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Shining a light on Arizona’s Sunrise regulations

November 27, 2017

By Dr. Murray Feldstein

While the federal government ponders how to fix America’s broken healthcare system, states can do more to help patients get greater access to healthcare at a lower cost. The best place to start is by eliminating regulations that prevent medical professionals from helping patients to the full extent of their training.

Occupational licensing laws are supposed to protect the public from dangerous, unethical, or poorly trained professionals. Having spent more than a half-century as a practicing physician in both urban and rural areas, I have found that medical licensing regulations do more to protect professions from competition than protect patients from incompetent practitioners. The result has been too few providers and higher costs.

The Arizona’s Sunrise Law (A.R.S. § 32-3103) is supposed to reduce the anti-competitive effects of occupational licensure. It states that regulation “shall not be imposed on any unregulated health profession except for the exclusive purpose of protecting the public interest.” Unfortunately, the Sunrise process, in actual practice, has created additional barriers to competition in professional turf battles, making it difficult for highly trained professionals, such as advanced practice nurses and pharmacists, from practicing at the top of their education and training. Patients are the ones who suffer.

The Sunrise process requires a written application to the Committee of Reference (COR) comprising both Senators and Representatives by September 1st. A public hearing on the application is usually held late in the year.

Too often, the powerful and well-organized medical associations successfully block or curtail requests by would-be competitors, such as advanced practice nurses and pharmacists, from providing needed services even when similar reforms have already been successfully adopted in other states When an application is blocked, the proposed application does not move forward to be considered as part of the legislative process, denying the opportunity for further public discussion and legislative consideration.

Last year dentists, represented by the Arizona Dental Association, prevented dental therapists from practicing in Arizona. Dental therapists are mid-level providers who can perform many dental procedures, such as preventive examinations, less complicated dental extractions, and routine restorations after intensive training and board certification. They function as part of a dental care team and are also able to deliver services to rural areas facing severe shortages of dental care providers.

Poor oral health has dangerous consequences and can even at times be life-threatening. Scholarly reviews have documented that dental therapists have safely filled gaps in access to dental care for nearly a century in 54 nations around the world. They currently are practicing in Maine, Vermont, Minnesota, and on tribal lands in Alaska, Washington state, and Oregon. There are ample publications that attest to both their safety and cost-effectiveness.

Organized groups of professionals sometimes have difficulty distinguishing their own special interests from the interests of the patients they serve. A problem with healthcare licensing in general is most people, including many of our elected representatives, don’t understand the intricacies of healthcare practice, and thus depend upon the professions they regulate to help them make their decisions. This is a recipe for putting politics ahead of the facts.

This week, the Committee of Reference will consider another dental therapy Sunrise application. This application is supported by a broad, bipartisan group of oral health advocates, rural interests representing patients without access to dental care, and free-market groups. The Committee can either slam the door shut on this important discussion or they can open the door for a full conversation between lawmakers and constituents by allowing this proposal to receive full legislative consideration.

When it comes to healthcare access and affordability, shouldn’t the Committee of Reference provide for more—not fewer—opportunities to do something positive for Arizonans?

Dr. Murray Feldstein is a visiting fellow at the Goldwater Institute.



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