Revisiting Post-war British Medical Migration: A Case Study of Bristol Medical Graduates in Australia

Revisiting Post-war British Medical Migration: A Case Study of Bristol Medical Graduates in... Summary Between 1954 and 1963, c. 4,000 British-trained doctors migrated to countries including Australia, Canada and the USA. Historians have positioned their motivations to migrate as either primarily ideological (opposition to ‘socialised medicine’) or economic (poor prospects within the NHS structure). Post-war British medical migrants are, however, understudied. This article adds to the growing body of literature on twentieth-century medical migration; it details the transnational lives of a group of Bristol doctors in Australia. Their medical lives are used as a case study to explore prospects in the NHS—particularly for GPs, contextualising these doctors’ decision to migrate. It continues by tracing the subsequent careers of this Bristol group in Australia. In doing so, it highlights the role of medical networks in understanding motivations to migrate, and the early readjustment of medical migrants. It also reveals the integral role British doctors played in alleviating GP shortages in rural Australia. Australia, Bristol, general practice, migration, NHS Martin Gorsky’s survey of the historiography documenting the British National Health Service from 1948 to 2000 identified the 1950s as a period which some contemporary observers argued, and historians agree, was unsatisfactory for general practitioners: they were overworked, underpaid and often criticised.1 By the late 1960s the British Ministry of Health broadly accepted that a quarter of Britain’s annual output of medical graduates—a high proportion of whom were general practitioners—had responded by migrating.2 Commonwealth countries including Australia, Canada and New Zealand were popular destinations because British qualifications were easily transferrable. British and Irish medical degrees were the only overseas qualifications explicitly recognised in all Australian state medical acts.3 Two of the more reliable surveys estimate that between 1,600 and 2,200 doctors with British and Irish qualifications moved to Australia between 1948 and 1963.4 Despite the long tradition of medical migration to Australia, this represented an almost five-fold increase compared to the decades before the Second World War.5 This article is a first step in documenting hitherto unexplored transnational professional lives—both individual and collective—of post-war British medical graduates in Australia. Historical analyses of twentieth-century medicine in Australia are characterised by the rise of the Australian profession, its institutions and its politics. In these accounts, medical migrants are occasionally subsumed in national narratives of Australian medicine and health.6 A subset of permanent British migrants who rose to prominence in Australia are memorialised in national registers, including the Australian National Dictionary of Biography. The literature on twentieth-century medical migration to Australia is dominated by examinations of the significant political, professional and social barriers faced by the smaller, marginalised group of pre- and-post war arrivals: European Jewish refugees and Displaced Persons.7 Historian Paul Weindling argues in his introduction to a special issue of the Social History of Medicine on ‘medical refugees in Britain and the wider world’ how studies of refugee and immigrant doctors can elucidate the important role they play in the ‘modernisation of healthcare’.8 This view has recently been extended by Laurence Monnais and David Wright, who argue medical migrants can ‘challenge’ and sometimes ‘transform’ local medical practice.9 Despite a growing body of literature on medical immigrants in the UK, the British medical emigrant has a relegated role in national narratives of the National Health Service (NHS).10 These migrating doctors are passingly represented as either casualties of early structural problems with the NHS; embedded in wider discussion of Britain’s post-war ‘brain drain’; or as part of the ‘wastage’ contributing to the shortage of doctors in the 1950s, resulting in the corresponding inflow to British hospitals of doctors from South Asia.11 Recently, historian Andrew Seaton has revisited the most controversial motivation ascribed to British medical migration: that it was also an expression of staunch opposition to socialised medicine.12 Seaton argues that opposition to what the NHS symbolised is critical to ‘fully’ understanding the post-war emigration of general practitioners.13 In one of the few studies of post-war British medical migration, historians David Wright, Sasha Mullally and Mary Cordukes noted the lack of transnational studies in the case of Canada and Britain.14 They similarly attribute the neglect of post-war British medical migrants to the centrality of the nation state in NHS historiography. By drawing on oral histories of British doctors in Canada, their study offers a contrasting approach to Seaton’s in evaluating British medical migration. It notes the interwoven strands that encompassed each interviewee’s decision to migrate, but also that ‘the inflexibility and hierarchy of the structure of British medicine loomed very large’ when analysing the collective.15 By adopting a transnational lens, the paper by Wright et al. connects the ‘exodus’ of disenfranchised British doctors from the NHS to the instrumental role they played in maintaining Canada’s new universal health care system, at a time when Canada’s own home-grown supply of doctors was inadequate.16 This study exemplifies how aspects of the history of the NHS, in this case the political and economic discourses of medical manpower in the UK, can be contextualised in a global market for doctors offering competing models of health care delivery. The analytical approach adopted in this article takes its cues from literature on medical immigrants and refugees, and the study by Wright et al. This article presents a case study of the transnational medical lives of a group of sixteen Bristol graduates, most of whom were general practitioners, who migrated to Australia. It traces and contextualises the lives of these doctors—from their war experiences to medical school, as early graduates in the NHS to their decision to migrate, and their subsequent transition and careers in Australia. This case study offers three contributions to the history of medicine and health in Britain and Australia. First, it adds to the literature on how British medical migration has been understood, and favours an interpretation that emphasises the complicated nature of these decisions. Second, it demonstrates the role medical networks can play in influencing choice of destination and experiences of migration—in this case, networks formed at university.17 In doing so, it highlights the potential of a prosopographical, transnational approach in revealing these networks. Finally, the medical careers of this group offer initial evidence and insight into the important role some British medical graduates had in maintaining primary health services in post-war rural Australia. Finding the Bristol Group: Context and Methods The Bristol group emerged as a cohort from a prosopographical study exploring European medical graduates first registered in the Australia state of Victoria between 1930 and 1960. Since British and Irish arrivals account for most of these practitioners—563 out of 735—a random sample, stratified by gender, was drawn for detailed analysis (Table 1).18 Dr Charles Gawthorn was one of the British graduates in this sample. He completed his finals at the University of Bristol in July 1952, and left for Australia later that year. In an autobiographical reflection he wrote for the Royal Australian College of General Practitioners decades later, he recounted that he saw 16 fellow students from the University of Bristol in Australia.19 How Dr Gawthorn defined classmates is debatable—did he mean the group of students he started medical school with? Or those who graduated in the same year as he did? Table 1. Overseas medical graduates registered in Victoria, 1930–60 Brit & Irish women Brit & Irish men Other European Rest of world ALL Sample ALL Sample Women Men Women Men 1930-45 23 14 66 13 2 25 3 13 1946-60* 88 41 386 73 17 42 9 61 Total (% in sample) 111 55 (50%) 452 86 (19%) 19 (100%) 67 (100%) 12 74 Brit & Irish women Brit & Irish men Other European Rest of world ALL Sample ALL Sample Women Men Women Men 1930-45 23 14 66 13 2 25 3 13 1946-60* 88 41 386 73 17 42 9 61 Total (% in sample) 111 55 (50%) 452 86 (19%) 19 (100%) 67 (100%) 12 74 *The numbers for 1960 is incomplete, and only includes those registered before the list went to press in Jan 1960. Source: Victorian medical registers, 1931–1960. Table 1. Overseas medical graduates registered in Victoria, 1930–60 Brit & Irish women Brit & Irish men Other European Rest of world ALL Sample ALL Sample Women Men Women Men 1930-45 23 14 66 13 2 25 3 13 1946-60* 88 41 386 73 17 42 9 61 Total (% in sample) 111 55 (50%) 452 86 (19%) 19 (100%) 67 (100%) 12 74 Brit & Irish women Brit & Irish men Other European Rest of world ALL Sample ALL Sample Women Men Women Men 1930-45 23 14 66 13 2 25 3 13 1946-60* 88 41 386 73 17 42 9 61 Total (% in sample) 111 55 (50%) 452 86 (19%) 19 (100%) 67 (100%) 12 74 *The numbers for 1960 is incomplete, and only includes those registered before the list went to press in Jan 1960. Source: Victorian medical registers, 1931–1960. To answer these questions, it was necessary to trace all Bristol medical graduates for that period. In total, 75 students are listed as completing their finals between December 1951 and December 1952.20 Of these, 16—representing approximately 20 per cent of the total number—did arrive in Australia between 1952 and 1965. One doctor partially completed his finals at Bristol but never graduated, qualifying instead with the English conjoint, and another’s wife had graduated from Bristol earlier in 1951—totalling 18 individuals including himself that Dr Gawthorn may have been referring to.21 In the full Victorian migrant sample alone, eight of the ten Bristol graduates registered in 1950–54 had graduated in 1952 (highlighted in Table 2). No such discernible pattern has been found for British graduates arriving in Victoria from other medical schools, despite them outnumbering Bristol graduates (Table 2). However, it does raise the possibility that similar cohorts might be found if the analysis was extended to all Australian states. Table 2. British and Irish medical graduates registered in Victoria, Australia, by year and place of graduation (n = 563) Year/Place of grad <1920 1920-24 1925-29 1930-34 1935-39 1940-44 1945-49 1950-54 1955-59 Total London London* 0 1 11 2 3 7 27 23 12 86 England** 8 8 13 13 17 23 19 16 3 120 Rest of England Birmingham 0 0 0 0 2 1 2 3 4 12 Bristol 0 0 0 0 0 1 2 10 (8) 1 14 Cambridge 0 0 1 1 2 2 6 3 5 20 Durham 1 2 0 0 7 4 (3) 4 3 2 23 Leeds 0 1 0 0 2 4 0 1 0 8 Liverpool 0 0 0 0 0 2 4 8 (3, 3) 3 17 Manchester 0 1 1 2 0 0 4 (3) 3 3 14 Oxford 0 0 1 0 0 1 2 6 0 10 Sheffield 0 0 0 0 0 1 1 1 1 4 Scotland Aberdeen 1 1 2 0 2 2 4 4 1 17 Edinburgh 2 0 6 3 11 (4, 3) 7 (3) 12 (3,3,4) 3 4 48 Glasgow 2 4 (3) 3 2 4 4 5 3 4 31 St Andrews 0 4 4 1 1 2 2 2 0 16 Scotland ^ 4 2 4 7 14 7 2 4 0 44 Wales Cardiff 0 0 0 0 0 0 2 1 1 4 N. Ireland Belfast 0 1 0 1 4 2 3 4 3 18 Ireland Dublin 1 0 2 2 2 2 5 6 (3) 2 22 Ireland ^ ^ 6 2 1 1 4 4 5 8 2 33 Yr reg in VIC, AUS 19 33 35 63 146 267 563 % <7 yrs from grad 47% 61% 31% 37% 41% 54% % <10 yrs from grad 68% 85% 66% 73% 75% 87% Year/Place of grad <1920 1920-24 1925-29 1930-34 1935-39 1940-44 1945-49 1950-54 1955-59 Total London London* 0 1 11 2 3 7 27 23 12 86 England** 8 8 13 13 17 23 19 16 3 120 Rest of England Birmingham 0 0 0 0 2 1 2 3 4 12 Bristol 0 0 0 0 0 1 2 10 (8) 1 14 Cambridge 0 0 1 1 2 2 6 3 5 20 Durham 1 2 0 0 7 4 (3) 4 3 2 23 Leeds 0 1 0 0 2 4 0 1 0 8 Liverpool 0 0 0 0 0 2 4 8 (3, 3) 3 17 Manchester 0 1 1 2 0 0 4 (3) 3 3 14 Oxford 0 0 1 0 0 1 2 6 0 10 Sheffield 0 0 0 0 0 1 1 1 1 4 Scotland Aberdeen 1 1 2 0 2 2 4 4 1 17 Edinburgh 2 0 6 3 11 (4, 3) 7 (3) 12 (3,3,4) 3 4 48 Glasgow 2 4 (3) 3 2 4 4 5 3 4 31 St Andrews 0 4 4 1 1 2 2 2 0 16 Scotland ^ 4 2 4 7 14 7 2 4 0 44 Wales Cardiff 0 0 0 0 0 0 2 1 1 4 N. Ireland Belfast 0 1 0 1 4 2 3 4 3 18 Ireland Dublin 1 0 2 2 2 2 5 6 (3) 2 22 Ireland ^ ^ 6 2 1 1 4 4 5 8 2 33 Yr reg in VIC, AUS 19 33 35 63 146 267 563 % <7 yrs from grad 47% 61% 31% 37% 41% 54% % <10 yrs from grad 68% 85% 66% 73% 75% 87% Numbers in parentheses indicate clusters that shared year of graduation. * Includes all London medical schools. ** Includes qualifications conferred by both Royal Colleges of Physicians and Surgeons, and the Society of Apothecaries.  ^ Only the Scottish double or triple issued by the Royal Colleges of Edinburgh and Glasgow.  ^ ^ Includes qualifications conferred by both university medical schools and the Royal College of Physicians in Ireland. Sources: Victorian medical registers and General Medical Council lists. Table 2. British and Irish medical graduates registered in Victoria, Australia, by year and place of graduation (n = 563) Year/Place of grad <1920 1920-24 1925-29 1930-34 1935-39 1940-44 1945-49 1950-54 1955-59 Total London London* 0 1 11 2 3 7 27 23 12 86 England** 8 8 13 13 17 23 19 16 3 120 Rest of England Birmingham 0 0 0 0 2 1 2 3 4 12 Bristol 0 0 0 0 0 1 2 10 (8) 1 14 Cambridge 0 0 1 1 2 2 6 3 5 20 Durham 1 2 0 0 7 4 (3) 4 3 2 23 Leeds 0 1 0 0 2 4 0 1 0 8 Liverpool 0 0 0 0 0 2 4 8 (3, 3) 3 17 Manchester 0 1 1 2 0 0 4 (3) 3 3 14 Oxford 0 0 1 0 0 1 2 6 0 10 Sheffield 0 0 0 0 0 1 1 1 1 4 Scotland Aberdeen 1 1 2 0 2 2 4 4 1 17 Edinburgh 2 0 6 3 11 (4, 3) 7 (3) 12 (3,3,4) 3 4 48 Glasgow 2 4 (3) 3 2 4 4 5 3 4 31 St Andrews 0 4 4 1 1 2 2 2 0 16 Scotland ^ 4 2 4 7 14 7 2 4 0 44 Wales Cardiff 0 0 0 0 0 0 2 1 1 4 N. Ireland Belfast 0 1 0 1 4 2 3 4 3 18 Ireland Dublin 1 0 2 2 2 2 5 6 (3) 2 22 Ireland ^ ^ 6 2 1 1 4 4 5 8 2 33 Yr reg in VIC, AUS 19 33 35 63 146 267 563 % <7 yrs from grad 47% 61% 31% 37% 41% 54% % <10 yrs from grad 68% 85% 66% 73% 75% 87% Year/Place of grad <1920 1920-24 1925-29 1930-34 1935-39 1940-44 1945-49 1950-54 1955-59 Total London London* 0 1 11 2 3 7 27 23 12 86 England** 8 8 13 13 17 23 19 16 3 120 Rest of England Birmingham 0 0 0 0 2 1 2 3 4 12 Bristol 0 0 0 0 0 1 2 10 (8) 1 14 Cambridge 0 0 1 1 2 2 6 3 5 20 Durham 1 2 0 0 7 4 (3) 4 3 2 23 Leeds 0 1 0 0 2 4 0 1 0 8 Liverpool 0 0 0 0 0 2 4 8 (3, 3) 3 17 Manchester 0 1 1 2 0 0 4 (3) 3 3 14 Oxford 0 0 1 0 0 1 2 6 0 10 Sheffield 0 0 0 0 0 1 1 1 1 4 Scotland Aberdeen 1 1 2 0 2 2 4 4 1 17 Edinburgh 2 0 6 3 11 (4, 3) 7 (3) 12 (3,3,4) 3 4 48 Glasgow 2 4 (3) 3 2 4 4 5 3 4 31 St Andrews 0 4 4 1 1 2 2 2 0 16 Scotland ^ 4 2 4 7 14 7 2 4 0 44 Wales Cardiff 0 0 0 0 0 0 2 1 1 4 N. Ireland Belfast 0 1 0 1 4 2 3 4 3 18 Ireland Dublin 1 0 2 2 2 2 5 6 (3) 2 22 Ireland ^ ^ 6 2 1 1 4 4 5 8 2 33 Yr reg in VIC, AUS 19 33 35 63 146 267 563 % <7 yrs from grad 47% 61% 31% 37% 41% 54% % <10 yrs from grad 68% 85% 66% 73% 75% 87% Numbers in parentheses indicate clusters that shared year of graduation. * Includes all London medical schools. ** Includes qualifications conferred by both Royal Colleges of Physicians and Surgeons, and the Society of Apothecaries.  ^ Only the Scottish double or triple issued by the Royal Colleges of Edinburgh and Glasgow.  ^ ^ Includes qualifications conferred by both university medical schools and the Royal College of Physicians in Ireland. Sources: Victorian medical registers and General Medical Council lists. The remainder of this article will primarily focus on the 16 Bristol graduates—thirteen men and three women—who qualified between December 1951 and 1952, and eventually moved to Australia (Table 3).22 This group of 1952 Bristol graduates are clearly unique because of their shared university education and their subsequent choice of destination. (Only a further seven of the 75 Bristol graduates who graduated in 1952 spent a portion of their medical career overseas in the first 20 years after graduating.23) I do not argue that the experiences of this Bristol group are wholly representative of British medical graduates in Australia. However, they are representative of a significant post-war migrant doctor profile, especially with respect to their war experience; marital status; migration ten or less years from graduating (Table 2); and their status as general practitioners. Therefore, the Bristol group’s experiences and their career trajectories once in Australia offer a distinct, convenient sample with which to explore and contextualise professional networks, factors that influenced British graduates to leave the UK, their choice of Australia as a destination, and their professional lives once there. Table 3. 1952 Bristol graduates—career summary before leaving UK Yr left UK Name Est. age on grad Military service (rank if known) House jobs (after graduation) Further career in UK (before leaving) Marital status on leaving UK 1952 Gawthorn, Charles 29 Fleet Arm Pilot, Royal Navy, 1940-46 None – Married (1944) with children 1952-3 Lowther, Gordon – Unknown Unknown Unknown Unknown – presumed unmarried 1954 Appelbe, Frederick 33 Navigation Officer, Royal Navy, 1940-46 Frenchay Hospital, Bristol GP, Bristol Married (1951) with children 1954 Martyn, Sheila 25 Unknown Southmead Hospital (Bristol) – Unmarried 1955 Bennett, Bernard 34 Staff Captain, RAMC, 1940-1946 Newton Abbott hospital, Devon GP, Devon Married (1946) with children 1955-6 Smith, Herbert 27 Unknown St Charles Hospital, London – Married 1955 Walker, Henry 28 Pilot, RAF, c. 1943-47 Southmead Hospital, Bristol GP (Locum work), location unknown Married (1950) with children 1956 Edmondson, Kenneth 23 RAMC, 1953-55 Royal Bristol Infirmary Dorchester Hospital; GP, Bristol Married (1954) 1956 Sherwood, Denise 23 None Royal Bristol Infirmary – Married (1952) to Peter Sherwood, with chidlren 1956 Sherwood, Peter 24 RAMC, 1953-55 Southmead Hospital, Bristol & Royal Devon and Exeter Hospital GP (Locum work), Bristol Married (1952) to Denise Sherwood, with chidlren 1956-7 Walker, Andrew 29 Pilot, RAF, 1939-45& RAF (Aux), 1945-53 None declared Paediatrician, Dept. of Health, Gloucester; Divisional Surg., St John’s Ambulance Unknown 1957 Hillier, Geoffrey 26 Captain RAMC, 1953-55 Royal Bristol Infirmary Senior House Surgeon, Royal Bristol Infirmary Registrar (Surgery), Cossham Memorial Hospital, Bristol Married (1949 – wife a doctor) with children 1959 Gear, Douglas 28 Unknown Royal Bristol Infirmary Registrar, Royal Gloucester Hospital, Gloucester; GP, South Petherton Hospital, Somerset Married (1948) with children 1959 Palmer, Ian 22 Captain RAMC, 1954-56 Royal Bristol Infirmary & Nobles Hospital, Isle of Man House Surgeon, then Obstetric Officer, Royal Victoria Hospital, Bournemouth Married (1958, wife a doctor) 1962 Jarvis, David 24 Medical Officer RAMC, 1953-55 Croydon General Hospital, London Demonstrator in Pathology, University of Bristol Married 1965 Fox, Audrey 25 None Royal Gwent Hospital, Newport Senior Resident Medical Officer, Bruce Melville Wills Memorial Hospital (Bristol); then GP, Bristol* Married with children Yr left UK Name Est. age on grad Military service (rank if known) House jobs (after graduation) Further career in UK (before leaving) Marital status on leaving UK 1952 Gawthorn, Charles 29 Fleet Arm Pilot, Royal Navy, 1940-46 None – Married (1944) with children 1952-3 Lowther, Gordon – Unknown Unknown Unknown Unknown – presumed unmarried 1954 Appelbe, Frederick 33 Navigation Officer, Royal Navy, 1940-46 Frenchay Hospital, Bristol GP, Bristol Married (1951) with children 1954 Martyn, Sheila 25 Unknown Southmead Hospital (Bristol) – Unmarried 1955 Bennett, Bernard 34 Staff Captain, RAMC, 1940-1946 Newton Abbott hospital, Devon GP, Devon Married (1946) with children 1955-6 Smith, Herbert 27 Unknown St Charles Hospital, London – Married 1955 Walker, Henry 28 Pilot, RAF, c. 1943-47 Southmead Hospital, Bristol GP (Locum work), location unknown Married (1950) with children 1956 Edmondson, Kenneth 23 RAMC, 1953-55 Royal Bristol Infirmary Dorchester Hospital; GP, Bristol Married (1954) 1956 Sherwood, Denise 23 None Royal Bristol Infirmary – Married (1952) to Peter Sherwood, with chidlren 1956 Sherwood, Peter 24 RAMC, 1953-55 Southmead Hospital, Bristol & Royal Devon and Exeter Hospital GP (Locum work), Bristol Married (1952) to Denise Sherwood, with chidlren 1956-7 Walker, Andrew 29 Pilot, RAF, 1939-45& RAF (Aux), 1945-53 None declared Paediatrician, Dept. of Health, Gloucester; Divisional Surg., St John’s Ambulance Unknown 1957 Hillier, Geoffrey 26 Captain RAMC, 1953-55 Royal Bristol Infirmary Senior House Surgeon, Royal Bristol Infirmary Registrar (Surgery), Cossham Memorial Hospital, Bristol Married (1949 – wife a doctor) with children 1959 Gear, Douglas 28 Unknown Royal Bristol Infirmary Registrar, Royal Gloucester Hospital, Gloucester; GP, South Petherton Hospital, Somerset Married (1948) with children 1959 Palmer, Ian 22 Captain RAMC, 1954-56 Royal Bristol Infirmary & Nobles Hospital, Isle of Man House Surgeon, then Obstetric Officer, Royal Victoria Hospital, Bournemouth Married (1958, wife a doctor) 1962 Jarvis, David 24 Medical Officer RAMC, 1953-55 Croydon General Hospital, London Demonstrator in Pathology, University of Bristol Married 1965 Fox, Audrey 25 None Royal Gwent Hospital, Newport Senior Resident Medical Officer, Bruce Melville Wills Memorial Hospital (Bristol); then GP, Bristol* Married with children Source: Fallon Mody database 2017. Table 3. 1952 Bristol graduates—career summary before leaving UK Yr left UK Name Est. age on grad Military service (rank if known) House jobs (after graduation) Further career in UK (before leaving) Marital status on leaving UK 1952 Gawthorn, Charles 29 Fleet Arm Pilot, Royal Navy, 1940-46 None – Married (1944) with children 1952-3 Lowther, Gordon – Unknown Unknown Unknown Unknown – presumed unmarried 1954 Appelbe, Frederick 33 Navigation Officer, Royal Navy, 1940-46 Frenchay Hospital, Bristol GP, Bristol Married (1951) with children 1954 Martyn, Sheila 25 Unknown Southmead Hospital (Bristol) – Unmarried 1955 Bennett, Bernard 34 Staff Captain, RAMC, 1940-1946 Newton Abbott hospital, Devon GP, Devon Married (1946) with children 1955-6 Smith, Herbert 27 Unknown St Charles Hospital, London – Married 1955 Walker, Henry 28 Pilot, RAF, c. 1943-47 Southmead Hospital, Bristol GP (Locum work), location unknown Married (1950) with children 1956 Edmondson, Kenneth 23 RAMC, 1953-55 Royal Bristol Infirmary Dorchester Hospital; GP, Bristol Married (1954) 1956 Sherwood, Denise 23 None Royal Bristol Infirmary – Married (1952) to Peter Sherwood, with chidlren 1956 Sherwood, Peter 24 RAMC, 1953-55 Southmead Hospital, Bristol & Royal Devon and Exeter Hospital GP (Locum work), Bristol Married (1952) to Denise Sherwood, with chidlren 1956-7 Walker, Andrew 29 Pilot, RAF, 1939-45& RAF (Aux), 1945-53 None declared Paediatrician, Dept. of Health, Gloucester; Divisional Surg., St John’s Ambulance Unknown 1957 Hillier, Geoffrey 26 Captain RAMC, 1953-55 Royal Bristol Infirmary Senior House Surgeon, Royal Bristol Infirmary Registrar (Surgery), Cossham Memorial Hospital, Bristol Married (1949 – wife a doctor) with children 1959 Gear, Douglas 28 Unknown Royal Bristol Infirmary Registrar, Royal Gloucester Hospital, Gloucester; GP, South Petherton Hospital, Somerset Married (1948) with children 1959 Palmer, Ian 22 Captain RAMC, 1954-56 Royal Bristol Infirmary & Nobles Hospital, Isle of Man House Surgeon, then Obstetric Officer, Royal Victoria Hospital, Bournemouth Married (1958, wife a doctor) 1962 Jarvis, David 24 Medical Officer RAMC, 1953-55 Croydon General Hospital, London Demonstrator in Pathology, University of Bristol Married 1965 Fox, Audrey 25 None Royal Gwent Hospital, Newport Senior Resident Medical Officer, Bruce Melville Wills Memorial Hospital (Bristol); then GP, Bristol* Married with children Yr left UK Name Est. age on grad Military service (rank if known) House jobs (after graduation) Further career in UK (before leaving) Marital status on leaving UK 1952 Gawthorn, Charles 29 Fleet Arm Pilot, Royal Navy, 1940-46 None – Married (1944) with children 1952-3 Lowther, Gordon – Unknown Unknown Unknown Unknown – presumed unmarried 1954 Appelbe, Frederick 33 Navigation Officer, Royal Navy, 1940-46 Frenchay Hospital, Bristol GP, Bristol Married (1951) with children 1954 Martyn, Sheila 25 Unknown Southmead Hospital (Bristol) – Unmarried 1955 Bennett, Bernard 34 Staff Captain, RAMC, 1940-1946 Newton Abbott hospital, Devon GP, Devon Married (1946) with children 1955-6 Smith, Herbert 27 Unknown St Charles Hospital, London – Married 1955 Walker, Henry 28 Pilot, RAF, c. 1943-47 Southmead Hospital, Bristol GP (Locum work), location unknown Married (1950) with children 1956 Edmondson, Kenneth 23 RAMC, 1953-55 Royal Bristol Infirmary Dorchester Hospital; GP, Bristol Married (1954) 1956 Sherwood, Denise 23 None Royal Bristol Infirmary – Married (1952) to Peter Sherwood, with chidlren 1956 Sherwood, Peter 24 RAMC, 1953-55 Southmead Hospital, Bristol & Royal Devon and Exeter Hospital GP (Locum work), Bristol Married (1952) to Denise Sherwood, with chidlren 1956-7 Walker, Andrew 29 Pilot, RAF, 1939-45& RAF (Aux), 1945-53 None declared Paediatrician, Dept. of Health, Gloucester; Divisional Surg., St John’s Ambulance Unknown 1957 Hillier, Geoffrey 26 Captain RAMC, 1953-55 Royal Bristol Infirmary Senior House Surgeon, Royal Bristol Infirmary Registrar (Surgery), Cossham Memorial Hospital, Bristol Married (1949 – wife a doctor) with children 1959 Gear, Douglas 28 Unknown Royal Bristol Infirmary Registrar, Royal Gloucester Hospital, Gloucester; GP, South Petherton Hospital, Somerset Married (1948) with children 1959 Palmer, Ian 22 Captain RAMC, 1954-56 Royal Bristol Infirmary & Nobles Hospital, Isle of Man House Surgeon, then Obstetric Officer, Royal Victoria Hospital, Bournemouth Married (1958, wife a doctor) 1962 Jarvis, David 24 Medical Officer RAMC, 1953-55 Croydon General Hospital, London Demonstrator in Pathology, University of Bristol Married 1965 Fox, Audrey 