The origin of licensure in the medical professions is outlined beginning in Europe around the first century with the examination of potential physicians by the most respected physician in the land. Guilds developed and licensing bodies became university medical faculties. Prussia was the firet country to require specific courses for license eligibility whereas state control first developed in Germany. Americans fluctuated among various licensing methods until the 1700s when state boards were established. Professional standards, including licensure, for allied health professions have typically followed the lead of physicians. The origins, advantages and disadvantages of licensure in several of these occupations are reviewed also

Baker, Shirley A., MT(ASCP)SC, Ph.D.

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Journal of Health Occupations Education Volume 1 Number 2 Article 8 1986 History of Licensure in Several Occupations in the Health Professions Shirley A. Baker MT(ASCP)SC, Ph.D. Southern Illinois University - Carbondale Find similar works at: https://stars.library.ucf.edu/jhoe University of Central Florida Libraries http://library.ucf.edu This Article is brought to you for free and open access by STARS. It has been accepted for inclusion in Journal of Health Occupations Education by an authorized editor of STARS. For more information, please contact STARS@ucf.edu. Recommended Citation Baker, Shirley A. MT(ASCP)SC, Ph.D. (1986) "History of Licensure in Several Occupations in the Health Professions," Journal of Health Occupations Education: Vol. 1 : No. 2 , Article 8. Available at: https://stars.library.ucf.edu/jhoe/vol1/iss2/8 Journal of Health Occupations EducationFall 1986, Vol. 1, No. 2HISTORY OF LICENSURE IN SEVEWiL OCCUPATIONSIN THE HEALTH PROFESSIONSI Shirley A. BakerlThe origin of licensure in the medical professions is outlinedin Europe around the first century with the examination ofphysicians by the most respected physician in the land. Guildsand licensing bodies became university medical faculties.Abstract:beginningpotentialdevelopedPrussia was the firet country to require specific courses for licenseeligibility whereas state control first developed in Germany. Americansfluctuated among various licensing methods until the 1700s when stateboards were established, Professional standards, including licensure,  forallied health professions have typically followed the lead of physicians.The origins, advantages and disadvantages of licensure in several of theseoccupations are reviewed also.Historians have recorded the revered status of physicians beginning fromthe first century B.C. in Rome under the reign of Julius Ceasar. In the bookand Health OccupationslShirley A. Baker, MT(ASCP)SC, Ph.D., is LecturerEducation Coordinator at Southern Illinois University-Carbondale.351Baker: History of Licensure in Occupations in the Health ProfessionsPublished by STARS, 1986History of Licensureof Vendidad, from the Parsis collection of sacred books known as the Avesta,the oldest known set of regulations for physicians (specifically surgeons) isrecorded. In 931 A.D. the ruler of Arabia required that all potentialphysicians undergo examination by the most respected physician of the land,Sinan ibn Thabit of Harran (Sigerist,  1935).Licensure of physicians, as a means of protecting the vulnerable public,began in the European Middle Ages during a time when crafts and professions ofall kinds were organized into guilds. From guilds came strict standards andregulations regarding the quality of professional services. The paramountimportance of developing standards for the medical profession was evident toI the structured medieval society. Regulated training was designed as the meanswhereby society considered the physician to be “legal” (Sigerist, 1935).Surgeons were consi&red craftsmen and therefore were allowed to formtheir own guild. The guild was responsible for governing itself and settingstrict standards for its members. In order to practice surgery, a surgeon wasrequired to be a member of the surgeon’s guild. Physicians, on the otherhand, were not allowed to form a guild due to the generalized nature of theirskills. Therefore, “physicians organized, and their licensing body became themedical faculty of the universities” (Sigerist,  1935, p. 1058) . The school ofSalerno became the first such university to be empowered as a regulatoryentity by Norman King Roger in the year 1140. Under the Hohenstaufen rulerFrederick II, very strict detailed laws were established during the period1231 to 1240. Licenses were issued by the emperor or his representative.Heavy penalties threatened those practicing without a license. Othercountries throughout Europe adopted thesewere required to renew their license eachpolicies. In addition, physicianstime they relocated. The362Journal of Health Occupations Education, Vol. 1 [1986], No. 2, Art. 8https://stars.library.ucf.edu/jhoe/vol1/iss2/8IHistory of Licensurerelicensure process involved a presentation of appropriate diplomas held bythe physician to the faculty of the local university for approval (Walsh,1935) . Since many