"Medical Men" and "Lady Doctors": the Making of a New Zealand Profession, 1867-1941

Abstract

This thesis studies the professionalization of medicine in New Zealand from the introduction of national medical licensing in 1867, to 1941, when the British Medical Association (New Zealand Branch) finally accepted social security. The study traces the transformation of medical practitioners from a group of scattered, divided and socially mixed medical entrepreneurs, into the politically powerful, educationally homogeneous and economically successful profession of the 1930s. The nature of this change is delineated by studies of the campaign for medical licensing, changes in medical education, the development of a full-time market for medical practitioners in New Zealand, the relations of doctors with corporate and state institutions, the significance of entrepreneurial migration on professional expansion, and the doctors' place in an expanding market for medical services. It is suggested that the key to the professionalization process was the successful metamorphosis of the Victorian role of educated, independent gentleman, into an occupational role defined by scientific training and technical skill. During the early colonial period, medicine was economically and socially less attractive than other areas of economic activity. Because of ambiguity in occupational roles, and extensive therapeutic conflict among those practising, doctors were defined by social rather than occupational status. As educated gentlemen, the most successful of then fitted easily into the colony's elite. Only from the 1880s were medical migrants, and the growing number of medical graduates from Otago University universally drawn into full-time medicine. This was partly a result of the increased status of medicine, but also because opportunities in other areas of the economy were becoming less appealing. When the medical market expanded to include a variety of other health occupations doctors were able to use their superior social position to control access to scientific medicine and to ensure their primacy within that market. While the educational and career patterns of twentieth century doctors became increasingly defined by professional criteria, these patterns were still subject to externally derived roles, especially those of gender and class. Although largely ignoring the debate over social security itself, it is argued that while doctors were dependent on Friendly Societies, hospital boards and the state, for income and professional status, they were able to maintain a degree of independence, despite an ongoing suspicion by the doctors themselves that individual private practices were vulnerable to the economic and political interference of the larger institutions. Research has been based on the collection and analysis of biographical data obtained from a variety of serial records and linked to information on the New Zealand medical register. These records include street directories; the 1882 Return of Freeholders; obituaries; death certificates and medical association membership lists. Computerised methods were developed for linking this material for quantitative and data base analysis, working on the methodological principle that machine readable documents should duplicate their originals to the greatest possible extent. This involved the development of software to manage primary source information through several levels of analysis, from its initial data entry, through record linkage and value recoding for statistical analysis. Information derived from this data base of 3068 doctors and from a series of autobiographical oral interviews, and secondary biographical material has been used to provide and integrated source base for the discussion of social and occupational change over a comparatively long period of time.