Licensure Laws Research Articles

Driver License Renewal Laws and Older Adults' Daily Driving, United States, 2003-2017.

Around the world, aging populations pose significant concerns regarding their community mobility and transportation safety. Most previous studies in the United States have focused on the associations between driver license renewal laws and crash outcomes among older adults (65 years and older). Few studies have evaluated the impact of driver license renewal laws on older adults' community mobility. This study aimed to identify the associations between driver license renewal laws and older males' and females' daily driving likelihood and duration. The 2003-2017 American Time Use Survey data were merged with driver license renewal legislation using ages 55-64 to control for effects of non-licensure factors (e.g., gasoline price). Weighted Poisson and linear regression models were used to estimate the associations of various driver licensure provisions with older males' and females' daily driving likelihood and duration. A shorter in-person renewal period and the presence of mandatory reporting laws for physicians were associated with a lower daily driving likelihood and shorter driving duration among females aged 75 years or older. The presence of mandatory reporting laws was also associated with reduced daily driving likelihood and duration for males aged 65-74 years. Policymakers should be aware that males and females may respond differently to older driver licensure laws, which may require distinct interventions to preserve their mobility. Future studies should consider the gender disparities when examining the association between driver licensure policies and older adults' transportation safety and mobility.

Telehealth for an Aging Population: How Can Law Influence Adoption Among Providers, Payors, and Patients?

Telehealth continues to experience substantial investment, innovation, and unprecedented growth. However, telehealth has been slow to transform healthcare. Recent developments in telehealth technologies suggest great potential for chronic care management, mental health services, and care delivery in the home-all of which should be particularly impactful for an aging population with physical and cognitive limitations. While this alignment of technological capacity and market demand is promising, legal barriers remain for telehealth operators to scale up across large geographic areas. To better understand how federal and state law can be reformed to enable greater telehealth utilization, we review and extract lessons from (1) establishment of a healthcare relationship, (2) state licensure laws, and (3) reimbursement. We analyze these areas because of the legal ambiguities or inconsistencies they raise depending on the state, which seem to be hampering telehealth growth without necessarily improving quality of care. We propose several solutions for a more unified approach to telehealth regulation that incorporate core bioethics principles of doctor-patient relationship, competence, patient autonomy, as well as population-wide questions of resource allocation and access. Lawmakers should clarify that healthcare relationships may be established outside of in-person meetings, align licensure laws via an interstate compact or federal preemption, and expand Centers for Medicare and Medicaid plans to reimburse telehealth delivery in the home.

California bill would grant full practice authority to nurse practitioners

A California bill that would give full practice authority to nurse practitioners (NPs), including psychiatric specialists, to work to the full extent of their training and education has been introduced to address a shortage of health care providers, especially in rural and underserved areas. To date, nearly half of states and U.S. territories have adopted full practice authority licensure laws for NPs.

Advocating for Educational Standards in Counselor Licensure Laws

As the counseling profession evolves, educational standards for counselor licensure must be standardized from state to state. In this article, the authors discuss historical and current influences and present an advocacy model that has been used to standardize educational requirements in state counselor licensure laws.

Review of Ethics Continuing Education Requirements in State Licensure Laws for Speech-Language Pathologists

Review of Ethics Continuing Education Requirements in State Licensure Laws for Speech-Language Pathologists

The case for full practice authority.

The Institute of Medicine (IOM) recommended in its 2010 report on the future of nursing that advanced practice registered nurses (APRNs) should factor prominently in providing care to the millions of Americans who access healthcare services under the Affordable Care Act (ACA). The IOM also recommended that APRNs practice to the full extent of their education and training.However, many states have laws in place that limit full practice authority for APRNs, specifically NPs, in providing basic health services such as primary care. These laws place restrictions on independent practice and Medicaid and Medicare reimbursement, which prevent nurses from “responding effectively to rapidly changing health care settings and an evolving health care system.” Less than half of the United States has adopted full practice authority licensure and practice laws (see APRN practice authority at a glance). This article discusses how the primary care needs of millions of Americans can be met by granting full practice authority to APRNs nationwide and provides evidence to support the high level of care these practitioners can provide independently.