cities in England were not fortunate enough to have auniveristy, a medical society known as the Royal College of Physicians wasestablished in London on September 23, 1518. Scotland became a charter memberof the college in 1681. Thus, in these two countries, licenses were grantedby a medical society rather than a school (Sigerist, 1935).In 1725 Prussia was the first country to require specific academiccourses for license eligibility, but the license examination was conducted bya state board of health. After the unification of Germany, responsibility forlicensing physicians was returned to the universities so candidates would nothave to take two examinations--one from the university and one from the state.Unfortunately, a law passed in 1869 required those using the title “physician”to hold a license but allowed anyone else to practice medicine without alicense. Austria, on the other hand, combined licensing practices of Prussiaand later Germany so that a state official controlled examinations given ‘bythe university faculty (Sigerist, 1935).Medical practice was controlled in America until after the Revolution.America then repeated the same sequence of events concerning licensure thathad taken place in Europe during the previous 2,000 years. But, as with otherdevelopments in this country, the entire sequence took Americans only 300years to complete (Sigerist, 1935). State boards of examiners had begun to beappointed by the 1760s with a state appointed board in New York (Shryock,1967) . Due to increasing demand for physicians during the nineteenth century,medical schools tended to relax standards in order to supply the country withneeded physicians. As a result, the university degree could no longer be373Baker: History of Licensure in Occupations in the Health ProfessionsPublished by STARS, 1986History of Licensureregarded as a symbol of competence. State boards soon became the regulatoryagencies. Medical licensure statutes in the various states were widelydivergent (Derbyshire, 1969). Only with the advent of a mobile society didinterstate licensure conflicts become a seemingly insurmountable problem thatsill exiets.Origin of Allied Health Professions’ LicensureIn the 1930s, other groups of health professionals sought licensure.(Dental hygienists established licensure in Colorado in 1889). The firstmedical support groups to obtain licensure  were nursing and medical technologyin 1938. A nursing licensure law was first passed in New York to registernurses to ensure a standard level of care. The statute was not enforced,though, until 1947. Today, all states require nurses to be licensed in orderto practice (Lesnik and Anderson, 1947).Medical technologists also obtained licensure  in 1938 in California.Since that time, only four other states (Tenneessee, Florida, Hawaii, andNevada) have passed licensure legislation. Most states regulate certainlaboratory procedures and/or require licensure of the laboratory director(Daley,  1984).In 1968, radiological technologists and occupational therapists becameregulated through licensure. Radiologicalby the state of New York. Almost 10 yearsfollowed with licensure laws. The federaltechnologists were first licensedelapsed before any other statesgovernment, recognizing the needfor regulation of all radiationmust have licensure legislationHealth and SafetyOccupationalhandling professions, mandated that all statesby January 1, 1985 (Consumer Patient RadiationAct, 1981).therapists were first licensed in Puerto Rico in 1968. Not384Journal of Health Occupations Education, Vol. 1 [1986], No. 2, Art. 8https://stars.library.ucf.edu/jhoe/vol1/iss2/8History of Licensureuntil 1975 did the continental United States have established licensure in thestatea of Florida and New York. Currently, 27 states and two territorieslicense occupational therapists (Information handouts, American OccupationalTherapy Association (AOTA),  1985).California was first to license respiratory therapists in 1982. NewMexico followed in 1984. Today, almost every state in the nation is in somestage of licensure  consideration (Brown, 1984).Conclusions and ImplicationsProponents of licensure in the health professions will list the majoradvantages as: (a) legal safeguard of the public’s interest, (b) formalestablishment of the occupation as a profession, and (c) proof of licensee’sattainment of a minimum competency level (Shimberg,  1981). Opponents tooccupational licensure propose that licensure is merely a means of controllingthe job market, thereby raising salaries.The present system of providing medical care has been so restricted bythe intervention of occupational licensure that it is almostimpossible to demonstrate what things would be like if the free markethad been allowed to prevail . . . . The customer himself should be thesupreme judge of who is competent to perform the services he requires. . . .One also receives scant assurance of competence under a licensingsystem. . . . We are never sure that a test has been devised to determinethe abilities of individuals to perform certain tasks. (F3arger, 1975,pp. 197-199)Kane (1982) argues “that licensure examinations