Presumably, people would bootstrap themselves into careers in pretty much the same way they do now. Of the top of my head ... 1) Working with (or interning wit

Presumably, people would bootstrap themselves into careers in pretty much the same way they do now. Of the top of my head ... 1) Working with (or interning with) someone reputable, and getting their public stamp of approval. 2) Certification agencies won't suddenly cease to exist; they just wouldn't have any force of law. Nothing would stop you from refusing to see a dentist who isn't certified by the ADA, just like nothing stops you today from buying a toaster that's not certified by Underwriters Labs. 3) Speaking of underwriting, insurance companies have an enormous incentive to only insure competent people. etc.