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There was a time when anyone could call himself a doctor, without being called on his credentials by any public or professional authority. State authority to regulate the practice of medicine was defined in the late 19th century. In the 20th century, specialty boards began to define the training, knowledge, and skills required to call oneself a pediatrician or a cardiologist or an ophthalmologist, and to offer physicians the opportunity to "certify" that they were qualified. These two mechanisms, mandatory licensure and voluntary certification, are still the means by which physician qualifications are assessed. This paper reviews how these processes operate and the ways in which they have evolved—and are still changing—to meet today’s ideas of accountability.

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