Does N.H. Set The Licensing Bar Too High For Certain Occupations?

Mar 16, 2018

There have long been complaints that the state's extensive training and certification requirements for some fields have led to workforce shortages, and the House recently passed a bill for a less restrictive approach. But opponents say caution is warranted - to protect the public and professional integrity.

GUESTS: 

  • Jackie Cilley, Democratic state representative from Barrington. 
  • Drew Cline, Director of the Josiah Bartlett Center for Public Policy and Chairman of the State Board of Education. 
  • Jerry Knirk, Democratic state representative from Freedom. He is also a retired physician.
  • Bill Ohm,  Republican state representative from Nashua. He is lead sponsor of HB 1685, which establishes a statutory commission for oversight of occupational regulation. 

Related Reading

The state handbook on licensing requirements: New Hampshire Licensed, Certified, and Registered Occupations 2017.  

Just some of the occupations covered:  

Accountant; Alcohol and Drug Counselor; Architect;  Audiologist; Barber;  Body Art Practitioner; Boiler and Pressure Vessel Inspector; Cosmetologist; Court Reporter;  Dental Hygienist; Electrologist; Geologist; Land Surveyor; Midwife; Physician; Plumber; Private Investigator; Reflexologist; School Social Worker; Soil Scientist; Tanning Equipment Operator; Teacher. 

Transcript

 This transcript is computer-generated, and may contain errors.  You'll get a better experience of the on-air conversation by listening to the audio posted above.

[00:00:00] From New Hampshire Public Radio I'm Laura Knoy and this is the exchange. New Hampshire's labor shortage is a huge concern and lots of ideas to ease it are percolating but one in particular got a recent boost in the legislature recently occupational licensing reform. The premise our state has too high a hurdle for entry into many professions requiring far too many is many hours of education and training before someone is certified to use their skills. And those occupations range from barbers to therapists to preschool teachers. Today in exchange. Do we need licensing reform. Let's hear from you. If you're in a licensed field how much does the state require for your occupation. What do you think is reasonable to protect the public. And what's overkill also as a patient or a consumer. Have you been hurt or helped by the standards that New Hampshire sets. Send us an e-mail exchange at NHPR dot org or respond on Facebook or Twitter at NHPR exchange or give us a call 1 800 8 9 2 6 4 7 7. We have four guests for the hour Jackie Cilley is here. Democratic state representative from Barrington - welcome back. Nice to see you. Good morning. Also with us Jerry Knirk, Democratic state representative from Freedom. He's also a retired physician and representative. Good to meet you. Thank you for coming. Thank you very much. Also with us Bill Ohm. He's a Republican state rep from Nashua. He's lead sponsor of HB 16 85 which establishes a commission for oversight of occupational regulations and representative.

[00:01:41] Good to have you. Thank you also for being here. Good morning. And also with us Drew Cline, interim director of the Josiah Bartlett Center for Public Policy. He's written a lot about this issue of occupational licensing reform. Andrew welcome good to see you too. Thanks. Well Drew to you first what is the problem that you and represented Almer trying to solve here. How much time do you have. It's actually quite a big problem. So since 1970 that means that 2000 new licensed new occupations licensed. That's been a 200 percent increase nationwide since 1983. So what we've seen is a massive increase in occupations that require license they tend to be. The increase tends to have been among blue collar and middle and low income occupations a lot of service industries. And what it's done it's it's set barriers to getting into these occupations. So for example we had just one last year where we removed a licensing occupation in New Hampshire from hairbrained. That was a good example where there was a minority community that had a traditional practice that was licensed as basically barbering. And so you can see how this can can affect low income communities so it creates a barrier to pursuing happiness. Right. So we have this in the United States you know you have a right to pursue happiness. These barriers to getting an occupation put up an obstacle to you choosing your occupation that you want to have. And being free to pursue that.

[00:03:17] Well in the Obama administration in 2015 did a pretty large study of this and kind of reach the same conclusions that that you do Drew. The funny thing about occupational licensing is it is a bipartisan issue that you can find people on the left and right that agree that it's gotten too burdensome the Obama administration found they did a study of studies and they found for example that occupational licensing tends to increase wages in industries about 40 to 16 percent. But it also creates a massive hurdle to employment. They concluded a lot of economic studies included this too that it actually exacerbates inequality when you prevent low income and middle income people from entering occupations that pay better or prevent them from going out on their own. So for example you can't start a business if you're if you're a if you work for a landscape architect near one of these contract employees you're just a wage employee and that's fine. But you can't become a landscape architect without a four year degree. Right. So it creates this jobs you may learn all the tricks but you have to go to school and get a license. And so it creates an obstacle it separates you from that hire wrong. And so that's what the Obama administration appreciate from it from an equity standpoint and I think they were right. And so the right also agreed. So you can have conservatives libertarians and liberals all agree on this. Well represented again you're the one who introduced this bill that seeks to look at occupational licensing. What are some of the stories that you heard from constituents that made you get into this. Well thank you for the question.

