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A few states have made meaningful efforts to lower the barriers to entry or to practice by explicitly allowing supervision that is not face-to-face, such as use of tele-health technologies or telephone. In some states, for some professions, a portion of the required supervision time can be obtained in a group format so that the time demand upon the supervisor is reduced. These efforts, in addition to the laws that permit “cross-discipline” supervision, could be particularly important accommodations for ensuring that practitioners who desire to practice in a rural area do not face sizeable barriers to obtaining necessary supervision.

Reducing Professional Competition

As indicated in our findings, evidence of the “guild environment” exists in current licensure laws. Licensed professions continue to seek limitations on the scopes of practice for other professions to protect their professional niche. When a profession seeks to secure exclusive rights to a specific practice, they must argue that other professions are not qualified in this area – an argument based on quality, often expressed as years of education. A profession may set extensive requirements for entry into the profession, such as many hours of supervised practice, or requiring a doctorate. Requiring that only members of the profession can supervise, or that a certain number of hours of supervision must be face-to-face, further establishes an explicit “gateway” into the profession, similar to an apprenticeship in a traditional guild. These strategies are rational means of protecting the market for a profession’s services in an environment where there are ample members of multiple professions competing for market share.

Guild behavior can help to define the philosophy and techniques of a profession in ways that are helpful to consumers in choosing a provider. Our brief histories of the professions and their historical approaches to mental health treatment (see Appendices) illustrate that there are some meaningful differences between them, differences that might be significant to both the practitioner and the consumer. If competition between the professions were solely on the basis of these philosophical differences, and if consumers were free to choose among the professions based on complete information, we would be less concerned about the potential impact of guild behavior on the supply of rural mental health workers.

From an access perspective the “guild environment,” or any other effort to limit professional supply, is of concern. These competitive behaviors have the unintended consequence of making it even more difficult to enter the profession in non-competitive markets where there are few or no practitioners. For example, it is more difficult to complete the required number of hours of supervised practice in a geographic area where there are fewer


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