Sacrificing Property Rights on the Altar of Gun Rights

[Libertarian666]

While it is true that this limitation was not set by a government-empowered engineers' union or something like that, it is still a limitation that causes fewer people to become engineers. To a certain extent, these kinds of "natural" barriers to entry are present everywhere. I guess I don't see what's so drastically different about the government-granted monopoly barrier you're objecting to that makes regulation of the profession acceptable.

There are real barriers to entry to a number of professions.  The main ones are the innate talent and intelligence necessary to master the discipline.  And of course the barriers applied by various professional organizations.

I would wager that there are far more people out there with the innate talent and intelligence to be doctors, lawyers, engineers, etc. than our society has the ability to train and employ.  And I would also bet that we have the capacity to train far more doctors and (gasp) lawyers than our professional organizations would allow.

Government control of the supply of professional people has its basis in real catastrophe.  It only takes one Triangle Shirtwaist Factory fire to spawn a whole bunch of industrial safety legislation, and only a few botched operations or mis-diagnosed illnesses to gin up public sentiment for laws regulating the training and licensing of doctors.

Actually, professional regulation, as distinct from safety regulation such as fire codes and the like, is and always has been primarily at the behest of members of the profession in question, as they understand perfectly how limiting supply raises prices (of their services). I'm not saying that they don't take advantage of public health disasters and the like, but the driving force is from the profession being regulated supposedly for the public good.

[Libertarian666]

It is NOT a matter of degree, but of kind.

I guess you don't know that YOU CANNOT TAKE THE BAR EXAM unless you have passed a course at a law school approved by an agency that is RUN BY LAWYERS!

And you CAN'T TAKE MEDICAL BOARDS unless you have passed a course at a medical school approved by an agency that is RUN BY DOCTORS!

And guess what? Those agencies LIMIT THE NUMBER OF PLACES in those schools, TO REDUCE COMPETITION!

I hope that helps, because if it doesn't, I'm out of options in explaining this to you.

Okay, I think I get it. Your objection is that entry to the profession is gated by existing members of the profession through government and a complicated system of licensure and certification, and that absent this system, there would probably be more people in those professions, increasing the amount of market competition that would drive down their wages and prices for their services.

I guess my real problem is that I don't see how this is so specially unique in the world which is full of impediments, quotas, and barriers to entry. For example, there are a limited number of slots available for aspiring engineers in the nation's universities, ultimately set by the number of professors available to teach them. To the extent that becoming an engineer virtually requires at least bachelor's degree, this requirement represents a distortion in the labor market for engineers that probably pushes up our wages.

While it is true that this limitation was not set by a government-empowered engineers' union or something like that, it is still a limitation that causes fewer people to become engineers. To a certain extent, these kinds of "natural" barriers to entry are present everywhere. I guess I don't see what's so drastically different about the government-granted monopoly barrier you're objecting to that makes regulation of the profession acceptable.

Let's take another example of where a distinction is a difference.

Imagine that there is a quota that would allow a maximum of 1 million immigrants per year from Luxembourg. Would this have any impact on immigration?

Imagine that there is a quota that would allow a maximum of 1000 immigrants per year from Mexico. Would this have any impact on immigration?

They are both quotas, so they are the same, right?

Obviously not, since the first quota allows more people in than want to come in, whereas the latter does not.

Regulation of professions such as engineering is like the former, because there is no effective limit on how many people can become engineers.

Regulation of professions such as law and medicine is like the latter, because they have highly limited quotas that effectively limit the number of entrants.

Do you really not see the difference?

[Pointedstick]

Let's take another example of where a distinction is a difference.

Imagine that there is a quota that would allow a maximum of 1 million immigrants per year from Luxembourg. Would this have any impact on immigration?

Imagine that there is a quota that would allow a maximum of 1000 immigrants per year from Mexico. Would this have any impact on immigration?

They are both quotas, so they are the same, right?

Obviously not, since the first quota allows more people in than want to come in, whereas the latter does not.

Regulation of professions such as engineering is like the former, because there is no effective limit on how many people can become engineers.

Regulation of professions such as law and medicine is like the latter, because they have highly limited quotas that effectively limit the number of entrants.

