Professionalism, Governance, and Self-regulation of Medicine

A revolution in medicine is occurring and is directly related to several major factors, including substantial changes in the health care system, largely due to the Affordable Care Act; remarkable scientific advances and an accelerated pace of discovery in biomedical science 1 ; increasing recognition of the need to practice restraint with respect to both diagnostic testing and therapeutic interventions; the promise of personalized medicine; more physicians being employed by large medical organizations; the increasing trend of consolidation and corporatization of health care delivery; and heightened public demands and expectations for transparency and accountability in health care. 2 At the same time, fundamental aspects affecting physician education and certification have come under intense scrutiny, with expansion of the number of medical schools, critical examination of government funding for residency training, and recent contentious debates regarding maintenance of board certification. 3onsidering these fundamental, dynamic, and rapid changes, there also could be challenges to and changes in the well-established governance structure and self-regulating functions involving the medical profession.Accordingly, this is an appropriate time to reexamine the various governing and professional bodies that influence the education, licensing, certification and recertification, and employment of physicians and, perhaps more importantly, to highlight the critically important and distinctive characteristic of medicineprofessionalism.How a profession self-governs has long been debated by scholars.What is its responsibility to its members and the public?Should medicine be held to a different standard than other professions?With the increasing proportion of physicians employed by health care systems, what is the role of employers in governing and overseeing professionalism among physician-employees?If medicine does not selfgovern effectively and responsibly, who should provide oversight?The banking and accounting industries are now subject to more federal oversight, at least in part because of their failure to effectively self-regulate.This issue of JAMA includes a series of Viewpoints by scholars and academic leaders about the responsibility and accountability of medicine to self-govern, self-regulate, and ensure the highest degree of professionalism.To reflect additional perspectives, 2 Viewpoints are written by authors from the United Kingdom and from Canada, and 3 Viewpoints are written by authors from disciplines other than medicine.Among the major issues addressed are the key roles and responsibilities of modern governing and accrediting bodies and of professional organizations and societies in ensuring effective governance and professionalism in medicine, as well as what these entities are doing and should do differently to enhance self-governance, safeguard self-regulation, and foster professionalism among physicians.