Medical Guilds are Bad MedicineMonopolies, Oligarchy, Elitism, Authoritarianism and Groupthink are hurting patients, driving up costs, blocking innovation, and trampling civil rightsRestored Medieval Guild Halls at Grand Place, Brussels In a broad, metaphorical sense (as often used by economists like Milton Friedman or in historical analyses), the term “guild” refers to professional organizations and regulatory bodies that function like traditional medieval guilds by controlling entry into the profession, setting standards, influencing licensing, and protecting members’ economic interests. Common examples of Medical guilds include:
In modern usage, most people refer to these as professional medical associations or specialty societies rather than “guilds.” Still, the guild analogy persists in discussions of professional self-regulation and barriers to entry because the documented monopolistic behavior of these organizations is very similar to the anti-competitive excesses associated with the Guild-controlled economies of Europe from the Middle Ages to the early stages of the Industrial Revolution. The disruptive, transformational culture of innovation and mass production finally broke the centuries-long economic hold of the Guilds, which played a key role in developing and organizing the European cities and States that arose during the Middle Ages. One of the most famous artifacts of the era of the Guilds can be seen at Grand Place in Belgium (just a short walk from the modern building that houses the European Union), where each elaborate building was built and owned by one of the powerful trade guilds that dominated the European economy at the time, serving as a physical reminder of the economic power and influence of the Guild that occupied each building. Headquarters of the American Academy of Pediatrics (AAP), 183,603 square feet, Itasca, IL, completed in 2017 at a cost of $47,356,708. Annual revenue of the AAP is approximately 75M$. Headquarters of the American Medical Association (AMA), a 52-story skyscraper in downtown Chicago, is located at 330 North Wabash Avenue, Suite 39300, and is known as AMA Plaza. The AMA leases floors 39-47 (265,000 square feet) at an annual cost of approximately 7-8M$. Annual revenue for the AMA is approximately 500M$. What is a Guild?In the most generous and benign sense, a Guild is a group of people who band together because they do the same kind of work, share common interests, or want to achieve something together. The meaning changes quite a bit depending on the context. Historically, Guilds have often been associated with a variety of self-serving, monopolistic, anti-competitive, and anti-innovative behaviors. In medieval Europe (roughly 11th–16th centuries), a guild was an influential professional association of craftsmen, artisans, or merchants of the same trade (e.g., blacksmiths, weavers, bakers, cabinetmakers, goldsmiths, merchants). Functionally, medieval guilds operated as a combination of a modern trade union, professional licensing board, cartel/quality control mafia, and social club/mutual aid society. Medieval guilds controlled who could work in the trade in a city (you usually had to join the guild), and often were a significant source of political power in city governments. Essentially operating as regional monopolies, the Guilds set quality standards, regulated prices & limited competition, provided training through an enforced system of apprentices, journeymen, and then eventually masters (the famous career ladder), and protected members by providing sick pay, widows’ & orphans ’ funds, funerals, and other membership benefits. The Medieval guilds were extremely influential until the rise of centralized States and early capitalism began dismantling them in the 17th–19th centuries. This challenges the narrative that all monopolies are the creation of the State. The monopolistic Guild structure predated the rise of the modern Nation-State and became a fundamental organizational force, playing a significant role in the rise of major European cities and Nation-States. The structure and function of Medieval Guilds is almost a precise analog to present-day American medical Guilds, except that medieval guilds did not rely on publications to communicate norms, expectations, and standards of practice (ergo, “Journal of the American Medical Association”). The printing press was a relatively recent invention, and printing had not become widespread. Instead, their internal communication and record-keeping relied on handwritten manuscripts. These were not periodically distributed like newsletters; they were official records kept in the guildhall for consultation by officers (e.g., masters, wardens) or read aloud at assemblies. Medieval Guilds emphasized oral traditions, in-person gatherings (e.g., feasts, processions, masses), and hierarchical control; information flowed top-down through masters and officials, not through mass-distributed publications. Members might hear rules announced verbally during meetings, feasts, or religious services rather than receive personal copies. Characteristics shared between Medieval Guilds and present-day American medical Guilds include the following:
Control of Entry
In both cases, control of entry ensures a scarcity of practitioners, and scarcity sustains high prices. Suppression of Competition
Both systems framed (and continue to frame) outsiders not as competitors but as “charlatans” — a moral framing to justify economic exclusion. Price Fixing and Economic Protectionism
The AMA’s control of CPT billing codes is directly comparable to a medieval guild controlling the ledger of what’s a legitimate trade. Credentialism as Authority
This creates a priestly hierarchy — credentialing as a form of secular anointment. Paternalistic Monopoly on Knowledge
Both systems equate secrecy with authority and protect the legitimacy of their monopoly through opacity. Claims of Serving the Public
Yet in both eras, the practical goal was preservation of professional privilege — not empowerment of the common man or patient. Co-opting of Regulators
Resistance to Innovation
The medieval Guilds and the modern medical boards and societies share the same soul: an oligopoly draped in moral virtue. Both arose from the belief that unregulated chaos harms people, but both evolved into self-sealing monopolies that suppress creative dissent, alternative innovation, and independent thought. Reforming medicine today demands what once broke guilds centuries ago — transparency, open access, and freedom to practice without institutional permission. If today’s Medical Guilds will not reform themselves, then governmental organizations, such as Congress, the judiciary, or HHS, will step in. To some extent, this is already happening to the American Academy of Pediatrics. Furthermore, transformational technologies like Artificial Intelligence and “Big Data” analytics will replace the current medical guilds, much as the Industrial Revolution destroyed the power of the Medieval Guilds. Invite your friends and earn rewardsIf you enjoy Malone News, share it with your friends and earn rewards when they subscribe. |