Dental hygienist Sarah Smith has skills that North Carolina needs. The state reports 55 available workers for every 100 open jobs, and the labor shortage extends to dental care. Yet regulators rejected her credentials when she applied for permission to earn an honest living.
The reason had nothing to do with Smith’s qualifications. She attended a dental hygiene program in 2017, graduated with honors, and became licensed as a dental hygienist in Idaho and then Tennessee. She has five years of experience and glowing recommendations from former employers and colleagues.
Normally, this would be enough for recognition of out-of-state credentials. Yet the North Carolina State Board of Dental Examiners demanded more. A rejection letter on Feb. 22, 2024, told Smith she is ineligible for licensure by credential due to nonviolent crimes she committed long ago.
In a former period of her life — before she went to dental hygiene school — Smith struggled with addiction and was a victim of domestic violence. Courts convicted her of felony drug possession in 2014 and two misdemeanor drug possessions in 2015.
After spending 30 days in jail, Smith turned her life around. She checked into a rehab program, got sober, and has lived clean for more than eight years. She poses no risk to North Carolina patients, especially considering that dental hygienists do not prescribe or have access to prescription drugs.
Regulators did not care. Based solely on Smith’s criminal history, they forced her to settle for a provisional license that will expire in one year. Smith can work, for now. But the license ties her to her current job, which will soon become part-time when a colleague returns from maternity leave.
If Smith wants full-time employment after that, she will have to apply for full licensure like a graduate fresh out of college. None of her experience will count. Among other requirements, she will have to pay $1,275 and pass a state-approved exam. The closest testing sites in the next three months are in Florida and Alabama, which means Smith would have to pay for travel.
Besides wasting money, the extra hurdles violate state law.
North Carolina passed reforms in 2019 that bar state boards from denying occupational licenses based on criminal history alone. People convicted of wrongdoing have a right to rejoin society after serving their time.
More generally, the US and North Carolina constitutions include due-process clauses that guarantee everyone’s right to earn an honest living. Yet people like Smith remain second-class citizens no matter what they do to turn their lives around.
This is not right. Our public interest law firm, the Institute for Justice, sent a letter to the State Board of Dental Examiners on May 28, 2024, calling for the immediate recognition of Smith’s credentials. The board reviewed the letter and invited Smith to reapply.
“If she chooses to do so, her application will be evaluated in light of current North Carolina statutes,” a board attorney wrote on June 12.
This is good news. But the case highlights a broader problem. Occupational licensing boards, charged with protecting health and safety, often go far beyond the scope of their mission and interfere in the labor market without a legitimate public purpose.
A criminal record is just one excuse. Licensing boards sometimes target people just to protect established interests from competition.
The North Carolina Board of Examiners for Engineers and Surveyors targeted drone operator Michael Jones when he challenged their monopoly on mapmaking in 2021. Property owners hire surveyors when they need official measurements for legal records like deeds. But Jones, who lives in Goldsboro, North Carolina, does something else: He uses aerial photographs to create annotated maps for unofficial purposes.
His clients understand the difference. But regulators insist Jones cannot work without a land-surveyor license. So far, the courts have agreed.
Thousands of North Carolinians face similar restrictions. Nearly 30% of US workers need a license to perform their duties, and the barriers to market entry can be onerous in North Carolina. Massage therapists in the state need 500 hours of training. Barbers need 1,528 hours. And American Sign Language interpreters need four years of college.
Even when state lawmakers reduce the burdens or enact special protections for workers, licensing boards cling to power. The result can be fewer workers, higher prices, and less consumer choice.