Free Market

Deregulating Telehealth and other Small Government Solutions to Improve our Medical System

Despite having a large medical infrastructure, Utah is struggling to meet the health care needs of its residents. Much of this inability can be attributed to a lack of healthcare workers able to provide patient care within the state. 

Just like other parts of the labor market, Utah’s healthcare industry has faced intense and crippling labor shortages. The growth of individuals entering healthcare fields simply has not been able to keep up with the need for treatment. Even the Utah State Hospital has felt the effects of this worker shortage with it having a staffing deficit of 20 percent and having close to two hundred open positions. 

This labor shortage is expanding to encompass nearly every field of medicine. To illustrate the effects of this shortage on patient outcomes, just examine what a shortage of psychiatrists and other mental health workers has created. In the state, only 53 percent of Utahns’ mental health needs are being met as many patients are stuck on long waiting lists or completely unable to meet with a medical provider. 

This has had severe and devastating consequences as Utah has had an average of 657 suicides per year, and in 2020, suicide was the leading cause of death for Utahns ages 10 to 17 and 18 to 24. This problem is persistent with 36.7 percent of Utah high school students feeling sad or hopeless, 22.3 percent seriously considering attempting suicide, and 18.7 percent making a suicide plan.

When looking for a culprit for these labor shortages, one needs to look no further than occupational licensing. Occupational licensing determines who can legally work in an occupation and provide particular services. In order to obtain a license, one must meet a series of state-mandated requirements that ensure someone is qualified to safely perform a profession. While this may seem reasonable at first, given obvious safety concerns associated with healthcare professions like surgeons, too often are these requirements overly restrictive, irrelevant, and frankly absurd. 

In fact, more often than not these requirements do not actually have any bearing on public health and safety, but are used by existing professionals to block hopeful professionals from obtaining the ability to work in their field. Occupational licensing is used in this way as a form of economic protectionism in which existing professionals attempt to keep their wages high and competition low by gatekeeping access to professions. 

Even when licensing isn’t used as a form of protectionism, these licenses often restrict individuals from entering professions as they are costly to acquire and maintain, limit the ability for professionals to move states to help underserved communities, and restrict health care practitioners’ activities in unnecessary and detrimental ways.

With the harmful effects of occupational licensing made clear, it is especially concerning that healthcare workers constitute the largest group of licensed professionals—nearly a fourth of those receiving a license work in healthcare. 

However, there is hope. Simply reforming these overbearing occupational licensing laws has the unique ability to alleviate these worker shortages quickly in a way that actually betters health outcomes. Occupational licensing reforms, specifically those that center around expanding professionals’ scope of practice, decreasing their licensing requirements, and improving the ability for these professionals to move states must be pursued. 

Scope of practice rules and other such requirements govern what activities health care workers are allowed to perform. For example, it might be in a surgeon’s scope of practice to surgically repair a hip, but not in your physical therapist’s. While most of these rules make sense, like the one listed above, many others are extremely arbitrary and must be done away with. When the scope of practice laws are expanded, a new group of healthcare professionals can perform tasks they were previously unable to perform. This opens up a whole new group of workers to perform tasks that communities are in need of and thus reduces shortages of qualified professionals. 

Scope of practice laws have already begun to be successfully relaxed in Utah. For example, in 2021, three bills expanded the scope of practice for medical professionals:

  • Senate Bill 27, proposed by Sen. Curt Bramble, R-Provo, expands the scope of practice for physician assistants (PAs). This bill absolves PAs from supervision by medical doctors and other health care professionals. With this bill, more physician assistants may move their practices to Utah.
  • Senate Bill 28, also proposed by Sen. Bramble, would allow for a physician assistant to specialize in psychiatric care. This bill would help combat a lack of mental health professionals operating in Utah.
  • Rep. Doug Welton’s House Bill 287 would allow nurse practitioners to prescribe medicine without having to consult with a doctor, improving access and convenience for patients.

Such policies have extremely promising results. In fact, increasing professionals’ scope of practice and subsequently increasing the population’s medical choices has been associated with higher employment of medical professionals, lower health care costs, and better health outcomes.

Improving the ability for professionals to move or change the states in which they practice to meet the demand of high-need areas is achieved in two ways: increased participation in interstate occupational licensing compacts and lessened telehealth restrictions. 

Interstate compacts are contracts between two or more states creating an agreement that a professional in one state will not have to be re-licensed when they move to another compact state. These ensure healthcare workers are not faced with having to re-obtain a license in which they already hold. This allows professionals to more easily move between states without worrying about the licensure process or having to miss out on valuable time serving the community by having to re-gain licensure requirements.

Telehealth provides a platform to address Utah’s health care system’s pervasive access, cost, and quality shortcomings. Additionally, telehealth has unique advantages like assessing patients’ home environment, reducing provider stress and burnout, enabling patients to continue working or doing other essential activities while getting treated, stigma, decreasing institutionalization avoidance, and allowing home-based care to avoid hospitalization. 

However, telehealth occupational licensing regulations create state boundary lines and artificial barriers, impeding proper treatment and innovation. While Utahns’ mental health needs should be the priority, occupational licensing laws constrain out-of-state healthcare professionals’ ability to deliver telehealth services to local patients. 

To practice telehealth in Utah, out-of-state specialists need to submit an application that can take months to process, pay fees, and comply with several requirements, including continuing education that may vary by state. As healthcare costs continue to outpace inflation and mental health issues arise, the urgency to remove barriers to telehealth remains pressing.

In order for Utah to keep its citizens healthy and safe, it must begin to embrace policies that can diminish shortages of healthcare professionals. Everybody deserves to have their health care needs met and not exacerbated due to a worker shortage caused by arbitrary government restrictions. Adopting such laws will not be avant-garde, but a logical next step.