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May 12, 2015

Professional Self-regulation in a Changing World: Old Problems Need New Approaches

Author Affiliations
  • 1American Board of Internal Medicine, Philadelphia, Pennsylvania
JAMA. 2015;313(18):1807-1808. doi:10.1001/jama.2015.4060

In 1767, 31 physicians in Litchfield County, Connecticut, formed a medical society, and, by 1778, they were proclaiming themselves “[t]he first Medical Society in the thirteen United States of America since their Independence.” Among other declared purposes, this society proposed to examine “every Candidate for Practice, either Apprentice or any Physician or Surgeon within this County, or Foreigner, coming into this County.”1 Their action illustrated a core challenge that remains today: How does the public know who is qualified to practice medicine? Given the critically important responsibility that practicing physicians assume every day, and given the inability of patients to judge independently the quality of their physician’s training, knowledge, and skill, the profession has always been involved in efforts to better serve the public by defining medical competence in a consequential way. One way to think about the work of the American Board of Internal Medicine (ABIM) and other boards is that they are a response to this professional and public need. Just as individual physicians cannot simply self-declare their competency and fitness to practice, neither can boards.