Really interesting article in the Seattle Times this morning about how our state’s dentists have successfully (so far) blocked Washington residents from having access to dental therapists.
These therapists (who are licensed in the states that allow them) are akin to physician assistants; they can perform a wide range of basic dental care procedures. And as with PA’s, dental therapists offer the promise of wider, cheaper access.
And of course, some – but not all – dentists are afraid of having to compete with these folks. So they lobby the state to preserve their monopoly. It’s akin to – but in some ways worse – the efforts of North Carolina dentists to foreclose tooth-whitening services as the unlicensed practice of dentistry.
I mean, it’s one thing to try and make it harder and more expensive for suburban moms to get blindingly white chompers at a mall kiosk; it’s another to force the poor to resort to do-it-yourself dentistry in order to get relief from tooth pain.
It’s a classic case of legitimate public interest – and there IS a public policy reason for maintaining professional licensing standards for dentists, just as there is for lawyers – being stretched to preserve the professional monopoly. 1
But just as with lawyers, there’s a point at which “protecting the public” becomes counter-productive. The monopoly extends too far, and big chunks of the public simply go without the services of the licensed professionals. It’s hard to see how that’s better, particularly when there’s an option that still preserves licensing AND expands access.
(I would also imagine that more strategic dental institutions would see the benefits of dental therapists; they could easily allow for greatly expanding a dentist’s reach and referral possibilities.)
Two thoughts on how this relates to lawyers:
First, as I’ve long harped on, the market for legal services is fundamentally broken due to a rigid-and-expansive definition of “the practice of law.” As with dentists sweeping all tooth-stuff into “the practice of dentistry” – and thus excluding lower-cost, more widely available offerings – the bars sweep all law-stuff into “the practice of law,” with the same effect on the public. 2
Secondly, the Washington State Bar shouldn’t get a pass here because they’ve allowed for “Limited License Legal Technicians.” These state-licensed professionals are a very tentative step in the right direction, but there’s a reason the first word in the title is “Limited:” there’s not much they can do, and they’ve got to jump through a whole lot of hoops to do even that.
There’s certainly a place for consumer protection. But just as dentists are spewing nonsense when they argue that therapists threaten public health (despite all evidence being to the contrary), the bars are doing the same when they argue that only lawyers can help consumers with anything related to the law.
- This kind of rent-seeking is common to licensed professionals, and it’s not hard to see why: cry “consumer protection” or “customer safety,” set up licensing rules and other barriers to entry, and then enjoy the higher prices that come along with your state-sanctioned monopoly. ↩
- And this problem is exacerbated in legal due to the inability of non-lawyers to even invest in the provision of legal services. ↩