Do you really not see the difference?

I do see the difference, but I'm not convinced that what we're discussing--law and med school admittance--are akin to limiting Mexican immigration to 1,000 people a year.

I am simply not convinced that entrance to law and med school is "highly limited." This conjures up in my mind the idea that qualified applicants are being routinely turned away due to a quota having been already fulfilled. I simply don't see this happening à la the Mexico example. Many members of my family and network of friends have become doctors or lawyers. Six doctors and four lawyers. All of them will discuss how the educational experience itself was grueling, but but none of them had any real difficulty being admitted to law or med school in the first place. None of them had to apply to like 20 schools for multiple years or "wait their turn" or anything. Every single one of them was admitted to at least one law or med school the very same year they applied. While I acknowledge that this is nothing more than an anecdote, unless all of my friends and family members are geniuses, it seems to cast doubt on the idea that admittance to law or med school is "highly limited" and that qualified applicants are being turned away on the basis of professional organizations artificially restricting the labor supply to only a subset of qualified applicants.

I acknowledge the principle of what you're saying, but I suppose I'm questioning whether it's actually happening in the way that you're suggesting. From my perspective, law or med school admittance looks more like the Luxembourg analogy than the Mexican one. If they do indeed gate entry, but appear to let in at the minimum a very large fraction of the people who actually meet the entrance qualifications, I don't see a ton of artificial limitation.

[Libertarian666]

Let's take another example of where a distinction is a difference.

Imagine that there is a quota that would allow a maximum of 1 million immigrants per year from Luxembourg. Would this have any impact on immigration?

Imagine that there is a quota that would allow a maximum of 1000 immigrants per year from Mexico. Would this have any impact on immigration?

They are both quotas, so they are the same, right?

Obviously not, since the first quota allows more people in than want to come in, whereas the latter does not.

Regulation of professions such as engineering is like the former, because there is no effective limit on how many people can become engineers.

Regulation of professions such as law and medicine is like the latter, because they have highly limited quotas that effectively limit the number of entrants.

Do you really not see the difference?

I do see the difference, but I'm not convinced that what we're discussing--law and med school admittance--are akin to limiting Mexican immigration to 1,000 people a year.

I am simply not convinced that entrance to law and med school is "highly limited." This conjures up in my mind the idea that qualified applicants are being routinely turned away due to a quota having been already fulfilled. I simply don't see this happening à la the Mexico example. Many members of my family and network of friends have become doctors or lawyers. Six doctors and four lawyers. All of them will discuss how the educational experience itself was grueling, but but none of them had any real difficulty being admitted to law or med school in the first place. None of them had to apply to like 20 schools for multiple years or "wait their turn" or anything. Every single one of them was admitted to at least one law or med school the very same year they applied. While I acknowledge that this is nothing more than an anecdote, unless all of my friends and family members are geniuses, it seems to cast doubt on the idea that admittance to law or med school is "highly limited" and that qualified applicants are being turned away on the basis of professional organizations artificially restricting the labor supply to only a subset of qualified applicants.

I acknowledge the principle of what you're saying, but I suppose I'm questioning whether it's actually happening in the way that you're suggesting. From my perspective, law or med school admittance looks more like the Luxembourg analogy than the Mexican one. If they do indeed gate entry, but appear to let in at the minimum a very large fraction of the people who actually meet the entrance qualifications, I don't see a ton of artificial limitation.

Ok, now I understand the problem. You are experiencing a form of the "apex fallacy". Your family and network of friends are completely and utterly unrepresentative of the population. The entry slots for medical and law schools are allocated to people well within the top 1% of ability, so an average person has slightly less chance of getting into and through one of these schools as they do of winning the lottery.

Maybe you think this is okay, and maybe you can make a valid argument that it is okay, but that argument would not include a claim that these schools aren't extremely selective and effective in limiting the number of professionals they allow into society.

By the way, my family and friends are ALSO extremely unrepresentative of the population, but the difference is that I know that, and so I don't make arguments based on the mistaken notion that they are representative.

[Xan]

Did Libertarian666 just argue that there are too few lawyers running around?

