Contingency and circumstance in history

Anyone with even a passing interest in history recognizes that contingency and circumstance are every bit the featured players in our unfolding human comedy.

My recent tweets (@davearlingtontx) bring to mind the role played by these forces. I have worked for the Federation of State Medical Boards (FSMB) just shy of twenty years. The organization represents an important player in the medical regulatory landscape though atypically its main offices are not in Washington DC or Chicago or Philadelphia like so main key groups and sister organizations. Instead, our main offices are just outside the Dallas-Fort Worth airport in Texas. Many times over the years, a colleague has asked me: “How did the Federation end up in Texas?”

The answer is an illustration of the role played by contingency and circumstance in the history of one organization. Founded in 1912, the FSMB functioned more like a “virtual” organization during its first half century. Lacking paid full-time staff and a permanent national office, the organization’s roots rested in Iowa with its long time Secretary-Treasurer Walter Bierring and a long line of elected presidents each serving a one-year term of office as head of the FSMB’s board of directors.

The arrangement worked well enough provided no one expected too much from the organization’s volunteer leadership and its shoe string budget. That changed by the early 1960s as perspectives on the role of medical boards began to shift along with the regulatory environment and the expectations for FSMB.

Historically, medical boards had long prioritized examining and licensing as their major functions. Discipline seemed a less critical function—and one that, when undertaken, focused more on maintaining professional boundaries, i.e., running off unlicensed practitioners, pushing back against other practitioners (particularly midwives, chiropractors and even osteopathic physicians in the first quarter of the 20th century).

By the early 1960s, this prioritization had shifted. The AMA’s Discipline Committee released a report underscoring the “veil of secrecy” shielding incompetent physicians and those engaged in unprofessional behavior. Even an internal survey conducted by the FSMB underscored how little the state medical boards seemed to value this basic component of their regulatory functions. Discipline may have once seemed like the red-headed stepchild of medical board priorities but as the 1960s unfolded this posture weakened.

As the winds of change altered the regulatory landscape and sentiments shifted on professional accountability, the FSMB and AMA commenced a series of meetings in 1961 that culminated in an offer too good for the FSMB to refuse. The AMA offered a $10,000 grant carrying two major stipulations. FSMB must (1) establish a permanent national office, and (2) create a data base of disciplinary actions taken by state medical boards. Both organizations saw this as a critical development to undercut the persistent historical problem of disciplinary ‘hide and seek’ carried on by rogue physicians bolting from one state to another just ahead, or in advance of, state board action; and with it the inadequate communication of these actions between boards.

So why did Texas become home for the Federation? The Secretary of the FSMB board of directors at that time, Dr. McKinley Crabb, resided in Fort Worth.

1955-president-mh-crabb    Crabb also served as Secretary of the Texas Medical Board—a position he held since 1941. In 1962, the Texas Medical Board also maintained office space in that city’s Medical Arts Building along with its main offices in Austin. Crabb and FSMB President Louis Jones had served as the primary negotiators with the AMA to secure financial support for an FSMB central office.

FSMB 1st offices in old med arts bld in Ft Worth


Thus, circumstances aligned. Discipline slowly began to acquire its greater emphasis; FSMB represented a logical host for a national disciplinary data base; a Fort Worth physician (Crabb) played a key role in the negotiations; the Texas board had office space, etc. Of course, it is just as likely that FSMB could have ended up someplace else as officers and members of the organization’s board came from all over the country: California, Idaho, Louisiana, New Mexico, Oregon, South Carolina. All of these men had personal and professional connections to the respective medical boards in their state. The FSMB could just have easily been headquartered in New Orleans or Charleston or Albuquerque if a medical board in one of those states had an even stronger desire to host the organization.

In brief, there was no grand design or master plan behind the organization’s headquartering…just contingency and circumstance, the usual unsung but featured players in human history.

(The thoughts expressed here are those of the author and do not represent the FSMB.)

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