STANDARDS OF PRACTICE
In the United States, medical licensure is controlled by each state, territory, and commonwealth. Licensure depends on furnishing evidence of satisfactory completion of the standard medical curriculum in an American or Canadian medical school, clinical experience, and satisfactory performance on an examination.
In theory, possession of a valid medical license entitles a physician to practice all branches of medicine and surgery within that jurisdiction. In actuality, further training is needed beyond receipt of the M.D. degree. Such training, called graduate medical education, is controlled by a quasi-autonomous nongovernmental body called the American Council on Graduate Medical Education. This body is made up of representatives from each specialty board and from hospitals, medical schools, specialty societies, and the American Medical Association (AMA), with one member appointed by the federal government. Working through committees and its constituent organizations, the council approves each hospital training program and endorses an examination given by the appropriate specialty board. This laborious method of specialty certification sets a standard of practice. As noted, when the family-practice specialty was established, certification was for the first time granted only for a defined interval, after which the practitioner must be reexamined. The specialist must also take part in a certain number of hours of continuing medical education each year. Both of these new departures may in time become standard for all of the other specialty boards.
Most physicians in active practice have hospital privileges. That is, they are members of the medical staff of a hospital and are allowed to admit patients to that hospital. To practice at a hospital, however, requirements in addition to a license are mandated by the governing body of the institution. Hospitals are divided into clinical services that reflect the various medical specialties, and staff privileges are valid only for a specific service. Increasingly, certification by the appropriate board as well as participation in the educational meetings of the service are being required for such validation.
In most nations other than the United States, licensure is a national rather than a provincial matter. Graduation from one of the schools within a country often entitles a physician to a license without further examination. In most countries, however, physicians are required to complete further examinations in order to be accredited as specialists.