[00:04:54] Typically people who have minimal experience would like to enter a profession without having to have the burden of a very extensive campaign of training or licensing of the hairbraiding was a very good example and ctually aspects and cosmetology I think would apply to people who'd like to get into a profession without a big burden. In other professions say like automotive you have certified technicians but they're not licensed by the state. You don't need a license by New Hampshire to be an auto mechanic but you should have certification by a professional group to say you're qualified. So the whole spectrum of occupations that people would like to enter that seemed to be overly restrictive and we like to take a look at that process and in some professions it seems all over the map some of them. And I was looking at some of the research some of them seem heavily licensed lots and lots of requirements. Others almost seem under licensed representative. Certainly the case we have a book here and various licensing requirements and things like a mobile home installer request a license. Crane requires a license with considerable four years of additional education and I'm not sure that's appropriate to have a license to have licenses. Is the restriction by the state that prevents you from getting into the occupation as a certification or registration allows you to enter and not have that restriction by the state. You have to demonstrate qualifications but you're allowed to enter the profession without having the state say yes you may or you may not sincerely love to hear from you on this. And there's the idea that you know some of these license requirements are quite burdensome preventing people from getting into professions.

[00:06:39] But the other side is some of them protect the public. I mean you don't want an unqualified hair colorist coloring your hair that could burn your scalp. Well there are a couple of points that I'd like to make based on the conversation so far you asked. You started off this conversation by asking what is the problem right in New Hampshire is far less of a problem and I don't disagree with Drew that occupational licensing has grown exponentially in the last three decades. So he's quite right about 30 percent of the jobs in the United States. When you combine federal and state are in occupational licensed fields however the one of the things if you if you look at New Hampshire where about 30 eighth on the list there are about 54 licensed professions or professions per state. But in New Hampshire we only have about 38 and that puts us about 38 down on the list for burdensome regulations. So we're one of the least regulated states by comparison with and that comes out of the Institute for Justice which doesn't particularly believe in occupational licensing to begin with. You've heard both of our guests talk about the hair braiding that and that's my other issue with this bill. The hair braiding we did the license and that was in the executive departments and Administration Committee that I have served on in both the House and Senate that is our job.

[00:07:59] This bill establishes what is rightfully I think not rightfully but I think can rightfully be described as a very political body that's going to duplicate the work of what should be the executive departments and Administration Committees in the House and the Senate and the JLCAR the Joint Legislative Committee on Administrative Rules. And we can get into that a little bit further. But I but that concerns me greatly. So you're saying representatively look at this occupation by occupation instead of broadly saying we need to reduce the level overall use use the scalpel. But that is not this is that this legislation is formulaic. It is much of the language comes from the American Legislative Exchange Council ALEC which we have seen before in New Hampshire and it is not it is not a right bill for our state.  Representative Knirk.  As I said earlier you're a retired physician so many many years in the health care field I wonder what your perspective is on this idea that New Hampshire has a burdensome licensing system. Well I think Representative so they made a very good point that we are a little lower on the scale of burdensome this. And that's again something which I have trouble with is this particular bill Mirpur that we vote we don't vote on a concept we vote on a bill and I agree that we need to do something about the burdensome occupational licensing. But this bill I thought simply went too far and it is kind of boilerplate that made a lot of things that might not really need to be done in our state. But I think we do need to look at it. I have a somewhat unique view of course being in medicine. The real issue here is a matter of quality and a matter of protection of the public more so than probably just about any other field.

[00:09:46] And I think that I have great concerns on some of the issues in the bill about cutting back too much on that. Well I'd love to ask you about that. Representative OMH and down from my personal standpoint a friend of mine's roof fell off her house a couple of years ago. They could have been killed. Luckily they weren't but obviously it was a nightmare and the more they looked into it it turned out that the contractor construction that the licensing wasn't all that it could have been so how do you find that balance where you're comfortable that the public is being protected. Thank you for the question of great activity we have now with social media where people can report on the quality of the contractors that are in your area for example when a brother wants to look for a plumber or he goes to Angie's List and looks for the recommendations picks a good one. There's ways that we can use social media to qualify the type of contractor they want to have. Let's speak a little bit about the bill itself. My colleagues talked about the idea and oversight of the regulation was very proper.

[00:10:52] But the question is how much time does the committee have to spend on looking at all the regulations we have and the thought of the bill was to set up a separate commission to do the research to look at items that might be a problem and if they're items that are potential problems that present a proposal to the committees to do the research for them that this is an item that might look at the regulation might be overly strict or maybe under restrictive and has the legislature to then take it from there and see if it's a make sense. I see so that's the intent of the commission you're saying representing to look broadly at what the problems might be and then go back to the legislature and say hey you should look at this one or this one. Repetitiously Well my concern with this is that the bill states there's a rebuttable presumption that it should be the marketplace that that dictates. You know how how issues that arise are adjudicated and that we look at the least restrictive form in all cases. So when you come from that kind of standard and listen the marketplace does work it always works eventually and it works only after harm has been done. Well I think somebody's roof falls off because contractors by the way are not licensed to. To me this bill is actually a really great approach because there's a lot of concern about doing away with occupational licensing right. This bill does not do that. While like the approach of this bill as it says as Senator represented so he said it creates a rebuttable presumption that rebuttable is the key to this bill. So the bill says under state law the presumption would be that the marketplace is the best regulator of occupations. But anyone can come to the state and say we think you should license this occupation we think there's a health or safety reason under the bill. It would get rid of the randomness that is in place now. So under the bill you would come and say we think this occupational license and then the state would say OK let's what's the least restrictive way we can certify that this that we have health or safety protections in here.

