Occupational and professional regulation is a process by which a government agency grants permission to individuals to engage in a specified occupation or profession upon finding that applicants have attained at least the minimal degree of competence required to ensure that the public’s health, safety, and welfare will be reasonably well protected.

-“Questions a Legislator Should Ask, Third Edition”

Government regulation serves to protect consumers. Regulatory agencies approach this work in many ways, including through compliance, discipline and enforcement, testing and examinations, entry to practice standards and continuing competence and regulatory agency administration.

Licensure is often the direct link to the workforce, but the U.S. has a patchwork quilt of licensing certification, registration and approaches to regulation that can create barriers for workforce entry. The number of professions that require licensure increases every year and can result in further challenges where demand is high, such as in highly regulated professions in health care or education, making it challenging for employers to fill workforce gaps.

As workforce shortages continue to increase worldwide — and particularly in health — including pharmacists, pharmacy technicians, mental health providers, medical assistants and other sectors, it is clear that no one group can address or “fix” the workforce issue alone, as it is an international conversation. There are many shared global issues that require thoughtful and meaningful dialogue across sectors and borders. These issues range from workforce mobility to remote education, training and examinations/proctoring and how regulators, credentialing organizations and examinations may use generative artificial intelligence (AI) and practice diversity, equity and inclusion (DEI). The challenges across these issues continue to be faced internationally, and with collaboration, the conversations likely will provide solutions.

Through the perspectives of two past presidents of the Council on Licensure, Enforcement and Regulation (CLEAR), this article will provide our insights into licensure, regulation, changes that have been made to address workforce shortages and how regulatory changes have and will continue to impact credentialing organizations and assessments.

Regulatory Shifts to Address Workforce Shortages

Significant changes have been made across many states in an attempt to influence regulatory and licensing decision-making and address workforce shortages. 

For example, license mobility has been a topic of hot discussion for many years, giving rise to an increasing number of licensing compacts, Universal Licensure Recognition and other approaches that will allow movement from state to state or even from country to country. In many states, military spouses are now easily able to move from state-to-state and can transfer their professional licenses.

Other approaches have focused on collaborative discussions to define and improve alternate pathways to licensure. Some professions have used an increased or expanded approach to apprenticeships to support a few main populations, including veterans, and foreign-trained professionals/immigrants/refugees. Veterans can have their education and training in the military evaluated for equivalency and can obtain licensure in certain states, saving repetitive education, money and time to serve the private sector. Foreign-trained professionals are also finding pathways to having their education evaluated and being able to work in other countries. Similarly, pathways for refugees who may not have access to their educational or experience documents are finding approaches to establish evidence of such training and education to enter professions. Examples include attestations from educational institutions in their countries, educational assessments, accessing organizations to support cultural differences and bridge pathways to establish adequate training and skills to enter the workforce without repeating the full education requirements.

Other states are also finding pathways to licensure in a variety of professions to support fair-chance licensure and to those with a criminal conviction to reenter the workforce as well as address labor shortages. Depending upon the profession or occupation, many individuals are able to be educated and trained while incarcerated, and then able to enter practice safely upon release with an emphasis on equity.

The COVID-19 pandemic had a significant impact on regulation, initially and critically in health care, and now across the entire global workforce. Workforce gaps were often filled during the pandemic by allowing professionals to practice to their highest training and education and resulted in expansions of scope and independent practice for nurses, physician assistants and other health care professionals, while maintaining the focus on ensuring entry-to-practice qualifications and continued competencies, supporting the economy and allowing access to care and services. For example, pharmacists and other healthcare professionals were able to administer vaccines, which had not been permitted prior to COVID, based upon their education and training but not within their traditional scope.

Regulatory Changes Impacting Credentialing Organizations 

With the broader perspective of regulation and regulatory changes and how those changes will influence the provision of and access to services, there is a clear connection to many of these changes impacting credentialing and assessment organizations. 

One example that highlights this connection is the increased demand for the provision of remote education, training and proctored examinations. While in large part these remotely proctored, high-stakes assessments were the result of the pandemic and the need to ensure competencies for a new workforce cohort, the effect is significant given the new expectations of candidates across professions and the technology that is now available. This type of event-based shift is an example of a need that was met during an emergency but now begs the question: Can we and should we go back to the way it was before?

Other changes that are giving rise to fast-paced evolution across the regulatory landscape include generative AI technology, remote workforce and DEI. While regulators have proven to be more flexible and nimbler in recent years, how consumers will be protected and how regulators will be able to keep pace with these important issues remains to be seen. These transformations will affect education, qualifications, assessments and may also lend to the provision of services to meet the needs of professionals, businesses, patients and consumers across the world.