- Stifling innovation. Getting certified typically requires immersing yourself, sometimes for years, in established ways of doing things and thus discourages people who thrive on innovation.
- Shortages. Certifications result in exclusive "clubs" that prosper by keeping competition low. The "clubs" typically help define the certification requirements, and the members of the club have a vested interest in making the requirements stringent.
- Expense. With shortages come expense. When you restrict the supply of people providing a service, the cost of the service stays artificially high.
India requires certain training for doctors, but the number of years of training are significantly fewer than in the U.S.