Prior to the mid 20th century, upon graduation Australian doctors spent time in general practice. A medical career usually included completing an intern year immediately after graduation as a resident in a major teaching hospital. After a period of time in general practice, some doctors would seek specialist qualifications. Possibly reflecting the historical origins of Australia as a series of British colonies, these doctors would travel overseas, most often to the UK, to specialise and then return to establish practice. As the Australian population grew post
World War II, the
public hospital system also grew demanding an increasing number of specialists. Local training program emerged and therefore the ability of a doctor to enter specialist training directly following the mandatory intern year post graduation without entering general practice. This increasing number of specialists made it increasingly difficult for general practitioners in Australia to hold and retain public hospital appointments, especially in procedural areas such as
surgery or
obstetrics. This was not a uniquely Australian phenomenon. Worldwide, medical practice was shifting focus onto hospitals with the expansion of
pharmaceuticals and medical and surgical interventions. In the United States, the number of doctors identifying as general practitioners fell markedly between 1931 and 1974 from 83% to 18%. This process began as specialisation increased prior to the War. US GPs increasingly felt that health care was becoming fragmented and weakening doctor patient relationships. "There are 57 different varieties of specialist to diagnose and treat 57 different varieties of disease but no physician to take care of the patient." "There are no real standards for general practice. What a doctor does and how he does it depends entirely on his own conscience" Dr Collings, 1950. He identified that general practice has no academic underpinning, no evidence upon which to base practice and no consistency of practice. The report did not pull punches. He described rural practice is "an anachronism", suburban practice is a "casualty-clearing" service and Inner city practice is "at best… very unsatisfactory and at worst a positive source of public danger". There was opposition in the UK to the creation of a College by the existing three Medical Colleges – Colleges of Surgeons, Physicians and Obstetricians and Gynaecologists – who held the belief that general practice should be a joint faculty of general practice linked to the existing Colleges. However, put into perspective, in the same document Hunt describes the two original British Colleges sought to stop the creation of the College of Obstetricians and Gynaecologists via legal action in 1929.
The development of the Australian College of General Practitioners The
British College of General Practitioners was formed in 1953 with many Australian doctors amongst the founding members including the RACGP's first president Dr William Conolly, again reflecting the origins of Australia as a series of British colonies, established a New South Wales faculty of the BCGP. This was followed by the creation of other state based faculties of the British College of General Practitioners in Queensland, Western Australia, Tasmania, Victoria and South Australia over the next 5 years. In keeping with the process for creating Medical Colleges under the British system, a group of Australian General Practitioners met in 1957 at the first Annual Scientific Convention in Sydney to declare an intention to form the Australian College of General Practitioners (ACGP) which was formally founded in 1958. This new College joined the state based faculties. State based faculties remain a key part of the modern day function of the RACGP.
Recognition of general practice as a medical specialty In modern Australia, general practice is listed by the AMC as a medical specialty and the RACGP as the specialist college responsible for assessment, as endorsed by the Medical Board of Australia inaugurated in 2010. Yet, on further examination of how general practice is considered across the nation, some of the now-defunct state-based Medical Practitioners' Boards such as Victoria, Queensland and South Australia, did not consider general practice a medical specialty and general practice qualifications, such as the Fellowship of the Royal Australian College of General Practitioners (FRACGP) were not registerable qualifications. The practical implication of the nationalisation of medical registration on the status of general practice as a medical specialty may be unclear. The oddity of general practice in Australia is a lingering and arguably outdated perception that the decision to practise as a GP has low or no standing and status. Comments heard by many GPs including; 'You are just a GP' or 'What do you intend on specialising in?’ reflect something of the community understanding of the general practitioner. This is not without precedent. The history of the general practitioner shows that GPs in early Australia through to GPs in mid and late 20th century, 'defaulted' into general practice having disliked surgical or physician training or having failed exit exams too often. In contrast, the United Kingdom had a powerful case for recognition by the late 1960s, and the United States recognised general practice in 1969.
Strengthening general practice The standing of general practice within academic faculties of universities and professionally has undergone a marked increase in recent decades. The RACGP has been a key driver of this shift. The development and consolidation of training programs, standards for training, standards for practice, curriculum of general practice and various evidence based guidelines and publications have occurred internally within the RACGP.
Academic general practice Demonstrating again the slow shift towards recognition, Australia was late in accepting that general practice should be taught or regarded as a discipline in its own right. The Whitlam government's Karmel committee into 'Expansion of Medical Education in Australia' compromised with departments of 'community medicine' – a confusing anachronism that persisted for many years in Australia's tertiary institutions. The RACGP sought strongly but unsuccessfully that this committee accept general practice into the universities. Today, general practice is listed or has been added alongside community medicine, highlighting the shift since the early 1970s (e.g. Department of General Practice and Community Medicine Monash University) Nine foundation professors of 'Community Practice' were appointed between 1974 and 1976. Again, Australia lagged behind the US and the UK who appointed their first professors and chairs of general practice and family medicine in 1967 and 1963 respectively. The foundation professors were: • Charles Bridges Webb MD FRACGP, Sydney University. Professor of Community Medicine • Max Kamien MD FRACP, MRCP, FRACGP, DPM, DCH
University of Western Australia, Professor of General Practice • Professor Neil Edwin Carson FRACGP FRACP Professor of Community Medicine Monash University • Jean Norella Lickliss MD MRACP, FRCP BMedSc DTM&H Professor of Community Medicine
University of Tasmania • Timothy George Murrell MD FRACGP DTM&H CLJ Professor of Community Medicine • Anthony James Radford FRCP MRCP FRACP MFCM SM DTM&H Professor of Primary Health care
Flinders University • James Geoffrey Ryan BSc FRACGP Professor of community practice
University of Queensland • Ian William Webster MD FRACP Professor of Community Medicine
University of New South Wales • Ross Wharton Webster FRACGP MRACP Professor of Community Health University of Melbourne Notably, many did not hold general practice qualifications either from Australia or international. ==Arms==