The number of professions subjected to occupational licensing has increased fourfold over the past 70 years, now affecting one in five workers. This includes non-life-threatening professions such as interior design and hair shampooing, which legislators sometimes deregulate with little pushback. However, it also includes hazardous fields such as health care.
Merging redundant occupational license requirements has become a popular way to slash red tape. This tactic bypasses immediate overhauls of individual rules that many people consider necessary for safety, while still limiting counterproductive duplicate credentialing.
An encouraging 2025 Archbridge Institute comparison of occupational license laws found that 28 states maintained some form of reciprocal recognition, and a Reason Magazine commentary on the study pointed to universal license recognition (ULR) as one of the most efficient and effective reform measures. Both publications emphasized the advantages in the healthcare field, and they also suggested ways ULR could develop further.
Easing Healthcare Profession Barriers To Entry
The medical field is notoriously difficult to deregulate, due to legitimate worries about potential dangers to patients. However, as Reason noted, this industry’s regulations vary little from state to state, with federal statutes governing much of the testing for the various specialties.
Despite this, medical workers face steep fees if they wish to practice in a new state. Physicians, for instance, have to either pay a base fee of up to $1,425 to obtain a license in a new state or pay $700 to use the Interstate Medical Licensure Compact (IMLC) if they are seeking licensure in one of the 37 participating states.
Furthermore, even among states recognizing reciprocity, 13 have hairsplitting “substantially similar” clauses that require virtually identical or more demanding training to qualify. Nitpicking scope of practice constraints also apply in nine states that recognize reciprocity, although they tend to be more relaxed than “substantially similar” clauses.
Certainly, equivalent standards need to apply in order to retain license integrity. However, rules can and should focus on the skills and experience achieved, rather than the minutiae of previous school curricula or job titles. Archbridge and Reason emphasized that although ULR was already functioning well, legislators should address these unnecessary caveats.
Access Improvement
ULR plainly eliminates onerous hurdles for medical doctors, but the analysis emphasized the significant advantages to patients as well. It specifically referenced a recent Federal Reserve Bank of Minneapolis (FRBM) staff report, the first comprehensive study examining the consequences of physician ULR on patient access to care.
After accounting for other possible factors, FRBM discovered that patient access increased appreciably due to ULR. Notably, both the elderly population and patients with limited funds especially benefited.
Importantly, this rapid rise in access occurred due to temporary rather than permanent relocation on the part of physicians, as well as increased availability of telehealth appointments. Granting reciprocity, therefore, drastically widened the market overnight. However, America First Policy Institute (AFPI) discovered states with ULR also saw roughly 50% more interstate migration, indicating that permanent adjustments also became easier.
Further Recommendations
Along with broadening the scope of ULR, Archbridge and Reason advocated several other simple means of loosening occupational licensing. For example, if a state mandates credentials for an industry that the other 49 states do not consider dangerous enough to license, it should surely consider deregulating it.
Regulatory creep in occupational licensing need not continue, and reversing it often entails little conflict. Legislators should be more aggressive in their efforts to do it.