In my last blog entry, I shared the page (below right) from the 1953 FSMB annual meeting program. I did so in order to spotlight the fact that discipline was such a minor concern of state medical boards that as a topic it appeared only once (1953) on the formal program of the Federation’s  annual meeting during the decade of the Fifties.

I think any member of a state medical board or its staff looking at this today would find this remarkable. After all, they understand all too well the extent to which the disciplinary role is a time, labor and resource intensive element of medical boards’ functioning.

So what was going on during the 1950s? Certainly physicians in those days were not demi-gods immune to human flaws and failures. I think a couple factors were at work.

Medical boards of that era still thought largely in terms of the primary function envisioned for them at the time of their creation in the late 19^th century—writing and developing an examination to assess physician knowledge prior to issuing a medical license.

Just how much priority and precedence did this aspect of medical boards’ activities take? It would be difficult to overstate the case.  Take this example. From 1906 to the mid-1960s, JAMA produced an annual issue featuring statistical data on the medical licensing examinations each year. (example below) Examinee counts, pass rates, licenses issued, statistical breakdowns by board, by medical school, etc. The list could go on for several paragraphs but my point is simple. Administering examinations and issuing licenses were the heart-n-soul of medical board activities in the 1950s. That is where they placed their greatest emphasis and focus.

So what does this mean about discipline? Here I will offer the opinions of a few medical regulators of the day.   Asked about the disciplinary role of state medical boards in 1952, the FSMB’s own president said, “The influence of professional organizations coupled with the desire for the respect of fellow practitioners is usually sufficient.” One regulator, when asked about his board’s budget for disciplinary investigations, explained that “none is needed” because “discipline is…of secondary importance.”

Admittedly, the plural of anecdote is not evidence. Yet statements like these from medical regulators of that era seem telling.

This is not to say that state medical boards had abandoned their disciplinary role entirely. While no definitive national data exists for this period, my own count of disciplinary actions published through the Federation Bulletin found approximately 1,800 actions taken by boards between 1950 and 1959. To put that in at least some type of context, in 2015 medical boards in the U.S. took 7,000 actions that year alone.

Ultimately, the problem of discipline in that era was attitudinal. The regulators themselves did not see discipline as a priority; in part, because they presumed others were tending to this. Specifically, the literature of the day underscores a dominant theme: the assumption that the profession would address—and if necessary remove—its outlier actors. Along with this was a bristly reaction to anyone outside the profession asking questions about problem physicians or questioning the efficacy of professional self-regulation.

To many retrospective observers, the Fifties ended in 1961 when America’s then-oldest president (Eisenhower) gave way to our youngest elected president (JFK). The quiet so often ascribed to the Fifties in popular culture was really more a matter of willfully overlooking some of the disquieting and disturbing issues that some preferred not to think about. The same might be said for medical regulation in the 1950s as a blithe professional attitude toward discipline soon gave way in the 1960s to a siren call: the medical profession and regulators had to clean up their act and make discipline a priority…or else.

The views expressed are those of the author and not the FSMB.

Sources:

See Chapter 6 of Johnson, Chaudhry. Medical Licensing and Discipline in America: A History of the Federation of State Medical Boards (Lexington Books, 2012)

Popular culture seems to enjoy looking back at the 1950s and characterizing it as this quiet but fun era that preceded a raucous psychedelic Sixties. That decade is often remembered as a period of sock hops, big cars with large fins fueled by cheap gas, suburbia, a grandfatherly President (Ike), I Love Lucy and early rock-n-roll. This selective nostalgia seemed to peak in the 1970s with Happy Days and American Graffiti; then sporadically resurfaced in films like Back to the Future.

Of course, pop culture is not history. It doesn’t aspire to be history and should never be mistaken for it. Popular culture seems selective in forgetting all those elements of the 1950s that were neither quiet nor fun. This same period witnessed the Civil Rights movement and the often violent responses it drew in places like Selma, Birmingham and Greensboro. Baby boomers have vivid memories of duck-n-cover drills at school and fallout shelters amidst our Cold War with the Soviet Union.

I’m sure there’s an apt metaphor for this juxtaposition of perception and reality… …pressure building and then released. Maybe it’s a tea kettle or the smooth surface of a pond hiding a tree stump just below the water line. In some ways, medical regulation in the 1950s mirrored this juxtaposition.

A sense of this disquiet despite the relative calm in medical regulation can be seen in a retrospective look at two documents from this period.

Pictured below is a page from the program of the 1953 annual meeting of the Federation of State Medical Boards (FSMB).

At first glance, there is nothing particularly remarkable about the document. The program contains much that we might expect to see: remarks from the organization’s president; committee nominations; program sessions on medical board discipline; etc.

Every year since 1913, state medical boards in this country convened as part of the annual meeting of the Federation of State Medical Boards. These yearly gatherings allowed members and staff from medical boards to discuss issues great and small relative to medical regulation.

Yet there is something truly remarkable about this page of the 1953 FSMB annual meeting program that only becomes obvious in retrospect. That year’s program marked the only time during the entire decade of the 1950s that medical boards’ disciplinary role and function were featured topics on the agenda of the FSMB annual meeting.

Thing about this for a moment. The single biggest area of medical board activities today warranted virtually no time on the agenda in 1953. Over a ten year period and as the only forum for a national gathering of medical regulators, discipline appeared on the formal agenda only once!

How should we interpret this? What does this suggest about how medical boards once regarded their disciplinary role?  To be perfectly honest, the evidence suggests that…

• Discipline represented a secondary function for medical regulators;
• medical boards seemed not particularly interested in carrying out this role and function; and
• medical boards once presumed that others (i.e., the profession through its local and state medical societies) were taking care of disciplinary matters.

How could this possibly be?

In my next blog post, I’ll share a second document from the 1950s that adds a little more context to our picture of medical regulation in the 1950s.

 

The views expressed are those of the author and not the FSMB.