[00:13:03] So you would do a certification first. If that's not sufficient you would go up ratcheted up to a license if it was justified. But you have to prove harm. And that's where this bill is brilliant. It says we're not going to just take the word of the occupation. You have to show to demonstrate that there's actual harm here. So for example in New Hampshire just as example of the randomness of our occupational licensing to be an emergency medical technician in New Hampshire an 18 hour fee and 150 hours of training but to be a cosmetologists is 198 dollar fee and 1300 hours of training. By the way most other states have about 1000 hours for cosmetology to be a sign language interpreter. Eight hundred and seventy five dollars and four years a shampooer just to shampoo here literally twenty five dollars and 150 hours of training the same number of hours of training to be a shampooer an EMT. It's completely random it makes no sense. So what this bill does is it creates a process by which we can get some order in here and some equity ribs and Canarc and then definitely won't go to the phones lots of listeners want to jump in on a concern I have about the bill those still is the political makeup of the Committee for example right now I'm doing a deep dive into SD 3 1 3 the Medicaid expansion and there's going to be a commission in that there are six politicians representatives and senators and 15 nonpoliticians. This sets it up with five rep representatives that are political and only three that are not.

[00:14:34] And the difficulty with that is that then as the politics may change in this stage of one party or another takes over the state house or whatever you can have a dramatic change in the philosophy of this committee and you can't do regulation which needs to be a long term thing as people look to the future and what they're going to do. You can't do that and have it potentially change every two years. Granted it would take time because they make recommendations but that flipflopping is a problem and I think that was a concern I had it should have more people who are non-political that have that anchor and that consistency over time. So would that make you feel better. Yes go ahead. I don't think that you know I don't think you can call what we do random in terms of setting and establishing the standards per industry. I understand when you compare across industries it may look very odd. Well the tinkling sounds a little silly. I think you need to be in the room when folks who actually practice these trades explain what they are doing during those hours and why those hours are necessary. We don't simply arbitrarily you know accept what they say we we press them about you know what what what those hours are being geared toward. If I could just respond. Even the national body the national trade group for cosmetologists has recommended a thousand hours of training. New Hampshire still has 1200 hours. It really is sort of random based on who gets to the legislator and who makes their case more forcefully.

[00:16:05] Well let's hear from our listeners because I've heard from a lot of people even before the show began and again you can send us an e-mail exchange at NHPR exchange at NHPR. org or give us a call 1 800 8 9 2 6 4 7 7 and Jean's calling in from Keene. Hi Jean you're on the air welcome. Hi. Thank you so much for taking my call. Sure. I I really appreciate a lot of the things that Representative Cilley. And I also understand I think clearly what 16 85 is trying to achieve. There's so much misinformation being used to create the good ideas that are supporting this bill. For example there is no such thing as a shampoo license in New Hampshire. We met for a great deal of time long before the Brady Bill was even approached to look at national trends to see that rating was something that we needed to look at as a board. I am on the board of Barbering intelligent aesthetics and also a school owner shampooing there is no license. Also it is a 25 dollar fee to register in the state of New Hampshire as an apprentice. No idea where a hundred ninety three dollars came from. But there's a lot of misinformation. And as a board we sit down as experts and objectively look at what is in the best interests of the public health and safety. And it has been done for a long long long time and there is no reason to redo this process with people that have no idea what we do in the time that we're educating our apprentices.

[00:17:50] There are states that have 20 300 hours a thousand hours is typically the lowest of any in the country for cosmetology. Fifteen hundred in New Hampshire is about the average. Okay so Jean as a school owner feeling pretty good about the licensor the process where it stands. Thank you for calling in. We'll pick up on some of the points you made Jean after short break and keep taking your calls 1 800 8 9 2 6 4 7 7. Email exchange at NHPR dot org. You can respond on Facebook or Twitter. It's NHPR exchange. More on occupational licensing in New Hampshire in just a moment. This is the exchange on NHPR I want to know why it is that people suggest telling your congressional representatives how you feel about the issues. Does it make a difference. Who can answer the burning questions about government operations. Where is this system outdated. Current democracy system what is a filibuster and what purpose does it serve in the government who can help us leave these Gordian knot. No one subscribe now wherever you get your podcasts. Thank you. This is the exchange I'm Laura Knoy. Today we're looking at occupational licensing in New Hampshire and calls for reforming the process. There have long been complaints that the state's extensive training and certification requirements for some fields have led to workforce shortages and difficulty for people trying to break into those fields. We're looking at that and at a new House bill that urges a less restrictive approach. Let's hear from you. 1 800 89 2 6 4 7 7. Send us an email exchange at NHPR dot org. Again 1 800 8 9 2 6 4 7 7.

[00:20:04] And Representative Cilly, Ohm and Knirk. Drew Cline we heard but just before the break from someone who runs a beauty school in Keene and represented real quick to you. Were there some points that our caller Jeanne made that resonate with you as the sponsor of this bill. Yeah I think so thank you. First of all the board of Barbering in Tulsa had required that chimp systems are no longer licensed as has been progress in that direction. Students appreciate the work that they've been doing to deregulate their profession. There are still a feeder nurseries. Well it makes me wonder though does that what you said. Represent support represent sillies approach which is don't do this blanket reform. Look at these piece by piece. Yeah I think so but there's so many pieces that blanket reform that I think we need to have a group that's dedicated to look at all the regulations we have and all the professions and make sure we got it right. Go ahead silly. But again I would say that that is the purview of the Edye and eight committees in both the House and the Senate and the Jelbart The Joint Legislative Committee on Administrative Rules that is that this is a this is an expansion of government. The legislators on this commission will get mileage. So we are adding costs and we are adding layers of bureaucracy to this system. I just on. I hear this argument a lot it's not a bureaucracy it's a legislative commission. It's not another state agency. What it does is again the key to this bill whether you.

