Different approaches to the study of the Royal Protomedicato have not been entirely successful in defining its roles and connections with other organizations that controlled the practice of health professions during the Enlightenment. The loss of manuscript sources relating to the institution has been an almost insurmountable obstacle. In this study we examine the difficult relationships between the Protomedicato and the elite members of the Corps of Military Surgeons who made possible the implementation of a new model of training in surgery in Spain. The establishment of teaching imparted by the new colleges of surgery, together with the restrictions on access to the profession, drove a wedge into the traditional forms of control previously exerted by physicians through the Royal Protomedicato. These changes led to reforms in the tribunal.