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Physicians' self-governance

About Physicians' self-governance


The principle of self-governance


Self-governance represents a form of active citizenship, an essential element in democratic political systems. At its core is the idea of assuming responsibility.


Self-governance is based on the principle of subsidiarity, according to which only those tasks which cannot be performed at a local level should be performed by a central authority. The central authority, i.e. the state, should only play a supporting role.


How does it work?


Self-governance means that the state delegates certain legally prescribed tasks and areas of responsibility in which the public has an interest to individuals or organised groups of professionals.


It can be seen as a contract between society and a profession, according to which society grants the profession autonomy in practice of the profession and protection from unqualified competition in return for the assurance of effective self-regulation, professional competence and integrity. The aim of self-governance is therefore to strike a balance between the interests of the profession and its duty to promote the general welfare of the population.


It means taking conscious responsibility for the tasks and interests of the profession, if necessary, also in opposition to the state. This is facilitated by the internalisation of a common attitude and understanding of the role of the profession and what constitutes appropriate behaviour. This is essential in order to ensure the quality of practise. In medicine, this can ultimately be a question of life or death.


Self-governance and the medical profession


In the case of the medical profession, this means assuming responsibility for its own regulation. Organisations of self-governance assume certain tasks. These vary from country to country and may include:

  • Setting the pre-requisites for access to the profession
  • Registering and supervising physicians
  • Organising, regulating, certifying and determining the content of specialty training and CME
  • Conducting quality assurance
  • Monitoring scientific developments and safeguarding scientific standards
  • Developing professional ethical standards and defining professional duties
  • Monitoring adherence to professional duties and ethical standards and penalising breaches against these norms via independent professional tribunals
  • Arbitration of patient-physician disputes
  • Safeguarding the professional interests of the physician community


Benefits of physicians’ self-governance

  • Self-control is the most effective means of governance and guarantees a high level of performance - the complex expert knowledge required by physicians and the formal, unstructured nature of the services they provide make control and detailed regulation by non-professionals or indirect quality assurance difficult.
  • Self-governance enhances professional integrity - the faith placed in the medical profession by society means that the profession must constantly strive to maintain this trust, or risk losing its independence.
  • Organisations of medical self-governance disburden the government and national administration of organisational and educational tasks and provide contact points for the government concerning questions of quality in medicine and healthcare.
  • Organisations of medical self-governance maintain structures of organised physicians and facilitate the collegial exchange of experience and knowledge at the national and international level.


Physicians' self-governance