[Pointedstick]

Ok, now I understand the problem. You are experiencing a form of the "apex fallacy". Your family and network of friends are completely and utterly unrepresentative of the population. The entry slots for medical and law schools are allocated to people well within the top 1% of ability, so an average person has slightly less chance of getting into and through one of these schools as they do of winning the lottery.

I'm not pretending that they're representative of the general population, just that perhaps they're representative of the kinds of people who apply to law and med school. And in fact...

http://lawschooladmissionscounselor.blo ... eases.html

According to the LSAC US National Decision Profiles, the acceptance rate to law school nationally increased to 77% for the 2013 entering class. This is up from the 75% acceptance rate for the 2012 entering class and represents the highest acceptance rate to law school in the last 11 years.

If your assertion that slots are "allocated to people well within the top 1% of ability" is true of law school, than that would imply that only people already in the top 1% or 2% of ability are actually applying in the first place, which would seem to support my theory that the biggest barrier to entry is the fact that it's a very difficult field that inherently requires high levels of intelligence, drive, etc. That would still be true even in the complete and total absence of professional trade organizations. Sure, Yale Law isn't going to let Cletus the slack-jawed yokel in, but I don't think Caltech, RIT, or Virginia Tech are going to let him in, either.

[Libertarian666]

Ok, now I understand the problem. You are experiencing a form of the "apex fallacy". Your family and network of friends are completely and utterly unrepresentative of the population. The entry slots for medical and law schools are allocated to people well within the top 1% of ability, so an average person has slightly less chance of getting into and through one of these schools as they do of winning the lottery.

I'm not pretending that they're representative of the general population, just that perhaps they're representative of the kinds of people who apply to law and med school. And in fact...

http://lawschooladmissionscounselor.blo ... eases.html

According to the LSAC US National Decision Profiles, the acceptance rate to law school nationally increased to 77% for the 2013 entering class. This is up from the 75% acceptance rate for the 2012 entering class and represents the highest acceptance rate to law school in the last 11 years.

If your assertion that slots are "allocated to people well within the top 1% of ability" is true of law school, than that would imply that only people already in the top 1% or 2% of ability are actually applying in the first place, which would seem to support my theory that the biggest barrier to entry is the fact that it's a very difficult field that inherently requires high levels of intelligence, drive, etc. That would still be true even in the complete and total absence of professional trade organizations. Sure, Yale Law isn't going to let Cletus the slack-jawed yokel in, but I don't think Caltech, RIT, or Virginia Tech are going to let him in, either.

Right, it is only those in the top fraction of a % that are applying. However, your conclusion doesn't follow. Those outside that fraction of a % KNOW THEY WON'T GET IN, so why should they bother applying? Whether or not they could do the work of the profession is irrelevant, since THEY CAN'T GET INTO the schools that LIMIT ACCESS to that profession!

At this point I'm coming to the conclusion that you are just pulling my chain, since this isn't that difficult to understand.

[Pointedstick]

Right, it is only those in the top fraction of a % that are applying. However, your conclusion doesn't follow. Those outside that fraction of a % KNOW THEY WON'T GET IN, so why should they bother applying? Whether or not they could do the work of the profession is irrelevant, since THEY CAN'T GET INTO the schools that LIMIT ACCESS to that profession!

At this point I'm coming to the conclusion that you are just pulling my chain, since this isn't that difficult to understand.

Maybe it's because they know they can't get in even though they want to be lawyers, or maybe it's because they know they're not lawyer material. At this point we need an anthropologist to tell us which one is right.

Here is my argument, stated very simply:

Law is hard. Most people won't want to do it or can't do it (likely both). Even if there was no law school requirement or Bar exam, the number of people successfully practicing law who could not have gotten admitted to law school or passed the Bar exam would be roughly zero.

Of the small subset of people who want to practice law and are intellectually capable of doing it, nearly all of them seem to eventually gain entry to law school and pass the Bar.

Therefore, because the supply of licensed lawyers relatively roughly tracks the supply of people who actually want to be lawyers, I don't see that there is a huge supply artificial government/law union restriction on the supply compared to the enormous "natural" restriction of law being frikkin hard!