[00:21:31] However you structure the committee and I hear your point about not having enough non legislators on it. The key to this bill is the law that says it's the rebuttable presumption that the market is the best regulator. Once you get that into law however you structure this commission you have a process by which people are presumed to have a right to pursue a living and then anybody who wants to put a barrier that will prevent people from pursuing living make it harder or more expensive has to come to the state and make their case and then they have to prove to the state that there's reasonable justification for this that there is a known provable danger to the public. That is what this bill does. Without that you continue to have this piecemeal system where an industry can come to the legislature and petition to be regulated for the purpose of excluding competition for the S.O.P of regulating situation you can charge higher prices. Yeah go ahead . Yes thank you. I did want to comment on that issue about the marketplace. Again I have perhaps a biased view being a physician but most people decide they like the doctor because they're a nice person and they don't really have a sense of what their qualifications are just for kicks. Last night I Googled myself to find out what's there and all these evaluations. I haven't even been in practice for two years. I'm still listed as being in practice in all these places and there's not a whole lot there. Even though I was in practice in this particular locale up in Conway for nine years.

[00:23:05] So the the problem too is we all know that it's very easy to wreck a reputation of something by doing much of negative posts or build it up by doing a much positive post. So social media I don't think works very well and in terms of marketplace and that we're getting out somebody is not so good. What are the arguments that's made in this bill is having insurance as a means of protection problem that if you have a medical malpractice insurance. First of all lawsuits take an average of five years to resolve. That's a very long time for them to continue. Secondly many lawsuits are because of incompetent practice but just because they didn't get along well with their doc and had a bad complication. And I had a situation once I used to do a little bit of reviewing for Risk Management Foundation for the Harvard programs. And I one time was reviewing a case where a person was doing a really bad operation poorly and getting bad outcomes. And what happened is what I called the attorney the defense attorney. I need to talk to you about this case on Dr. So and so they said which case it turns out there were numerous cases and those would be grinding through for years so I called the Border Registration in Medicine he had voluntarily relinquished his right to do that surgery or surgery period I should say. But nevertheless if we said let's just rely on the market to do this and the insurance that's going to take a long time that I don't think that's what this bill does and said the beauty of Bill is it doesn't eliminate licensure.

[00:24:26] It just says to require a license you have to prove that there is a public safety or health interests. I don't think anybody prove that actually I'm curious about that because the Obama report says you know urges states to assess quote whether the education and training required is commensurate with protecting public interest. So that's sort of what you're talking about. True and that sounds good but it does seem subjective. How do you objectively decide that this level of training this number of hours this kind of certification is needed to protect the public but this is not it seems very early. It's a judgment call everybody wants to jump in on this represent a silly will because I see it all the time before the executive departments administration and that is where I have spent my legislative time in all the time that I've served the committee I've served on so I have never seen a group come before that body and ask to be licensed who hasn't presented a compelling case about what the harms are. That is one of the first things they describe about what harm to the public can occur without license. So give us an example. So we had radiological tests that we licensed last year and and they explained the the need for clear standards with the application of you know radiographs where they do x rays and so on. And Representative Knirk can speak to this one far more than I can because Medically it's difficult to follow this but that was that was the foot they put forward in asking for licensure.

[00:26:02] So Drew go ahead I want to hear from you on this so how do you make that judgment that this amount is needed to protect public health and safety and that is a judgment call and just to get to represent a point. I mean this is exactly the problem with the current system we have cosmetologists came in and said Oh absolutely this is a major health problem we burn people scalps and so forth and the state granted them 1300 hour minimum requirement of training their own national body says that 1000 is essential. 8000 is all that's necessary. We require 500 more hours to become a cosmonaut than the national body requires. Right. That that is how they. So they come in and make this case. Sure they're making these claims but in 16 85 it says they have to be provable. And we have to ratchet them down to the minimum level that would make sense. So for example there are a lot of occupations in New Hampshire that we do license that Massachusetts and Vermont don't. So taxidermy requires a license in New Hampshire. I believe it doesn't. And in Massachusetts there is no public health or safety rationale for licensing taxidermists. But they came to the state and they got a license under 16 85. If they wanted that they would have to prove rather than just suggest that there's a public health or safety as it is a bit of a judgment call. That's why you have the hearings. And that is in place in 16 85. Well lots of people want to jump in on this as I suspected that they would so let's go back to our listeners and Joan is calling in from Amherst. Hi Joan you're on the exchange welcome. Good morning. Morning Go ahead Joan.