Interstate Practice of Dental Teleradiology in the United States: The Effect of Licensing Requirements on Oral and Maxillofacial Radiologists' Practice Patterns.

In the United States, each state has independent licensing standards. Dentists wishing to practice in more than one state must apply to each individually. The goal of this study was to assess whether board-certified oral and maxillofacial radiologists interpreted images taken outside the states in which they were licensed and whether coverage provided by the malpractice insurance plans to which they subscribed affected their behavior. An electronic survey was sent to all current members of the American Board of Oral and Maxillofacial Radiology, with a response rate of 74%. Descriptive statistics were calculated. The majority of respondents (54.6%) indicated they write reports for patients in states for which they do not have a dental license. An even larger majority (80.0%) do not know whether their malpractice insurance protects them in these cases. Qualitative responses indicate that there is confusion among practitioners as to what is legally permitted pertaining to teledentistry of this nature. Much of the work in which oral and maxillofacial radiologists engage may be considered teledentistry. In other settings, teledentistry has been proposed as a means to improve access to care for vulnerable populations, yet current licensure laws may make this more difficult to implement. Based on the results of our survey, many oral and maxillofacial radiologists in practice may be considered to be practicing without a license. Portability of diagnostic images may make it more difficult to enforce geographic practice boundaries. A national licensure system would be easier to enforce while maintaining high levels of patient safety.

MCAC and State Counselor Licensure Laws

Although all 50 states, as well as Washington DC and Puerto Rico, have passed laws that license master’s-level professional counselors, the American Psychological Association has historically not taken a role in addressing master’s-level education. In 2009, the Council for Accreditation of Counseling and Related Educational Programs (CACREP) initiated standards excluding psychologists as core faculty and has been a driving force with state licensing boards to credential graduates from CACREP-accredited programs exclusively. The Council for Counseling Psychology Training Programs explored the Masters in Counseling Accreditation Committee (MCAC) as an alternative accreditation for master’s counseling programs. This study examined the extent to which MCAC accreditation standards align with state counselor licensure statutes. Content analyses indicated that MCAC is a viable alternative accreditation if programs pay attention to state required credits for a degree, curricular requirements not specified by MCAC, and clinical requirements. Implications of these findings and recommendations are discussed.

Licensed to Practice: The Supreme Court Defines the American Medical Profession by James C. Mohr (review)

Reviewed by: Licensed to Practice: The Supreme Court Defines the American Medical Profession by James C. Mohr Joel D. Howell James C. Mohr. Licensed to Practice: The Supreme Court Defines the American Medical Profession. Baltimore: Johns Hopkins University Press, 2013. Viii + 216 pp. Ill. $21.95 (978-1-4214-1142-2). This short, eminently readable book tells the story of a generally underappreciated episode in the history of U.S. medicine—passage of the first effective medical licensure law. Throughout most of the nineteenth century the medical marketplace was open to just about anyone who claimed to be a physician. Although several states authorized “regular” physicians to issue licenses as early as the 1830s, absent criminal consequences for practicing without one these licenses had little practical effect. West Virginia was formed in 1863, and the unsettled nature of the new legal system following the Civil War meant that it was fertile ground for those wishing to rethink state control of physicians. The Medical Society of West Virginia, founded in 1867, was an effective enabler for such a project. They hewed obsessively to AMA guidelines for education and practice, prohibiting members from even the most casual contact with physicians who did not fit their model. [End Page 137] The society took as their goal the passage of legislation to limit medical practice to regular physicians. They proved to be politically astute, supporting physicians who successfully ran for seats in the state legislature. When they proposed the creation of a state board of health they focused on public health promotion, a less controversial issue than licensure, and one given salience by the threat of smallpox from nearby Pittsburg. The bill’s primary goal came near the end—the proposal that a person could practice medicine in West Virginia after either graduating from a “reputable medical college” (which was meant to imply a regular medical college), passing an examination, or demonstrating that the person had been in practice in West Virginia for ten or more years. Those who violated the law would be subject to criminal penalties. After legislative changes and debates, well described in the book, the bill was signed into law in 1881. A challenge came quickly. Frank Dent, holder of a diploma from the American Medical Eclectic College of Cincinnati and no stranger to the Society, was denied a certificate in 1882. He challenged the ruling in circuit court, was found guilty, and was fined fifty dollars (the lowest amount permitted under the law). The case eventually made its way to the U.S. Supreme Court (one of whose members was a physician). There Dent claimed that the law violated the Fourteenth Amendment to the Constitution by depriving him of his occupation without adequate due process. In January 1889 Justice Field observed for the Supreme Court that doctors deal with “all those subtle and mysterious influences upon which health and life depend” (p. 150), and since the average citizen was not prepared to judge a physician’s qualifications, the practice of medicine was not an avocation but a governmentally-recognized profession. The court did not state just how the government should regulate the profession, but left no doubt that they could do so. Over the following decades state licensure of physicians became the norm. Mohr’s sources include not only medical writings and newspaper accounts but also careful analysis of a plethora of legal sources, including both court rulings and contemporary discussions of the rulings. Legal historians might wish for a bit more about just how the Dent decision was used in the passage of subsequent licensure laws. But this is not only a book about legal theory. The author pays nice attention to the social implications of regulating medical practice as well as the importance of geography. The book will appeal to a variety of readers, and could be effectively used in classes. Mohr clearly explains the rationale for opposing licensing and makes it easy to understand why for over a decade legal authorities remained confused and unconvinced by the decision. This book will be a useful case study for historians attempting to make the case for the contingent nature of change to non-historian policy makers. The fundamental...

