Review

p EER review first consisted in the establishment by physicians of standards for licensure to practice medicine and surgery. This form has continued to be administered by state departments of education. Another type of peer review was developed for appointment to hospital staffs. In time learned societies set up their own higher standards for admission. For many years the latter groups included a small and exclusive portion of the medical profession. However, for the vast majority of physicians it was possible to spend an entire career in practice without ever coming under review, unless one committed some serious breach of trust or etiquette. This quiet was disturbed in the 193OS by demands that physicians who were engaged in certain specialty practices be certified by examination. The specialty boards were organized to set up standards for training qualifications and for examinations which were designed to test professional knowledge. Enforcement was implemented through economic pressure, in that hospitals were required to have board-certified physicians and surgeons in the several specialties in order to maintain accreditation. In the 1930s there were relatively few places in the United States where residency training could be obtained. Until World War II the certified specialist was a member of the elite of medicine. After World War II there was a great expansion of postgraduate training facilities, accompanied by a broadening of the base of the specialty certifications. The exclusiveness of these certifications soon disappeared but was succeeded by the development of subspecialty boards. One wonders what will happen when most of us are certified