A century ago, when young physicians finished medical school and obtained state licenses, they had learned all they were required and expected to know about medicine for the rest of their careers. Many American medical schools were questionable in their scope, competence, and discipline, and their graduates were doubtful in knowledge of biology, pharmacology, and even anatomy. Those concerns prompted the American Medical Association to stimulate the investigations and scathing reports on many medical schools by Abraham Flexner that led to the destruction of most proprietary schools and the improvement of others, mostly those with hospital affiliations and academic sponsorships with public and private universities.
One of the structures that crept into being at the same time was hospital internships, which gave medical graduates a year or more in which they could learn the actual practice of patient care. Some internships were sophisticated, and others were simply free labor. Some became apprenticeships, wherein interns scrubbed with self-anointed surgeons or aspired to concentrate on what were beginning to be other medical specialties. Ophthalmology was one of the first examples.
The absence of any formal requirement for continuing to learn new things did not inhibit bright and energetic young physicians from devising and applying new concepts and technology to their practice. One example, in the first decade of the 20th century, was the medical application of that amazing and invisible form of electromagnetic energy called x-rays, both for diagnosis and for treatment of diseases, including cancer.
These concepts led in the next decades to the development of self-styled medical specialties, still without formal training or even definitions of what constituted any growing specialty. And before the formal definitions were established and endorsed, most burgeoning specialties simulated the organization of specialty-oriented societies, accompanied by journals and annual meetings. Yet there were no formal training programs and no defined qualifications or credentials. But the tides were starting to flow. The American Medical Association looked with favor upon the creation of medical specialties and set up structures to help with the process. Still, state medical licenses covered all of medicine and surgery and made no requirements for postdoctoral training.
The first functional specialty board was ophthalmology, starting in 1917. Otolaryngology started in 1924, obstetrics and gynecology in 1930, and dermatology and syphilology in 1932. Then came the American Board of Radiology, incorporated and implemented in 1934.
Ophthalmology was eyeballs. Obstetrics was baby snatching. Surgery was cutting and carving. But the overlaps sparked turf struggles that continue to these days. Radiology posed a different problem. Were physicians in everything but dermatology and psychiatry to use x-rays as part of their practice, as they used tongue depressors and stethoscopes? Or was radiology to grow into a separate discipline with members who concentrated on x-ray uses for other doctors’ patients?
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