History of Medical Licensing and Federal Drug Control

Introduction

Licensing, in its broadest sense, is the application of legal authority to regulate a collective group of people engaged in a particular activity. Understanding this concept is critical to developing an informed perspective on the history of licensing for health care professionals. This essay describes how it came to be that physicians are licensed and essentially subject to governmental oversight and direction. It provides a brief history of that process to help contextualize these regulatory efforts. Before concluding, the essay also addresses the importance of why the federal government serves as the sole licensing authority for physicians who dispense or prescribe controlled substances.

The Role of Government in Medical Licensing

Before examining the impact of government licensing on health care professionals, it is necessary to understand the role of government itself. While it is historically and culturally common to view government as a crucial guide for citizens, this is not always the case. This is especially true when governmental authorities do not hold their citizens' best interests as a primary concern. Ultimately, the responsibility rests with citizens themselves, who must hold the representatives they elect to that standard.

Because medical practices are not widely understood or sufficiently mastered by the general public, it is a broadly shared belief that these processes must be governed by a collective authority. This reasoning is what brought the issue of licensing health care professionals to prominence. Without oversight, there is too much opportunity for predatory individuals willing to exploit vulnerable people in exchange for fraudulent health care services. The need for professional licensing therefore appears necessary in today's world.

History of Licensing

In the mid-nineteenth century, at the beginning of the industrial age, there were no government barriers to entry into the medical field. Anyone could assist anyone else using whatever methods they chose — it was essentially unregulated. The creation of the American Medical Association (AMA) in 1847 began a new era in which medicine was first formally regulated within the United States. Since that time, the AMA has concentrated considerable political influence to shape the licensing procedures that exist today.

The federal structure of the United States places significant political power in the hands of individual states, enabling them to address problems suited to their local circumstances. Medical licensing has followed this model. The federal government does not directly license medical professionals; licensure is attained at the state level, where differing standards apply to differing local conditions.

This arrangement emerged from the impossibility of managing such a complex and vast array of medical products and services from a single central authority. The scope of the problem required regulation at multiple levels. Medical degrees — a prerequisite for licensure — are authorized by agencies operating at the national level, which provides a degree of quality control over state-level decisions while still allowing for local adaptation within the medical community. This balance is key to the success of the relationship between state and federal oversight.

Conclusion

This essay has traced the history of medical licensing in the United States, from the absence of regulatory barriers in the mid-nineteenth century through the founding of the AMA and the eventual development of state and federal oversight frameworks. Government involvement in medical licensing arose from a genuine public need to protect citizens from unqualified practitioners and predatory actors. The division of authority between state licensing boards and federal agencies — particularly with respect to controlled substances — reflects the complexity of regulating a field as consequential as medicine. The Controlled Substances Act and the five-schedule drug classification system stand as concrete examples of how federal authority reinforces and complements state-level licensing to safeguard public health.

References

American Medical Association. (n.d.). Medical licensure. Retrieved July 20, 2014, from

Hamowy, R. (1979). The early development of medical licensing laws in the United States. The Journal of Libertarian Studies, 3, 73.

U.S. Department of Justice. (n.d.). Drug schedules. Retrieved July 20, 2014, from http://www.justice.gov/dea/druginfo/ds.shtml