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A while back, I talked about some secondary press on "The Licensing Racket". In that book, the author talked about just showing up to board meetings for various licensing boards and just watching what they do. Her takeaway was that when it came to disciplining bad behavior of their members, it was supreme leniency, but when it came to any sniff of an unlicensed person doing anything, it was knives out. High crimes. Treason.
At that point, I was mostly just taking her account as an account. It certainly seemed plausible, but of course, she may have been motivated to exaggerate things for an agenda or just to sell more books or something.
But someone on the HVAC subreddit just linked to this. It's from North Carolina's board for plumbing, heating, and fire sprinklers. Looks like they publish one of these newsletters every couple months. Front page is the most important bit - PAY YOUR MONEY TO RENEW YOUR LICENSE! Then some information about the board and forms. Finally, the bulk of the newsletter is reporting their disciplinary stuff.
It's all right there. In black and white. From their own pen. You can just read through it and see. The majority of items (~60%) were them going after unlicensed folks. Near as I can tell, in almost all of the examples of discipline against their own, licensed folks, the result was "probation" and maybe taking a class (almost certainly paying the board to take said class). I think the only examples of anything more significant than that were cases where a licensee did something, how shall I phrase it, 'against the integrity of the licensing scheme'? Like, they let someone else use their license number, for example. That's a real crime that will get your license revoked.
Whereas they seem to have quite the scheme for going after unlicensed folks. They may get someone to sign a "consent agreement", promising not to do any unlicensed work. Or they might take it to a court, potentially getting real, big boy penalties. Did you know that they can get you put in jail for 30 days and slap you with a $5,000 fine? I learned that.
They publish this! You don't have to go to their meetings to find out! You don't have to believe what some random author said about them! They just tell you!
What would you change?
The government outsources quality control by letting each guild collect its rent. There’s deadweight loss, but that’s the price you pay for hedging out some of the worst outcomes.
Maybe we have the capacity to do a more laissez-faire model based on reputation? It’s more plausible now than in the Yellow Pages era.
I don't think it is, even within the field with expert level knowledge it's hard for me to know if a doctor I'm seeing is good before I go, and depending on my knowledge of the speciality it's also hard afterwards.
Patient surveying and other mechanisms of assessing doctor quality tend to zero in on customer service which is important but is often the opposite of what you need for an actual quality doctor.
In smaller tighter knit communities you were more likely to get to "he was gruff but I think he caught things others wouldn't."
I have a friend in primary care who picked up most of the local population of a specific ethnic group. He's a good doctor but they don't know that, he was just nice to them and understood their culture so they all came.
They don't know that he's not making mistakes other PCPs would make.
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