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State medical boards are the public's first line of defence against bad medical care. By licensing and disciplining physicians, the boards help maintain high standards in the medical profession. But how well have the boards succeeded in fulfilling their mission, especially in an era of managed care and its attendant impact on medical accountability?;This text offers a political account of state medical boards. Drawing on board records and files, interviews with prominent physicians, and his own experience as former Assistant Attorney General in charge of administrative prosecutions, the author reconstructs the political maelstrom surrounding physician discipline before and after the advent of managed care. He shows how the widening scope of conflict in the health care field and improvements in case management and reporting techniques led to a substantial increase in the number of disciplinary actions in the 1980s and 1990s. He also describes the battle fought between state boards and their founding professional associations over efforts to prosecute physicians for drug abuse, sexual misconduct and poor technical performance.