In 18th Century England, there were three main classes of medical men: physicians, surgeons and apothecaries. Physicians were considered the elite among the three groups, holding medical degrees from universities and serving mainly the upper classes. In contrast, English surgeons and apothecaries rarely held medical degrees and often gained their training through apprenticeship. By and large the doctors of early colonial America were not English physicians but “ship’s surgeons”. They had learned their trade through apprenticeship or hospitals and often took on their own apprentices in America, which became the chief means of medical education at the time. While referred to as physicians or doctors, most colonists practicing medicine did not qualify as such back in England.
Colonial “physicians” practiced medicine, surgery and apothecary together as needed. As the colonies grew and prospered, some could afford to be trained at the universities abroad and earn their medical degree. Upon their return, however, colonists expected even European trained physicians to open the same general practices as their untrained countrymen. As might be expected, colonial physicians with formal degrees were often more prosperous and enjoyed greater prestige, but these were few and far between. On the eve of the Revolutionary War it has been estimated that the colonies contained 3,500 physicians, only 400 of whom had undergone some sort of training, and about 200 of these actually held medical degrees.
In 1751, American medical education took a leap forward when Dr. Thomas Bond and Benjamin Franklin established the Pennsylvania Hospital, the first formal institution of its kind. Fifteen years later, medical schools in Philadelphia and New York were established. These institutions offered training and lectures to colonial medical practitioners. Despite the presence of these institutions, the American colonies did not have formal policing of the medical profession. Those rules and regulations enforced in England were not carried across the Atlantic and few colonial cities had the wherewithal to create their own licensing or examinations.