[00:27:30] I'm calling you and I am the executive director of the New Hampshire Nurses Association and we oppose 16 85 because we feel that you know it's the profession particularly in the health care profession.  Public Safety is tantamount. That the professionals in the profession should be determining what sort of morals and regulations govern that profession. And I know that it's unlikely registered nurses are a target however of this kind of legislation but licensed nursing assistant. According to the Occupational Licensing Group are one of the targeted professions yet licensed nurses who often work in the home of individuals and in care for people who are particularly at risk and therefore it's really important that the appropriate precautions be taken in allowing this kind of individual to participate in the profession. So you think that the current system is working pretty well Joan protecting people who are going into vulnerable people's homes. Absolutely. I recognize that there are a work order at work. Workforce issues involved in going through this crisis but nonetheless it's important that we safeguard individuals. You know I know from personal experience when my father was quite elderly and frail we had homecare workers come in and we insisted that these be licensed homecare workers it was in a different state where he left because we wanted to make sure that he was being protected on time because that really wasn't there on a day to day basis and to make sure that that his his and his safety was taken care of. OK Joan thank you for calling and represent.

[00:29:26] I don't think you're talking about getting rid of licensing completely for nurses and other occupations but just looking at what's in place and whether that needs to change. You know very true. The medical profession clearly deals with public health and safety and that gentleman needs to be licensed. But we're talking about here in this bill is the lower level professions people who do not something directly involved with health and safety. But something like animal trainers or drilling water wells or do in makeup do have to have a license for that type of occupation or can that be done through a less restrictive set of rules such as certification or simply registration in that profession. So people would still be certified but they wouldn't have this extra level of licensure. Yeah like on the state yeah the licenses a restriction that you can't perform that profession a certification said you can't perform it but you better have some recognition by your profession. OK so here's an e-mail from Nancy who says How about the fact that a master plumber can't install a new pump without a separate pump license. This puts the homeowner at a great disadvantage. While we look for a different professional to do the job represent silly seems like a master plumber should be able to do just about anything. There are issues I would never argue that we shouldn't be looking at this topic so my hairdresser's said you know the Solanas license she's licensed why does she need an additional Buth license. Absolutely. We should be looking at those things but I would point out when Representative Olm said you know there are certain professions that shouldn't be looked at this bill is being driven nationally. It's supported by the administration.

[00:31:03] During the hearing on this bill they flew in somebody from the Department of Labor. They also brought in somebody for the Justice Institute for Justice which is an extreme libertarian group. I pressed that individual about you know what licensure his organization would support in any way. No you'd think that brain surgery might have come up. They could not answer the question. There is no licensure that I can see that they support. So this is this is being addressed nationally. It was pressed by the Obama administration too by the way there is no such thing as a separate brain surgeon license you get a medical degree. Period. Basic medical degree. You can do brain surgery general practitioner. There's no additional license for brain surgery but for nursing for example there is a trend now to require all nurses in this passed in the house for school nurses to have to have a bachelor's degree. So a lot of small towns in New Hampshire that need a school nurse they could get a nurse that had an associate's degree. Now they can't. This is the kind of ratcheting up that happens when the state sets these barriers and it prevents people from from finding work. And it makes it harder for people to get employed it makes it harder for people to find employees. We have a major problem in New Hampshire right now with 15000 unfilled jobs in New Hampshire. And when you ratchet up these licenses in unnecessary ways you know just throwing on additional things to keep people out.

[00:32:26] You're creating massive problems in the economy well and since we're talking about health care I should turn to you Rep. Knirk again as a retired physician. Sure the. That's why I still have this concern about how broad the mandate is for this commission because for example this idea of the fact that there's a presumption of that market competition or private amateur's are sufficient and that's stated in the bill. And it goes on with for example saying if the need is protect the consumer against damage due to failure to meet standards should be bonded. And if it has to do with imbalance of knowledge or better yet to take a fly by night they ought to be registered. And my concern with that is that that's not really going to be a sufficient thing for the fields of medicine by any means but this gives the authority that one could make those changes because the difficulty is this says we ought to have insurance. OK. So that means that you lose your wife to some incompetent physician. Don't worry it's too bad but you can always sue and get some money. Well I think you ought to stop that person from doing bad practices. I don't think anybody's saying we should have doctors who have no no credentials whatsoever. I mean is the way that it's worded it kind of allows that the commission could do that if they chose to do so which bothers you but only if the profession can't prove that's the key. Like the profession has to prove there's a health or safety I think doctors are perfectly fine there. Well from cosmetologists and and people who run beauty schools to plumbers from our e-mail. We heard from a nurse and Joan.

[00:34:06] Here's an email from Don who says electrical engineers should be able to get a master electrician license with a much shorter field experience period and pass a field test. And Don also says EMTs with the extra training should be able to give medication just like an LPN. So there's Don jumping in on two other professions where he feels like it's a little overboard. Got a couple e-mails folks from people who are very concerned about the shortage of mental health counselors and substance abuse counselors. And in fact we've heard from so many people on this. So here's let's start off we've got a lot of e-mails on this topic here's one from Lori who says I'm a licensed independent social worker in New Hampshire. I work at community mental health. I have colleagues who have joined us from other states. The license they have isn't recognized by New Hampshire. So they have to go through a rigorous process that takes about two years. Lori says I think New Hampshire should recognize licenses from out of state a couple of the people who make that same point. What about reciprocity Rep. Knirk, you first. Yes because I've had personal experience with that. I practiced with a license in Massachusetts for nearly 30 years with unblemished license. And when I moved here about in 2007 just 120 miles. It was like I came from a different planet because I had to go through a process with a credential verification that lasted two to three months there with the board the less than a couple of months. I started this in April. And you can't get your credentialing for insurance until after you have your license in October.

