In the Anglo-American model of care, the physician remains the leader of the care team, but paramedics function much more independently than in the Franco-German model. This has not always been the case. In the earliest days of paramedicine, paramedics were required to contact a physician for formal orders for each intervention that they performed. Some specialists believed this was the only safe approach to providing care in this fashion. In some early cases, 'paramedics' operated blindly, providing medications from numbered or colour-coded syringes as they were directed by the physician, with no real understanding of the actions they were performing. Control was absolute and immediate; there were examples of paramedics being trained, but not legally permitted to perform their skills, or in other cases, they could take action only with a physician or nurse present, much like the existing Franco-German model. In the earliest stages of paramedicine, the paramedics were not yet formally licenses and often served as an extension of the physician's medical license. The Canadian province of Ontario continues to have such a system, as of 2008. As the training, knowledge and skill level of paramedics increased, licensing and certification were formalized, and physicians became more comfortable in working with this new profession; then paramedics were permitted greater degrees of independent practice. In the 21st century, most paramedics function based on complex written protocols or committed to memory, often numerous pages in length, and contact a physician only when standing orders have been exhausted.