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Strengthening the links between the public health community and health professions regulation.

LICENSURE OF HEALTH PROFESSIONALS IS A BUREAUCRATIC behemoth made of up 50 different state systems, each with its own dozens of agencies, departments, divisions, boards, and committees. The current system is the product of legislative and political battles well financed by professional associations. Though far from a sexy media topic, licensing policies hold the key to the number of practitioners available in underserved areas, and licensing regulations set the minimum levels of competence for safe health care delivery; endeavor to prevent substandard care; and mandate sanctions for incompetent providers. The web of statutes, rules, and regulations that control the practice and provision of health care is intimately grounded in protecting the public. In many ways, licensure serves to promote and enhance the public health mission, specifically the essential public health services of enforcing laws and regulations that protect health and ensure safety; linking people to needed personal health services; and assuring a competent public health and personal health care workforce.' Why then has professional licensure traditionally not been the concern of state and federal public health agencies? Why have policy makers largely ignored the calls from public health leaders2 and the Institute of Medicine3 for state public health departments to regulate health care professionals? Why have public health professionals failed to see what implications licensure holds for health care access and quality? And why, at a time when policy analysts have exposed the shortcomings of regulatory systems, have public health professionals not been at the forefront of reform efforts? In what follows, we illuminate the regulatory infrastructure and its shortcomings, highlight recent policy developments, and suggest that public health agencies and leaders can and should play a pivotal role in improving a system that is no longer protecting the public's health as intended.