The fundamental legal relationship is between the physician and the state and
federal governments. In the United States, most of the law governing medical
practice, exclusive of payment issues, is state law. The legal status of
physicians is created by state law. (In contrast, the licensing of pilots is a
creature of federal law.) It is the state laws that allow the practice of
medicine and restrict it to physicians. While this monopoly is frequently taken
for granted, there is no legal principle that would prevent a state from
allowing a nurse or a layperson to practice medicine.
The physician owes the state certain duties in return for the right to practice
medicine: the duty to protect the public health, the duty to practice
competently, the duty to practice within the constraints established by the
state laws, and the duty to help ensure that other physicians maintain proper
standards of medical practice.
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