[00:35:36] Still didn't have some of these credentials. So reciprocity sounds good to us personally. Sounds good that we would need some safeguards to make sure we're not having reciprocity with the state who has low standards. But I think that one could certainly develop a system but I wouldn't foresee as we should have a national standard really for example we have national standards for certification as we commented for any physician could do brain surgery but they wouldn't normally unless there were a board certified neurosurgeon. But that's a national certification. It's only a certification is not a license but the standards can be set nationally because to do that is the same whether you're in Alabama or New Hampshire. Does your bill talk about reciprocity. I've heard this from a lot of people I practice for 20 30 years in Vermont or Maine or Massachusetts I come to New Hampshire and they say that's not good enough. It doesn't really address for us. That's the topic. This bill is really the purpose of getting lower entry jobs without a lot of restrictions. A lot of our talks has been about the medical profession but certainly the intent of the bill here of this bill is to look at the lower level Crescence folks who are struggling and want to get a job without having to go through four years of college and how do we make that easier for those folks. What do you think about that. First Knirk and then other folks too. Just in terms of reciprocity there is a bill that's going through the Senate.

[00:36:54] SB 333 334 that allows a temporary licensure of 120 days when somebody comes which is actually a good start. But in my experience would not have even been enough time to get relicensed. But I think still either reciprocity or better yet a simple national licensing whether you might still have a hybrid system where the states would take care of the discipline in the rulemaking could be reasonable. But the whole concept of what you need to be credentialed should be a national thing and get rid of the states doing it. So and we find many of the professionals the nurses I think are the most aggressive and advanced in this regard are forming compact which is reciprocity but it covers a certain number of states and they can all join if they'd like. And those folks set the standard for that compact. So it be like a New England nursing compact anybody. All the way out to the Midwest I believe. OK. And if you meet the standards then in New York you meet the standards in New Hampshire. Well thank you for the question Laurie because reciprocity is a big deal. We'll take more of your e-mails in just a moment. Exchange NHPR dot org will give us a call 1 800 8 9 2 6 4 7 7 this is the exchange I'm Laura Knoy. Tomorrow on our show the author of a new book on the brain science behind raising resilient and independent kids. That's tomorrow on the exchange. This hour we're looking at professional licensing here in New Hampshire and whether the process needs to be reformed. There have long been complaints that the state's extensive training and certification requirements for some fields have led to workforce shortages.

[00:38:54] We're looking at a House passed bill that aims for a less restrictive approach and some of the issues around it. Let's hear from you. We've heard from lots of people in different occupations around this state. We encourage your e-mails exchange at NHPR dot org. Your calls at 1 800 8 9 2 6 4 7 7 or respond on Facebook or Twitter. AtNHPR exchange and all of you here's a comment on Facebook from Philip who says many towns in New Hampshire don't require building permits and some don't have building inspectors. Phillips says I think New Hampshire is lacking in requiring licensure for contractors. New Hampshire does require less than ster for plumbers electricians gas technicians. But oftentimes there are no licensed trade people working on structural issues drainage plane issues and other life safety issues addressed by building codes. Other states do require licensure for contractors and represent to you first a whole program on this. A couple of years ago. Because it does seem like there's some questions around building contractors and how extensive their licensing is. I wonder what you think that's a very good point. Back to the premise of the bill to have somebody if was to be a roofer to have to get a license from the state to be a roofer or can I just get a apprentice program with the contractor learn the profession and join that contract and be certified and be certified. Right. So it's not like you're going out there with zero credentials at all you've got that certification but it's not that extra level. You jump in Rep. Cilley.

[00:40:20] No I just I think I was making the comment during the break that the executive departments and ministration committee goes over these standards very very carefully with each group that comes in and says this is what we'd like to do. The other issue that I have with this bill is the fact that and again I think it comes from the rebuttable presumption and then there's more language in there but you have to show harm. It does not ask to have a demonstration of who's harmed that's been prevented. I mean there's there's this assumption that you know you have to demonstrate somebody has been harmed. You can't within the context of the bill you can't show that there were that there's there's prevention of harm and I want not be implying that again. I think that would be allowed. I think if you just as I read the bill I don't think you have to say look here's a news story that shows somebody being harmed. I think you just has to be approvable rather than theoretical. Who wants to be that first person who puts the bad review up on social media. You don't want to be that person you're saying put the licensor in place so that that person doesn't get into the profession in the first place. Is that what you're saying represent.

[00:41:30] I mean listen I don't disagree that what the studies show is that when you put licensure in place practitioners there's a decrease in practitioners in that field but there's an increase in compensation which I do not think is a bad thing but it is a bad thing and here's why there's a decrease in compensation for unlicenced so it is the Obama administration correctly pointed out it creates more inequality in New Hampshire everywhere. So when when you so if you license suddenly paralegals everybody who is a paralegal with a license would make more money. But those people who are paralegals who are certified without a license would make less money. So if you put in the extra time if you have the resources and time to devote to going to extra school you're gonna make more money if you don't you're going make less money and that creates inequities and I think that's a really terrible outcome of licensing. Then I think we should be putting our our emphasis on training people to get into these professions and more towards education rather than lowering the standards. Let's take another call. This is Gayle in Wolfeboro. Hi Gayle you're on the air. Thanks for calling in Hi thanks for taking my call. Sure. Go ahead. So my my question is mostly about the the process of licensor itself. So this would apply to any category as a licensed professional in New Hampshire. I know that the licensing process precludes those that have credentials but have committed a crime that would endanger their potential clients. So how does the regulation protect the public from that reality and what license profession are you and Gayle that massage therapists. Okay so sounds like what you're saying is you want some public protection so that people aren't put in sketchy situations. Exactly.

