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Arizona briefing spotlights licensure and workforce barriers as contributors to pediatric disparities
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Summary
A Goldwater Institute visiting fellow argued the state’s licensing and medical-education constraints reduce provider supply and diversity; panelists and committee members debated whether state-level scope-of-practice reforms could help narrow pediatric access gaps in rural and tribal areas.
Dr. Murray Feldstein, a visiting fellow at the Goldwater Institute, told the Arizona Advisory Committee to the U.S. Commission on Civil Rights that longstanding professional licensing practices and limited medical‑education capacity contribute to shortages of clinicians in underserved areas.
Feldstein said U.S. medical schools admit only a fraction of qualified applicants and that postgraduate training lengths, reimbursement incentives and scope-of-practice rules combine to favor specialists and more affluent applicants. "Twenty‑first‑century health care is regulated by a fourteenth‑century mentality," he said, arguing for stacked, competency‑based certifications and greater scope for nonphysician clinicians to perform tasks in communities that lack pediatric providers.
Committee members pressed Feldstein on direct links to pediatric disparities and on whether state statutes are the right lever for reform. Feldstein recommended state legislative changes to licensing statutes (he referenced an Arizona statutory citation in the discussion as quoted in the hearing) and cited examples where expanded pharmacist roles and federal facilities' flexibility increased access. Several committee members noted the Commission’s federal role and asked whether recommendations should be framed for state legislatures.
Feldstein acknowledged political barriers but described concrete approaches—credentialing reforms, expanded training pathways, and reciprocal licensing—that he said could increase provider diversity and availability in underserved communities. The committee discussed but did not adopt language for a formal recommendation; members asked staff to pursue further input from Indian Health Service representatives and state licensing entities.
