Who Wants Licensing? Occupational Insiders, Not Consumers
Sunrise review data confirm that occupational lobbies—not consumers—usually propose occupational regulation and that these groups typically seek the most stringent form of regulation, licensure. As described above, sunrise reviews typically start when an individual or group requests regulation. The overwhelming majority of sunrise reviews in our sample—83%— started when professional and occupational associations sought regulation of their own or related occupations (see Figure 2).
Often, a single group launched a request, such as when the Maine Association of Wetland Scientists sought licensure of soil scientists and the Vermont Alarm and Signal Association sought licensure of burglar alarm installers. But sometimes different groups from related occupations joined forces—for example, the American Society of Radiologic Technologists and the Certification Board for Radiology Practitioner Assistants. In a more extreme example, in 2002, a coalition of 10 occupations from four behavioral health groups came together to lobby the Arizona Legislature for licensure of their occupations. 1
After industry groups, the most common initiators of sunrise review were government entities, but they accounted for just 6% of our dataset. And usually, the government entities were occupational licensing boards, whose membership often includes occupational insiders. For example, in 2002, the Arizona State Board of Pharmacy, which oversees state regulation of pharmacy technicians, proposed swapping state certification for licensure. In other cases, those seeking licensure similarly already had regulatory power over the field, such as Vermont’s Office of Alcohol and Drug Abuse Programs, which sought licensure of addiction counselors, and West Virginia’s Division of Motor Vehicles, which pursued licensure of motor vehicle salespeople.
Figure 2: Most Requests for Regulation Come from Industry Groups
Note: Analysis considers 405 reviews that named the person or group requesting regulation. Unknown captures reviews that named regulation proponents but did not describe them in detail sufficient for us to determine a category. We excluded Hawaii’s reviews because they did not name or describe regulation proponents. We also excluded general reviews where we could not determine the impetus behind the review.
Consumers launched just 14 (4%) of the reviews in our sample, but in five of those, consumers sought regulation jointly with industry groups. In one example, the Metro Denver Fair Housing Center, a consumer advocacy group, joined with the Colorado Mortgage Lenders Association and the Colorado Association of Mortgage Brokers to seek licensure of various mortgage-related occupations. In another, the Colorado Association of the Deaf and the Colorado Registry of Interpreters for the Deaf worked together to request licensure of interpreters. So the 4% figure overstates how often consumers were the sole drivers behind regulation campaigns.
In the end, occupational lobbies were directly or indirectly behind nearly all reviews where we could identify those seeking regulation. And the regulation most often sought was licensure; less restrictive regulations were rarely requested (see Figure 3). Fully two-thirds of reviews sought licensure of a previously unlicensed occupation, while another 9% sought distinct licenses for occupations already licensed under another, usually broader, occupational category.
In terms of restrictiveness, distinct licenses are difficult to classify. Most often (37 out of 42), such requests involved health occupations where licensees’ scopes of practice overlap and boundaries are disputed. Sometimes, these requests sought a marker of distinction for a subspecialty, such as marriage and family therapy or art therapy as separate from general counseling or psychology licensing. Other times, proponents argued distinct licenses would open new avenues of practice effectively closed by an existing license. One example is acupuncturists asking to be licensed separately from doctors. 2
Another is mid-level dental hygienists, commonly known as dental therapists, who have sought their own license granting more responsibility than dental hygienists but less than fully licensed dentists. 3
But even in cases where broader licenses shut off practice, a distinct license may not be the least restrictive solution. When a Colorado hair braider proposed a license for braiders separate from cosmetologists, the Office of Policy, Research and Regulatory Reform instead recommended exempting them from licensing altogether. 4
Figure 3: Licensure Was the Most Requested Regulation
Note: Analysis considers all 494 requests in our dataset. Registration includes one request for a distinct registration scheme.
Whether counting distinct licenses or not, licensure requests swamped all less restrictive alternatives. Just 12% of the reviews in our dataset considered proposals for certification (9%) or registration (3%), while only a handful of those classified as other/none (3%) addressed other less restrictive regulations such as title protection. 5
Even so, our figures may underestimate how often sunrise reviews were driven by demand for licensure. The next largest category of reviews, at 10%, is what we call “general reviews.” Most often, these considered whether a state should enact some regulation of personal qualifications—licensure, certification or registration. Most begin when a legislature requests sunrise review without proposing a specific regulation, most commonly in Washington and especially Virginia. Though these reports do not specify, some may have been prompted by advocates seeking licensure but aware that local custom dictates a general request as a starting point. 6
Overall, our sunrise request data validate prior research showing demand for licensure most often comes from within occupations, not from consumers— and thus calling into question whether licensing is pursued to serve the public or members of the occupations themselves. 7