[00:43:20] So what is your potential client have to fall back on what would they be required to do a background check on every professional that has now been regulated or how would they do that. Make sure that they're getting a sync service. OK. Gail thanks for the call and we keep getting back to this representative. All right people some people are calling in or sending us e-mails saying well it's way too strict and people should be able to do this at a lower level of these many many hours required but some people are saying you've got to protect the public especially nursing in-home care massage therapy and so forth. Absolutely. And we have licensing boards in place to provide that perfect protection. But I like to talk about the case where a person has committed a crime has paid dues back to society and now wishes to re-enter the workforce in a responsible way. And sometimes the professions are very restrictive on re-entering the workforce. For example you want to have a drug person get into a pharmacy as a licensed pharmacy technician. However there are patients that they might qualify for having done their time and paid their dues to society. And what the bill does is provide a hearing process before the licensing board to see whether this person would be qualified if they got the training to enter the profession and become a productive member of society. Well it's interesting that you say that represent because I saw that in your bill and in the Obama administration review two or three years ago again extensive review encouraging states to look at this. They also spent a lot of time and attention on people with criminal records and how they should be treated. Why is that Drew.

[00:45:01] Cline. Well this is an example of an area where libertarians and liberals agree if you get out of prison. So a lot of these licensing laws simply have good character provision which means you can't have any conviction at all. Some of them have a felony conviction. What that does is it punishes people for making a mistake early in life and it prevents them from ever working in a licensed occupation. And that's not right. It creates massive social problems if you get out of prison. I mean re-entry into the workforce is one of the ways you prevent recidivism. So if we are licensing as senators who are represented so we said we'd 30 some percent now of occupations or license and this is growing out of prison 30 percent of occupations are off limits to you. Right depending on your crime. So we've all seen limits. You know Jean Valjean should be able to get a job as a landscape architect right. Maybe maybe not. You know in certain fields but there are some that you would want to have him get a job in. We have to look at that and that's a process where this bill would take that into account and say OK well you can't do a blanket no convictions but there may be certain crimes that you want to weed out because nobody wants a sex offender working at a preschool. This is this is really you know precipitous because more timely I should say because we just heard a bill before the executive departments Administration Committee about nurses nurses are on the frontlines of the opioid epidemic. They are one of the most vulnerable groups that we have.

[00:46:29] So there have been nurses who have succumbed to the temptation of drugs and now they're going through rehabilitation. Typically you're quite right they'd be barred from the profession but the nurses association wants and board wants these people back in. They want to rehabilitate them. It's got to be very very carefully done. You do not put a nurse that's still dealing with the temptation into somebody's private home with access to a lot of drugs so I mean we did go down very thoroughly through that bill and managed to you know to come to some kind of an accommodation. Well here's an e-mail from Emily who says please ask the panelists for their views on the particularly heavy burden shouldered by persons in recovery seeking employment in licensed professions. For example Emily says while New Hampshire Employment Security and HHS has identified nursing assistance medical assistance and hairdressers as three other professions will experience the which will experience the most openings in New Hampshire during the period from 2014 to 2024. Emily says persons who have felony convictions. An unfortunate but frequent consequence of untreated substance misuse may be unable to join their ranks. So there's Emily talking about that issue. Is there some bipartisan agreement on this what do you think Representative Canarc I think. I think it's going to be good to look at it. I think that's a good part about this bill. I think that we don't want it is a real problem with Drew made a very important point that recidivism is lessened by getting people back in the community and actually working and you've got to get a job. And if a lot of occupations are closed to them it's not so good.

[00:48:04] A fair number of people do are in recovery and can be actually very good. Is peer support people that magic be able to go on at the very good lead that counselor and so on. And it is silly to block them out of those things. All right let's take another call. This is and. Hi John glad you're on the air welcome. Hi this is John Hunt a state representative. In fact the chairman of the House Commerce Committee and Hi everybody. I know everybody there so I have a rule like that you know and it's called the rule of licensure and the purpose of licensure is not to really show anybody that you're competent because you are not to take to get a license. The rules licensure is that the reason we give out licensure is so that when you do harm or you do something bad you take your license away where there are no tests to get a license. Aren't there many many hours of schooling and and so forth. Well your only test you know is the state has no test which I know we don't know. And we're very open about licensure in terms of you know pretty much almost every profession. You know you're in it even I do liquor laws you know. Some states restrict who can get a liquor license. We will let anybody get a license. But the only thing we're carrying about is that when you do harm or you do something wrong that we can take it away from you. So I'm glad you called in.