should be interpreted asmeasures of specific abilities that are critical for professionalpractice . ...” (p. 911).395Baker: History of Licensure in Occupations in the Health ProfessionsPublished by STARS, 1986Wilensky (1964)dentistry, medicine,examinednursing,History of Licensurethe history of eighteen occupations includingoptometry, and pharmacy. He determined that~crucial events in the advent of professionalism occurred in the followingorder:1. People start working full-time performing groups of related tasks.2. A training school is established.3. People with like occupations combine co form aassociation.4. Incessant political agitation requires passagejob territory and to enforce a code of ethics.professionalof a law to protect5. A formal code of ethics is developed containing various rulesaddressing issues surrounding unqualified or unscrupulous practitioners,internal competition, and client protection and service (pp. 142-145).Licensing is the most restrictive of all forms of regulation. Noregulation should be more restrictive than what is necessary to protect thepublic. In many cases, certification or registration are better alternatives(Shimberg,  1981).Disadvantages of licensing include limited interstate mobility, highcosts of licensure  administration, limited reciprocity, increased expensesincurred in policing the profession, limited scopes of practice, andrestricted entry to jobs and training (Shimberg, 1981). The major issuefacing licensing boards today is “How do we assure the public of anindividual’s continued competence?*’ Many state legislators may be addressingthis issue inBarger, M. D.195-201.the months to come.References(1975) . Occupational licensure under attack. The Freeman, 25,406Journal of Health Occupations Education, Vol. 1 [1986], No. 2, Art. 8https://stars.library.ucf.edu/jhoe/vol1/iss2/8Wilensky (1964)dentistry, medicine,examinednursing,History of Licensurethe history of eighteen occupations includingoptometry, and pharmacy. He determined that~crucial events in the advent of professionalism occurred in the followingorder:1. People start working full-time performing groups of related tasks.2. A training school is established.3. People with like occupations combine co form aassociation.4. Incessant political agitation requires passagejob territory and to enforce a code of ethics.professionalof a law to protect5. A formal code of ethics is developed containing various rulesaddressing issues surrounding unqualified or unscrupulous practitioners,internal competition, and client protection and service (pp. 142-145).Licensing is the most restrictive of all forms of regulation. Noregulation should be more restrictive than what is necessary to protect thepublic. In many cases, certification or registration are better alternatives(Shimberg,  1981).Disadvantages of licensing include limited interstate mobility, highcosts of licensure  administration, limited reciprocity, increased expensesincurred in policing the profession, limited scopes of practice, andrestricted entry to jobs and training (Shimberg, 1981). The major issuefacing licensing boards today is “How do we assure the public of anindividual’s continued competence?*’ Many state legislators may be addressingthis issue inBarger, M. D.195-201.the months to come.References(1975) . Occupational licensure under attack. The Freeman, 25,407Baker: History of Licensure in Occupations in the Health ProfessionsPublished by STARS, 1986History of LicensureBrown, C. (1984). States step up credentialing efforts. AARTimes,  a, 36-39.Consumer Patient Radiation Health and Safety Act, Title IX, Subtitle 1 ofPublic Law 9735, part of the Omnibus Budget Reconciliation Act of 1981.Daley, D. M. (1984). State licensure for laboratory professionals: A survey.Laboratory Medicine, ~, 554-557.Derbyshire, R, C. (1969). Medical lfcensure discipline in the United States.Baltimore: Johns Hopkins Press.Information handouts. (1984). Rockville, Maryland: The American OccupationalTherapy Association.Kane, . M. T. (1982). The validity of licensure  examinations. AmericanPsvcholozist,  ~, 911-918.Lesnik, M. J. &Anderson, B. E. (1947). Nursi.n~  Practice and Law, edition 3,Philadelphia: J. B. Lippincott.Shimberg,’B.  (1981). Licensure: What vocational educatora should know.Columbus, Ohio: Ohio State University.Shryock. R. H. (1967). Medical licensinz  in America, 1650-1965. Baltimore:Johns Hopkins Press.Sigerist, H. E. (1935). History of medical licensure. Journal of the AmericanMedical Association, ~, 1057-1060.Walsh, J. J. (1935). Earliest modern law for the regulation of the practiceof medicine. Bulletin of the New York Academv of Medicine, 11, 521-527.Wilensky, H. L. (1964), The professionalism of everyone? American Journal ofSociologV, ~, 137-158.418Journal of Health Occupations Education, Vol. 1 [1986], No. 2, Art. 8https://stars.library.ucf.edu/jhoe/vol1/iss2/8

History of Licensure in Several Occupations in the Health Professions

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History of Licensure in Several Occupations in the Health Professions

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