Has state licensing gone too far?

NURTURING SUCCESS: A new state license for lactation consultants is expected to increase the amount of lactation services that insurers will pay for, thus encouraging breast-feeding. Pictured above, from left, are: Ashley Biller, state breast-feeding coordinator; Denise Fenick, chair of the Rhode Island Breast Feeding Coalition; and Michael W. Fink, chair of the State Licensing Committee and director of the Prenatal Education Program at Memorial Hospital. / PBN PHOTO/MICHAEL SALERNO
NURTURING SUCCESS: A new state license for lactation consultants is expected to increase the amount of lactation services that insurers will pay for, thus encouraging breast-feeding. Pictured above, from left, are: Ashley Biller, state breast-feeding coordinator; Denise Fenick, chair of the Rhode Island Breast Feeding Coalition; and Michael W. Fink, chair of the State Licensing Committee and director of the Prenatal Education Program at Memorial Hospital. / PBN PHOTO/MICHAEL SALERNO

When Rhode Island lawmakers this summer approved new state licenses for lactation consultants, many observers scratched their heads.
Others wondered if state occupational licensing had gone too far and whether the public really needed government oversight of people advising mothers about breast-feeding. All six Republicans in the House voted against the measure.
As it turns out, the new license has more to do with whether insurers will cover lactation-consultation services than public-health concerns.
But the discussion raised questions of how far state occupational licensing and professional accreditation should go.
In addition to lactation consultants, lawmakers in the 2014 legislative session approved the creation of three new professional licenses to be managed by the R.I. Department of Health, including music therapists and dental-surgery assistants. Another new license for e-cigarette parlors is a business license rather than occupational.
Health care is an obvious area for licensure to grow over the past decade of medical advances and accelerating costs.
However, while the number of professions subject to licenses has increased, that growth has been relatively modest.
In 2013, the Department of Health issued licenses for 77 different professions, from hearing aid dealers to chiropractors, compared with 67 professions in 2003, according to lists provided by the agency.
Numerous Rhode Island agencies have licensing responsibilities, with the R.I. Department of Business Regulation and R.I. Department of Labor and Training joining the health department as the biggest three.
Although quantifying professional licenses issued by DBR is difficult, as they are lumped in with numerous corporate requirements, a rough count suggested the number had hardly changed over the last decade.
DBR licenses – which include auto-body salvage rebuilders, securities brokers, auctioneers and caterers – have held steady at just under 70 for the past decade. Even if the number of different professions licensed hasn’t grown rapidly, the number of Rhode Islanders issued licenses has risen significantly in the past decade.
At the Department of Health, for example, the number of licenses issued has skyrocketed to 152,747 this year, according to the agency, though a spokesman could not provide figures for previous years.
At the Department of Labor and Training, which oversees testing and registration for 67 trade occupations in categories including electricians, plumbers and telecommunication installers, the number of licenses has grown from 20,152 in 2003 to 25,896 last year.
Although DLT could not provide an apples-to-apples comparison of occupations covered between 2003 and now, at least one whole category, “burglar alarms,” did not exist a decade ago.
Coincidentally, licensing new professions and significantly boosting the number of licenses issued has not caused the state to add personnel to the agencies responsible.
DLT spokesman Michael Healey said his agency’s head count has dropped from 45 full-time equivalent workers in 2003 to 25 currently.
Department of Public Health spokeswoman Christina Batastini said “new staff has not been allocated to oversee any additional licenses.”
At its most basic level, state professional licensing exists to protect the public in fields where untrained or reckless practitioners could cause serious harm.
But over the years it has broadened beyond consumer protection into a tool to professionalize and elevate the practitioners of a given field. Some have suggested it can fill some of the gaps left behind by the decline of private-sector labor unions.
House Minority Leader Brian Newberry, R-North Smithfield, one of the state lawmakers who voted against the lactation-consultant bill, said he did so out of concern the state was involving itself in unnecessary areas. Although he isn’t opposed to professional licensing and voted for the music-therapist bill, Newberry said licensing can be abused when incumbent professionals in a field use it to block competition.
“No one is advocating that there shouldn’t be professional licenses, but it is a great way to stifle competition and create a barrier to entry,” Newberry said. “One problem is that whoever is going to be creating the licenses isn’t an expert in that particular field, so the details of the license are typically spoon-fed by the people who benefit from it.”
On the music-therapist license, Newberry said the compelling argument for a new license was that most other states have already created something similar, and Rhode Island not having it was making it difficult on local professionals.
Passage of the consultant bill, sponsored by Sen. Gayle Goldin, D-Providence, and Rep. Teresa Tanzi, D-South Kingstown, makes Rhode Island the first state in the country to license that profession.
Michael Fink, prenatal care coordinator at Memorial Hospital in Pawtucket, said the license is designed to increase the amount of lactation services that insurers will pay for, thus encouraging breast-feeding.
The Affordable Care Act requires reimbursement for breast-feeding services to encourage the practice, but only from licensed providers, something that had stymied efforts up until this point.
Rather than limit competition, Fink said she expected allowing consultants to be paid for their services would encourage more to enter the field.
“This raises the bar of the profession, a licensed provider becomes a more integral part of the care team,” Fink said. “The other benefit is that women will have more access to consultants and may be employed, in addition to in hospitals, in pediatric, family medicine or OB-GYN offices. So when the mothers bring their babies to the office, there is someone there who can help them.” •

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