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[[File:The_City_of_San_Francisco,_panorama_by_Currier_&_Ives,_1878.jpg|thumbnail|left|380px|San Francisco 1878]]

Finally, in March 1876, after a year of debate in the legislature, the California Assembly and Senate passed an act to “Regulate the Practice of Medicine in the State of California.”<ref> “Annual Address by the President”, A.B. Nixon, M. D., <i>Transactions of the Medical Society of the State of California During the Years of 1875-1876</i>, (Sacramento, 1876): 25, http://books.google.com/ebooks.</ref> It permitted graduates of medical schools to practice without being tested by an examining board, but it differed somewhat from other licensing laws passed the 1870s, because it authorized “each State Medical Society, incorporated and inactive existence” when the bill was passed to appoint seven people to separate boards of examiners.

====Efforts to Amend the Licensing Law====

Regular physicians in California did not have to pair the state’s licensing law with a public health measure. But they were significantly aided because the California Board of Health had been created the year before the licensing law was passed. Even though physicians did not piggy-back the state’s licensing on the creation of the board of health, members of the Board of Health in California strongly advocated on behalf of licensing as an essential component of public health. The board members’ support for licensing was unsurprising because all of the members of the board were Regular physicians. What was surprising was the state Regulars’ willingness to compromise with Irregulars. In many states, Regular physicians proposed laws that clearly sought to limit the influence of Irregulars, but in California, the leaders of CSMS fairly early on were committed to compromising with Irregulars. The leadership of CSMS and the Board of Health in California never sought to eliminate Irregulars. The Regulars’ willingness to compromise encouraged the state’s Irregulars to quickly support the law and overcame any objections in the legislature.

Even though the law was passed with overwhelming support from the state’s Regulars and Irregulars, Ira Oatman, Chairman of the Committee on Medical Legislation for the California State Medical Society, fought tooth and nail “to defeat” subsequent legislation that upset the original compromise. Oatman often worked with several other state medical societies to defeat any and all proposals to amend the licensing law from the Regular society. In 1878, Oatman was faced with multiple bills that sought to upend the state’s law. There were so many proposed alterations and amendments to the licensing, and Oatman admitted that he struggled to keep abreast of all the proposals. Oatman’s struggle was not unique. After licensing laws were passed, legislators constantly sought to tinker with them.'

The California law not only required examinations of all applicants, the new law explicitly, but it created separate Regular, Eclectic, and Homeopathic boards. Each of these boards was explicitly tied to the state board for each sect. Additionally, the medical societies retained the right to change the members without interference from the governor’s office. This effectively prevented any additional medical sects from creating their own medical examining boards, thereby establishing a medical cartel among the three dominant sects. Additionally, the law was altered to give the medical societies more money for examinations. Physicians who submitted false diplomas would be fined an additional fifteen dollars by the board. The examining boards also were required to refuse certificates to any applicant accused of unprofessional conduct. Finally, itinerant vendors were required to pay for one-hundred dollars licenses if they wanted to sell any “drugs, nostrum, ointment or appliance of any kind intended for the treatment of disease.” <ref><i>Laws Regulating the Practice of Medicine in the State of California, Passed April Third, 1876, and April First, 1878</i>, (San Francisco, A. L. Bancroft and Company, 1878): 7–11, http://books.google.com/ebooks.</ref> Essentially, Oatman and the CSMS were successful in achieving almost everything they wanted from the 1878 amendments. Additionally, the 1878 bill enabled more rigorous enforcement of the licensing law.