it is argued that across countries, the regulation of health professionals, and particularly medical professionals, has increased as nation states seek high quality, cost effective healthcare. The safety of patients has become a paramount concern, as research on adverse events and instances of poor performance have shown healthcare to be a high risk activity. Many countries are now actively engaged in developing ways of assessing continuing professional competence and detecting poor practice. This chapter draws on the findings from a study of medical regulation in seven countries (Australia, Canada, Finland, France, the Netherlands, New Zealand and the United States). In addition, policy developments in the United Kingdom are also considered. It looks at trends in medical governance across these countries; how physicians' continuing fitness to practise is maintained and how poor practice is identified and acted upon. The findings show that there are some common trens across countries and areas that were once the preserve of the professional group are now subject to external control by a range of regulators. However, there are also differences between countries in how continuing competence is assured. Although the emphasis in the chapter is on medicine, other healthcare professions are affected by reforms in regulation. In many countries there is now a common framework for health professional regulation with greateer accountability of professional governing bodies to government.