It's okay if you reject this argument, but I don't think it's really all that strange.

running a food cart/roach coach has a low threshold for ability and takes limited capitol to begin, yet (here in CA at least) it is almost impossible, or fairly difficult, to get yourself in business due to limitations and regulations that are in place for the benefit of brick and mortar restaurants and existing food cart/roach coach owners...

so if i am following this correctly. according to Libertarian666, if those food cart/roach coach owners were strongly encouraged (and potentially soon to be required) by government to ask their customers BMI before selling them a chilli-dog, it would be acceptable for an "association of fat people" to come along and push passage of legislation that prohibited them from asking, since the ability to get into the profession is already limited by government on the behalf of existing cart and restaurant owners.. and the choices of available carts for customers to eat at are also limited, is this the gist of it?

if so i don't agree with this, but i do understand the desire to try to fix it this way. unfortunately i doubt the problem of bad regulation cant be solved with more regulation...

[Libertarian666]

Right, it is only those in the top fraction of a % that are applying. However, your conclusion doesn't follow. Those outside that fraction of a % KNOW THEY WON'T GET IN, so why should they bother applying? Whether or not they could do the work of the profession is irrelevant, since THEY CAN'T GET INTO the schools that LIMIT ACCESS to that profession!

At this point I'm coming to the conclusion that you are just pulling my chain, since this isn't that difficult to understand.

Maybe it's because they know they can't get in even though they want to be lawyers, or maybe it's because they know they're not lawyer material. At this point we need an anthropologist to tell us which one is right.

Here is my argument, stated very simply:

Law is hard. Most people won't want to do it or can't do it (likely both). Even if there was no law school requirement or Bar exam, the number of people successfully practicing law who could not have gotten admitted to law school or passed the Bar exam would be roughly zero.

If this is true, then the bar association and those who regulate the law schools would have no objection to letting anyone practice law if they wished.

Do you actually believe this is true? If so, I suspect you are the only person in the world who believes it.

[Pointedstick]

If this is true, then the bar association and those who regulate the law schools would have no objection to letting anyone practice law if they wished.

Do you actually believe this is true? If so, I suspect you are the only person in the world who believes it.

It seems like you believe that the number of people who would succeed at practicing law but don't apply to law school due to the suspicion that they would not be admitted is higher than I believe it is. If these people are so discouraged by the idea of even applying to law school, what kind of prospects do you think they would have for actually practicing law with any degree of success whatsoever? I believe that the people who fail to even apply for entrance to law school are making it clear with their own actions that they are not lawyer material.

You make it sound like I'm some kind of complete lunatic for believing this, but I fail to see what is so bizarre about it.

[moda0306]

If this is true, then the bar association and those who regulate the law schools would have no objection to letting anyone practice law if they wished.

Do you actually believe this is true? If so, I suspect you are the only person in the world who believes it.

It seems like you believe that the number of people who would succeed at practicing law but don't apply to law school due to the suspicion that they would not be admitted is higher than I believe it is. If these people are so discouraged by the idea of even applying to law school, what kind of prospects do you think they would have for actually practicing law with any degree of success whatsoever? I believe that the people who fail to even apply for entrance to law school are making it clear with their own actions that they are not lawyer material.

You make it sound like I'm some kind of complete lunatic for believing this, but I fail to see what is so bizarre about it.

This.

[Libertarian666]

If this is true, then the bar association and those who regulate the law schools would have no objection to letting anyone practice law if they wished.

Do you actually believe this is true? If so, I suspect you are the only person in the world who believes it.

It seems like you believe that the number of people who would succeed at practicing law but don't apply to law school due to the suspicion that they would not be admitted is higher than I believe it is. If these people are so discouraged by the idea of even applying to law school, what kind of prospects do you think they would have for actually practicing law with any degree of success whatsoever? I believe that the people who fail to even apply for entrance to law school are making it clear with their own actions that they are not lawyer material.

You make it sound like I'm some kind of complete lunatic for believing this, but I fail to see what is so bizarre about it.

