Medical Services in New Zealand and The Pacific
XIII: Rehabilitation of Medical Officers
XIII: Rehabilitation of Medical Officers
The rehabilitation and post-graduate training of medical officers serving in the forces first received the attention of the National Medical Committee on 24 November 1942, when it considered a report from the Director-General of Medical Services (Army and Air). (The matter had originally been raised by ADMS 2 NZ Division in June 1942.) It was decided that the DGMS should formulate definite proposals for further consideration.
A scheme for post-graduate study by medical officers on demobilisation was prepared by the DGMS on 19 August 1943 and submitted to the Minister of Defence. The DGMS pointed out that when demobilisation occurred the country would be faced with the problem of medical officers (old and young) accumulating an extensive knowledge of preventive medicine among the fighting forces, but gaining next to no experience in the diagnosis and treatment of diseases of women and children, and having little opportunity for keeping up to date in modern medicine and surgery.page 424
In his scheme the DGMS divided medical officers into four classes. First, those who were practising specialists and consultants before enlistment and who would benefit by a three-months' refresher course overseas. Second, those who were actually studying or contemplating studying for a higher degree on enlistment and who should have an opportunity to complete their studies or examinations, entailing a course of six to twelve months. Third, general practitioners practising as such before enlistment, for whom a three-months' refresher course in Australia or New Zealand would be sufficient. Fourth, medical officers who had had only a short term as house surgeons after graduation and before enlistment and who intended to become general practitioners. This last group would be the largest, and for them practical courses in medicine, surgery, diseases of children and obstetrics at the main hospitals were suggested.
The proposals were discussed by the DGMS on 16 December 1943 with the Minister of Health, who believed that the situation after the war would be such that New Zealand should endeavour to rely on her own resources for post-graduate training, it being probable that rehabilitation demands on the hospitals of Great Britain would be so great that New Zealanders would not be able to secure appointments with the same facility as previously. The Minister recognised, however, that it would be desirable for some of the returning medical officers to be sent to Great Britain and believed that it should be part of the rehabilitation programme to make grants for this purpose in suitable cases. It was suggested that the matter be further discussed with officers of the Health and Rehabilitation Departments to draw up concrete plans for ministerial consideration.
A meeting of representatives of the Army, Health and Rehabilitation Departments was held in January 1944, when the following decisions were made:
That opportunity for post-graduate experience should be made available to medical men who had served in the forces for eighteen months or longer, or in exceptional circumstances for a shorter period, and particularly to the younger men with short periods of hospital training. (The same grouping as originally outlined by the DGMS was adopted and similar benefits were recommended.)
That the Director-General of Medical Services and Director-General of Health should confer as to the measure of practical assistance to be granted medical men coming within the four groups set out.
That members of the armed forces who wish to become medical men, and who had the necessary educational background, should be given preference in the matter of bursaries to enable them to take the medical course.
That a recommendation should be sent from the meeting to the Ministers of Defence, Rehabilitation and Health to the effect that in the page 425 matter of the rehabilitation of medical men the Government should accept the guidance of the National Medical Committee, with co-opted members consisting of a representative of the Rehabilitation Board and of the Medical Faculty, Otago University.
These decisions were before the sub-committee of the Education Committee of the Rehabilitation Board when it made its report on 30 March 1944 on rehabilitation proposals for professional men discharged from the armed forces. The sub-committee (consisting of Lieutenant-Colonel Ball,1 Sir Thomas Hunter, and Wing Commander Caradus2) was of the opinion that the Rehabilitation Department should not deal with each professional governing body separately, but that principles should be defined upon which all proposals should be based. Only by this means could there be uniformity in the benefits to be approved for the various professions, and an assured equality of treatment. The sub-committee recommended assistance equally to all professional groups in the provision of correspondence courses, weekly classes and discussions at university colleges, short refresher courses in New Zealand for men with little professional experience, and overseas post-graduate bursaries with an allowance of £250 per annum plus fares, fees and books. It was thought that these recommendations would meet most applications for assistance in most professions, but that special provision would be necessary for those medical men who had done short periods as house surgeons and were prospective general practitioners, and that treatment of this group was a matter for arrangement between the Health Department and the Rehabilitation Department.
The proposals of the sub-committee were in turn approved by the Education Committee, the Rehabilitation Board and the Government, and attempts by the National Medical Committee to win special treatment for medical officers were unsuccessful.
Meanwhile, on 30 November 1943, the National Medical Committee had decided that a special committee should be set up to consider medical rehabilitation. The National Medical Committee, being representative of the Department of Health, the Army Department and the British Medical Association, was prepared to act with co-opted members representative of the Rehabilitation Department and the Medical School, Dunedin. A request for such a committee was received from the British Medical Association on 20 December 1943.
1 Lt-Col D. G. Ball, QBE, m.i.d.; Wellington; born Wanganui, 19 Oct 1895; school inspector; NZ Rifle Bde 1915–19 (2 Lt, 4 Bn); Director, Army Education and Welfare Service, 1942–46; later Asst Director of Education.
At this stage the National Medical Committee convened on 6 June 1944 a special meeting which was attended by members of the committee, the Dean of the Otago Medical School, a representative of the British Medical Association and three representatives of the Rehabilitation Department. At this meeting the whole question of rehabilitation was fully discussed and various recommendations made. These were conveyed to the Director of Rehabilitation on 16 June 1944.
