This article seeks to examine the status of the medical profession in Tanzania, in the context of political and economic developments since independence. It demonstrates that doctors have maintained a relatively privileged position within the health care system and in the wider society from the colonial period, through the early years of indpendence, to the present. This has been achieved by a variety of means. During the 1970s and early 1980s the profession was closely associated with the developmentalist project of the state. Because of economic restructuring since then it has had to adopt the rhetoric and techniques of accountability, to distance itself from the state and position itself in the notional realm of civil society. Recent cases of the Medical Council are used to demonstrate this trend. Renewed legitimation is most significant as a means of maintaining the profession's links with its international counterparts, and with foreign donors who support the health care system in Tanzania.