Many occupations in our dataset underwent review multiple times in a state. As Table 11 shows, we identified 64 sets of such reviews, accounting for 160 reviews total—nearly a third of our dataset. Usually an occupation underwent review twice, but some occupations were reviewed three, four or even five times, as with dietitians, laboratory scientists and roofing contractors.
Table 11: Repeat Reviews in This Study
|State||Repeat Reviews||Percent of All Reviews||Repeated Occupations||Percent of All Occupations|
Note: * = does not regularly produce reports.
Repeat reviews show how persistent licensure advocates can be. Indeed, they were usually triggered by the same industry groups, and they usually sought licensure—the same regulation previously requested and rejected. For instance, in Georgia, electrologists and roofing contractors each requested licensure on three separate occasions. Similarly, in Colorado, funeral directors, cremationists and embalmers came together twice to request licensure. In all, in 73% of sets of repeat reviews, the reviews all considered the same proposed regulations. 1 And those regulations were always new or distinct licenses. All sets included at least one request for a new or distinct license.
In a few cases, industry groups waited 10 or more years after a first sunrise review to propose regulation again. Washington surgical technologists requested licensure in 1996 and again in 2012. And the Nebraska Dental Assistants Association proposed licensure for dental assistants in 1986 and again over two decades later in 2009. In other cases, repeat proposals were separated by just a few years. In Hawaii, various social worker occupations sought licensure in 1986 and again in 1988. In Nebraska, surgical technologists requested certification in 2015 and then licensure in 2016.
Over time, such industry persistence can result in licensure recommendations and enactments despite earlier rejections. Across sets of repeat reviews, reviewers recommended licensure in only 3% of initial reviews but in 22% of final reviews (see Figure 9). This is about the same rate of licensure recommendations among occupations reviewed just once (21%). To be sure, in half the sets of repeat reviews recommendations did not change, but when they did, they typically became more restrictive.
For example, speech language pathology assistants requested licensure in Washington in 1995, and the Department of Health found no need for new regulation. But after a second request in 2009, the Department recommended certification. Similarly, when the Virginia Board for Professional and Occupational Regulation first reviewed regulation of electrologists in 1999, it did not recommend new regulation, but in 2002 it recommended licensure. In Colorado, the Office of Policy, Research and Regulatory Reform reviewed respiratory therapists four times, rejecting regulation in its first three reviews, but recommending licensure in its fourth.
Figure 9: Reviewers Were More Likely to Recommend Licensure Following Final Reviews
Note: Initial: n = 96 reviews in sets, final: n = 64 final reviews in sets
Similarly, repeat requests can eventually succeed with legislatures. In fact, they are slightly more likely to enact new or distinct licenses following repeat reviews (45%) than they are following any review (40%) or a one-time review (39%), 2 though in all three situations they decline to enact new regulation about half the time. To the extent persistence pays with legislatures, shifting sunrise recommendations may play a role: Legislatures enacted a new or distinct license 50% of the time when recommended in a final review (n=7), but a bit less frequently—44%—when licensure was not recommended (n=22), though sample sizes are small.
Reviewers and legislatures might change their minds for any number of reasons. Licensing proponents might learn from failed requests, making more sophisticated arguments. Personnel changes in reviewing agencies or in legislatures could mean subsequent requests are considered by people more favorable to licensure. Or perhaps repeat requests simply wear down reviewers and legislatures.
Regardless of the reason, it appears persistence is a reasonable strategy for groups wishing to achieve licensure. And occupational lobbies likely know this. When Colorado home inspectors requested regulation in 2001, COPRRR recommended against it. But 13 years later, their recommendation changed to licensure. In the legislature, a licensing bill was narrowly defeated, but a private certification board for home inspectors claimed COPRRR’s changed recommendation as a small victory: “It remains to be seen, whether Colorado may one day require licensure of home inspectors . . . .[W]here [COPRRR] once opposed the idea, it had changed its position. So the tide may be turning.” 3