[00:49:32] What do you think about this bill then from Representative Ohm to establish a commission to look at the process of how we license the thought that are a lot of our licensing is burdensome. What do you think about that. I think it's a wonderful idea and it wasn't so long ago that I think represent MacGuire had a bill and McGuire had a bill in to try to try to remove licensure but you can't because every single license your husband has somebody who's got their license who has an investment has been has been maintaining it and feels like now they say it's theirs and they want to keep it. OK you know let me out into the club because it's good for you to call in and I can see a lot of people want to jump in. So hold on a second if you could please go ahead Rep. Cilley. I think I think Representative Hunt is mixing apples with oranges. I think he's talking about a certain type. He talked about liquor licensing right to you know to be able to care. We're talking about occupational licensing and I can hardly think of an occupation that doesn't have you know an exam it doesn't have standards that you have to demonstrate. That's just John you're a little off on that. There are a few that have no test but you're right. Most of them do. OK. Thank you for calling in we appreciate it. Let's go to Bow where Brandy is waiting. Hi Brandy you're on the air welcome. Hi. Thank you. I'm calling to chair the medical imaging professionals Board in New Hampshire.

[00:50:54] And you know we've had many conversations about this bill and we do think that there is a place for it but we do feel that the wording is really quite vague. I know that there's no intention to take away imaging or take away licensure for those that are practicing in the medical field. But unfortunately the wording for this bill doesn't really come out and say that it's pretty vague. So what would you like to see in it Brandy instead. You know I think that it needs to be more specific and if we can table the bill and come back with something that's more specific and that actually sits upon you know what areas they're really looking to either do away with licensure or have a second look at it. I think that it would be more of a common ground and I think that it would actually gain some more support. OK Randi thanks. Oh sorry go ahead. No no that's that's fine. You know we feel that this right now the way it is presented them in a way it's worded isn't really feasible and I think that it's going to leave a lot for interpretation. OK. Thank you for the call. Brandy Richardson you first. Go ahead. Know I just want to point out that this is a research project to look at the topic of whether a license is appropriate or not and if there are some concerns we'd bring that to the committees that would have the oversight to set policy through. Go ahead.

[00:52:12] Well I just going to make the point that the beauty of this bill is that it doesn't do what she wants her to do it does not single out occupations and say we're targeting these to remove the licenses. It doesn't. It simply applies a process to all license occupations or occupations that people might come and ask to be licensed. So it's not it doesn't single anyone out and say we're going to take these licenses away and it doesn't even ultimately have to result in licenses coming away just simply says if you want it to be licensed you have to show that there's a need for to be licensed to have some. And I want to look at some of the specific language of the bill in light of those two comments because. And in the legislature we make a big deal out of do we put may in in in the piece of legislation that we've put show this is all shell. So the Commission shall review occupational laws shall decide regulatory schemes that should be reformed develop a show develop a mechanism for mandatory disclosure to consumers and practitioners chosen not to be licensed. It goes down through all of these shells. So it's not even clear to me within our scheme of laws how that would how that would work but it definitely this is not. This is not just research but essentially it says and correct me if I'm wrong. It says the committee shall review. It doesn't say the committee shall change shall develop a mechanism for mandatory disclosure to provide a mechanism for enforcement if disclosure to consumers is not properly made by a licensed practitioner.

[00:53:39] The other thing that is particularly unnerving to me is this bill goes goes into effect July 1 2018 and then if you look at the language of the bill on page 5 beginning on July 1 2018 the Commission shall report annually the findings of the reviews to the speaker of the house. There is in the feeling of this bill in the language constructed here that they're coming from a predisposition toward licensing and there are things that appear to be foregone conclusion. I will review is OK but you're a little suspicious of where they're where they're going with this. The motives. Absolutely. And as I said it comes right out of some of the you know the furtherest right think tanks in the country Alec and the Institute for Justice are using using arguments that the Obama administration promoted. I mean this is not a right wing Bill. The showers that you highlighted are shall create a process shall create a process shall do a review. That's what the bill is about. It doesn't say shall take away a license. It's just creating a process that this commission will review the licensing credential requirements. That's what it does and they may and then they make recommendations to the legislature. So nothing in this committee will remove a license. It's still up to the legislature. It'll still go for your committee. It still goes through the whole legislative process to change the licenses. What about the issue of reciprocity where there seemed to be some agreement that we need to look at this reciprocity maybe make it a little easier for practitioners in Vermont or Massachusetts to come to New Hampshire and work. Representative Knirk are you hopeful on that score. Yes.

[00:55:20] Well I'm not sure if I'm hopeful but I would hope that it would make progress because I also serve on the commission for involuntary commitment. We're looking at the mental health system and indeed workforce and recruitment is a big problem. So if we offer somebody a job but they're going to have months before they can get licensed to be able to do that job and there's some other place they can go where even their own state we're not going to get them. So I think the Senate bill 334 is a good start is the reciprocity. That's the short term and I think we need to develop a better system for reciprocity to be able to recruit well. All right all of you. Thank you very much for coming in. I really appreciate you calling. Good to see you. Good to see you. Drew Cline interim director of the Josiah Bartlett Center for Public Policy. Representative Tom thank you for coming in. Thank you. That's Bill Omh. He's a Republican representative from Nashua. Lead sponsor the bill we talked about HB sixteen eighty five. And Jerry Knirk thank you for making the trip. Thank you. That's Representative Knirk. He's a Democrat from Freedom. And Jackie Cilley. good to see you. Nice to see you. And that's Jackie Cilley,  Democratic state rep from Barrington. This is the exchange on NHPR. the views expressed in this program are those of the individuals and not those of NHPR or its board of trustees or its underwriters. If you liked what you heard spread the word. Give us a review on Apple podcasts to help other listeners find us. And thanks.