What is so bizarre about it is that you refuse to acknowledge that the law school regulatory apparatus has deliberately acquired and is intent on maintaining their stranglehold on the number of places available in law schools. What is your explanation for this? Is it just a hobby of theirs? I think it should be obvious that any economic analysis of this situation would have no other outcome than that they consider it very important.

I'll tell you how we can settle this. Why don't you write to the regulatory body in charge of regulating the practice of law in your state and ask them if they would mind if you were to practice law without going to law school?

What do you think they will say? I'm going to predict that they will be against that in no uncertain terms, and in fact will threaten you with legal action if you try it.

And if anyone else who is not a member of a profession with similar rules, e.g., medicine, is still following this thread, please chime in and tell us whose position makes sense to you.

[Pointedstick]

Tech, I think we are focusing on different groups. I am asserting that nearly all of the people who are capable of ultimately becoming respectable lawyers are the kinds of people who don't have much difficulty jumping through the hoops you're complaining about. And you are saying (correct me if I'm wrong) that these restrictions cause a goodly number of people--many of whom perhaps might not actually make it as lawyers, but that's immaterial--to fail to enter the profession in the first place, this artificially reducing the supply of lawyers compared to if there were no such restrictions.

I agree! And maybe we're both right!

It seems completely obvious to me that the barriers to entry that these groups pressure the government to enact are intended to keep out people who are not serious enough about the professions in question to jump through the hoops; i.e. they prevent competition from those who are likely to be the worst competitors, but whose incompetence could tarnish the profession as a whole. Ask contractors and tradesmen they'll straight-up tell you this, and bemoan the fact that anyone can enter various trades and bring down their reputation as a whole by doing shoddy work and then disappearing. It's an endemic problem. Such people do not succeed, become respected businessmen, and offer serious long-term competition to the respectable folks, but they burn so many people on their own roads to ruin that they cause people to distrust their field as a whole.

That's the whole point of many of these kinds of hoops: to weed out the unserious, the hucksters, the lazy, and those who dream but never act. The de facto bachelor's degree requirement for modern employment is another example, I believe; it's not that college grads are the only people who are qualified for modern work, but rather, possession of a bachelor's degree has become a social signal that indicated that you are serious enough to have put a measure of time and money into your education and credentialing.

I'm not saying I actually agree with any of this, mind you.

[Libertarian666]

Tech, I think we are focusing on different groups. I am asserting that nearly all of the people who are capable of ultimately becoming respectable lawyers are the kinds of people who don't have much difficulty jumping through the hoops you're complaining about. And you are saying (correct me if I'm wrong) that these restrictions cause a goodly number of people--many of whom perhaps might not actually make it as lawyers, but that's immaterial--to fail to enter the profession in the first place, this artificially reducing the supply of lawyers compared to if there were no such restrictions.

I agree! And maybe we're both right!

It seems completely obvious to me that the barriers to entry that these groups pressure the government to enact are intended to keep out people who are not serious enough about the professions in question to jump through the hoops; i.e. they prevent competition from those who are likely to be the worst competitors, but whose incompetence could tarnish the profession as a whole. Ask contractors and tradesmen they'll straight-up tell you this, and bemoan the fact that anyone can enter various trades and bring down their reputation as a whole by doing shoddy work and then disappearing. It's an endemic problem. Such people do not succeed, become respected businessmen, and offer serious long-term competition to the respectable folks, but they burn so many people on their own roads to ruin that they cause people to distrust their field as a whole.

That's the whole point of many of these kinds of hoops: to weed out the unserious, the hucksters, the lazy, and those who dream but never act. The de facto bachelor's degree requirement for modern employment is another example, I believe; it's not that college grads are the only people who are qualified for modern work, but rather, possession of a bachelor's degree has become a social signal that indicated that you are serious enough to have put a measure of time and money into your education and credentialing.

I'm not saying I actually agree with any of this, mind you.

Ok, I think we are mostly on the same page then, so long as you agree that the restrictions are morally invalid, which you seem to.

[WiseOne]

Just peeked in on this thread and saw this interesting discussion going on.  If I may...

Professional schools have limited spots for various reasons.  In the case of law schools...do you REALLY want more lawyers??