American society for parenteral and enteral nutrition (a.s.p.e.N.) standards of practice for nutrition support pharmacists.

American society for parenteral and enteral nutrition (a.s.p.e.N.) standards of practice for nutrition support pharmacists.

Telehealth technology applications in speech-language pathology.

Speech-language pathologists are anxious to adopt telehealth technologies but have encountered barriers such as limited reimbursement, state licensure laws, and medical information privacy laws. Moreover, speech-language pathologists are confronted with the hurdle of evolving face-to-face clinical practices into effective telehealth practice adapted to the current national infrastructure. Factors such as costs, availability of resources, and diagnostic/intervention and patient needs should be considered when selecting the telehealth infrastructure for service delivery. Understanding the new role of technology in the diagnosis and treatment of communication disorders is vital for the expansion of telehealth as a standard of care. The purpose of this article is to overview the current technologic infrastructure and procedures for telehealth applications in speech-language pathology (SLP) and the innate challenges and opportunities. A literature search was conducted for telehealth publications in the field of SLP. Given the rapid rate at which technology advances, only peer-reviewed articles published over the past 5 years (2008-2013) were included. The majority of articles reviewed used hybrid methodologies to maintain traditional SLP service standards. General technological components for telehealth activities included computers, Web cameras, headsets with an embedded microphone, and Internet connectivity. Advanced technology has limitations in the application of telehealth. Technological adversities were not reported as the cause of discontinuation of telehealth services by the practitioner or the individual. Audio and visual disturbances were primarily associated with videoconferencing. Supplemental asynchronous technology was widely reported as a solution to real-time instabilities.

How Can Registered Dietitian Nutritionists Use Health Coaching Techniques?

How Can Registered Dietitian Nutritionists Use Health Coaching Techniques?

Let's Abolish Licensure Laws for Accountants: An Analysis from the Perspectives of Law, Economics & Ethics

Licensure laws are ostensibly passed to protect the public from incompetence and fraud. The problem is that they don't. However, they do have unintended negative consequences that actually harm the public by reducing the quantity of service, raising the cost of services and perhaps reducing the quality of service. Licensure laws also violate contract rights and the right to earn a living. Thus, there is a strong case for abolition. This article discusses accounting licensure laws from the perspectives of law, economics and ethics. It concludes that accounting licensure laws should be abolished because they violate rights and do not protect the public.

