Let the consumer beware: maintenance of licensure and certification in the United States

This chapter explores the medical licensure and specialty certification environment in United States and examines the persistent difficulties with ensuring that all physicians keep up with the changing demands and advances in medicine. Government agencies (state and federal legislatures, departments and courts), multiple medical organisations, and market bodies (consumers and insurance companies) are intertwined in complex and conflict-prone interactions. This chapter critically explores if the United States can continue to leave it to medical professionals or local state legislatures to oversee maintaining competency and licensure. States currently vary as to the strategy they adopt, the preferred method reflecting local traditions and physician practices, leaving gaps in standards. Anti-regulation sentiments have been on the rise, with the result that efforts by some medical organisations to nudge others toward greater oversight have been stymied by others which launch legal and political challenges against regulatory changes. The diversity of institutions with a stake in the regulatory process complicates the matter. The chapter concludes that what tends to get lost in this state of affairs is the ‘public interest’.