Fully 20%–25% of jobs in the United States now require a state-issued license, but the percentage is closer to 75% in the one-fifth of the US economy that is devoted to health care, according to a manuscript published in the April 2023 issue of the Journal of Health Politics, Policy & Law. Since a license is required for many occupations in health care, restrictions on applicants with criminal records can foreclose substantial employment. Also, to the extent that occupational licensing restrictions affecting allied health professions (AHPs) prevent workers from marginalized groups from securing better jobs and economic opportunities, they have the potential to entrench economic and racial inequality. Researchers examined how 12 representative states (California, Colorado, Connecticut, Delaware, Florida, Illinois, Missouri, New York, Ohio, Pennsylvania, South Dakota, and Texas) handle applicants with criminal records. The focus was on five entry-level AHPs (dental hygienist, occupational therapy assistant, physical therapy assistant, respiratory therapist, and radiologic technologist).
The data set covers 24% of the U.S. states and 50% of the U.S. population. All 12 states license four of the five AHPs (dental hygienist, occupational therapy assistant, physical therapy assistant, and respiratory therapist), and a majority of those states (8 of 12) license the fifth AHP (radiologic technologist). Every state requires consideration of whether an applicant for a license has a criminal record, and each state provides a list of categorical and discretionary exclusion criteria. About half the states limit the scope of discretionary exclusions to convictions that are related substantially to the scope of services in the AHP, but the other half do not have such restrictions. Only three of the 12 states prohibit their licensing boards from evaluating “moral character” when evaluating licensing applicants. A combination of dynamics seems likely to deter individuals with a criminal record from even considering entering an AHP. Because the likelihood of having a criminal record is not uniform across the population, excluding applicants with a criminal record seems likely to have a disparate impact across various subpopulations (principally race and gender) and has the potential to affect health equity.