unconventional ways of obtaining the knowledge necessary to competently practice medicine?
