In the view of the Spanish population, physicians are the most highly valued professionals. On a scale of 1 to 5, we receive a score of 4.7.1 Nonetheless, some aspects of medicine, such as continuing education and accreditation, conflicts of interest, and the cost and growing judicialization of health care, require a re-examination of the profession's organizational structure. The low turnout for the board of directors elections in medical associations accurately reflects the extent to which there has been a gradual separation from these organizations. This situation is a challenge that we cannot and should not ignore. It compels us to rethink a type of governance that provides a proper self-regulatory function, safeguards medicine as a profession, and preserves the dignity of physicians and their utmost professionalism as a distinguishing characteristic.

Medical associations have a responsibility to their members, but also to the public. Because of the intrinsic characteristics of medicine, its standards differ from those of other professions and occupations. It is essential that medical practice be self-governed in an effective and responsible manner, as failure to do so would open the door to supervision by others. An example can be found in the case of banks, which are now subject to increased supervision, in part because of their inability to effectively self-regulate.2 In our case, external control would cause deep concern. Given the characteristics and objectives of our profession, self-governance is vital; only physicians are in a position to evaluate the personal, ethical, and professional quality of the care provided by their colleagues.

Medical associations need independence, broad participation, communication, transparency, innovation, and collaboration. There is growing concern that the organizations representing physicians are not proactive enough to protect the public.3 This unease is compounded by the crisis of confidence experienced by the medical profession,4 in part because medical information, once the exclusive property of physicians, is now available to anyone with a computer or mobile phone. This information is often unreliable or misinterpreted, and it can undermine the doctor-patient relationship.

There is an urgent need for physicians to feel good about themselves and better appreciated.5 To this end we must revitalize the professional values that underpin ethical practice in accordance with the Hippocratic oath and scientific foundations. We should promote teamwork and corporate responsibility, while always respecting each physician's uniqueness. In this line, medical associations are ideal meeting points for the development of cross-sectional, multidisciplinary working groups.6,7 We believe this is only possible in a model with strong ties to institutions of learning (scientific societies, universities, foundations, and academies).8 The recent framework agreement between the Spanish Heart Foundation and the Official Physicians Association of Madrid is an example of this collaborative work.

Only medical associations have the legal power to regulate professional practice. Compulsory membership, in a society that increasingly overvalues individual freedom, can lead to rejection. It is only justified by the extraordinary importance of what it safeguards (for physicians and for the public), which includes registration and representation of the medical profession and quality assurance of professional practice.9,10 In essence, only medical associations can guarantee physicians’ commitment to their patients, their professional ethics, and suitable conditions for high-quality medical practice based on scientific evidence.11,12 Through independent self-regulation13 and ongoing accredited training, they ensure that physicians have the professional competence to provide patients with the care they need.