Doctor of medicine profession (MD)

The emergence of specialization within American medicine did not take root until the middle of the 19th century. People who objected to specialization said that "specialties operated unfairly toward the general practitioner, implying that he is incompetent to properly treat certain classes of diseases" and that specialization tended "to degrade the general practitioner in the view of the public." However, as the base of knowledge within medicine continued to grow and many doctors chose to do more of what they were interested in and good at, specialization became inevitable.

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Economics may have also played an important role as the specialists typically enjoyed higher incomes than did the generalist physicians. The debates between specialists and generalists continue and have recently been fueled by issues related to modern health care reform.

Medicine was the first of the professions to require licensure. State laws specific to the licensure of medicine outlined the activities of "diagnosis" and "treatment" of human conditions strictly within the domain of medicine. Any individual who professed to diagnose or treat as part of the profession could therefore be charged with "practicing medicine without a license." As a result of strict licensure laws that were issued by the various medical societies, conventional Western medicine was able to establish itself as a monopoly over the health care of the American populace.

SCOPE OF PRACTICE

The practice of medicine includes the diagnosis, treatment, correction, advisement, or prescription for any human disease, ailment, injury, infirmity, deformity, pain or other condition, physical or mental, real or imaginary.

PRACTICE SETTINGS

MDs may be found within a wide range of practice settings, including private practices, group practices, hospitals, health maintenance organizations, teaching facilities, and public health organizations.

REGULATION OF THE PROFESSION

Medicine, like many other professions, is regulated at 2 different levels:

Licensure is a process that takes place at the state level in accordance with specific state laws.
Certification is established through national organizations with requirements for minimal professional practice standards being consistent nationally.

Licensure: All states require applicants for MD licensure to be graduates of an approved medical school and complete the USMLE (United States Medical Licensing Exam) Steps 1 - 3. Steps 1 and 2 are completed while in medical school and step 3 is completed after some medical training (usually between 12 - 18 months, depending on the state). People who obtained their medical degrees in other countries also must satisfy these requirements before practicing medicine in the United States.

With the inception of telemedicine, there has been concern as to how to handle state licensure issues when medicine is being shared between states through telecommunications. Laws and guidelines are being addressed.

Certification: MDs who wish to specialize must complete an additional 3 - 4 years of postgraduate work within their area of specialty, then pass board certification examinations. Doctors who claim to practice within one of the specialties should therefore be board-certified within that specific area of practice.