Application numbers went up hugely after the application process was partly automated, so that all you have to do is check off the schools to apply to and then write a check for the admission fees.  It used to be that you had to write up a separate application for each school, so there was a practical limit on the number you could apply to.  Now it's common practice to apply to ridiculous numbers of schools, hoping to beat the "lottery".

So each school gets overwhelmed with applications, and it's physically impossible to sort through all of them by hand.  So each of them is going to prescreen based on something easy and quick, like exam scores and gradepoint averages in college, to get the number down to something reasonable.  Then they will go through the remaining applications, looking for what they consider to be good predictors of success.  So the people who make it past the screen are, say, the top 10% of LSAT scores, which is not necessarily the top 1% in IQ as there are other factors involved (like how much money you forked over for the LSAT preparation course).

So what do admissions offices consider to be good predictors?  Having had a hand in this process a couple times, I can say that it boils down to evidence that the applicant really and truly wants to be a <lawyer/doctor/fill in the blank>, and has a decent amount of common sense.  Like, no spelling errors on the personal statement which shouldn't read like it was written by someone from Mars.  Unusual/extensive life experiences tends to get extra attention.  My medical school, for example, was extremely proud of having admitted students with prior careers ranging from mechanical engineering to Broadway actor to pole dancer.

So it does come down to what you said, "That's the whole point of many of these kinds of hoops: to weed out the unserious, the hucksters, the lazy, and those who dream but never act.  -- PS".  However, it's not government mandated.  It's more like the rather tremendous job of setting up a new law school, which probably wouldn't succeed if not blessed by the American Bar Association and the law community in general.

The situation in medicine is similar.  I'm pretty sure the government would like nothing more than to see new medical schools and/or larger classes, because right now there are more residency spots than med school graduates.  The extras, generally in less desirable fields such as primary care, are filled by foreign medical school graduates ("FMGs").  (Can you all hear Craig's ears burning??)  However IMHO, primary care is a dinosaur that needs to go away in favor of nurse practitioners, who receive more than enough training to do what PMDs do (treat sore throats, hand out referrals, and occasionally check blood pressure).  And instead of "PMD" I'd call them "patient care advocates" or some such, since mostly what's needed is support to navigate the medical system and figure out how to implement the stuff the specialist told the patient to do.  Then we'd instantly not need nearly so many FMGs, if any at all.

[Libertarian666]

Just peeked in on this thread and saw this interesting discussion going on.  If I may...

...
The situation in medicine is similar.  I'm pretty sure the government would like nothing more than to see new medical schools and/or larger classes, because right now there are more residency spots than med school graduates.  The extras, generally in less desirable fields such as primary care, are filled by foreign medical school graduates ("FMGs").  (Can you all hear Craig's ears burning??)  However IMHO, primary care is a dinosaur that needs to go away in favor of nurse practitioners, who receive more than enough training to do what PMDs do (treat sore throats, hand out referrals, and occasionally check blood pressure).  And instead of "PMD" I'd call them "patient care advocates" or some such, since mostly what's needed is support to navigate the medical system and figure out how to implement the stuff the specialist told the patient to do.  Then we'd instantly not need nearly so many FMGs, if any at all.

I'm all in favor of this change, and in fact this system is pretty much in effect already in certain places where there are no physicians, so obviously there is nothing impossible about it.

Now all you have to do is convince the medical licensure boards to let NPs practice without "physician supervision". I wish you the best of luck!

[Pointedstick]

Ok, I think we are mostly on the same page then, so long as you agree that the restrictions are morally invalid, which you seem to.

Phew, glad we got that worked out!

So what do admissions offices consider to be good predictors?  Having had a hand in this process a couple times, I can say that it boils down to evidence that the applicant really and truly wants to be a <lawyer/doctor/fill in the blank>, and has a decent amount of common sense.  Like, no spelling errors on the personal statement which shouldn't read like it was written by someone from Mars.  Unusual/extensive life experiences tends to get extra attention.  My medical school, for example, was extremely proud of having admitted students with prior careers ranging from mechanical engineering to Broadway actor to pole dancer.

Yeah, and this kind of thing is largely true for undergraduate admissions as well at most reasonably selective schools.

