Licensing

Background

The government sanction of medical practice dates back thousands of years in India and China. In the Western world, King Henry VIII of England in 1518 established a charter to grant licenses to qualified physicians. In the United States, the American Medical Association (AMA) played a pivotal role in the 19th century supporting state enactment of licensure laws for physicians. Between 1874 and 1915, licensing requirements for medical practice were passed in all states in the nation. Often, as one state passed licensing requirements, poor-quality physicians would move to another unregulated state to practice. However, eventually, as all states required licensing, many poorly trained and unqualified physicians left the profession, [Page 685]which ultimately resulted in better quality of care and increased status of the profession.

The push by the AMA for state licensure served as a model for the licensing of other healthcare professionals. By the 1920s, most states enacted licensing programs for dentists, pharmacists, nurses, and other healthcare providers. Most allied health professionals, including dental hygienists, physical therapists, and emergency medical technicians, were required to receive licensing by 1960. The health professions have generally advocated for state licensure in addition to standardized education and training.

Role of State Licensing Boards

State licensing boards serve as gatekeepers to control the entry of clinical practice. The role of the state boards is to confirm a provider's training and education and to administer a prerequisite examination before allowing providers to engage in clinical practice. The state boards issue licenses to providers who pass the examinations, renew licenses, and enforce the basic standards of the profession. Members of state boards generally consist of individuals in the profession and sometimes include consumer representatives. The state boards may function independently or as part of a state's department of health. State licensing boards operate under statutes and regulations and have oversight by the state legislature. The boards also maintain procedural rules.

The licensing of providers usually entails two components. First, they must have graduated from a school that has been certified in the state desired to practice in as well as pass a state-administered examination. Second, they must also provide the state board with basic information about themselves. The education requirement has allowed for state oversight of education curricula.

The renewal of a license is generally based on not having any disciplinary action against a provider since the period of the individual's last review and fulfilling a certain number of continuing-education units. If a provider, however, has had a disciplinary action against it, it must be given due process that entails a fair proceeding to contest the charges before the state board revokes or suspends its license. The provider must be properly informed of the charges and be given a fair hearing. An appeal board may determine if proper procedures were followed if a discipline is sanctioned, and the provider may appeal to the courts. Although disciplinary actions are made public, they are usually not widely publicized.

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