The method now dismantling one profession’s autonomy was built to be used on yours.
Every protection a physician has against being told to practice badly comes down to one thing: the power to refuse. When a payer wants a cheaper drug than the patient needs, when an employer wants the visit shortened or the diagnosis shaded to fit a contract, the only thing that lets you say no is a standard that did not come from the payer or the employer. Your board, your code, your evidence base. These are not bureaucracy. They are the legal ground you stand on when you refuse, and they are being quietly relocated, out of the profession and into the hands of legislatures and the corporations that lobby them.
The method was tested first on social work because it was the softest target.
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In Alabama this year, a two-section bill repealed the 1965 statute that required the state’s flagship university to maintain a standalone School of Social Work. There was no ban and no argument about clinical science. The school simply lost its independence, was absorbed into a larger college, and its accreditation defense dissolved because there was no longer a distinct entity for the national accreditor to accredit.
A companion bill, advanced during the same session, would have allowed the state’s universities to bypass that accreditor altogether by seeking approval from a brand-new body the federal government has not recognized and that has so far accredited no one. Lawmakers wrote a phantom accreditor into law before it existed.
The method does not care about the politics used to carry it.
The same week Alabama did this in the name of fighting woke ideology, Kansas enacted something structurally similar affecting its Board of Nursing. It was signed by a Democratic governor, advanced by a libertarian legal foundation, and presented as mercy for nurses punished over lapsed paperwork. The motives could not be more opposed. The act is the same: taking the authority to define professional competence away from the profession.
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The new law strips the nursing board of authority over anything but immediate physical harm and voids two decades of its disciplinary record. A board that can only intervene after immediate physical harm cannot stop a corporate owner from working a nurse to exhaustion, because understaffing is not immediate physical harm until it is.
In medicine, the capture is cleaner because a board is a small body of appointees. Fill the seats and you do not need a single ban.
Florida’s reconstituted Board of Medicine declared a category of evidence-based care to be unprofessional conduct, overriding the national specialty societies without the legislature ever voting.
The same machinery runs in the opposite direction as well. When boards tried to discipline physicians for promoting unproven pandemic treatments, several legislatures passed laws shielding them, and several attorneys general ordered their boards to stand down.
A board that cannot enforce the evidence base in either direction is not a self-governing profession. It is a logo.
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Beside the real boards, alternative certification bodies now sell credentials to physicians who reject the consensus, including, by the main certifying body’s own documentation, physicians it stripped for sexual misconduct and for mis-prescribing controlled substances, who carry the alternative credential and go on practicing.
None of this is really about ideology because ideology is simply the vehicle. To see what it is for, look at the one doctrine that has, for a century, kept corporations from owning physicians: the corporate practice of medicine, still law in about two-thirds of states. It exists so that no company can buy a doctor’s loyalty.
Capital already routes around it through the management services organization and the friendly PC, installing a compliant physician as the paper owner and binding that owner to a contract that hands the firm the billing, the staffing, the schedule, the referrals, and the revenue.
In at least one case, a private equity owner walked away from an entire state rather than let a court rule on whether that arrangement amounted to practicing medicine without a license.
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The only thing a physician inside that structure can use to refuse a corporate order is the professional standard, and the same think tanks writing the bills against licensing want it gone too.
The Cato Institute’s handbook for state lawmakers lists, in one sentence, three things states should eliminate: the licensing of physicians, certificate-of-need laws, and the corporate practice of medicine. Not reform. Eliminate.
The same page that calls licensing a cartel wants gone the last doctrine standing between a hospital ward and a hedge fund.
Social work was never the target. It was the proving ground, chosen because it was underpaid, undefended, and easy to caricature.
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The question Alabama actually tested is whether a legislature can overrule a profession’s own definition of competence and make the practitioner answer to the election and the payer instead of the standard.
If that answer holds, it holds for the board that licenses you, the certification that says you are qualified, and the doctrine that keeps your practice from being owned outright.
The mistake is to wait for the version that arrives wearing medicine’s name, because by then the method will look like housekeeping. It will look like a two-section bill.
The refusal has to come while it is still someone else’s profession, because after that there is no one left with the standing to refuse.
The method now dismantling one profession's autonomy was built to be used on yours.
