Yamilet

Scope of practice of MD's

The practice of medicine in the United States dates back to colonial times (early 1600s). At the
beginning of the 17Th century, medical practice in England was divided into three groups: the
physicians, the surgeons, and the apothecaries.

Physicians were seen as elite and usually held a university degree. Surgeons were typically
hospital-trained and they didapprenticeships. They often served the dual role of barber-surgeon.
Apothecaries also learned their roles (prescribing, making, and selling medicines) through
apprenticeships, sometimes in hospitals.

This distinction between medicine, surgery, and pharmacy did not survive in colonial America. When
university-prepared MD’s from England arrived in America, they were expected to alsoperform
surgery and prepare medicines. The class distinctions and snobbishness of physicians over surgeons
quickly changed.

The New Jersey Medical Society, chartered July 23, 1766, was the first organization of medical
professionals in the colonies. It was developed to "form a program embracing all the matters of highest
concern to the profession: regulation of practice; educational standardsfor apprentices; fee schedules;
and a code of ethics." Later this organization became the Medical Society of New Jersey. It remains
the oldest medical society in the United States.

Professional societies began regulating medical practice by examining and licensing practitioners as
early as 1760. By the early 1800s, the medical societies were in charge of establishing regulations,standards of practice, and certification of doctors.

A natural next step was for such societies to develop their own training programs for doctors. These
society-affiliated programs were called "proprietary" medical colleges.

The first of these proprietary programs was the medical college of the Medical Society of the County of
New York, founded March 12, 1807. Proprietary programs began tospring up everywhere. They
attracted a large number of students because they eliminated two features of university-affiliated
medical schools: a long general education and a long lecture term.

To address the many abuses in medical education, a national convention was held in May 1846.
Proposals from that convention included the following:
A standard code of ethics for the professionThe adoption of uniform higher educational standards for MDs, including courses of premedical
education

The creation of a national medical association

On May 5, 1847, nearly 200 delegates representing 40 medical societies and 28 colleges from 22 states
and the District of Columbia met. They resolved themselves into the first session of the American
MedicalAssociation (AMA). Nathaniel Chapman (1780-1853) was elected as the first president of the
association. The AMA has grown to become an organization that has a great deal of influence over
issues related to health care in the United States.

The AMA set educational standards for MDs, including the following:
A liberal education in the arts and sciences

A certificate of completion in anapprenticeship before entering the medical college

An MD degree that covered 3 years of study, including two 6-month lecture sessions, 3 months
devoted to dissection, and a minimum of one 6-month session of hospital attendance

In 1852, the standards were revised to add more requirements:
Medical schools had to provide a 16-week course of instruction that included anatomy,medicine, surgery, midwifery, and chemistry

Graduates had to be at least 21 years of age

Students had to complete a minimum of 3 years of study, 2 years of which were under an
acceptable practitioner

Between 1802 and 1876, 62 fairly stable medical schools were established. In 1810, there were 650
students enrolled and 100 graduates from medical schools in the...