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Chapter 4 71 Local medical societies often resisted changes, yielding only when media campaigns grew too hot and when boards found they had less to do since licensure issues were largely resolved by the use of national exams.1 As George Bernard Shaw argued in the 1930s, “In the main, then, the doctor learns that if he gets ahead of the superstitions of his patients he is a ruined man; and the result is that he instinctively takes care not to get ahead of them. That is why all the changes came from the laity.”2 The 1980s saw a gradual decoupling of boards from medical societies. Whatever the regulatory agenda national authorities had in mind, they had to coordinate with local associations, the media, the public, and state legislatures and agencies. Constituencies often emerge in response to specific issues brought to their attention by the media, which plays a vital role in mobilizing public attention in defense of its interests. Some credit for making the public aware of its stake in the regulation game belongs to scholars like Benjamin Shimberg, who worked with local consumer groups and sensitized state government agencies about the deficiencies in the regulatory process. Media exposés and editorials were consistent with these critiques. Dr. Sidney Wolfe, director of the Public Citizen Health Research Group, wrote in 1993 that “despite the seriousness of many of these offenses, the licenses of the physicians who committed them are often neither revoked nor suspended and many of these doctors are practicing medicine, seeing patients who are completely in the dark about what the state boards have concluded. . . . The patients who go to these doctors have a right to know more about them than they can read in the yellow pages.”3 The State, the Media, and the Shaping of Public Opinion Once discipline became the focus and the media took it upon itself to “define an issue and to create a story,”4 local publics grew increasingly alarmed about the lack of disciplinary action against errant doctors. Legislators , especially those in states with sunset legislation, which mandated review of agencies, could not ignore the negative board coverage in the media, whose harangues shaped as well as served to express public opinion. Adding public members to medical boards seemed like the least legislators could do to mollify public opinion. With public members the question arose as to their qualifications and proper role. Public-interest groups took up this question and supported government agencies in their agenda to push boards to pursue quality-of-care (negligence and incompetence) cases more aggressively. As the number of disciplinary actions grew, the courts increasingly found themselves drawn into the fray, particularly by due-process issues.5 Responding to public outrage, legislators began to weigh in on the lack of oversight, and some demanded not only public members on boards and increased transparency but incorporating boards more into state bureaucracies. By the twenty-first century, the public in many states had evolved into a constituency that had to be reckoned with. Activists and citizen groups demanded to know why doctors continued to practice in one state after they lost licenses in others, how many malpractice suits it took for a doctor to be deemed unfit, and what the reasons were behind the wide range of disciplinary actions taken among in different jurisdictions. To understand how these questions were raised and answered, we need to examine how public opinion was mobilized with the help of the media in defense of patients’ interests. The division of labor between state and public actors in the early public dialogue advocating for change was fuzzy. With funding from the U.S. Department of Labor, Shimberg worked for Educational Testing Service and tried to sell the idea of public board members directly to states. ProForum, a newsletter dedicated to improving professional regulation, was written by a public-interest group (the National Center for the Study of Professions) funded by the U.S. Department of Education. Common Cause, another public-interest group, pushed sunset legislation as a response to the possible overexpansion of government regulation and thereby could provide an opportunity for change.6 The 1976 Colorado sunset legislation mandated regular state review of agencies and demonstration of accountability . Most of the thirty-six states that passed sunset legislation did so between 1976 and 1980. National consumer groups kept licensing boards under close scrutiny. In 1978, a conference on licensing sponsored by COCO (the Conference of...

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