In today’s world, the permission to practice medicine (prescribe medication, operate etc.) is usually closely regulated by the state.
In the west during 11th – 13th century several distinctions were made between the grades of knowledge and practical training a medical practitioner had.
A rather small group were called physicus / fisicien. They had a high degree of knowledge for their time, combining the study of liberal Arts at a university with medical education. The title of physicus/fisicien usually implied the degree of magister because of the received education in liberal Arts. The centres for learning in the Latin west were Salerno, Montpellier, Paris, Bologna, Cambridge, Oxford or Padua. It was at these universities that the physicus/ficicien were trained.
Notably, there are examples of female physicians such as Hersende. Hersende was physician to Louis IX and accompanied him during the crusade to Egypt (1248-50).
The term medicus/ miege /mire was used for all types of doctors during the medieval period. They would take the patients history, examine them and treat them, for example with diet, medication or bloodletting. To some degree they also practiced surgery.
The profession of cyrurgicus (surgeon) was considered a trade rather than a profession. It was learned via an apprenticeship, until the end of the 13thcentury when it started to be studied on the universities of the Latin west.Cyrurgici were commonly seen as less well educated, were worse paid and had a lower social status than physici. Surgery was seen by medici as a manual trade along the line of carpentry or stone masonry. During the late 13thcentury cyrurgici with the title of master, indicating their academic education started to appear. Their task was the treatment of wounds as well as the treatment of illnesses that could be seen from the outside (like leprosy or venereal diseases) or might require a surgical treatment.
The profession of berberus /rasorius was likewise a trade learnt via an apprenticeship. Their task was to shave as well as to care for wounds in time of need.
Similarly, the minutor/phlebotomus/sangunator was a specialist tradesman that only did bloodletting. He was also educated during an apprenticeship and would follow the orders of a physician or blood-let on the request of a patient.
The apothecarius/ herbolarius/ spicer prepared medicine according to the orders of a medicus or he could sell the medicine directly to the patients.
Despite the restrictions that were placed on medical education of clergyman during the council of Tours many physicians (physicus/fisicien) were clergyman. Apart from minor restrictions by the fourth Lateran council for subdeacons, deacons and priests, clergyman could practise surgery to the full extant.
The known sources suggest a strong influx of European physicians and surgeons as well as barbers to Outremer. However, there is also documentary evidence for local Christian and Jewish physicians. Furthermore, there seem to have been Muslim physicians as in the hospital of St John in 12th century Jerusalem there were two versions of an oath for newly hired surgeons, supposedly allowing also non-Christians to practise. In addition, a decree of the Frankish church of Nicosia forbade their employment in a church run hospital. Note, however, that we have no comprehensive records of the overall numbers and qualifications of medical practitioners, but are instead dependent on predominantly juridical documents where physicians stood witness for testaments etc.