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Patients and their families create their own remedies, or they seek medical assistance from herbalists, "granny women," or lay midwives. Medicine is practiced by anyone claiming to be a physician, and quackery is rampant. All doctors are generalists, and they usually travel to treat patients at patients' homes. A doctor may have a home office, which doubles as a compounding pharmacy. Technology is limited to what can be carried in a doctor's bag.
Germ theory is in its infancy, and physicians have access to only a few anaesthetics. Hospitals exist, but high infection rates make them dangerous places. Most patients are treated in their home, or by traveling to the doctor's home. While anyone can practice medicine, with or without specific education, there is a growing awareness of the need to create a medical profession.
Medicine has become recognized as a profession which requires extensive training and competence. Although most NC physicians are white men, African Americans and women are beginning to enter the profession. The house call remains the basic way most patients receive treatment. Specialization, antibiotics and use of technology are advanced by WWII.
Rapid expansion in the numbers of physicians licensed in North Carolina, with approximately 30,000 as of 2009. Diversity in the profession explodes with increasing numbers of women, African Americans, and Asians, as well as physicians trained internationally. The house call is a thing of the past. The state's four graduate medical schools anchor world-renowned centers for treatment and research. Technology becomes the basis of practice for most physicians. Increasing complexity of medical science, professional differentiation, and increased regulation lead to new categories of licensure.