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https://archive.is/Tcc1J https://archive.is/Tcc1J Excerpted and discussed at https://marginalrevolution.com/marginalrevolution/2025/02/the-licensing-racket.htm

https://archive.is/Tcc1J https://archive.is/Tcc1J Excerpted and discussed at https://marginalrevolution.com/marginalrevolution/2025/02/the-licensing-racket.html https://marginalrevolution.com/marginalrevolution/2025/02/th... The book site is https://www.hup.harvard.edu/books/9780674295421 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.'

turtlesdown11 2y ago
[flagged]
- hollerith 2y ago
  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.
  - sarchertech 2y ago
    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.
    - hollerith 2y ago
      OK I stand corrected. I bet the situation is quite complicated, and I now regret offering a one-sentence explanation.
    - EvanAnderson 2y ago
      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.
      - sarchertech 2y ago
        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.
- deleted 2y ago
  [deleted]
deleted 2y ago
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deleted 2y ago
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mjd 2y ago
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. https://ij.org/case/saint-joseph-abbey-et-al-v-castille-et-al/ https://ij.org/case/saint-joseph-abbey-et-al-v-castille-et-a...
- mjd 2y ago
  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? https://en.wikipedia.org/wiki/Black_Codes_(United_States) https://en.wikipedia.org/wiki/Black_Codes_(United_States)
  - deleted 2y ago
    [deleted]
  - ty6853 2y ago
    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.
    - eesmith 2y ago
ghaff 2y ago
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.
- psychlops 2y ago
  Next time you get an x-ray, drop it in your favorite LLM and start asking it questions. It's eye-opening.
  - gorkish 2y ago
    ChatGPT does not carry expensive malpractice insurance. The Radiologist is human in the loop for reasons other than their pattern recognition ability.
    - psychlops 2y ago
      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.
- senkora 2y ago
  The UMKC 6-year one seems to still exist as far as I can tell: https://med.umkc.edu/academics/degree-and-certificate-programs/ba-md/faqs.html#admissions https://med.umkc.edu/academics/degree-and-certificate-progra...
sarchertech 2y ago
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.

turtlesdown11 2y ago

[flagged]

hollerith 2y ago
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.
- sarchertech 2y ago
  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.
  - hollerith 2y ago
    OK I stand corrected. I bet the situation is quite complicated, and I now regret offering a one-sentence explanation.
  - EvanAnderson 2y ago
    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.
    - sarchertech 2y ago
      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.
deleted 2y ago
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deleted 2y ago

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deleted 2y ago

[deleted]

mjd 2y ago

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. https://ij.org/case/saint-joseph-abbey-et-al-v-castille-et-al/ https://ij.org/case/saint-joseph-abbey-et-al-v-castille-et-a...

mjd 2y ago
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? https://en.wikipedia.org/wiki/Black_Codes_(United_States) https://en.wikipedia.org/wiki/Black_Codes_(United_States)
- deleted 2y ago
  [deleted]
- ty6853 2y ago
  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.
  - eesmith 2y ago

ghaff 2y ago

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.

psychlops 2y ago
Next time you get an x-ray, drop it in your favorite LLM and start asking it questions. It's eye-opening.
- gorkish 2y ago
  ChatGPT does not carry expensive malpractice insurance. The Radiologist is human in the loop for reasons other than their pattern recognition ability.
  - psychlops 2y ago
    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.
senkora 2y ago
The UMKC 6-year one seems to still exist as far as I can tell: https://med.umkc.edu/academics/degree-and-certificate-programs/ba-md/faqs.html#admissions https://med.umkc.edu/academics/degree-and-certificate-progra...

sarchertech 2y ago

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.