Professionalism and Self-Regulatory Standards: Responsiveness of Medical Licensure and Certification
Date
2014-10-16
Authors
Cerenzia, Julia
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Abstract
The medical profession in the United States has traditionally been the quintessential example of a self-regulated profession, invested with deep public trust and granted the privilege of self-regulation through credentialing. However, in the latter half of the twentieth century an erosion of public confidence led to a rise in malpractice claims and three consecutive malpractice crises. Medical malpractice has become a highly salient public policy issue, punctuated by fierce battles for tort reform at the state level. The issue has sparked a large body of research regarding the response of the medical community to tort pressure, but such research has largely focused upon practice changes made by individual physicians. Theory suggests, however, that responsiveness should take place at the level of the medical profession, with the profession strengthening its standards for medical licensure and specialty board certification. This dissertation addresses a gap in the research by studying the regulatory responsiveness of the medical profession and its self-regulatory institutions. Using a qualitative case study design, this dissertation examines each of the medical professional credentials – licensure and specialty certification. An evidence-based image of each credentialing institution is synthesized through triangulation of quantitative and qualitative evidence and analyzed using the analytic frame provided by the theory of professionalism. The dissertation finds that neither state medical (licensing) boards nor medical specialty boards significantly strengthened their respective credential in response to a “crisis” of tort regulation. The case studies did show that the credentialing institutions were cognizant of external regulatory pressures and acted to improve quality, but did not do so primarily by strengthening the credentialing standards. The analytic frame of professionalism facilitated a refinement of the evidence-based image by suggesting “contingencies” – including the state and its policies, and the organization of the profession – that acted to shape and moderate the responsiveness of the profession.
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Certification, Healthcare, Licensing, Professionalism, Quality, Regulation