Professional Regulation: divvying up the spoils

“States that require dental hygienists to be supervised by dentists suffer a 1 percent annual reduction in the output of dental services.”

The Effect of Licensing on Dentists and Hygienists by Morris M. Kleiner and Kyoung Won Park, NBER working paper No. 16560.

As states require occupational licenses for everyone from surgeons to interior decorators. Licensing in effect creates a regulatory barrier to entry into licensed occupations, and thus results in higher income for those with licenses.

In Battles among Licensed Occupations: Analyzing Government Regulations on Labor Market Outcomes for Dentists and Hygienists (NBER Working Paper No. 16560), co-authors Morris Kleiner and Kyoung Won Park use state variations in dental hygienists’ licensing, along with data from the 2001-2007 American Community Survey, to estimate the value created by limiting occupational competition through licensing.

Like dentists, dental hygienists clean teeth, apply sealants, take X-rays, and screen for dental problems. Because dentists are in the majority on the state licensing boards that license dental hygienists in most states, they can in theory create rules that limit the extent to which dental hygienists can compete with them. In fact, most states require dental hygienists to practice under the direct supervision of a dentist, but some allow dental hygienists to own their own practices, clean teeth, and apply sealants.

The authors find that in states that allow dental hygienists to have their own practices, hygienist employment is about 6 percent higher than in other states, and hygienist earnings are about 10 percent higher. At the same time, the growth rate of dentists’ employment is lower — 1.5 percent per year versus 2 percent — in these states.

Assuming that less stringent regulation of dental hygienists has no effect on the quality of services they provide to patients, the authors calculate that reducing regulation would reallocate about $1.34 billion from dentists to dental hygienists and would reduce the output losses caused by restricting employment by $80 million. Overall, Kleiner and Park estimate, states that require dental hygienists to be supervised by dentists suffer a 1 percent annual reduction in the output of dental services.

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Michael
Michael
10 years ago

Your last paragraph says everything you need to know: If you ASSUME no effect on the quality of services … thats a pretty brave assumption to make with everyone elses health care.

Patrick
Patrick
10 years ago

I am not sure I have ever met a professional standards regulatory body that didn’t operate to transfer wealth from the public to the profession.

Medecine and Law are merely the most egregious examples.

Michael
Michael
10 years ago

Nicholas – they get TWO years training most often, Dental Therapists ( a different category) get three, ans are able to treat people up to the age of 16, depending on the state. One thing hygienists dont get taught is how to recoignise oral pathology such as oral cancer (one of the most frequently occurring locations for cancer), or the medical issues underlying much of the practice of dental work – and that is exactly what they are doing. Yes, before you ask, I’m a dentist and a strong supporter of hygienists and Dental therapists, but not in unsupervised practice, there is a lot more going on in the mouth than just teeth.

Patrick, thats pretty glib of you. Would you prefer that health professionals were unregulated? I’m pretty sure you wouldn’t. Remember that these regulatory authorities are statutory authorities established by state or Federal governments and they exist to safeguard the public, not the professions. Just look at their charters and powers.

murph the surf.
murph the surf.
10 years ago

Patrick the regualtory bodies shouldn’t be confused with the professional associations.
They exist to do as you say and to screw the smaller practices or partnerships and anyone not within various self serving circles.
At times they will offer to confuse the public by conducting misconduct hearings but these are not much mor than conciliation sessions.That can be useful but are often a problem dodging exercise not a disciplinary hearing.

Patrick
Patrick
10 years ago

Murph, yes, that is true pre-regulatory capture. See further: medecine and law.