Chapter 1 - ‘A Game of Animal Grab’: Medical Practice, 1920–1939

Summary

By the 1920s the Australian medical profession had achieved a nearly unchallenged dominance over the supply of personal health services. Its rivals in homoeopathy and other irregular medical traditions had been driven out or marginalized and in each state medical boards, dominated by the profession, ensured that this dominance would remain unchallenged. The costs of medical education were enough to restrict new entrants to the profession. Practitioners, the public and governments agreed that shortages of practitioners rather than excessive competition was the major problem. Paradoxically, these professional advances were accompanied by growing economic insecurity. Private medical practice on a fee-for-service basis faced the insuperable obstacle of a lack of capacity to pay from all but an affluent minority of the population. The politics of organized medicine increasingly centred on finding a means to guarantee medical incomes, and extend services to wider sections of the population without compromising professional autonomy.

At the same time the plight of the 'middle classes' entered the language of medical politics. Conflict over the future of medical practice revolved around growing demands to widen access to the public hospital system to sections of the population previously excluded from charitable institutions. The growing sophistication and expense of hospital-based technologies made the small private hospital and home-based care increasingly inferior for all but simple ailments and operations. In all states organized medicine, represented by the state branches of the British Medical Association (BMA), fought a losing battle to exclude potential paying patients from the public system.