LICENSE OR LIBERTY: PUBLIC HEALTH AND MEDICAL LICENSURE’S MOVERS AND MOTIVES, 1870s to the 1910s

Abstract

A profoundly important step in political development is the licensing of professions as quasi-public agencies of societal and especially economic governance. Medical licensing of the 1870s onward ranks as about the most important step in America’s move away from Jacksonian libertarianism toward a progressive social and political order. Social, political, and medical historians have paid little attention to the American medical licensure movement’s leaders and their motives, leaving other scholars to surmise and theorize about why licensing emerged in the 1870s. A near-hegemonic view holds that medical licensing was the work of state medical societies desiring to reduce the supply of physicians and thus prop up their incomes. Public regarding motives were at best secondary, and arguments about them were, supposedly, often subterfuge to hide real intent. An investigation of key figures in ten states behind their early medical practice acts and later improvements from the 1870s onward drastically undermines the pecuniary motive argument. Practically all were public health missionaries. Many were wealthy, and some were not even active medical practitioners. State medical societies only sometimes played a role, and often they were led by the public health missionaries who expected preventive action to reduce, not increase doctors’ incomes. In addition to the paternalistic motive of protecting citizens from unschooled and dangerous healers, they saw licensed physicians as de facto and real civil servants needed for the modern state, among other things, collecting quality vital statistics for tracking and researching disease, staffing public health departments for preventive measures, educating the public on hygiene, and more. Perversely, the initial laws triggered the formation of numerous, low-quality private for-profit medical schools because most laws required no more than a medical degree from a state chartered medical college. The licensure reform movement thus expanded to include reform of medical education, prompting progressive medical reformers and politicians to bring states into the regulation of medical education.