Friday, July 30, 2010

Part 6: Regulation of Medical Practice and Schools in the United States.

On May 27, 2010, I posted a blog concerning medical training in the United States before the 20th Century. In that blog, I mentioned that as early as 1732, I found complaints about the lack of regulation and licensing of doctors. As I researched the history of medicine in the United States, I found that there was no overall regulation of the practice of medicine until the 20th Century.

There was very little regulation in the British North American colonies. Although regulatory powers traditionally were given to the legislatures of the provinces, it was the professional societies that initiated regulation of medical practices. The first organization of medical professionals was chartered July 23, 1766 in the Province of New Jersey. The New Jersey Medical Society was established to develop a code of ethics, fee schedules, education standards and regulation of medical practice.

When the United States Federal government was formed, regulatory powers for the most part remained in the hands of the states. The state of New York in 1806 legislated licensing but only for the purpose of allowing licensed medical practitioners to sue in court for the recovery of fees. Attempts by other states to regulate medicine were repealed because public sentiment bristled at the thought of government control. By the early 1800s, medical practice regulation was firmly in the hands of the medical societies and by 1850 only three states and the District of Columbia had licensing regulations.

One would think the fact that the medical societies had instituted licensing regulations was adequate. However, there were different types of medical practices that were recognized including homœopathy, allopathy, herbalism, etc. Each had its own medical societies and each medical society defined its own regulations and guidelines. Competition in the medical field was intense and practitioners resorted to many means in order to compete that included ignoring regulations set by their societies.

Dr. Nathan S. Davis, instrumental in the creation of the American Medical Association, in 1845 commented on page 418 in the Journal of Medicine concerning the lack of thorough training and education acquired by students of medicine. However, the real force in the founding of the AMA was the fact that doctors in order to compete in the free market made little money.

A national convention of physicians was held in 1847 and on May 5th the delegates established the AMA. Dr. Davis' complaint concerning the educational standards was addressed and for the first time a medical student was required to have clinical experience at a hospital. The AMA also defined requirements that a prospective student meet in order to be admitted to a medical school. The AMA strengthened the standards in 1852.

However, even by the 1870s many medical schools were not equipped with laboratories nor its own hospital. Johns Hopkins University decided to create a model school of medicine. In 1893 the School of Medicine opened with well-equipped laboratories and its own hospital. As universities overhauled their medical programs, many medical schools with inadequate facilities closed.

Between the establishment of the AMA and the creation of the medical program at Johns Hopkins University, by 1900 quality of medicine had vastly improved for patients.

U. S. National Library of Medicine,

Wellness Directory of Minnesotat,

Francis Randolph Packard, M.D. The History of Medicine in the United States. Philadelphia: J. B Lippincott Company, 1901.

Nathn Smith Davis, M.D, LL. D. History of Medicine with the Code of Medical Ethics. Chicago: Cleveland Press, 1907.

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