Crossing Boundaries

In the United States, recent judicial interpretation of interstate licensure laws has found pathologists guilty of malpractice and, more importantly, the criminal practice of medicine without a license. These judgments against pathologists highlight the need for a timely and comprehensive survey of licensure requirements and laws regulating the interstate practice of pathology. For all 50 states, each state medical practice act and state medical board website was reviewed. In addition, each medical board was directly contacted by electronic mail, telephone, or US registered mail for information regarding specific legislation or guidelines related to the interstate practice of pathology. On the basis of this information, states were grouped according to similarities in legislation and medical board regulations. This comprehensive survey has determined that states define the practice of pathology on the basis of the geographic location of the patient at the time of surgery or phlebotomy. The majority of states (n=32) and the District of Columbia allow for a physician with an out-of-state license to perform limited consultation to a physician with the specific state license. Several states (n=5) prohibit physicians from consultation without a license for the specific state. Overall, these results reveal the heterogeneity of licensure requirements between states. Pathologists who either practice in multiple states, send cases to out-of-state consultants, or serve as consultants themselves should familiarize themselves with the medical licensure laws of the states from which they receive or send cases.

The “Doctor of Osteopathy”: Expanding the Scope of Practice

This article-the third in a 6-part series-examines the status of the DO degree in the first 3 decades of the 20th century. This time was an era when osteopathic practitioners established other colleges, developed state and national organizations, upgraded the length and breadth of curricula, and sought to secure licensure laws commensurate with their expanded education. During this period, osteopathic practitioners debated whether the DO degree was the most appropriate degree for their colleges to award or whether the MD degree alone or in conjunction with the DO degree better signified to lawmakers and the public their expanded academic training. At the end of this period it appeared likely that the DO degree would continue to be the sole designation by which osteopathic physicians would identify themselves in continuing their fight to obtain further legal rights and privileges.

The Future of Nursing Leadership: A Commentary

Let whoever is in charge keep this simple question in her head [not, how can I always do this right thing myself, but] how can I provide for this right thing to be always done?- Florence Nightingale, Notes on Nursing: What It Is, and What It Is NotNURSES WERE THE original servant leaders-at the patient's bedside and in communities-and now they are perfectly positioned to take their experience with leadership to a heightened level. In the new world order, nurses have moved from the background to the boardroom, and they have been put in the spotlight to lead the transformation of quality healthcare.The feature article in this issue, by Donna E. Shalala, PhD, and Amy Carlton's interview with Linda Burnes Bolton, DrPH, RN, FAAN, describe visions and pathways for the future of nursing that have been highlighted by the Institute of Medicine's (IOM 2011) Future of Nursing report and the resulting Campaign for Action, which aims to implement the findings of the IOM report in all 50 states. Shalala and Burnes Bolton agree that nurses are poised to lead the way in managing a complex healthcare delivery system to expand coverage and access to care, improve quality, and connect and coordinate care across the healthcare delivery continuum. Shalala focuses on the broader policy issues and implications for the future of nursing, while Burnes Bolton comments on the role of leadership in individual healthcare organizations.Key Nurse Leadership ThemesIn the following paragraphs, I discuss a number of themes and messages shared by Shalala and Burnes Bolton (plus a few of my own views).Importance of Removing Practice BarriersThroughout nursing's history, its practice boundaries have shifted with circumstance to provide access to care. Keeling (2007, xix) notes: When care was to be provided in remote areas of the country, in theless desirable sections of urban cities, with minority cultures, on nights and weekends, when physicians were not readily available, the boundary moved to accommodate an expanding scope of practice for nursing. However, the shifting boundaries create practice barriers, even today. Shalala and Burnes Bolton discuss removing those obstacles-restrictive licensing laws; prohibitive Medicare and Medicaid reimbursement policies; and outdated scopes of practice for nurse practitioners (NPs) and a short-term focus on illness intervention, rather than longer-term patient education and prevention strategies-to utilize nurses for expanded access to care. Burnes Bolton advocates for nurses at the organizational level to come together to identify the obstacles that need to be removed or processes that need to be added for them to do their jobs well, and she mentions shared governance as a model that promotes staff-level leadership, as described through the Transforming Care at the Bedside initiative (IHI 2014).But practice barriers are not drawn only by national policies or imposed solely by state licensure laws or regulations. Sometimes, practice barriers are a result of many past decisions in organizations and a culture that may not be nurse- or patient care-centric. Organizational leaders can do much to remove obstacles to practice by promoting a culture of interprofessional teamwork, including staff nurses on teams to solve quality and safety problems, and by designing improvements in the patient experience. For NPs, practice barriers may exist in antiquated language that resides in medical staff bylaws and the designation of their institutional scopes of practice by physicians, rather than by the medical staff's NP counterparts. Health system leaders would benefit from examining the ways in which policies, procedures, cultures, and systems might be redesigned to remove practice barriers.Value of Nurses Practicing at the Top of Their EducationBurnes Bolton describes many evidencebased patient and organizational benefits from nurses working at the top of their education-and their game-as is the topdown-driven policy at her organization. …