25 None Royal Gwent Hospital, Newport Senior Resident Medical Officer, Bruce Melville Wills Memorial Hospital (Bristol); then GP, Bristol* Married with children Source: Fallon Mody database 2017. The professional careers and experiences of this ‘Bristol group’ have been reconstructed from interviews with surviving members of the group and their immediate family, and from published and private autobiographical accounts, to supplement the employment histories declared in the medical directories of Australia and the UK. Additional information was collected from archival collections held at the National Archives of Australia and the UK, the Public Records Offices of Australian states, the Victorian medical registers published in the Victorian Government Gazette, annual medical registers published by the General Medical Council of the UK, obituaries published in medical journals and newspapers, and records held by local councils in Australia. This article focuses primarily on themes that influenced the career trajectories of this Bristol group. The role that other social factors will have played in each of these individual’s lives is undeniable. The accounts of the Bristol group touch on a number of social and cultural issues relevant to nuancing their decision to leave the UK and their subsequent Australian migrant experience, particularly, social adjustment after the war, familial relationships, and perceptions of Australia. This article explores the individual and collective experiences of the politics and practice of medicine and health care in both countries through a case study of this one inter-linked group.24 They highlight the myriad of ways the rank-and-file doctor experienced the policies and politics of health care delivery in the early NHS, and the particular problems faced by recent graduates in general practice in Britain. This exploration of the careers of this Bristol group in Australia, whilst limited in size, highlights how their experiences and assessment of the NHS prompted their emigration. Once in Australia, this study discusses the ways in which the group’s British training and experience shaped how individuals navigated opportunity in Australia. They sought fairer terms, higher income, a better life for their families. However, in doing so, their experiences challenge the assumption that British migrants had a seamless transition into the medical profession in Australia—on the contrary, their inexperience, lack of capital and local networks meant they had to work hard, often in remote areas to establish themselves. This article offers the first, and therefore necessarily exploratory interpretation, of post-war British medical graduates in Australia. The focus on the complete medical careers of a single cohort, using a mixed method approach, provides a qualitative update to what has so far been a statistical footnote in the historiography. Military Service, and on Becoming Doctors All but one member of the Bristol group entered university at the end of the war, between 1945 and 1946.25Table 3 summarises the group’s military service where traceable, and this immediately stratifies the cohort into those who had and those who had not served during the Second World War. The five men who were 29 years or older on graduating had all seen active service—two in the Royal Navy, in the Royal Army Medical Corps, and two in the Royal Air Force. The younger men and the women had an unbroken pathway from secondary to medical school. Although some form of mandatory military service was maintained in the UK until 1960, students were among those allowed to postpone it. The younger men in the cohort took advantage of this—four of them completed their two years of service after graduating in 1952. The ages of the Bristol group, as we will see, was a deciding factor in their choice of medical career, and arguably indirectly influenced their choice to migrate to Australia. However, for the mature students, their initial pathway to medicine was a direct consequence of their war experiences, and in some cases was a conscious effort to lift their social status. Dr Frederick Appelbe, for example, was born into an Irish farming family in west county Cork, Ireland. He was the last of eight children, and attended the local state school, and later a private school until he was 16. His parents could not afford to buy him a farm of his own, instead he was sent to Dublin to prepare for the British Civil Service exam, which he passed in 1938. His appointment in the Department of Customs and Excise in London was interrupted by the outbreak of the war. Appelbe served six years in the Navy, working his way up from the lower deck of the HMS Comorin as a naval rating to a commissioned officer in 1943, which he describes as a personal ‘turning point’. Up till that time I had mixed with people of limited ambition for their future or their country. [Now] as an Officer I mixed with a different social group. They were men of middle class extraction. Many were from the business world. Others had plans to go to university after the War and study law, dentistry, medicine, accountancy. … Almost subconsciously I absorbed the idea that what they were doing, I also could and should do. Up until [then] I had taken for granted that at the end of the War (if I was still alive) I would go back to my previous job …26 Bennett was also a civil servant in the Department of Customs and Excise before the war. He was called up in 1940, and served initially as a stretcher-bearer in the Royal Army Medical Corps. He recounts realising that he was as intellectually capable as the army doctors he was working with, prompting his application to study medicine once demobbed in 1946.27 Bennett applied for entry to the University of Cambridge and the University of Bristol, and was originally accepted into dentistry at Bristol.28 Others, like Gawthorn and Henry Walker had had a middle-class upbringing and schooling. Gawthorn attended King’s Ely public school in Cambridgeshire. He claims no ambition to study medicine in school, and was diverted by his uncle from the priesthood to join the Navy.29 He recalls knowing that he would ‘do something worthwhile’ after the war, but decided that would be medicine only after meeting his future wife—a nurse—whom he married in 1944.30 Her father was a general practitioner whom Gawthorn used to accompany on house calls when on leave from active duty. From the outset, these older ex-servicemen knew their medical careers would at best be shortened by at least a decade, providing they passed their examinations and remained in good health. Their pathway to choosing medicine contrasts sharply with the more commonly cited childhood aspiration of the other men and women in the cohort, often influenced by early exposure to the profession, either from immediate family or admiration of their family doctor. It displays a more calculated choice, based on a desire to earn a better income after the war, or enter what they saw as a stable and respectable profession—understandable motivations in the austerity of post-war Britain. The University of Bristol offered a standard six-year medical degree, therefore the first members of the cohort graduated in January 1952. Some of the later members sitting their finals in December 1952 were among the first groups subject to the compulsory hospital pre-registration year introduced by the General Medical Council, starting in 1953. Prior to that, applying for hospital house jobs was at the discretion of each individual, but critical for those aspiring to consultant status and a hospital career.31 As summarised in Table 3, almost every member of the Bristol group undertook the two common six-month house jobs—most often at the Bristol Royal Infirmary. In the cases of the younger men, although deferred military service encroached on their early careers, they were drafted to work in their professional capacity. For example, Drs Palmer and Jarvis both served as medical officers in the Royal Army Medical Corps in Malaya after they had completed their house jobs. Dr Hillier served two years as a Junior Specialist in Surgery in the RAMC in the military hospital at Tidworth camp, in Wiltshire. Career Choices and Leaving the NHS The NHS had been operational for approximately four years when the Bristol group graduated in 1952–3. By the time they had graduated, half of the group were married, some with children. Dr Gawthorn recalled that being an older, ex-Naval officer with a wife and child on graduating meant a hospital house job with ‘four pounds per week with £3/5/0 deducted for keep, left only fifteen shillings for the family. General practice it had to be.’32 The additional time and training required to specialise—at a low income—was not conducive to supporting a family, and represented further uncertainty to those older servicemen whose careers were already attenuated by the war. The original NHS hospital career structure—or the Spens ladder—predicted a graduate would need seven years to reach consultant status. Between 1950 and 1961, this expectation was subjected to a number of readjustments as demand outstripped the availability of consultant posts.33 Additionally, hospital posts generally came with compulsory residency requirements and poor accommodation for married couples. Dr Bennett, who married the year he started at Bristol, chose a six-month initial house job at Newton Abbot hospital specifically because they offered married quarters.34 General practice, despite suffering from a lower status compared to a hospital career, offered mature graduates the opportunity to establish a steady income with a higher degree of independence. This tendency for the group towards general practice is why working conditions for general practitioners (GPs) will claim a central part of the remaining narrative. When the NHS was introduced, GPs had to spend 10 years in the system before they could claim a pension; the private sale of practices including the sale of goodwill ceased; and professional ‘squatting’—setting up a new practice in an area, and building a patient list slowly—was only possible in severely under-doctored areas, as determined by local committees. Recent graduates had to look for assistantships ‘with a view’ to partnership in existing practices only—creating in those early years a flooded market of graduates with very little bargaining power.35 The British Minister for Health reported to the House of Commons in October 1952, that since the introduction of the NHS there had been a 206 per cent increase in the number of assistants in general practices.36 These questions arose in relation to a recent committee investigating GPs’ wages chaired by Mr Justice Danckwerts. The resulting 1952 ‘Danckwerts award’ was an increase in average gross income for partners in a general practice of almost 20 per cent, but conditions for assistants—now allowed 2,000 patients on their list, compared to 3,500 for partners—in terms of both income and partnership opportunities were still comparatively low. Dr Gawthorn describes the prospect of working as one such ‘poorly paid sweated assistant’ as one of his motivations for migrating.37 Abel-Smith and Gale’s study of 275 randomly selected doctors showed that 40 per cent of the departures between 1949 and 1962 had been a GP, (junior) House Officer in a hospital or, like Dr Gawthorn, had never held a position within the NHS on leaving.38 Ten members of the Bristol group fell into one of these categories, six of whom had been GPs.39 The study of British doctors in Canada by Wright et al. noted that although their interviewees were reticent to discuss their wages, they commonly cited wanting to improve their quality of life as one reason to migrate.40 Dr Bennett was one in the group who directly linked material dissatisfaction of assistantships to desired status-driven expectations for his future life. He had two children by the time he graduated, and had secured an assistantship ‘with a view’ in Bristol. He recalls one factor that weighed into his decision to migrate was his ability to afford private education for his children: the terms were pretty harsh. It was a partnership of two, I was on one third of the income going up one per cent each year. It was going to take 17 years to reach equality. … I couldn’t see ever being able to educate my children.41 Dr Appelbe left England in 1953. His private memoirs detail his unhappiness and professional discomfort with the assistantship he held with Dr AB in a husband-and-wife-partnership practice in Bristol. Having originally accepted a second house job offering a post in obstetrics in Haverfordwest in Wales, he soon returned to Bristol, back to his wife and child. He describes the working conditions in Dr AB’s practice as exploitative—the wife of Dr AB worked only two hours a week despite having a full list of patients whom Dr Appelbe was also expected to service, on top of his own list of 2,000. Their standard of practice was also contrary to his Bristol training: Dr AB was one of those General Practitioners whose skill included