[WiseOne]

Just peeked in on this thread and saw this interesting discussion going on.  If I may...

...
The situation in medicine is similar.  I'm pretty sure the government would like nothing more than to see new medical schools and/or larger classes, because right now there are more residency spots than med school graduates.  The extras, generally in less desirable fields such as primary care, are filled by foreign medical school graduates ("FMGs").  (Can you all hear Craig's ears burning??)  However IMHO, primary care is a dinosaur that needs to go away in favor of nurse practitioners, who receive more than enough training to do what PMDs do (treat sore throats, hand out referrals, and occasionally check blood pressure).  And instead of "PMD" I'd call them "patient care advocates" or some such, since mostly what's needed is support to navigate the medical system and figure out how to implement the stuff the specialist told the patient to do.  Then we'd instantly not need nearly so many FMGs, if any at all.

I'm all in favor of this change, and in fact this system is pretty much in effect already in certain places where there are no physicians, so obviously there is nothing impossible about it.

Now all you have to do is convince the medical licensure boards to let NPs practice without "physician supervision". I wish you the best of luck!

Such a thing has already been contemplated.  The people on those medical boards well understand that given the current rule structure, there aren't enough PMDs to go around and the shortage is only going to get worse when all those newly Obamacare-insured people turn up at their local PMDs office wanting attention.  The main limitation right now is that the nurses are saying that even THEY don't want the PMD job.  That's why "patient advocate" makes more sense - nothing illegal about that.  In fact, New Jersey tried it with their highest-cost Medicaid patients, and found that they saved a bundle in unnecessary hospitalizations.

[Libertarian666]

Just peeked in on this thread and saw this interesting discussion going on.  If I may...

...
The situation in medicine is similar.  I'm pretty sure the government would like nothing more than to see new medical schools and/or larger classes, because right now there are more residency spots than med school graduates.  The extras, generally in less desirable fields such as primary care, are filled by foreign medical school graduates ("FMGs").  (Can you all hear Craig's ears burning??)  However IMHO, primary care is a dinosaur that needs to go away in favor of nurse practitioners, who receive more than enough training to do what PMDs do (treat sore throats, hand out referrals, and occasionally check blood pressure).  And instead of "PMD" I'd call them "patient care advocates" or some such, since mostly what's needed is support to navigate the medical system and figure out how to implement the stuff the specialist told the patient to do.  Then we'd instantly not need nearly so many FMGs, if any at all.

I'm all in favor of this change, and in fact this system is pretty much in effect already in certain places where there are no physicians, so obviously there is nothing impossible about it.

Now all you have to do is convince the medical licensure boards to let NPs practice without "physician supervision". I wish you the best of luck!

Such a thing has already been contemplated.  The people on those medical boards well understand that given the current rule structure, there aren't enough PMDs to go around and the shortage is only going to get worse when all those newly Obamacare-insured people turn up at their local PMDs office wanting attention.  The main limitation right now is that the nurses are saying that even THEY don't want the PMD job.  That's why "patient advocate" makes more sense - nothing illegal about that.  In fact, New Jersey tried it with their highest-cost Medicaid patients, and found that they saved a bundle in unnecessary hospitalizations.

I'm pretty sure RNs would take those jobs if they paid enough; they already have lots of responsibility without commensurate authority or pay. I'm guessing compensation is probably the main difficulty...

[Pointedstick]

Just read an article that reminded me of this discussion:

http://www.forbes.com/sites/timworstall ... overnment/

Take, for example, the manner in which fully one third of all jobs in the US now require a government licence to be qualified to perform them. Smith would have immediately identified this as being the same as the guild systems he so railed against. And he would have been right too: it’s, today, the local florists and the local cosmetologists and so on who decide who may become, at what cost in training, a florist or cosmetologist.  This is a conspiracy by those trades against the consumer, deliberately restricting the supply of those services so as to raise the incomes of those who provide them. The same can be said of taxi medallions and so on right through that third of the economy that faces such restrictions.

It strikes me that supply restrictions of this nature at a far bigger problem in fields with low natural barriers to entry, as in these cases, the licensure requirements represent the only major impediment to entering the field.