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France lagged several decades behind Germany and the USA in dealing with specialist certification. The reason for this delay, it is argued, has to do with the centralized, state-controlled structure of French medical institutions and with the lack of a powerful national professional association capable of taking on the task. Once such an association did appear in the late 1920s, debate within the profession began in earnest. Nonetheless, it took several years to define an acceptable form of certification from among several possible alternatives and many years more to implement the ambitious national system of state regulation that French doctors wished to introduce. Once the system was established in 1947, the attempt to set rigorous, national rules in a multi-regional and multi-institutional context provoked considerable difficulties and complaints.
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