examining the chest without taking off the patient’s shirt, pullover or coat. … [He] held his evening surgery from 5 until 7 o’clock. He had no problem seeing sixty patients in that time. Most of them received no attempt at an examination; they were simply given a prescription. … While working for him I saw patients in what was, in fact, an old bicycle shed at the back of the premises.42 Dr Appelbe’s recollections echo some of the problems inherited from the old voluntary panel system introduced by the British National Health Insurance scheme in 1911; the mechanics of which were tweaked before it was expanded to define all general practice under the NHS.43 A GP’s income was directly proportional to the size of his patient list, since he was paid a fixed, annual capitation fee for each patient regardless of the quality of care or the practice setting within which it was provided. NHS historian Charles Webster labelled this as a set of ‘perverse incentives’ of the early NHS that rewarded GPs who maximized the size of their patient list and minimized their expenses.44 Recent graduates like Dr Appelbe keen to provide a better standard of care, had to temper their enthusiasm or risk losing their job. Dr Appelbe decided to migrate when the practice owner retracted his verbal promise of making him an assistant ‘with a view’—with it, removing all hope of him improving the quality of the practice once an equal partner. Staying in England appeared untenable: If I left Dr AB’s practice I would probably have to go on the unemployment list, as indeed was the case with some of the students who had been in my year. … The truth of the matter is that basically I was not the migrating type. Though I had travelled the world for six years in the Royal Navy, I always regarded England and Ireland as home and expected to live there after the war.45 An immigrant doctor from Dublin observed in a letter to the British Medical Journal in 1968 that Australia has ‘a veritable army of us refugees from that crumbling socialist edifice—the British N.H.S.’46 The NHS was clearly divisive, and many immigrants evoked strong language when discussing it.47 However, there is little empirical evidence to support the suggestion that ideological opposition to socialised medicine was the sole or even primary motivator for these Bristol graduates, and for the recent graduates among migrating British practitioners generally. Three separate studies—of a random sample by Abel-Smith and Gale, of Birmingham medical graduates between 1959 and 1963, and of Aberdeen medical graduates from 1956 to 1958—independently discovered recurring themes identified by emigrating respondents.48 Namely: dissatisfaction with conditions of general practice within the NHS, lack of opportunity for higher incomes, the desire to increase the quality of life for their families, and reluctance to wait longer for consultant posts. These complex interrelated series of considerations are also borne out in the recollections of the Bristol group when examined as a collective. One member of the group when asked for their individual motivations for leaving England, replied with an assessment to describe the collective: Disillusionment was foremost—the future … seemed difficult and without good prospects; places in [general] practice were limited (and therefore the incumbents tried to get all they could from the enquirers). The world outside Britain seemed beckoning, and transfer to another country seemed easy: jobs were plentiful, the remuneration good, places inside and out of GP work was available, and British degrees were accepted too.49 What this and the previous statements capture is the complexity of each decision to migrate—the interplay between the social, professional, economic and political factors. Seaton’s recent analysis questions the importance placed on structural dissatisfaction at the expense of political opposition to the NHS.50 I argue, however, that it would be a trivialisation of the complicated matrix of factors described above to privilege ideological opposition in understanding the Bristol group’s drive to migrate; just as it would be an overgeneralisation to attribute the motivations expressed by this one group to all migrating British graduates. By 1959—less than eight years from graduating—all but two of the Bristol group had left for Australia (see Table 3). Half of them are known to have secured employment before they left, most commonly as GPs in country towns. A quarter of them arrived in Australia as free agents. Australia’s assisted passage scheme for British nationals, colloquially known as the ‘10 pound Pom scheme’, required families to be sponsored (typically by an Australian resident, local or state government, or a charitable organisation). Dr Gawthorn—the first who left—is known to have sponsored three of his classmates, starting with Dr Appelbe in 1953. Dr Bennett recalled that when Dr Gawthorn offered to sponsor him, he ‘did not know what that meant’.51 Bennett had also been considering Canada and Southern Rhodesia (Zimbabwe) as possible destinations. Gawthorn not only sponsored Bennett, he found the Bennetts a furnished house, and a four-month locum in the practice he worked in.52 Similarly, Gawthorn helped Appelbe secure his first assistantship in Australia; and Dr Edmondson also worked as a locum in Gawthorn’s practice when he first arrived.53 The recollections of the group around why they chose Australia in particular also noted its political stability—many members stated that a civil war in Southern Rhodesia seemed likely; better weather compared to Canada; cheap fares offered by the 10 pound scheme; and—especially for those who did not have a job on leaving—personal endorsement of career prospects from their fellow colleagues.54 The two Drs Palmers, for example, were childless and did not need to be sponsored, but they had corresponded with the Edmondsons about migrating, and were hosted by them when they first arrived.55 The Bristol group reflects the central role their professional networks and shared circumstances played in each individual’s decision to resettle in Australia. Just as conditions in the UK pushed thousands of practitioners to consider emigrating, Australia’s immigration policies allowed this particular group of graduates to leverage their individual professional networks when seeking better alternatives. Life in Australia, 1952–1990 What factors might have lead Dr Gawthorn, and other British doctors, to recommend Australia as an alternative? The culture and practice of medicine differed in significant ways, despite the strong influence of British medicine in Australia. All but three of the Bristol group started their working life in Australia as GPs (see Table 4), therefore, three interrelated comparisons between general practice are worth noting. First, the conditions governing provision of universal health care in the UK and Australia were in constant flux from their inception in 1948 and 1953 respectively. If you accept that the period 1948–66 was arguably the most challenging for GPs in the UK, the reverse is true for Australia.56 The Page health scheme implemented in 1953 was operational without significant revision until 1972. One of the most compelling and succinct descriptions of this scheme, which for this reason is often-repeated, comes from a former editor of The Lancet, Sir Theodore Fox. He described Page’s scheme as ‘private practice, publicly supported’, which essentially it was.57 British graduates arriving in the 1950s would have found a medical profession recently victorious in their lobby to preserve fee-for-service as the dominant model for private practice. In the late 1930s the Australian profession resisted multiple attempts by successive Labor governments to introduce a national health insurance scheme similar to Britain’s, and later, any bills that foreshadowed moves to introduce an Australian version of the NHS.58 The National Health Service Act passed in 1953 reduced but did not absorb the cost of health care to citizens. GPs and specialists could continue to charge a patient whatever they judged best, with the federal government paying a fixed rate back for all known medical services and procedures. Australians were encouraged to take out voluntary health insurance to cover the gap in costs. Pensioners (including war veterans) were the only Australian citizens entitled to an entirely free medical service. Table 4. 1952 Bristol graduates—career summary in Australia, 1952–present Yr arr. in Aus Name States regd in Pgrad quals & memberships Initial employment in Australia Further career in Australia Est. yr ret’d in Aus** Status on retirement Country of Death 1952 Gawthorn, Charles VIC then WA AMA#; FRACGP^ 1978 Locum, Brunswick (VIC – suburban) GP, Brunswick (VIC – suburban); GP, Perth (WA – suburban) 1987 Partner, group practice Aus c. 1952-3 Lowther, Gordon N/A* English conjoint ’53; DTM & H Liverpool ‘54; FFA RCS &I; DA ‘62 Department of Territories, (ACT – suburban) Left Australia N/A Specialist - anaesthetist Unknown 1954 Appelbe, Frederick VIC Dip. RCOG ’77 AMA, FRACGP GP - assistantship, Beaumaris (VIC – suburban) GP, Sandringham (VIC – suburban) 1994 Partner, group practice Aus 1954 Martyn, Sheila VIC FRCOG ‘73 House job - obstetrics, Royal Women’s Hospital (VIC – metro) Left Australia, c. 1958-9 1984 Specialist - obstetrician UK 1955 Bennett, Bernard VIC AMA, MRACGP^ GP - locum, Clayton (VIC – suburban) GP, Clayton (VIC – suburban) 1988 Partner, group practice – c. 1955-6 Smith, Herbert NSW – Unknown GP, Surry Hills & Maroubra (NSW – suburban) N/A Unknown Aus 1955 Walker, Henry WA AMA GP, Three Springs (WA – rural) GP, Midland (WA – suburban) 1989 Partner, group practice Aus 1956 Edmondson, Kenneth VIC then ACT Dip. Public Health, Syd ‘65; FRACMA, FFCM GP - locum, Brunswick (VIC – suburban) GP, Port Fairy (VIC – rural) Public Health roles (VIC & ACT – suburban) 1989 Sen. medical administrator – public health Aus 1956 Sherwood, Denise VIC then TAS Medical Defence Union GP - locum, Flinders Island (TAS – rural) GP, Westbury (TAS – suburban); MO (TAS – suburban) c. 1969 Medical administrator – public health – 1956 Sherwood, Peter VIC then TAS – MO, Ararat Mental Hospital (VIC – rural) MO/GP, Flinders Island (TAS – rural); Medical administrator – pvt hospital (TAS – suburban) c. 1970 Sen. medical administrator – private practice Aus c. 1956-7 Walker, Andrew NSW then SA AMA, Nat. Assoc. GPs. Aust, MRACGP Unknown MO, Royal Flying Doctors Service, Broken Hill (NSW – rural); GP, Glenelg (SA – suburban) 1989 Unknown Aus 1957 Hillier, Geoffrey NSW – GP, Broken Hill (NSW – rural) Deceased 1977 N/A Aus 1959 Gear, Douglas QLD then NSW AMA Unknown Medical administrator, Charleville (QLD – rural); GP & hospital sessional, Warialda (NSW – rural) Unknown Unknown Aus 1959 Palmer, Ian VIC then QLD Dip. RCOG ’58 AMA GP - locum, (VIC, NSW and QLD – suburban and rural) GP, Caloundra (QLD – rural) 1986 Partner, group practice – 1962 Jarvis, David VIC then ACT AMA, FRACGP Unknown GP, Ballarat (VIC – rural); GP, Macquarie (ACT – suburban) 1986 Unknown Unknown 1965 Fox, Audrey SA – MO, Mental Hygiene, Mt Pleasant (SA – rural) Unknown Unknown Unknown Aus Yr arr. in Aus Name States regd in Pgrad quals & memberships Initial employment in Australia Further career in Australia Est. yr ret’d in Aus** Status on retirement Country of Death 1952 Gawthorn, Charles VIC then WA AMA#; FRACGP^ 1978 Locum, Brunswick (VIC – suburban) GP, Brunswick (VIC – suburban); GP, Perth (WA – suburban) 1987 Partner, group practice Aus c. 1952-3 Lowther, Gordon N/A* English conjoint ’53; DTM & H Liverpool ‘54; FFA RCS &I; DA ‘62 Department of Territories, (ACT – suburban) Left Australia N/A Specialist - anaesthetist Unknown 1954 Appelbe, Frederick VIC Dip. RCOG ’77 AMA, FRACGP GP - assistantship, Beaumaris (VIC – suburban) GP, Sandringham (VIC – suburban) 1994 Partner, group practice Aus 1954 Martyn, Sheila VIC FRCOG ‘73 House job - obstetrics, Royal Women’s Hospital (VIC – metro) Left Australia, c. 1958-9 1984 Specialist - obstetrician UK 1955 Bennett, Bernard VIC AMA, MRACGP^ GP - locum, Clayton (VIC – suburban) GP, Clayton (VIC – suburban) 1988 Partner, group practice – c. 1955-6 Smith, Herbert NSW – Unknown GP, Surry Hills & Maroubra (NSW – suburban) N/A Unknown Aus 1955 Walker, Henry WA AMA GP, Three Springs (WA – rural) GP, Midland (WA – suburban) 1989 Partner, group practice Aus 1956 Edmondson, Kenneth VIC then ACT Dip. Public Health, Syd ‘65; FRACMA, FFCM GP - locum, Brunswick (VIC – suburban) GP, Port Fairy (VIC – rural) Public Health roles (VIC & ACT – suburban) 1989 Sen. medical administrator – public health Aus 1956 Sherwood, Denise VIC then TAS Medical Defence Union GP - locum, Flinders Island (TAS – rural) GP, Westbury (TAS – suburban); MO (TAS – suburban) c. 1969 Medical administrator – public health – 1956 Sherwood, Peter VIC then TAS – MO, Ararat Mental Hospital (VIC – rural) MO/GP, Flinders Island (TAS – rural); Medical administrator – pvt hospital (TAS – suburban) c. 1970 Sen. medical administrator – private practice Aus c. 1956-7 Walker, Andrew NSW then SA AMA, Nat. Assoc. GPs. Aust, MRACGP Unknown MO, Royal Flying Doctors Service, Broken Hill (NSW – rural); GP, Glenelg (SA – suburban) 1989 Unknown Aus 1957 Hillier, Geoffrey NSW – GP, Broken Hill (NSW – rural) Deceased 1977 N/A Aus 1959 Gear, Douglas QLD then NSW AMA Unknown Medical administrator, Charleville (QLD – rural); GP & hospital sessional, Warialda (NSW – rural) Unknown Unknown Aus 1959 Palmer, Ian VIC then QLD Dip. RCOG ’58 AMA GP - locum, (VIC, NSW and QLD – suburban and rural) GP, Caloundra (QLD – rural) 1986 Partner, group practice – 1962 Jarvis, David VIC then ACT AMA, FRACGP Unknown GP, Ballarat (VIC – rural); GP, Macquarie (ACT – suburban) 1986 Unknown Unknown 1965 Fox, Audrey SA – MO, Mental Hygiene, Mt Pleasant (SA – rural) Unknown Unknown Unknown Aus *Registration was not required for some federal civil servant roles. **Retirement declared, or transitioned to minimal part-time/voluntary work. #AMA—Australian Medical Association, previously British Medical Association. F or M RACGP—Fellow or Member, Royal Australian College of GPs; RCOG—Royal College of Obstetricians and Gynaecologists. Source: Fallon Mody database 2017. Table 4. 