Every year roughly 10-15% of all the members serving on state medical boards across the country complete their term of volunteer service and rotate off their board. As this group exits, a new set of board members enter. This diverse group of new board members includes physicians, allied health professionals and members of the public drawn from all walks of life.

To get these new members up-to-speed, every state medical board conducts some type of orientation training for its new members. Invariably, this training focuses on practical matters specific to that state and its medical board, e.g., relevant state law, state ethics policy, board administrative operations, etc.

This training also represents an opportunity for broader, contextual education. It’s appropriate to learn the ins and outs behind state law and board operations but foundational knowledge is important too. It’s not enough to know how the current regulatory system runs; it important to know why the system operates in the shape it does today.

Indulge me as I play Professor Johnson and share my reading list for newbies enrolling in “Medical Regulation 101.”

Origins of Medical Licensure

Our course starts with James Mohr’s Licensed to Practice: The Supreme Court Defines the American Medical Profession. Mohr analyzed the backstory and implications of the US Supreme Court decision in Dent v. West Virginia (1889) that cemented state prerogative to regulate the practice of medicine.

Mohr does a marvelous job telling his story and teasing out the leap of faith that the justices made to rationalize the broad discretionary authority bestowed upon the profession and, by extension, medical regulators.   As Mohr pointed out, this was a leap of faith well beyond what was easily justifiable by the existing science of that day.  Looking back, the Court’s decision was less inevitable that we might imagine today.

 

An Overview of Medical Regulation

Okay, if I wanted to be humble, I would direct you to a pair of short works dating from the late 1960s by Robert Derbyshire and Richard Shryock…but dating (or in this case, “dated”) is the operative word. These texts were excellent but are now so old as to be of limited value for regulators today.

Instead, I’m going to assign David Johnson & Humayun Chaudhry, Medical Licensing and Discipline in America: A History of the Federation of State Medical Boards.    Yes, I’m recommending my own book and yes, the title suggests an organizational history; but hear me out. This organizational story is nested within a broader narrative tracing multiple main threads in the evolution of the current state-based system of medical regulation. And it addresses everything that followed Derbyshire and Shryock. Trust me, this is a better one-stop option for gaining a sense of the big picture. 

Board Dynamics

So what’s it like to serve on a medical board? How do boards—or more specifically, board members—approach their role, especially in disciplining physicians? Here’s one answer. Take a professionally trained sociologist (Ruth Horowitz), place her as a public member on not one but two medical boards over the course of her career and you get this fantastic offering—In the Public Interest: Medical Licensing and the Disciplinary Process. This book should be shared with every new member to a state medical board—especially the public members. Her analysis is spot on and her recommendations apt.

 

 

Disciplinary Role of State Medical Boards

In terms of the disciplinary function of state medical boards, here’s your critical reading: State Medical Boards and the Politics of Public Protection by Carl Ameringer. This relatively slim volume explains the shift that occurred in medical boards’ philosophical approach to discipline beginning in the 1960s and gathering steam in the 1970s and 80s.

I don’t want to oversell the shift tin discipline and mindset that occurred. Our system isn’t perfect (see Milwaukee Journal Sentinel). But we are headed the right direction compared to the veiled secrecy that  previously characterized medical boards’ operations in the area of discipline.

Another Ameringer work (The Health Care Revolution: From Medical Monopoly to Market Competition) presents a treat for board attorneys or public members with legal background as it traces the important case law impacting medical regulation.

 

Medical Licensing Examinations

Finally, there is an important 2009 essay by Donald E. Melnick. See “Licensing Examinations in North America: Is External Audit Valuable?” in the journal, Medical Teacher. One thing you’ll soon discover on your medical board is that the boards long ago left the business of writing their own exams and ceded responsibility for assessing prospective licensees to national entities such as the National Board of Medical Examiners, the Federation of State Medical Boards and the National Board of Osteopathic Medical Examiners. That doesn’t mean you have no responsibility or obligation in this area as a medical regulator. Statutes in every state require you to assess prospective candidates knowledge before issuing a license. Dr. Melnick’s short essay makes a persuasive case for the continued value of the assessment role played by state medical boards.

There are other important works I could advocate for but…I’ll stop here. After all this is our introductory course, right? So…you have your reading assignment. Class dismissed.

The views expressed are those of the author and do not reflect those of the Federation of State Medical Boards.