Bicycle Helmet Laws Are Associated with a Lower Fatality Rate from Bicycle–Motor Vehicle Collisions

To assess the association between bicycle helmet legislation and bicycle-related deaths sustained by children involved in bicycle-motor vehicle collisions. We conducted a cross-sectional study of all bicyclists aged 0-16 years included in the Fatality Analysis Reporting System who died between January 1999 and December 2010. We compared fatality rates in age-specific state populations between states with helmet laws and those without helmet laws. We used a clustered Poisson multivariate regression model to adjust for factors previously associated with rates of motor vehicle fatalities: elderly driver licensure laws, legal blood alcohol limit (<0.08% vs ≥ 0.08%), and household income. A total of 1612 bicycle-related fatalities sustained by children aged <16 years were evaluated. There were no statistically significant differences in median household income, the proportion of states with elderly licensure laws, or the proportion of states with a blood alcohol limit of >0.08% between states with helmet laws and those without helmet laws. The mean unadjusted fatality rate was lower in states with helmet laws (2.0/1,000,000 vs 2.5/1,000,000; P = .03). After adjusting for potential confounding factors, lower fatality rates persisted in states with mandatory helmet laws (adjusted incidence rate ratio, 0.84; 95% CI, 0.70-0.98). Bicycle helmet safety laws are associated with a lower incidence of fatalities in child cyclists involved in bicycle-motor vehicle collisions.

Academic Programs, Class Sizes, and Obstacles to Growth in Audiology

Over the past 25 yr, the number of academic programs in audiology has been cut by half, yet there continue to be calls for further reductions in the number of programs. Reducing the number of programs potentially affects the number of graduates and therefore could impact the availability of audiologists in the future. There is a question as to whether academic programs in audiology could accommodate more students. To examine the impact of closure of programs on the number of graduates and to identify obstacles to programs growing class sizes. An analysis of audiology class sizes over time based on data available from the Council of Academic Programs in Communication Sciences and Disorders, and a comparison of audiology class sizes with other health professions, to identify trends that affect growth in program size. The key obstacles to growth of academic programs are (1) the availability of sufficient clinical experiences to meet the licensure and certification requirements and (2) financial resources to expand didactic and clinical teaching needs associated with larger class sizes. (1) Certification regulations and licensure laws should be revised to eliminate requirements that directly impact on academic programs or students prior to graduation. (2) The profession should undertake the effort designed to change Medicare regulations to allow alternative supervision models. (3) Academic programs need freedom to be creative in their approaches to teaching and financing programs. (4) A concerted and coordinated effort needs to be undertaken to increase the number of persons interested in audiology as a career.

Trying to summarize state licensure laws for psychologists: Burial by grains of salt.

Trying to summarize state licensure laws for psychologists: Burial by grains of salt.

The Role of Government and Lobbying in the Creation of a Health Profession: The Legal Foundations of Counseling

The state and federal governments, along with private industry, play an important role in the development of a health profession. State governments establish training standards through licensure laws, and state programs dictate employment and payment opportunities. The federal government unifies a profession through recognition in national health care programs. Private industry provides public access through private health insurance. The counseling profession has spent decades opening these federal, state, and private programs to become an established health profession.