1952 Bristol graduates—career summary in Australia, 1952–present Yr arr. in Aus Name States regd in Pgrad quals & memberships Initial employment in Australia Further career in Australia Est. yr ret’d in Aus** Status on retirement Country of Death 1952 Gawthorn, Charles VIC then WA AMA#; FRACGP^ 1978 Locum, Brunswick (VIC – suburban) GP, Brunswick (VIC – suburban); GP, Perth (WA – suburban) 1987 Partner, group practice Aus c. 1952-3 Lowther, Gordon N/A* English conjoint ’53; DTM & H Liverpool ‘54; FFA RCS &I; DA ‘62 Department of Territories, (ACT – suburban) Left Australia N/A Specialist - anaesthetist Unknown 1954 Appelbe, Frederick VIC Dip. RCOG ’77 AMA, FRACGP GP - assistantship, Beaumaris (VIC – suburban) GP, Sandringham (VIC – suburban) 1994 Partner, group practice Aus 1954 Martyn, Sheila VIC FRCOG ‘73 House job - obstetrics, Royal Women’s Hospital (VIC – metro) Left Australia, c. 1958-9 1984 Specialist - obstetrician UK 1955 Bennett, Bernard VIC AMA, MRACGP^ GP - locum, Clayton (VIC – suburban) GP, Clayton (VIC – suburban) 1988 Partner, group practice – c. 1955-6 Smith, Herbert NSW – Unknown GP, Surry Hills & Maroubra (NSW – suburban) N/A Unknown Aus 1955 Walker, Henry WA AMA GP, Three Springs (WA – rural) GP, Midland (WA – suburban) 1989 Partner, group practice Aus 1956 Edmondson, Kenneth VIC then ACT Dip. Public Health, Syd ‘65; FRACMA, FFCM GP - locum, Brunswick (VIC – suburban) GP, Port Fairy (VIC – rural) Public Health roles (VIC & ACT – suburban) 1989 Sen. medical administrator – public health Aus 1956 Sherwood, Denise VIC then TAS Medical Defence Union GP - locum, Flinders Island (TAS – rural) GP, Westbury (TAS – suburban); MO (TAS – suburban) c. 1969 Medical administrator – public health – 1956 Sherwood, Peter VIC then TAS – MO, Ararat Mental Hospital (VIC – rural) MO/GP, Flinders Island (TAS – rural); Medical administrator – pvt hospital (TAS – suburban) c. 1970 Sen. medical administrator – private practice Aus c. 1956-7 Walker, Andrew NSW then SA AMA, Nat. Assoc. GPs. Aust, MRACGP Unknown MO, Royal Flying Doctors Service, Broken Hill (NSW – rural); GP, Glenelg (SA – suburban) 1989 Unknown Aus 1957 Hillier, Geoffrey NSW – GP, Broken Hill (NSW – rural) Deceased 1977 N/A Aus 1959 Gear, Douglas QLD then NSW AMA Unknown Medical administrator, Charleville (QLD – rural); GP & hospital sessional, Warialda (NSW – rural) Unknown Unknown Aus 1959 Palmer, Ian VIC then QLD Dip. RCOG ’58 AMA GP - locum, (VIC, NSW and QLD – suburban and rural) GP, Caloundra (QLD – rural) 1986 Partner, group practice – 1962 Jarvis, David VIC then ACT AMA, FRACGP Unknown GP, Ballarat (VIC – rural); GP, Macquarie (ACT – suburban) 1986 Unknown Unknown 1965 Fox, Audrey SA – MO, Mental Hygiene, Mt Pleasant (SA – rural) Unknown Unknown Unknown Aus Yr arr. in Aus Name States regd in Pgrad quals & memberships Initial employment in Australia Further career in Australia Est. yr ret’d in Aus** Status on retirement Country of Death 1952 Gawthorn, Charles VIC then WA AMA#; FRACGP^ 1978 Locum, Brunswick (VIC – suburban) GP, Brunswick (VIC – suburban); GP, Perth (WA – suburban) 1987 Partner, group practice Aus c. 1952-3 Lowther, Gordon N/A* English conjoint ’53; DTM & H Liverpool ‘54; FFA RCS &I; DA ‘62 Department of Territories, (ACT – suburban) Left Australia N/A Specialist - anaesthetist Unknown 1954 Appelbe, Frederick VIC Dip. RCOG ’77 AMA, FRACGP GP - assistantship, Beaumaris (VIC – suburban) GP, Sandringham (VIC – suburban) 1994 Partner, group practice Aus 1954 Martyn, Sheila VIC FRCOG ‘73 House job - obstetrics, Royal Women’s Hospital (VIC – metro) Left Australia, c. 1958-9 1984 Specialist - obstetrician UK 1955 Bennett, Bernard VIC AMA, MRACGP^ GP - locum, Clayton (VIC – suburban) GP, Clayton (VIC – suburban) 1988 Partner, group practice – c. 1955-6 Smith, Herbert NSW – Unknown GP, Surry Hills & Maroubra (NSW – suburban) N/A Unknown Aus 1955 Walker, Henry WA AMA GP, Three Springs (WA – rural) GP, Midland (WA – suburban) 1989 Partner, group practice Aus 1956 Edmondson, Kenneth VIC then ACT Dip. Public Health, Syd ‘65; FRACMA, FFCM GP - locum, Brunswick (VIC – suburban) GP, Port Fairy (VIC – rural) Public Health roles (VIC & ACT – suburban) 1989 Sen. medical administrator – public health Aus 1956 Sherwood, Denise VIC then TAS Medical Defence Union GP - locum, Flinders Island (TAS – rural) GP, Westbury (TAS – suburban); MO (TAS – suburban) c. 1969 Medical administrator – public health – 1956 Sherwood, Peter VIC then TAS – MO, Ararat Mental Hospital (VIC – rural) MO/GP, Flinders Island (TAS – rural); Medical administrator – pvt hospital (TAS – suburban) c. 1970 Sen. medical administrator – private practice Aus c. 1956-7 Walker, Andrew NSW then SA AMA, Nat. Assoc. GPs. Aust, MRACGP Unknown MO, Royal Flying Doctors Service, Broken Hill (NSW – rural); GP, Glenelg (SA – suburban) 1989 Unknown Aus 1957 Hillier, Geoffrey NSW – GP, Broken Hill (NSW – rural) Deceased 1977 N/A Aus 1959 Gear, Douglas QLD then NSW AMA Unknown Medical administrator, Charleville (QLD – rural); GP & hospital sessional, Warialda (NSW – rural) Unknown Unknown Aus 1959 Palmer, Ian VIC then QLD Dip. RCOG ’58 AMA GP - locum, (VIC, NSW and QLD – suburban and rural) GP, Caloundra (QLD – rural) 1986 Partner, group practice – 1962 Jarvis, David VIC then ACT AMA, FRACGP Unknown GP, Ballarat (VIC – rural); GP, Macquarie (ACT – suburban) 1986 Unknown Unknown 1965 Fox, Audrey SA – MO, Mental Hygiene, Mt Pleasant (SA – rural) Unknown Unknown Unknown Aus *Registration was not required for some federal civil servant roles. **Retirement declared, or transitioned to minimal part-time/voluntary work. #AMA—Australian Medical Association, previously British Medical Association. F or M RACGP—Fellow or Member, Royal Australian College of GPs; RCOG—Royal College of Obstetricians and Gynaecologists. Source: Fallon Mody database 2017. Secondly, expected incomes for Australian practitioners were much higher than their British counterparts. For example, in 1955 the average GP in Australia could expect to net between £4,000 and £6,000 a year after expenses. This still compared favourably to the projected increase from the 1952 Danckwerts award that raised GPs’ incomes for the first time since 1939.59 By 1961, a GP in the NHS with a full panel of 3,500 patients could expect to earn £2,055.60 Effectively, there was a more proportional relationship between the hours of work and rate of remuneration in Australia. Frequent discussion and comparison of the two systems—particularly in the correspondence columns—in the British Medical Journal and The Lancet tended to focus on the benefits of working in a social system like the NHS compared to the more ‘commercial’ fee-for-service system in Australia. Success for the latter relied on non-medical aspects of practice management that had troubled GPs’ private practices before the introduction of the NHS, including persistent debt collection.61 Although as one British correspondent pointed out, it appeared to be a trade-off between the indignity of ‘constantly squabbling with the Government of the day over pay’ or ‘asking sick patients to sign an out of hours certificate’ in the NHS.62 Finally, the higher incomes were related to the scope of work undertaken by Australian GPs.63 There was little overt regulation of specialist practice in Australia, which in Britain started in the 1930s.64 The state of Queensland introduced a specialist register in 1939. South Australia was the next state to introduce one, in 1966. For all other states, the scope of GP-work was limited by what an individual practitioner felt competent—and was sometimes qualified—to undertake. For example, a literature review of services provided by GPs in Australia showed that in 1971 they still held honorary hospital appointments, had access to hospital beds, and between 48–64 per cent of them reported performing surgical procedures, including appendectomies and curettages.65 In 1977, 76 per cent of GPs surveyed reported that even though they were no longer practising obstetrics, they had done so in the past 30 years.66 The historiography on the scope and acceptance of the role of a GP in the NHS agree that most GPs in Britain accepted their role as ‘family doctors’ in the late 1940s; a situation Rosemary Stevens described as ‘most singular’.67 For the Bristol group with experience of general practice in the NHS, the expectation was to refer cases to hospitals. Referral underpinned the success of the bi-modal structure of the NHS. Irvine Loudon and Mark Drury highlighted the challenges GPs faced in the 1950s to access even diagnostic services from hospital pathology and radiology departments, based on a prevailing belief that the patient should be referred to the local hospital at that point.68 Overwhelmingly, the accounts from the Bristol group suggest how their British training and expectations of the scope of a GP’s work in the NHS made them more conservative in their Australian careers. One member of the group recounted a particularly negative experience they had assisting in an appendicitis operation by another, older British graduate in Australia, where the latter spent ‘two hours poking around, pulling out loops of bowel in a vain search for the missing appendix’.69 Dr Peter Sherwood accepted a position with Tasmania’s district medical service after working at a country Victorian mental health hospital. The Tasmanian service paid GPs to work in areas too small to support private practice. His recollections typify the variable demands placed on a country GP, and on the reliance for each individual to judge the scope of their competence: I cover the Furneaux group of Islands [Palana, Flinders and Cape Barren in Tasmania], about the size of a small English county, with a total population no greater than that of a large village. … I am physician, surgeon, medical officer of health, school medical officer, sanitary inspector, pharmaceutical chemist, radiographer and last but not least, dentist (extractions only, no fancy stuff).70 Dr Sherwood’s role and account also signals the great and immediate demand for doctors in Australian country towns. This suggests that the fact that ten members of the Bristol group worked in country areas at some point in Australia—as detailed in Table 3—was not coincidental. Dr Palmer and his wife undertook a series of locums across country and suburban Victoria and New South Wales before Ian Palmer bought a private practice in the small country town Caloundra, with a population of 2,807 at the time, in the northern state of Queensland. Dr Hillier was in general practice in an isolated mining town, Broken Hill in the outer western part of New South Wales (its population was c. 30,000), where incidentally, his fellow graduate Dr Andrew Walker worked out of a Royal Flying Doctor Service base, before moving to suburban South Australia. The choice of destinations by the Bristol group highlights a significant role adopted by British medical graduates: doctoring in country Australia. A report published in 1972 by the AMA study group on medical planning referenced previously unpublished findings that the doctor–patient ratios in country areas of Victoria had been maintained due to foreign medical graduates.71 Graduates from the UK had increased in rural areas by 29 per cent between 1964 and 1970 compared to 1.3 per cent of Victorian graduates, and a decrease of 4.7 per cent of graduates from other states.72 This is confirmed in my own analysis: a quarter of the post-war British graduates sampled were working in an Australian country town in 1966.73 By 1978, this distribution had not changed. Australian doctors were not unique in their reticence to work in rural areas; the World Health Organisation published a report in 1968 that found this to be a global problem.74 In Australia, sustaining a profitable rural practice required significant travel, especially in sparsely populated yet geographically vast areas.75 