@Oddthinking Whatever legislators decide. Preferably those elected, not appointed. There are laws in the USA, but they aren't always scientific based. Stem cell research, for example, has been greatly hindered since Bush Jr and some law that conflates it with cloning, abortion, etc.

"State boards" in the USA are not elected, yet hold a great deal of power over clinicians. Some states are worse than others, but license revoked and financial ruin aren't uncommon results when they come after you. Yes, they take down genuine quacks, yet I've known plenty that just practiced differently, or were on the wrong side of a more dogmatic debate, rather than scientific.

The problem is there's no checks and balances against them when they go dogmatic over scientific.

I don't value a clinician that can't and won't practice outside "the standard of care". These are "cookbook" physicians whose mode of practice could and even is sometimes entirely computer automated. I'll hard pass everytime a person tries to do a computer's job.

But using that wonderful human mind to solve problems ... that's what I seek, and gladly pay for.

If labs would run tests without a doc's signature, I'd have about 90% less doctor's visits necessary.

"Diagnose and prescribe", as in "parse reported symptoms, orders labs, look up approved treatments in some book", is not what I'm paying for, yet that's about all most docs will do. I can do all that very easily thanks to the internet (except the damn labs!).

Compare to dentistry, or chiropractic. They actually do stuff I can't do myself.

200 years ago docs made the drugs (pharmacists) and tests (labs) themselves! Now they run around pretending they aren't just phoning it in most of the time.

Doctors are essentially consultants these days. If they aren't putting their special knowledge to use for my unique needs when I hire them, then they aren't earning it.

But I can't blame them! Patients are so disinterested in their own health, they phone it in themselves. Docs are just giving them what they expect.

But their accountant, boy wow they start caring.