Power, Diversity and Medical Regulation: State Medical Boards Move Beyond the Old Boys’ Club

By David Johnson

Recently, the Association of American Medical Colleges announced that for the first time ever women comprised the majority of matriculants into US medical school programs.  This triggered a few thoughts of my own.

In 2017, I debuted my Twitter account focusing on the history of medical regulation.  In the fall of that year, I shared several historical snippets focusing on women in medical regulation.  In one I focused on a regulatory trailblazer: Adele Hutchinson, MD, a graduate of Boston University who appears to have been the first woman to serve on a state medical board anywhere in the United States.  This occurred surprisingly early–in Minnesota in the 1890s.  The fact that two other women (Margaret Koch; Hannah Hurd) succeeded her on the Minnesota medical board struck me as all the more remarkable considering the male domination of medical boards individually and collectively throughout the majority of their history.

This gender landscape has changed over time. One rough calculation I made in 2011 using records from the Federation of State Medical Boards (www.fsmb.org) indicated that women comprised 40% nationally of all members serving on state medical boards.  Similarly, women served as the executive director (i.e., chief staff position) on half of the boards in 2011; a figure that holds true currently.

Federation of State Medical Boards c. 1960

I can’t help but think about these otherwise random facts when I reflect on a picture like the one below featuring the board of directors of the Federation of State Medical Boards (FSMB) in 1960.  Established in 1912, the FSMB served the individual state medical boards of this country both then and now.  I have been proud to work for twenty years with this organization.

There is nothing particularly remarkable about the photograph.  In fact, I could show many more photos just like it of FSMB leadership.  Whether plucked from 1930 or 1950 or 1980, the photos would all look very similar in one regard, leadership involved no one of color and no women.  Truth: This is what power looked like in this country for many years, indeed the vast majority of this country’s history.  Pick virtually any area you wish to analyze: medicine, law, business, government.  A picture like this is reflective of where power rested in the United States for a long time. A picture of the individuals generally holding power in any of these areas (in this example, medical regulation) would look a lot like this.

I think this is part of the reason so many people looked at the Confederate monuments in 2017 and saw them through a different lens. These symbols harken back to this kind of world and power structure; they no longer feel appropriate today on multiple levels.

I am proud to say that leadership of the organization I work for no longer resembles a photo like this.  Still, it gives pauses to consider just how late it was when change finally arrived in these power dynamics.  The first woman did not serve on the FSMB board of directors until the 1970s.  Coincidentally, this woman, Dr. Dorothy Bernstein, came from the Minnesota medical board.

Yet, her brief appointment to serve out a vacancy on the board didn’t translate into a woman being directly elected to FSMB governance until the 1980s.  Dr. Susan Behrens gained this honor and later was elected to serve as the organization’s board chair from1989 to 1990.  Another woman, Dr. Barbara Schneidman (1991-1992), soon followed.

Dr. Behren’s story as a woman moving amongst governance circles was shared in the Journal of Medical Regulation, 2012;98(2).  It is worth reading, especially as such a landscape now seems all the more unfamiliar considering the recent news from the AAMC and it is all too easy to forget our recent history..

David Johnson
, M.A., is Senior Vice President for Assessment Services at the Federation of State Medical Boards. You can follow his reflections on the history of medical regulation in the United States on Twitter @davearlingtontx

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