Idaho’s occupational licensing to undergo a lengthy exam

Sharon Fisher//September 13, 2017//

Idaho’s occupational licensing to undergo a lengthy exam

Sharon Fisher//September 13, 2017//

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Dr. Diana Crumrine at Foothills Family Medicine, 24 August 2017, Photo Patrick Sweeney
Naturopathic physician Diana Crumrine at Foothills Family Medicine in August. Crumrine, who is on the board of the Idaho chapter of the AANP, is working with a lobbyist to create a licensing structure for naturopaths in Idaho. Photo Patrick Sweeney

Want to be a log scaler, or someone who grades or estimates the value of logs? It’s tougher to be one in Idaho than almost anywhere else in the United States: Idaho is one of only two states that licenses professional log scalers, and they must pass two exams.

That’s just one example of occupational licensing, or statewide permission to perform a profession – usually through the help of boards of examiners composed of people already in the profession – based on requirements such as schooling, experience, and continuing education.

Proponents say occupational licensing helps protect consumers and ensure they are getting the competent service they expect, while opponents say it actually helps people already in the profession by limiting entry and raising prices.

Those licensing requirements add up, according to Michelle Cottle in the Atlantic, which recently looked at the issue. Cottle cited a 2011 study finding that occupational licensing results in 2.8 million fewer jobs and costs consumers $203 billion a year. “Once licenses are on the books, it’s hard to get them off,” she wrote. “Trade groups and training schools that benefit from the system lobby hard to keep them in place.”

workforce-story-sept-2017According to the Institute for Justice, a national law firm focusing on the issue, Idaho ranks 23rd when it comes to the burdens of occupational licensing, based on a 2012 report. (The report is scheduled to be updated in November.) Factors include the number of low-income occupations licensed (47), the average fees ($122), and the average education and experience required (240 days), as well as the barriers to entry for hopeful log scalers.

Idaho’s Bureau of Occupational Licenses serves 30 of the state’s self-governing boards, including the Idaho State Board of Acupuncture and the Board of Drinking and Wastewater Professionals. Other boards, such as the Board of Medicine, manage themselves. The IBOL is a dedicated fund agency, meaning it is supported exclusively by licensing fees, as opposed to taxpayer dollars. Its fiscal 2016 budget was $3.8 million to cover 67,815 licensees.

Over the past several years, several legislative efforts have been made to both eliminate and create new occupational licenses, some of which were passed by the Legislature and then vetoed by Governor C.L. “Butch” Otter.

For example, in the 2017 session, the Legislature passed a proposal to combine the Board of Barber Examiners and the Idaho Board of Cosmetology into a single board. It was delivered to Otter the day before the Legislature adjourned, and vetoed after adjournment, which meant the Legislature did not have the opportunity to override the veto. The Governor had harsh words in his veto message. “House Bill 139 was developed without input from interested parties or due regard for the health, safety and welfare of the public,” he wrote. “Idahoans deserve better.”

A number of states, including Alabama, Arkansas, Connecticut, Delaware, Idaho, Indiana, and Massachusetts, are looking at their state’s occupational licensing in response to a 2015 Supreme Court case against a North Carolina board that required teeth whiteners to be licensed dentists, according to the National Conference of State Legislatures.

When he was serving as acting governor in May, Idaho Lt. Gov. Brad Little – who is running for governor in 2018 — signed Executive Order 2017-06, which requires state agencies to submit a report to governor’s office no later than July 1, 2018. “The report will assess whether the licensure requirements are necessary and in the public interest while providing recommendations for improvement, modification or elimination,” his office noted in a press release.

This means the issue won’t be addressed until the newly elected Legislature – and governor – take office in January 2019. Little said he set a long time period because some of the boards meet only once a year, and he wanted them to take time to go through the public input thoughtfully.

“When the report comes out, I think people will be shocked by how many licenses we do in Idaho,” Little said. “It’s a big number – in the hundreds and hundreds of thousands.” That includes people outside Idaho who have to be licensed to do business in Idaho.

Discontinuing a particular occupational license needs to be done by the Legislature. “I fully anticipate there’ll be interest groups and the people who always have a problem with licenses who’ll go to the Legislature and want to make a big change,” Little said.

That said, Little said he does see a role for occupational licenses. “The No. 1 thing is the safety of the public,” he said. “That’s part of the proper role of government. People have an expectation of some level of professionalism, and that’s part of it. It’s always a judgment on how you maintain safety and credibility but not create a barrier to entry that drives the cost up of what it would be.”

For naturopaths who want licensing, “It doesn’t matter what the training is. There’s no regulation of that training.”

You have probably heard of an MD, but how about an ND? An ND is a naturopathic doctor, and they are licensed in 23 states and territories, as well as Canada.

Naturopathic medicine emphasizes “prevention, treatment, and optimal health through the use of therapeutic methods and substances that encourage individuals’ inherent self-healing process,” according to the American Association of Naturopathic Physicians (AANP). It represents licensed naturopaths, who first earn a four-year undergraduate degree, followed by a four-year doctoral program at one of seven medical schools, as well as pass a national licensing exam.

NDs used to be licensed in Idaho as well, said Diana Crumrine, a licensed naturopathic physician and a board member of the Idaho chapter of the AANP. In 2005, the group passed a law establishing a board that began licensing naturopaths.

But by 2007, after giving out 14 licenses, the state shut the board down due to infighting over disagreements on educational standards. And while the organization attempted to reinstitute the board, instead the Legislature repealed the law altogether in 2015.

“Now we have to start over,” she said.

In the meantime, there is no regulation of the term ND.

“It doesn’t matter what the training is, and there’s no regulation of that training,” Crumrine said. “You could have read some books or been through an online program, and as a consumer, they wouldn’t know.”

Licensing is a way that an ND could differentiate themselves, much like certified public accountants can differentiate themselves from bookkeepers, she explained.

With as many as hundreds of people calling themselves NDs in Idaho, and fewer than 20 licensed NDs, reinstituting licensing is an uphill battle. Many practitioners oppose these efforts because they are concerned that the AANP organization will try to keep them from using the ND term or even from practicing at all.

And then there’s the ideology argument. “Licensing in general in Idaho – people come at it very cautiously,” Crumrine said. “If licensing comes up, certain groups will always oppose it.”

Crumrine’s organization is working to re-implement the law and re-establish naturopath licensing.

“We have a lobbyist, and every legislative session, we work with that lobbyist, write draft legislation, meet with legislators, and try to get to the point to introduce a bill,” as well as working outside the legislative session to build relationships. “By the time we get something going, there’s little time to help everyone understand.”

Crumrine emphasized that the organization isn’t trying to stop anyone who’s now practicing as a naturopath. It just wants to create a definition for a licensed naturopath and find a place for them within the medical hierarchy.

“We’re not saying any of them are bad or don’t know what they’re doing, but that there’s a different level of training,” she said. “We’d like to be considered primary care physicians to any patient who would like to come to us. There is a physician shortage in Idaho. We can be a part of that solution.”