This memorandum was referred by the Rehabilitation Department to its own Education Committee for its consideration. This committee did not agree with the recommendations and considered that medical officers should be dealt with in similar manner to other groups of professional men (i.e., architects, engineers, accountants, etc.). This information was conveyed by the Director of Rehabilitation on 15 August 1944 to the National Medical Committee. The reply was received at a meeting of the latter committee with the additional representative of the British Medical Association on 28 August. Its views were set out in the following terms:
The National Medical Committee is not satisfied that the Education Committee of the Rehabilitation Department, composed as it is entirely of lay members, has sufficient knowledge and experience to deal with such a complex subject as the rehabilitation and post graduate training of medical men and regards itself as the Body best qualified to advise in the matter. The National Medical Committee is most anxious to ensure that all young medical men are adequately trained before entering private practice and are not unduly prejudiced in after life by reason of their service overseas. It is gravely concerned about the future of medicine in New Zealand. The medical profession have been proud of the fact that heretofore the greater number of our graduates have, as a matter of course, gone to the United Kingdom for post graduate experience – after completion of a period as a House Surgeon in a public hospital. Many of them, moreover, have taken a higher qualification in medicine or surgery before returning to New Zealand. Today the rewards of private practice are so great and so immediate that there has been a tendency for young doctors who are not liable for military service to embark on practice immediately after qualification and sometimes even without serving a term as a House Surgeon. If the tendency continues the community will suffer by a lowering of the quality of our medical services. Every effort should be made, therefore, to encourage young doctors on demobilisation to return to hospital for further experience and to go overseas for post graduate study.
Unless encouragement is given on the lines recommended by the National Medical Committee the standard of work of the future generation of General page 427 Practitioners will show marked deterioration and the numbers of specialists and consultants will rapidly decline due to the retirement of the large number of specialists and consultants who are past middle life and the failure to replace them. There is no need to stress the serious consequences to New Zealand if the present tendency continues for young doctors to enter practice before their medical education has been completed.
To sum up it is strongly recommended:
That the National Medical Committee with co-opted members, i.e. the Dean of the Medical School with a representative of the New Zealand Branch of the B.M.A. should be recognised as the official advisers to the Rehabilitation Board in all matters relating to the rehabilitation and post graduate training of medical officers serving in the Forces.
That the recommendations embodied in the memorandum of 16th June from the Chairman of the National Medical Committee to the Director of Rehabilitation should be accepted as the basis for bursaries and other assistance to medical officers on demobilisation.
These decisions were placed before the Government but no response was made. A further memorandum of 7 November conveyed to the Minister of Health through the National Medical Committee the views of the planning committee of the British Medical Association on the subject, but again no reply was received. In the meantime rehabilitation assistance for medical officers became a function of the Rehabilitation Department exclusively.
The members of the National Medical Committee felt that they were placed in a false position in that medical practitioners generally looked to the committee and the Department of Health to care for their interest in respect to rehabilitation matters. It seemed to the committee that the Rehabilitation Department preferred to be guided by the advice of its own educational committee rather than by the National Medical Committee with co-opted members representing the Medical School and the British Medical Association. It was decided on 18 December 1944 that, under the circumstances, the only course to adopt was for the committee to dissociate itself from giving any advice to the Director of Rehabilitation in connection with these matters. The Director of Rehabilitation was accordingly advised of the committee's decision.
This communication was received by the Director of Rehabilitation with regret. He pointed out that the recommendations of the committee for dealing with doctors on a different basis from other professions was fully considered by the Rehabilitation Board. The board felt, however, that it could not support a recommendation which would result in having two groups of men overseas on rehabilitation post-graduate scholarships, one group receiving £250 per annum and the other £1000 per annum, particularly in view of the fact that all were professional men desirous of improving their page 428 knowledge and qualifications in their own particular sphere. Further, a number of the professional men had served in the ranks or in generally less favourable conditions than officers of the medical profession while they were in the forces, and it was felt that any action which discriminated against these professional officers compared with doctors on their return to civil life would, with some justice, be most unfavourably received. This was a broad policy matter in which the Government had approved the views of the Rehabilitation Board. The proposal was made to the Director-General of Health that additional grants in the national interests of health might be made by the Health Department.
The final decisions reached by the Rehabilitation Board enabled ex-medical officers completing their training as house surgeons at hospitals to be subsidised up to a maximum for married men of £500 if living in, or £600 if living out. The board also offered overseas post-graduate bursaries in suitable cases, valued at £250 sterling per annum plus fares (where necessary), as well as fees and a grant towards the cost of books.
In retrospect it would seem that the Rehabilitation Board acted sympathetically, and that the attitude of the National Medical Committee in demanding specially favoured treatment for medical officers, and denial of its co-operation when its suggestions were not agreed to, was hardly justified; that the standard of medical service was adequately safeguarded by the opportunities that were made available; and that the British Medical Association's Rehabilitation Committee performed a useful duty with great credit.
Some 151 post-graduate bursaries for overseas studies were granted up to the end of 1951, the additional qualifications studied for including FRCS (66), MRCP (53), MRACP (9), MRCOG (9), and FRACS (6). In addition, 72 grants were made for courses of study overseas, among them being pathology 6, surgery 6, gynaecology 5, anaesthetics 5, dermatology 4, obstetrics 4 and ophthalmology 3. Forty-seven grants were made to subsidise the salaries of house surgeons.
The members of the NZANS received 10 post-graduate bursaries for overseas study and 89 for study in New Zealand, and there were 36 NZMC other ranks among the 169 ex-servicemen and women granted bursaries to study medicine at the University of Otago.