Even in country towns that could support private practice, holidays were difficult to take because locums were hard to find, continuing professional education was difficult to pursue consistently, and city life was often 50 or more miles away. Queensland, Tasmania and Western Australia in particular used a variety of initiatives to cope with the challenge of providing adequate services to their country areas. Western Australia and Tasmania were the last states to establish medical schools in 1956 and 1965 respectively. Until their first classes graduated, these states relied heavily on the willingness of graduates from other parts of Australia to move there. These two states also controversially retained wartime legislation to place ‘alien’ European medical graduates in rural areas due to a shortage of supply.76 The pattern of the Bristol group to settle in country areas extends to initial findings of the broader British medical graduate cohort sampled. One interpretation could be that those young or recent graduates, with little capital, wanting to establish themselves as private practitioners in Australia found it easier to do so in less-competitive, country areas. Repeated attempts to describe the distribution of practitioners in Australia suggested a disproportionate density of practitioners in urban areas.77 Politically, the BMA in Australia represented this as an overcrowding of the profession generally, and fought several attempts to increase the supply of doctors in the 1950s in particular.78 The estimated proportion of doctors in metropolitan private practice in all Australian states reduced from one doctor for 1,240 people in 1947, to 1:1,084 in 1954.79 This was much lower compared to country areas, where the ratio had reduced from one doctor for 2,116 people in 1947, to one doctor per 1,973 people seven years later.80 By 1961, it appears doctors were responding to the competition in cities, as the ratio in country areas improved to one doctor for every 1,787 people (compared to the marginal change to 1,031 people in metropolitan areas).81 Dr Appelbe wrote that it was sheer luck that led his medical agent, Roger Van Asche, to offer the Victorian suburban practice in Sandringham to him: My choice was limited as we had virtually no finance behind us except our clothes and one small car. … Van Asche sensed that he had got an inexperienced novice from England and started off by sending me to various practices which were hopeless prospects. … These were practices he could not sell as no Australian doctor would be so naïve as to buy them. Thus I got into the routine where each weekend I would visit one practice, usually in the country …82 Dr Edmondson worked as a country GP in a Victorian country town, Port Fairy for five and a half years—a similar opportunity Appelbe originally turned down as unsuitable because the practice income as he was presented it, was less than the rent.83 Bristol graduate Dr Henry Walker settled in Three Springs, Western Australia. Once more, my initial exploration suggests that, similar to Victoria, British medical graduates propped up Western Australia’s country medical service. For example, British medical graduates comprised 36 per cent of all country practitioners in 1966.84 For 21 out of 58 of these country towns, they were the only practitioners listed.85 Dr Walker worked in Three Springs from 1955 to 1963. In an interview with local historian Jill Tilley in 2006, Dr Walker recalled the circumstances that brought him there: As there were no jobs in the UK, I applied for Three Springs and was flown out by Dr Couch within two months of applying. … When I arrived I had only £30 altogether. I had to buy into the practice, but as I didn’t have any money I paid over time and with interest …86 Dr Walker recalled spending 18 months as a solo practitioner after Dr Couch retired owing to the lack of interest in the post. He said he ‘advertised but didn’t get a single reply. Doctors were afraid to come up to the bush’.87 Buying into or entering general practice ‘with a view’ offered the quickest, most lucrative pathway to a stable income source. Six of the sixteen transitioned from their country practices to suburban ones as they came closer to retirement, and when they were able to afford to (Table 4). An alternative interpretation would be that British graduates saw the opportunity of Australian country towns, where for example, they would have greater scope to pursue their specialist interests, and insert themselves more easily in country hospitals in honorary positions, to maximise their income but also maintain future opportunities to specialise.88 The career trajectories of the Bristol group in particular do not bear the latter suggestion out—only Dr Edmondson left general practice for a public health role, and completed a Diploma of Public Health at the University of Sydney. The rest of the group showed postgraduate qualifications consistent with career GPs, most prominently membership (and later fellowship) of the Royal Australian College of GPs (Table 4). My initial analysis of the larger cohort of British graduates suggests that a high proportion of them who stayed were able to specialise in Australia—particularly in anaesthesia, dermatology, radiology and surgery.89 This difference is arguably linked to the immediate demands of the Bristol group who had families, and as mature medical students, career goals that were aligned to their responsibilities. It certainly warrants further investigation. A second fresh perspective offered by the Bristol group is one of intention. It was clear from the interviews and surveys they conducted that doctors who left the UK intending to migrate permanently returned and vice versa.90 Others left Australia only to return again, and yet others spent the rest of their careers overseas, and returned to the UK only to retire. An obvious limitation encountered by contemporary studies of emigrating British doctors, like that of Abel-Smith’s and other researchers in the 1960s and 1970s, was trying to ascertain or predict intention. The Bristol group mirror the broader trends of immigrant doctors in Victoria, and with the benefit of hindsight, provides an update to the older body of literature regarding what doctors who migrated to Australia actually did.91 For example, of the 86 male doctors in the Victorian sample, 60 spent most of their career in Australia, and 37 are known to have died there.92 This indicates that a high proportion of those migrating to Australia stayed, whether they originally intended to or not. Of the 16 in the Bristol group, only two returned to England permanently.93 Dr Sheila Martyn moved to Melbourne for a second house job in obstetrics at the Royal Melbourne Hospital. On returning to Bristol, she married a GP, and together they moved to Guernsey in the Channel Islands where she continued to practice obstetrics for the remainder of her career.94 Gordon Lowther briefly worked in Los Angeles as a Burroughs Wellcome Fellow in Anaesthetics before permanently returning to the UK. With the exception of Dr Edmondson, who was posted in London while working for the Australian federal Department of Health, the rest of the Bristol group spent the remainder of their traceable careers in Australia. Thirteen of the 16 died or still reside in Australia as outlined in Table 3. None of the members of the Bristol group or their family interviewed (seven in total) seriously considered returning to the UK. Conditions for GPs—which proved to be critical in prompting emigration from the UK—changed gradually but considerably for Australian-based practitioners. There was a shift in the balance between GPs and specialists in Australia. This was prompted by government-led changes to the health care scheme, greater access to local postgraduate education, and by the rapidity with which medical research outputs and diagnostic technology was changing the practice of medicine globally. In Australia, the 1960s can be seen as the beginning of the end of the hybrid or self-styled GP specialist. A government committee published findings (the Nimmo Report) in 1968 that found that the Page health scheme was unnecessarily costly to the government and to citizens, and was being exploited by practitioners.95 It controversially recommended a schedule of common fees, with GPs being paid less for the same procedures as specialists; and the establishment of a national board to accredit specialists. In political terms, general practitioners exploded. This was seen as an assault on the very necessity of general practitioners in Australia.96 Despite heavy lobbying, the recommendations of the Nimmo committee were passed in 1970 and spelled a slow decline as practitioners were forced to choose.97 This shift is compellingly reflected in the statistics: in 1961 it was estimated there were 2,758 specialists compared to 5,805 GPs. By 1971, the specialist figure had almost doubled to 5,007 compared to the GP figure that modestly increased to 7,376.98 By 1976, the same source was reporting almost equal numbers of GPs and specialists practising in Australia. The changes created an artificial shortage of GPs as they rushed to be reclassified as specialists. Although politically prominent issues, the Bristol group did not dwell on later Australian working conditions in any great detail, like they did the NHS. Nor did they associate it with a consideration to return to the UK. This is particularly notable since the proposed changes to the scope and income of GP work in Australia appeared to mirror frustrations with the NHS that prompted their migration initially. This suggests that on an operational level, these later changes in Australia had less material impact on this group. Most of the Bristol group were firmly committed to being career general practitioners by this stage, therefore, they were arguably the least affected. They had had at least a decade to establish themselves and their families in Australia. Of the remaining 14, by the mid-1970s five are known to be partners in group practices, and four more were in secure, salaried positions as outlined in Table 4. In this they mirror the broader post-war British settlers in Australia, few of whom expected to raise their social status by migration.99 Rather, they aimed to improve the quality of their life and the conditions of their employment.100 Return migration to the UK would now have presented a risky, expensive and disruptive alternative, especially to those originally older graduates who were closer to retirement. Conclusion The historiography of British medical migrants in post-war Australia is fragmented, and the contribution the rank-and-file migrant made to medicine and health is poorly understood. Although there is a rich body of literature on the National Health Service in Britain, the tendency by historians to focus on the pivotal and symbolic role of the NHS in post-war Britain, particularly influenced by a myriad of inquiries and reports, has meant that emigrating British graduates are often a footnote in these narratives. This case study of 16 Bristol graduates, and their journey from university to Australia highlights how, too often, the constraints of national boundaries means we miss or dilute opportunities to understand historical events. Using a transnational approach—connecting the historiographies of the NHS in the UK and its counterpart Australian health scheme—was integral to revealing how medical practitioners were able to leverage their networks in a Commonwealth market for medical education and experience. The experiences of this Bristol group challenge the assumption that British doctors transitioned seamlessly into the Australian profession. Their privileged status in Australian medical legislation only translated into professional success by a complex mix of deploying their own British professional network, a willingness to be flexible and mobile once in Australia, and adapting their British medical training and expectation of conditions in Australia to viably fulfil their own standards and economic goals. This case study suggests the potential of a transnational, comparative and collective biographical approach for future research into the operation of medical networks in understanding British medical migration. Secondly, there is scope to further analyse the role war experience might have on had on the post-war mobility of medical practitioners. Recently, historians have revisited the question of what motivated this post-war medical emigration from Britain. The transnational approach, drawing on oral histories, adopted by Wright et al., portrays a complex array of social and professional considerations in each individual’s decision to migrate (to Canada).101 Seaton’s account of an anti-NHS group—The Fellowship for Freedom in Medicine—in contrast, aims to recover the significance of political opposition to the NHS, including our understanding of post-war medical migration. He argues this ‘anti-NHS’ sentiment was more pervasive and influential than has been portrayed in historical analyses (including of British medical migration).102 The evidence presented in this paper does not bear out the latter interpretation. Rather, it extends the emphasis on pragmatic considerations—the inescapable link between family responsibilities, individually determined social and professional goals, and the structural and economic realities of the early NHS for GPs—in understanding the medical migrant journeys of the Bristol group to Australia. However, it does point to an avenue for future research. What Seaton’s analysis suggests is the need to stratify medical migrant cohorts, to demonstrate the possible disconnect in motivations for migration between older, experienced GPs (arguably more representative of members of the Fellowship for Freedom in Medicine, for example), and more recent British graduates (including the Bristol group). Finally, the methodological approach adopted in this study also enabled a demonstration of how rank-and-file medical migrants can assume a critical role in their new environment. The case study of this Bristol group suggests those ‘wasted’ British general practitioners, fleeing to Australia in search of an alternative to the conditions of the early NHS, might also collectively be remembered as a group who played an important part in providing valued primary care when and where Australia needed it most. Acknowledgements I wish to thank Dr James Bradley, Dr Eureka Henrich and Dr Katherine Foxhall for their feedback and advice on early drafts of this article; and also all three reviewers for their insightful comments. Fallon Mody is a PhD candidate in the Department of History and Philosophy of Science at the University of Melbourne. She is currently researching the professional lives of European medical graduates in Australia, c.1930–1960. Funding This work was supported by a National Archives of Australia and Australian Historical Association postgraduate scholarship. Footnotes 1 Martin Gorsky, ‘The British National Health Service 1948–2008: A Review of the Historiography’, Social History of Medicine (SHM), 21, 437–60. For a review of historical interpretations of the state of general practice, see Rosemary Stevens, ‘Fifty Years of the British National Health Service: Mixed Messages, Diverse Interpretations’, Bulletin of the History of Medicine, 2000, 74, 806–11. Together, these authors’ reviews cover the three main histories of the NHS that include significant sections on general practice: Irvine Loudon, John Horder and Charles Webster, eds, General Practice under the National Health Service, 1948–1997 (London: Clarendon Press, 1998); Charles Webster, The National Health Service: A Political History (Oxford: Oxford University Press, 1998) and Geoffrey Rivett, From Cradle to Grave: Fifty Years of the NHS (London: King’s Fund, 1998). For influential contemporary accounts of general practice, see Joseph Collings, ‘General Practice in England Today—A Reconnaissance’, The Lancet, 1950, 255, 555–79; and Michael Balint, The Doctor, His Patient and the Illness (London: Churchill Livingstone, 1957). 2 This amounts to approximately 390–400 practitioners annually; most estimates start from 1955. The best known, and most cited, contemporary analyses of rates of medical emigration include: Brian Abel-Smith and Kathleen Gale, British Doctors at Home and Abroad, Occasional Papers on Social Administration No. 8 (Hertfordshire: Cordicote Press, 1964); John Seale, ‘Medical Emigration from Britain’, British Medical Journal (BMJ), 1962, 782–5; and a later revision, also by John Seale, ‘Medical Emigration from Great Britain and Ireland’, BMJ, 1964, 1, 1173–8. 3 British and Irish medical qualifications were included in most Australian state medical acts around 1905 at the instigation of British authorities keen to protect British interests. See Moira Salter, ‘Prejudice in the Professions’, in F. S. Stevens, ed., Racism: The Australian Experience (NSW: Hobgin Poole, 1974), 67−75. 4 James Last, ‘Migration of British Doctors to Australia’, BMJ, 1963, 2, 744–5; John Seale, ‘Migration of British Doctors to Australia’, BMJ, 1964, 2, 994. The discrepancy between these figures is due to differing methodology employed by Last and Seale—particularly adjustments made to account for return migration, and those doctors who registered in one or more states in Australia. I have used Seale’s 1964 paper, since he significantly revises his 1962 findings in the face of criticism of his original methodology. 5 Hugh Poate, ‘The Capacity of the Medical Profession in Australia to Absorb New Members’, Medical Journal of Australia 1953, 16, 616−21. 6 See for example, James Gillespie, The Price of Health: Australian Governments and Medical Politics 1910–1960 (Cambridge University Press,1991), 181 and 191; Janet McCalman, Sex and Suffering: Women’s Health and a Women’s Hospital: The Royal Women’s Hospital, Melbourne, 1856–1996 (Melbourne University Press, 1998), 247–51. 7 For example, Egon Kunz, The Intruders: Refugee Doctors in Australia (Canberra: ANU Press, 1975); Suzanne Rutland, ‘An Example of Intellectual Barbarism: The Story of Alien Jewish Medical Practitioners, 1933–56’, Yad Vashem Studies, 1987, 18, 233–57; John Weaver, ‘A Glut on the Market: Medical Practice Laws and Treatment of Refugee Doctors in Australia and New Zealand, 1933–1942’, ANZ Law & History E-Journal, 2009, 1–38; and Peter Winterton, ‘Alien Doctors: The Western Australian Medical Fraternity’s Reaction to European Events 1930–50’, Health and History, 2005, 7, 67–85. 8 Paul Weindling, ‘Medical Refugees and the Modernisation of British Medicine, 1930–1960’, SHM, 2009, 22, 489–511, 456. 9 Laurence Monnais and David Wright, eds, Doctors Beyond Borders: The Transnational Migration of Physicians in the Twentieth Century (Toronto: University of Toronto Press, 2016), 3–4. 10 Apart from the special issue on the subject published in Social History of Medicine in 2009, see for example, Julian Simpson, Aneez Esmail, V. S. Kalra and S. J. Snow, ‘Writing Migrants back into NHS History: Addressing a “Collective Amnesia” and its Policy Implications’, Journal of the Royal Society of Medicine, 2010, 103, 392–6; Joanna Bornat, Leroi Henry and Parvati Raghuram, ‘The Making of Careers, The Making of a Discipline: Luck and Chance in Migrant Careers of Geriatric Medicine’, Journal of Vocational Behavior, 2011, 78, 342–50; John Zamet, ‘Aliens or Colleagues? Refugees from Nazi Oppression 1933–1945’, British Dental Journal, 2006, 201, 397–407; and Karola Decker, ‘Divisions and Diversity: The Complexities of Medical Refuge in Britain, 1933–1948’, Bulletin of the History of Medicine, 2003, 77, 850–73. 11 For discussion of structural problems with the NHS, see David Morrell, ‘Introduction and Overview’, in Loudon et al., General Practice under the NHS, 5. For ‘brain drain’: Matthew Gowin, Jane Gregory and Brian Balmer, ‘The Anatomy of the Brain Drain Debate, 1950s–1970s: Witness Seminar’, Contemporary British History, 2009, 23, 35–60; this paper offers an historical overview of the ‘Brain Drain’ debate of the 1960s. The term ‘wastage’ is typically in the context of medical manpower planning and the ‘wastage’ of state-funded medical education. One of the first official reports to use the term is the Willink report, see: Ministry of Health, Report of the Committee to Consider the Future Numbers of Medical Practitioners and the Appropriate Intake of Medical Students (London: HMSO, 1957), 30. Finally, for the inflow of migrants into the system, see Oscar Gish, Doctor Migration and World Health, Occasional Papers on Social Administration No. 43 (London: Cordicote Press, 1971). 12 Andrew Seaton, ‘Against the “Sacred Cow”: NHS Opposition and the Fellowship for Freedom in Medicine, 1948–72’, Twentieth Century British History, 2015, 26, 424–49. 13 Ibid., 446. 14 David Wright, Sasha Mullally and Mary Colleen Cordukes, ‘“Worse than Being Married”: The Exodus of British Doctors from the National Health Service to Canada, c.1955–75’, Journal of the History of Medicine, 2010, 65, 546–75. 15 Ibid., 553. 16 Wright et al, ‘Worse than Being Married’, 573. 17 For a discussion of the role of ‘informal interpersonal networks’ in understanding migration of New Zealand doctors to Britain for specialist training, see John Armstrong, ‘A System of Exclusion: New Zealand Women Medical Specialists in International Medical Networks, 1945–1975’, in Monnais and Wright, Doctors Beyond Borders, 118–41. 18 Cited as ‘Fallon Mody database 2017’ throughout this paper. 19 Why and how I became a general practitioner--and other observations, Edward Charles Gawthorn, 1987, <www.racgp.org.au/yourracgp/organisation/history/biographies/gawthorn/> (accessed on 8 March, 2017). 20 ‘Universities and Colleges’ section in: BMJ, 1952, 1, 52–3; BMJ, 1952, 2, 167–70; and BMJ, 1953, 1, 108–11. 21 The English conjoint diploma of the Royal College of Surgeons and Physicians of London (post-nominally recorded as MRCS LRCP) was a common entry-level medical qualification, recognised by the General Medical Council in the UK. 22 Two of these doctors arrived after 1960, and seven were registered in states other than Victoria—both technically are outside the remit of the larger project, but have been included in this article for completion. 23 Based on entries in medical directories of UK and annual General Medical Council lists for 1952–1972 inclusive. 24 There is no scope in this article to discuss the role of gender in understanding the experiences of medical migrants. However, the author aims to address this in a forthcoming article, provisionally titled: ‘“Have Stethoscope, will Travel”: British Migrant Medical Women in Australia, 1930–60’. 25 Dr Henry Walker commenced at Bristol, studied two years before joining the RAF in c. 1943, then returned in 1947 to complete his medical degree. 26 Frederick J. Appelbe, The Life and Times of a Man from Skibbereen (self published autobiography). A copy is held by Sandringham Library in Victoria. 27 Dr Bernard Bennett, interview with Fallon Mody, Melbourne, 15 January 2016. 28 Ibid. 29 Gawthorn, ‘Autobiography’, 1987. 30 Ibid. 31 David Hannay, ‘Undergraduate Medical Education’ in Loudon et al. General Practice under the NHS, 167–81 discusses the inadequacy of early post-war medical training in equipping graduates for general practice. 32 Gawthorn, ‘Autobiography’, 1987. 33 Ministry of Health, Report of the Joint Working Party on the Medical Staffing Structure in the Hospital Service (London: HMSO, 1961)—known as the Platt Report. 34 Bennett, interview. 35 The other option was to accept a position in the Trainee Assistants’ Scheme, however, this was not popular. See Loudon et al., General Practice under the NHS, 309—Table D2 reports under 370 trainees between 1952–1971; and ‘Trainee Assistants’ Scheme’, BMJ, 1952, 2, 482–3. 36 According to statistics reported in 1948, there were 17,438 GP partners and 562 salaried assistants working for them. In 1951 there were 18,195 partners and 1,724 assistants. General Practitioners (Danckwerts Award) HC Deb 30 October 1952 vol 505 cc2108–59 <http://hansard.millbanksystems.com/commons/1952/oct/30/general-practitioners-danckwerts-award> (Last accessed 26 September, 2017). 37 Ibid. 38 See Abel-Smith, British Doctors Abroad, 42, Table 21 Last Position held in Great Britain by Year of Leaving. 39 The status of general practice was especially low when the NHS was first introduced—this was not the most common career aspiration for young/recent graduates. See for example, Rosemary Stevens, Medical Practice in Modern England (New Haven and London: Yale University Press, 1966), 153–68. 40 Wright et al., ‘Worse Than Being Married’, 571. 41 Bennett, interview. 42 Dr AB’s name has been anonymised on request, Barbara Appelbe, in conversation with Fallon Mody, Melbourne,13 January 2016. The quote is from Appelbe, The Life and Times of a Man from Skibbereen. 43 This was parodied by A. J. Cronin in The Citadel. For an full academic analysis on the subject, see Anne Digby, The Evolution of British General Practice, 1850–1948 (Oxford: Oxford University Press, 1999). 44 Charles Webster, ‘The Politics of General Practice’, in Loudon et al., General Practice under the NHS, 20–44. Rosemary Stevens also identified similar problems with the income structure of the NHS for GPs, in Stevens, Medical Practice in Modern England, 127–38. 45 Appelbe, The Life and Times of a Man from Skibbereen, 87. 46 A. Clements, ‘Australia Next?’ BMJ, 1968, 1, 121–2. 47 Abel-Smith, British Doctors Abroad, 49–50. 48 Ibid.; A. G. W. Whitfield, ‘Emigration of Birmingham Medical Graduates 1959–63’, The Lancet, 1969, 293, 667–9; and D. Ogston, A. Dawson and G. M. McAndrew, ‘Present Employment of University of Aberdeen Medical Graduates 1956–58’, The Lancet, 1969, 294, 427–8. 49 Dr Denise Sherwood, email correspondence, 21 March 2016. 50 Seaton, ‘Against the “Sacred Cow”’, 424–49. 51 Bennett interview. 52 Ibid. 53 Jill Edmondson, letter to Fallon Mody, 21 January 2016. 