CLEAR

PSA's Ethics in Extraordinary Times: Practitioner Experiences During the Covid-19 Pandemic

From the Professional Standards Authority:
The Professional Standards Authority for Health and Social Care has published Ethics in extraordinary times: practitioner experiences during the Covid-19 pandemic. The research describes a focused review of the literature that was published during the pandemic about practitioners’ ethical experiences and what was shared during individual interviews and focus groups with practitioners from a range of professions. The report describes how the pandemic shaped and altered the ethical experiences of practitioners and develops new insights, including

i) What duties of care to self and others might mean in professions and settings including but also beyond intensive care;

ii) How underexplored ethical approaches such as the ethics of care, relational ethics, virtue ethics and narrative ethics resonate with practitioners and relate to their experiences during the pandemic;

iii) How practitioners perceive and engage with ethical guidance, including from professional regulators, and the significance of judgement; and

iv) The extent of moral injury and ensuing moral distress which will endure long after the pandemic.

Professor Bowman found considerable congruence between how regulators and practitioners describe the ethical experiences of professionals during the pandemic. However, the interview and focus group data suggest that many practitioners do not perceive regulators, especially in their own profession, to be a source of advice and support in terms of ethical practice, with many drawing more on the support and advice of colleagues, local leadership and professional bodies. Practitioner understanding of the role of ethical guidance from regulators, the regulatory response to the pandemic and the statutory remit within which regulators work varied widely with implications for trust and relational regulation.

The report concludes that it is time to think about and approach ethics in a different way that is grounded in the experience of practitioners and focuses on building ethical confidence and capability. Specifically, by focusing on moral distress, the ethics of care, the role of judgement and practical ways of providing ethical support, learning from the pandemic will be grounded in what has been experienced.

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New article: "The Labor Market Consequences of Regulating Similar Occupations"

Morris Kleiner, University of Minnesota, shares an article, "The Labor Market Consequences of Regulating Similar Occupations: the Licensing of Occupational and Physical Therapists," recently published in the Journal of Labor Research.  From the abstract:

This study examines the influence of occupational licensing on two significant occupations that provide similar health care services: occupational therapists and physical therapists. Since many of the tasks that these occupations overlap, individuals in both occupations can have legal jurisdiction over these tasks. We examine how these two occupations interact with one another in the labor market on wage determination and employment. Unlike previous analyses of occupational licensing, our study evaluates two professions that are female dominated both within the vocations, and among its leadership. Our results show that the ability of physical therapists to have direct access to patients is associated with a reduction in hourly earnings for occupational therapists, suggesting there is substitution for certain overlapping service tasks across the two occupations. The ability of these two occupations to be mainly substitutes for one another provides new evidence on how the growing numbers of regulated occupations that provide similar tasks influence one another.

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New paper: "Analyzing the Influence of Occupational Licensing Duration and Grandfathering on Wage Determination"

Morris Kleiner, economist with the University of Minnesota, has shared a new paper with CLEAR. From the Abstract: "The length of time from the implementation of an occupational licensing statute (i.e., licensing duration) may matter in influencing labor‐market outcomes as entry requirements evolve. In addition, states enact grandfather clauses that allow existing workers to continue employment following these regulations, while ratcheting up requirements to increase entry costs for new entrants. We analyze the labor‐market influence of the duration of occupational licensing statutes for fifteen state universally licensed occupations over a 75‐year period. We find a positive nonlinear wage effect for licensing duration. Further, we find that occupational licensing raises the wages of grandfathered workers by almost 5 percent. The licensed occupations, however, exhibit heterogeneity in outcomes. Duration of occupational licensing influences wage determination when measured over longer time periods."

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ARPL issues report on "Valuing Professional Licensing in the US"

The Alliance for Responsible Professional Licensing commissioned Oxford Economics to conduct a quantitative study of the "effects of occupational licensing across the skill spectrum." Similar to some past research, this research found that, in fields requiring advanced education, the requirement of a license narrows the gender wage gap by almost one-third and the race-driven wage gap by about half. A prior study by the ARPL found that 75% of 952 registered voters supported licensing requirements for highly technical professions. The current report "points to the fact that professional licensing of highly skilled workers should be understood and regulated separately from occupational licensing of trades and vocations."

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US: Research on de-licensing of occupations

A paper presented for the American Economic Association looks at cases in the US from 2015 to 2020 where licensing requirements have been removed for certain occupations. The research was conducted by Dr. Edward Timmons of Saint Francis University and the Knee Center for the Study of Occupational Regulation and used CLEAR's Regulatory News blog as a source. The research found 35 cases of de-licensing over the past five years.

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New research shows improved public health after licensing laws established

New research by an economist at Montana State University studied maternal and infant mortality rates in the US from 1900 to 1940, the time period when almost half of states mandated licensing requirements for midwives. The analysis revealed a 7-8% decrease in maternal mortality and a decrease in infant mortality following the adoption of licensing requirements for midwives. The research team notes, "Given the levels of health, medical technology and wealth that prevailed in the United States during the time period we study, our results are directly relevant to ongoing policy debates about the merits of licensing and training midwives in developing countries today." The research gives evidence to prove the importance of licensing to public health outcomes.

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State RegData 2.0 released

Researchers at the Mercatus Center at George Mason University have released state RegData 2.0, a dataset that includes the cumulative volume of regulations found in the administrative codes of 44 states and DC, collected between March and June 2020. data measurements include word counts, restriction counts (instances of the terms "shall," "must," "may not," "prohibited," and "required"), industry relevance, and complexity (a new metric in version 2.0). The data was used to rank states by restrictiveness (most regulated) and rank industries by most regulated. Combining the two, the report lists the most-regulated industries and that state that regulates them most. The report also shoes percentage change in restrictions by state since the release of RegData 1.0.

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Annual Telemental Health Laws Survey released

Epstein Becker Green has released their annual "Telemental Health Laws Survey," a review of behavioral telehealth legislation, regulation and policies for the 50 US states, DC, and Puerto Rico. The report noted a trend of increased government attention on behavioral telehealth, specifically in the context of COVID-19 and emergency orders at the state level.  The report found that "all states required telehealth providers to hold a state professional license, while 10 issue special telemedicine licenses to out-of-state physicians that sidestep the need for a full professional license. A growing number of states are allowing non-controlled substances to be prescribed through telehealth without a prior in-person examination, and about half of them have data privacy or confidentially measures in place that go above and beyond requiring health care providers merely to follow federal and state privacy/confidentiality requirements pertaining to medicine."

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NBER paper on occupational licensing and labor market fluidity

A new National Bureau of Economic Research working paper by Morris Kleiner and Ming Xu shows "that occupational licensing has significant negative effects on labor market fluidity defined as cross-occupation mobility."  The research finds that "workers with a government-issued occupational license experience churn rates significantly lower than those of non-licensed workers. Specifically, licensed workers are 24% less likely to switch occupations and 3% less likely to become unemployed in the following year."

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PSA publishes report on research into health and care professions regulation

The Professional Standards Authority in the UK has released a report reviewing the research into health and care professional regulation since 2011. Objectives of the project were:

1. To source research in the area of health and care professional regulation in English since 2011;
2. To evaluate the research and draw out what it has taught us; and
3. To identify any gaps in the research and areas that would benefit from deeper exploration to inform the focus of further research and continue to build the evidence base in relation to health and care professional regulation.

"A strong overall finding to emerge from the work is that – whereas health and care professional regulation studies is rapidly emerging as a new field – it is still less developed compared with other areas, such as financial, legal or aviation regulation studies."

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