Abstract
Medieval guilds for a time grew wealthy under a system of work rules that granted them a virtual trade monopoly, but such protection was worthless in the face of innovations in communications and commerce. Many medical specialists have grown wealthy under a guild system based on board certification. Unfortunately, creation of a vascular medicine board is unlikely to resolve the ongoing turf wars between cardiologists, radiologists, and vascular surgeons. Moreover, if medical specialists (who are facing innovations in the form of the Internet and telemedicine) wish to avoid the fate of the medieval guilds, a more flexible system based on individual competency is needed. While credentialing based on individual competence is good for specialists, it creates increased liability for hospitals because specialist credentialing will become more discretionary and less ministerial.
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