Only in very recent times have physicians as a class enjoyed a highly favored economic status. Formerly medicine had been a poorly paid profession. In the very largest cities a handful of doctors might be accounted wealthy but the vast majority had to struggle to make a barely comfortable living. "Too many doctors" had been the prevalent explanation, too many practitioners trying to earn a living by ministering to the sick. There was too much competition seeking to attract the paying patient.
In the 19th century the American Medical Association, trying to advance the interests of the regular physicians, had waged a campaign against the cultists and irregular practitioners, many of whom were financially quite successful. The battle, however, progressed slowly and the gains were more than offset by the increasing numbers of regular physicians, most of them poorly educated, who entered practice. For the AMA educational reform was thus