OCCUPATIONAL LICENSING: THE MERRISON REPORT ON THE REGULATION OF THE MEDICAL PROFESSION*
| Published date | 01 March 1977 |
| Date | 01 March 1977 |
| Author | W. S. Siebert |
| DOI | http://doi.org/10.1111/j.1467-8543.1977.tb00070.x |
British Journal
of
Industrial Relations
Vol.
XV
No.
1
OCCUPATIONAL LICENSING: THE MERRISON REPORT ON THE
REGULATION
OF
THE MEDICAL PROFESSION*
W.
S.
SIEBERT?
THE
British medical care system is going through a troubled phase. There are pro-
blems concerning the long waiting lists for hospital admission, pay beds, and the
competence of foreign medical graduates, to list only a few. That the problems
are serious is shown by the recent setting up of an official inquiry into the
National Health Service, soon after an inquiry into the regulation
of
the medical
profession,' which itself was preceded only a few years ago by the Todd Com-
mission on medical education? Still, the fact that a commission has been set up in-
dicates that policy alternatives are being actively considered, and the situation
might be reasonably fluid. It seems worthwhile therefore to take the opportunity
now to raise some issues in one of the problem areas-the training of doc-
tors-issues which have generally been passed over
in
the public discussion.
The outcome of the public discussion on the training of doctors has been:
recommendations for better trained junior staff and specialists, exclusion
of
the
majority of foreign trained entrants, and tighter demarcation of specialists' areas
of care. The major advantage of this is that the Health Service will have to hire,
and the public therefore receive, the services of more competent doctors. The
main disadvantage is that the costs
of
medical services will increase both because
the extra training required must eventually be reflected in higher lifetime earnings
and because the flexibility with which medical personnel can
be
deployed will be
reduced. American results for example suggest that the general practitioner ap-
parently uses too few paramedical staff, given their relative cheapness, because
substitution is frustrated by legal statutes governing medical pra~tice.~ However,
it would require major research to estimate these costs and relate them to the pos-
sible public benefits from higher training. The aim of this paper is rather to show
how the disadvantages have received scant attention in public discussion because
medical practitioners, necessarily
our
main advisers on training standards, have
an economic interest in raising entry requirements.
Higher standards of entry into the medical profession and clearer demarcation
within it are usually justified in terms of the need to lay down expertly judged
standards
of
medical competence
so
as to preserve the public from quacks. How-
ever, there is a school of thought which takes tight entry control to be a result of
organised pressure for monopoly gains: rather than as preserving public safety.
In
the next section we devise tests to discriminate between these two hypotheses,
and then in the following section consider the publicly raised arguments. In brief
we find that there appears to
be
opposition to re-licensure (i.e. imposing higher
standards on practising doctors as well as new entrants) as well as nepotism in
selection of medical school applicants, neither of which is likely to be in the public
interest. This, plus the finding of a very high present value of lifetime net earnings
for general practitioners (far higher than
is
easily compatible
with
competition)
indicates that the profession has been successfully using. the licensing rules to
pur-
sue sectional interests. In the last section, policy alternatives are considered which
*John Addison,
J.
R.
Crossley, Meghnad Desai,
J.
G.
Picton, Peter Sloane,
D.
Lees and Robert
Weeden have
all
commented
on
a previous draft but none is responsible for remaining errors of
opinion
or
fact.
t
Lecturer in Economics, Paisley College
of
Technology.
29
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