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The Federation's Predecessor Organizations

National Confederation President, Dr. William Warren Potter (Photo from the U.S. National Library of Medicine)The origins of the Federation of State Medical Boards (FSMB) stretch back more than twenty years prior to its 1912 creation. In that year, two separate organizations representing state medical boards — the National Confederation of State Medical Examining and Licensing Boards and the American Confederation of Reciprocating Examining and Licensing Boards—merged to create the FSMB.

The National Confederation was the older of the two, established in 1890. Its vision called for creating uniform standards for both medical schools and medical licensing boards. Because of the Illinois State Board of Health's long interest and involvement in fostering high standards for medical education, their long-time chair Dr. John Rauch served as the National Confederation's first president until his death in 1894. Leadership then passed to New York's Dr. William Warren Potter who formalized the National Confederation through the creation of a constitution and by-laws for the organization. From his editor's desk at the Buffalo Medical Journal, Potter served as their primary spokesman for many years.

The National Confederation had three areas of focus: higher matriculation standards for medical education; a more robust medical education curriculum; and opening state board exams solely to graduates from legally registered schools. The National Confederation acknowledge the work of other groups such as the Association of American Medical Colleges (AAMC) to foster higher standards but stressed that only the licensing boards possessed the legal authority to set or enforce these standards for the benefit of the public and the profession. This was a significant issue as individual state boards were struggling to address two interconnected problems: the largely unregulated practice of medicine and the proliferation of substandard medical schools.

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Control of HealingThe Federation's other predecessor organization, the American Confederation, can be traced to an 1899 meeting of the Wayne County (Michigan) Medical Society. The society's efforts to assist colleagues by facilitating greater uniformity in licensing laws contributed to a growing national dialogue on license reciprocity. The Michigan, Wisconsin, Illinois and Indiana medical boards had addressed this issue on a regional basis. Their passion for the subject shifted the conversation to the June 1900 meeting of the National Confederation. Drs. Emil Amberg (Michigan) and W.A. Spurgeon (Indiana) argued that this issue should move forward in parallel with the group's ongoing efforts to support higher standards in medical education. Leadership of the National Confederation reluctantly formed a committee to study the issue, concerned that focusing on license reciprocity undermined their long-term efforts to accomplish this goal through common higher standards for medical education. The committee report one year later was received and filed without further action. Dissatisfied representatives from Illinois, Wisconsin, Indiana and Michigan gathered six months later and formed American Confederation in January 1902. Within two years, 17 boards had joined the American Confederation.

The American Confederation's constitution identified its goal as establishing reciprocal relations between the medical boards so that well-qualified physicians legally practicing in one state could do so in another. The organization urged medical boards to reach this goal by using two lines of qualification: Either possession (for at least one year) of a medical license presented by virtue of a satisfactory diploma and an examination by the board; or possession (for at least one year) of a medical license presented by virtue of a satisfactory diploma and upon the recommendation of that state board in lieu of an examination.

The two Confederations engaged in series of talks in 1910 that culminated in their 1912 merger. The motives for the merger are clear. Both groups lacked sufficient financial resources to sustain a strong national organization. Second, everyone recognized that the interests of the public and medical regulation were ill-served by two organizations operating within the same arena and sometimes at cross purposes. Merger talks were aided by representatives from the AAMC (William Harlow, Fred Zapffe); the American Medical Association's Council on Medical Education (N.P. Colwell, Arthur Bevan); and the Carnegie Foundation (Abraham Flexner).

Key meetings took place in February and March 1912. With an agreement in principle for union, the two parties drafted a constitution and bylaws for a new organization called the Federation of State Medical Boards. Drs. Charles Tuttle, George Matson, William Harlow, N.P. Colwell and Albert Brown served as the National Confederation's negotiating committee. Dr. Beverly Drake Harrison represented American Confederation. On February 28, 1912, the two committees agreed upon the general framework for a constitution and bylaws for the FSMB. The next day's election of officers provided the following results: President Arthur Brown (Louisiana), Vice Presidents Charles Cook (Massachusetts) and Pearl H. Tatman (Arkansas) and Secretary-Treasurer George Matson (Ohio). The FSMB's first executive committee included also James Duncan (Ohio), Charles Tuttle (Connecticut), W. Scott Nay (Vermont), Lee H. Smith (New York) and Fred Murphy (Arkansas).

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