Medical practitioner regulation: is it all about protecting the public?

This article explores the purpose of professional regulation as it applies to medical practitioners in Australia and New Zealand. Purpose is considered in terms of regulatory theory legislative statement, judicial commentary, and the realities of who and what is regulated and by whom. It is considered both in relation to the regulatory framework as a whole, and more specifically in relation to the disciplinary system that operates as a critical component of that framework. The author concludes that the dominant purpose of medical practitioner regulation should be the protection of the public, particularly when it comes to disciplinary decision-making. While it may be reasonable for broader public interest considerations, such as workforce supply, to be taken into account when it comes to making registration decisions, extreme caution should be exercised in allowing such considerations to influence disciplinary decisions.

Testing the limits

Three tests, three chances per test, and a total of seven years. Those are the general rules and timeframes physicians must follow in passing the necessary exams to get licensed to practice medicine in Texas. Almost every legislative session, state lawmakers introduce a handful of bills to expand those limits, most of which fail. And almost every legislative session, lawmakers call upon TMA for advice on how they should weigh in on the legislation. The TMA Council on Medical Education is evaluating whether to recommend new policy for the TMA House of Delegates to consider in May.

Regulating impaired doctors: a snapshot from New South Wales

This article examines the regulation of impaired doctors in Australia and explores the inherent tensions in the new Health Practitioner Regulation National Law in attempting to both treat the doctor and protect the public. It discusses both informal and formal mechanisms of regulation with particular reference to therapeutic jurisprudence and mandatory notification. It focuses particularly on New South Wales and examines all the impairment cases which resulted in disciplinary proceedings in the Medical Tribunal of New South Wales in 2010. It identifies the most common forms of impairment and discusses the particular challenges that impaired doctors pose for regulators.

The changing meaning of a health care workforce

In this commentary, the author describes how the meaning of the health care workforce has changed, focusing on the physician workforce. Some questions have been asked consistently over the years: How many should we have? What type? Where should they work? In 1830 there were no licensing laws, and every literate American could be a member of the health care workforce by following detailed instructions in a popular handbook. Subsequent years saw the initiation of state licensing laws and the reform of medical education. Medical specialties and specialty boards were created, although it was not until after World War II that the dominance of the general practitioner gave way to specialists. For over a century, estimates of physician supply have swung between "too many" and "too few." Rural and economically disadvantaged communities have long struggled with access to health care providers. The author also identifies some issues that have only been considered fairly recently, such as the ethnic and gender diversity of the workforce. Wars have played a major role in changing ideas about the workforce, often in ways that long outlast the actual dates of the conflict. The meaning of the health care workforce has always been deeply embedded in a specific social, political, and economic context.

The origins of American health libertarianism

This Article examines Americans' enduring demand for freedom of therapeutic choice as a popular constitutional movement originating in the United States' early years. In exploring extrajudicial advocacy for therapeutic choice between the American Revolution and the Civil War, this piece illustrates how multiple concepts of freedom in addition to bodily freedom bolstered the concept of a constitutional right to medical liberty. There is a deep current of belief in the United States that people have a right to choose their preferred treatments without government interference. Modern American history has given rise to movements for access to abortion, life-ending drugs, unapproved cancer treatments, and medical marijuana. Recently, cries of "Death Panels" have routinely been directed against health care reform proposals that citizens believe would limit the products and procedures covered by government health insurance. Some of the most prominent contemporary struggles for health freedom have been waged in court. But other important recent battles for freedom of therapeutic choice have taken place in other forums, from legislative hearings to Food and Drug Administration advisory committee meetings to public demonstrations. This attitude of therapeutic libertarianism is not new. Drawing mainly on primary historical sources, this Article examines arguments in favor of freedom of therapeutic choice voiced in antebellum America in the context of battles against state licensing regimes. After considering some anti-licensing arguments made before independence, it discusses the views and statements of Benjamin Rush, an influential founding father who was also the most prominent American physician of the early national period. The Article then analyzes the Jacksonian-era battle against medical licensing laws waged by the practitioners and supporters of a school of botanical medicine known as Thomsonianism. This triumphant struggle was waged in explicitly constitutional terms, even though it occurred entirely outside of the courts. The Thomsonian campaign thus offers one of the most striking examples of a successful popular constitutional movement in American history. This article shows that, at its origin, the American commitment to freedom of therapeutic choice was based on notions of not only bodily freedom, but also economic freedom, freedom of conscience, and freedom of injury. Finally, this Article considers ways in which this early history helps illuminate the nature of current struggles for freedom of therapeutic choice.