The ramifications of regulatory reform

This article examines the regulatory reform proposals for the health care workforce recently proposed by politicians and members of the Pew Health Professions Commission. These proposals attempt to address issues related to state practice acts, competence, advanced practice, "boundaryless" practice, the disciplinary process, consumerism, and umbrella legislation. Questions are presented for each issue to guide practitioners when deliberating about possible actions professional organizations can take in proposing legislation at the state level. Various external forces shape each issue and lead to the need to seek such regulatory reform as improving disciplinary processes and activity, assessing competence beyond the entry level, and increasing involvement of consumers. However, there are risks associated with any proposed regulatory reform, particularly if one realizes the potential financial costs associated with competency assessment and advanced-practice regulation. We must also carefully examine any reform proposals that advocate title protection and the licensing of invasive procedures in place of licensing professionals. The fact remains that the impact on quality of care and long-term cost-effectiveness from the unrestricted use of less qualified professionals and unlicensed aide-level personnel to provide skilled services has not been adequately determined.