Regulation often does more to help regulated industries than to protect either consumers or the country at large.

Rules imposing costs on an entire industry can benefit large players at the expense of smaller businesses or new entrants.

Standards can work to block imports rather than protect consumers.

And it can be far too easy for regulation to turn a competitive industry into an unbreakable cartel.

Economist Bruce Yandle warns the really bad regulations come when one group can make a strong and sincere moral case for the regulations untainted by pecuniary interest, while another group profits from them. Yandle’s classic example: bootleggers and Baptists.

In some American states, Baptists worked to maintain a ban on Sunday alcohol sales. Nobody could accuse them of having venal motive. They wanted to save souls.

Bootleggers willing to sell alcohol illegally on Sundays profited by rules forcing their legal competitors to close one day a week. They could quietly grease any necessary wheels to keep the rules in place.

Baptists then unwittingly provided the moral veneer necessary for achieving rather less laudable purposes.

There are not a lot of cases where the ‘bootlegger’ is the ‘Baptist’. The Baptist’s lack of pecuniary interest in making the moral case for the regulation really matters.

But New Zealand’s medical professionals, like medical professionals elsewhere, have managed to pull off that difficult trick. Backed by the force of the state, they have engineered an impossible situation for foreign-trained doctors wishing to practice here.

And they have largely managed to convince us all that it is for our own good.

Here is how the trick works.

Imagine that you are a 50-year-old doctor with decades of experience, wanting to move to New Zealand and set up practice for the long term. You go to the Medical Council of New Zealand’s website. It provides a helpful flow-chart.

You did not graduate in New Zealand or Australia and you do not have a medical degree from the UK or Ireland, so tick those boxes. You have not previously been registered here – your career has been based elsewhere. You have never had an Australasian Fellowship, so you do not have an approved postgraduate qualification. Tick those boxes too.

You will be required to work under supervision.

If you are lucky, you are a general practitioner from Europe, Canada, the United States, or Singapore allowed to work under the supervision of another GP through the Comparable Health System pathway. You will have to find a General Practice office willing to serve as your supervisor.

If you are unlucky, you are not from one of those countries, or you are a specialist. General practitioners from other countries must pass the registration exam, then find a supervised position. Specialists must work under supervision for 6 to 18 months.

It all sounds like it makes sense and is designed to ensure that doctors are up to spec.

Except for one small detail.

There are effectively no positions available for foreign doctors to do the required supervised work in New Zealand hospitals.

Ripu Bhatia reported last week that at least a hundred and fifty foreign-trained doctors are in New Zealand right now and would like to help. Doctors who have passed their New Zealand exams and done everything they are supposed to do to be able to practice here are not able to do so.

The rules require that they work under supervision. But the system seems designed to throttle the number of doctors entering the system. Limited supervised slots are available and most are allocated to recent New Zealand medical graduates.

Specialists’ pathways are also fraught. The New Zealand Herald this month reported on a neurosurgeon, trained and endorsed by the President of the British Neurosurgical Society, whose specialist practice has been blocked by the Medical Council for no apparent good reason.

The rules, enforced by the state, work to enforce what is effectively a cartel.

It makes little sense at the best of times. During a pandemic surge, the rules hurt everyone – from those needing medical treatment, to GPs and specialists under incredible strain, and the doctors here who yearn to serve but who are barred from doing so.

In a better world, the Commerce Commission would launch a market study into medical services to see whether the rules really are, as I strongly suspect, mainly a cartel enforcement mechanism.

In this one, we have to wonder at what point New Zealand’s medical professionals will tell their Council that they would sooner have more colleagues to help share the load rather than continued protection from competition.

It is hard to get out of Bootlegger and Baptist scenarios. But rules blocking perfectly capable foreign doctors from helping during a pandemic have no moral virtue. And the impossible workloads now facing medical professionals mean they are not being helped by the rules either.

It may finally be time for change.