54 Note that better weather dominated the general immigration propaganda in recruiting offices all over the UK. For a fuller discussion of perceptions of Australia in the UK, see for example, A. James Hammerton and Alistair Thomson, Ten Pound Poms: Australia’s Invisible Migrants (Manchester: Manchester University Press, 2005), particularly the chapters ‘Imagining Australia’, 28–47 and ‘Leaving Britain’, 48–95. Hammerton and Thomson also note the importance of direct endorsements of life and opportunities in Australia in prompting the decision to migrate. 55 Jill Edmondson letter. 56 This period before the introduction of the Family Doctors Charter in 1966 in the UK is identified in this way, and forms a dominant structural theme, in several chapters of Loudon et al., General Practice Under the NHS, particularly 4–6, 46–50, 120–1; 183–5. See also, Stevens, Medical Practice in Modern England, 311. 57 Sir Theodore Fox, ‘The Antipodes: Private Practice Publicly Supported’, The Lancet, 1963, 281, 988–94. 58 James Gillespie, The Price of Health: Australian Governments and Medical Politics 1910–1960 (Cambridge: Cambridge University Press, 2002), and Anne Crichton, Slowly Taking Control? Australian Governments and Health Care Provision, 1788–1888 (London: Allen & Unwin, 1990). 59 Stevens, Medicine Practice in Modern England, 131–3. 60 Paul Gemmill, Britain’s Search for Health: The First Decade of the National Health Service (Philadelphia: University of Pennsylvania Press, 1960). 61 Anne Digby and Nick Bosquanet, ‘Doctors and Patients in an Era of National Health Insurance and Private Practice, 1913–1938’, The Economic History Review, 1988, 41, 74–94. 62 P. B. Forbes, ‘Australia Next?’, BMJ, 1968, 1, 450. 63 There is very little historical analysis documenting the changing scope of general practice in Australia. One exception is: Bryan Gandevia, ‘A History of General Practice in Australia’, reprinted from Canadian Family Physician in Medical Journal of Australia, 2, 1972, 381–5. More illuminating accounts that highlight the gradual change in scope for GPs in Australia can be found in contemporary studies, see for example, General Practice and its Future in Australia—Report No. 1 of the AMA Study Group on Medical Planning (Sydney: Australasian Medical Publishing Company, 1972). 64 George Weisz, Divide and Conquer: A Comparative History of Medical Specialization (New York: Oxford University Press, 2006), 164–80. 65 Neville Andersen, ‘Services Provided’, in Neville Andersen, Charles Bridge-Webb and Alan H. B. Chancellor, eds, General Practice in Australia (Sydney: Sydney University Press, 1986), 49–52. 66 Ibid. 67 See, for example, Frank Honigsbaum, The Division in British Medicine (London: Kogan Page, 1979), 299–318. Stevens, Medical Practice in Modern England, 104. 68 Irvine Loudon and Mark Drury, ‘Some Aspects of Clinical Care in General Practice’, in Loudon et al., General Practice under the NHS, 103–110. 69 Citation anonymised. 70 Peter Sherwood, ‘Tasmanian Island Practice’, The Practitioner, 1958, 181, 199–204, 202. 71 General Practice and its Future in Australia, ‘The Scope and Method of Practice of the Future General Practitioner’, 21–9. 72 R. F. F. Harbison, unpublished data, The Melbourne Postgraduate Committee Conference on Continuing Medical Education in Country Areas of Victoria, 1971 in General Practice and its Future in Australia, Table 7.4, 48. 73 Of the 69 British graduates in the sample that arrived after the war, 30 were working in suburbs, 17 in country towns, 14 had left and 8 entries are unknown (Table 1). 74 WHO, World Health Statistics Report (Geneva: WHO, 1968). 75 In 1963, 52 of 138 shires in the state of Victoria reported less than 3,500 people. In the extreme, some shires had a population of less than 800. 76 Western Australia kept emergency war legislation and allowed ‘alien’ doctors to practise in regional areas; Tasmania introduced a system of hospital placements for foreign doctors in 1951. 77 See, for example: Committee on the Future of Tertiary Education, Tertiary Education in Australia [Martin Report] (Canberra: Government Printer, 1964), volume 2, chapter 12. 78 The official response of the BMA in Australia to a federal inquiry was published as: Poate, ‘Capacity … to Absorb New Members’, 621. Professional resistance to government intervention in medical school intakes is discussed in: Crichton, Slowly Taking Control, 89–91. 79 R. B. Scotton, ‘Medical Manpower in Australia’, MJA, 1967, 1, 984–90. 80 Ibid. 81 Ibid. 82 Appelbe, The Life and Times of a Man from Skibbereen. 83 Ibid. 84 Medical Directory of Australia (Sydney: Australian Medical Press Company, 1966). 85 Ibid. 86 Dr Henry Walker, interview with Jill Tilley for Carnarmah Historical Society, 24 November 2006. 87 Ibid. 88 The honorary hospital appointment system in Australia was dominated by a core group of medical elites. See, for example: McCalman, Sex and Suffering, 314–16; Anthea Hyslop, Sovereign Remedies: A History of the Ballarat Base Hospital 1850s to 1980s (London: Allen & Unwin, 1989), 248–61. 89 Based on published career trajectories for 71 UK male graduates and 39 UK female graduates. Initial exploration suggests these specialists were in particular demand in Australia, and this might account for attracting British graduates interested in specialising in these areas. 90 Oscar Gish and James A. Wilson, ‘Emigrating British Physicians’, Social Science & Medicine, 1970, 3, 495–511. 91 Historical accounts have acknowledged the lack of data on return migration. For example, Stevens, Medical Practice in Modern England, 245. 92 Defined by a Medical Directory entry that explicitly indicates retirement and/or the address provided in these entries. 93 Abel-Smith, for example, noted some reticence about return migration owing to uncertainty about being able to practise in the UK again. Abel-Smith, Doctors Abroad, 53–4. 94 Struan Robertson, ‘Sheila Anne Robertson (née Martyn)’, BMJ, 2004, 328, 1264. 95 For a detailed discussion of this report, see J. C. H. Dewdney, Australian Health Services (Adelaide: Griffin Press, 1972), 52–65; and the subsequent chapter for the profession’s reaction to the proposal of a common fee, particularly 68–73. 96 See for example, Ronald Winton, A Body’s Body: The First Twenty-one Years of the Royal Australian College of General Practitioners (Sydney: RACGP, 1983), 53–57; and F. Woodhouse, ‘Valuing the General Practitioner in Australian Society: A 50th Year Commemorative Essay of the Royal Australian College of General Practitioners’, published in 2008, <http://www.racgp.org.au/yourracgp/organisation/history/college-history/history-of-the-racgp> (accessed on 26 September, 2016). 97 This is not dissimilar to the position of specialist GPs when the NHS was introduced, and the SHMO role created to accommodate those GPs who failed to be assessed at consultant status. 98 These figures exclude salaried doctors in hospitals. R. B. Scotton, ‘Keynote Address’ in Medical Manpower and Training in Victoria—Proceedings of a Seminar held on 16 April 1983 (The Victorian Medical Postgraduate Foundation, 1983), 12–18, see Table 3, on 18. 99 See, for example: Reginald Appleyard, The Ten Pound Immigrants (London: Boxtree, 1988); Hammerton and Thomson, Ten Pound Poms, 214 and passim. 100 Ibid. 101 Wright et al, ‘Worse than Being Married’, 546–75. 102 Seaton, ‘Against the “Sacred Cow”’, 446. © The Author 2017. Published by Oxford University Press on behalf of the Society for the Social History of Medicine. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Social History of Medicine Oxford University Press

Revisiting Post-war British Medical Migration: A Case Study of Bristol Medical Graduates in Australia

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Oxford University Press
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© The Author 2017. Published by Oxford University Press on behalf of the Society for the Social History of Medicine.
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0951-631X
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Abstract

Summary Between 1954 and 1963, c. 4,000 British-trained doctors migrated to countries including Australia, Canada and the USA. Historians have positioned their motivations to migrate as either primarily ideological (opposition to ‘socialised medicine’) or economic (poor prospects within the NHS structure). Post-war British medical migrants are, however, understudied. This article adds to the growing body of literature on twentieth-century medical migration; it details the transnational lives of a group of Bristol doctors in Australia. Their medical lives are used as a case study to explore prospects in the NHS—particularly for GPs, contextualising these doctors’ decision to migrate. It continues by tracing the subsequent careers of this Bristol group in Australia. In doing so, it highlights the role of medical networks in understanding motivations to migrate, and the early readjustment of medical migrants. It also reveals the integral role British doctors played in alleviating GP shortages in rural Australia. Australia, Bristol, general practice, migration, NHS Martin Gorsky’s survey of the historiography documenting the British National Health Service from 1948 to 2000 identified the 1950s as a period which some contemporary observers argued, and historians agree, was unsatisfactory for general practitioners: they were overworked, underpaid and often criticised.1 By the late 1960s the British Ministry of Health broadly accepted that a quarter of Britain’s annual output of medical graduates—a high proportion of whom were general practitioners—had responded by migrating.2 Commonwealth countries including Australia, Canada and New Zealand were popular destinations because British qualifications were easily transferrable. British and Irish medical degrees were the only overseas qualifications explicitly recognised in all Australian state medical acts.3 Two of the more reliable surveys estimate that between 1,600 and 2,200 doctors with British and Irish qualifications moved to Australia between 1948 and 1963.4 Despite the long tradition of medical migration to Australia, this represented an almost five-fold increase compared to the decades before the Second World War.5 This article is a first step in documenting hitherto unexplored transnational professional lives—both individual and collective—of post-war British medical graduates in Australia. Historical analyses of twentieth-century medicine in Australia are characterised by the rise of the Australian profession, its institutions and its politics. In these accounts, medical migrants are occasionally subsumed in national narratives of Australian medicine and health.6 A subset of permanent British migrants who rose to prominence in Australia are memorialised in national registers, including the Australian National Dictionary of Biography. The literature on twentieth-century medical migration to Australia is dominated by examinations of the significant political, professional and social barriers faced by the smaller, marginalised group of pre- and-post war arrivals: European Jewish refugees and Displaced Persons.7 Historian Paul Weindling argues in his introduction to a special issue of the Social History of Medicine on ‘medical refugees in Britain and the wider world’ how studies of refugee and immigrant doctors can elucidate the important role they play in the ‘modernisation of healthcare’.8 This view has recently been extended by Laurence Monnais and David Wright, who argue medical migrants can ‘challenge’ and sometimes ‘transform’ local medical practice.9 Despite a growing body of literature on medical immigrants in the UK, the British medical emigrant has a relegated role in national narratives of the National Health Service (NHS).10 These migrating doctors are passingly represented as either casualties of early structural problems with the NHS; embedded in wider discussion of Britain’s post-war ‘brain drain’; or as part of the ‘wastage’ contributing to the shortage of doctors in the 1950s, resulting in the corresponding inflow to British hospitals of doctors from South Asia.11 Recently, historian Andrew Seaton has revisited the most controversial motivation ascribed to British medical migration: that it was also an expression of staunch opposition to socialised medicine.12 Seaton argues that opposition to what the NHS symbolised is critical to ‘fully’ understanding the post-war emigration of general practitioners.13 In one of the few studies of post-war British medical migration, historians David Wright, Sasha Mullally and Mary Cordukes noted the lack of transnational studies in the case of Canada and Britain.14 They similarly attribute the neglect of post-war British medical migrants to the centrality of the nation state in NHS historiography. By drawing on oral histories of British doctors in Canada, their study offers a contrasting approach to Seaton’s in evaluating British medical migration. It notes the interwoven strands that encompassed each interviewee’s decision to migrate, but also that ‘the inflexibility and hierarchy of the structure of British medicine loomed very large’ when analysing the collective.15 By adopting a transnational lens, the paper by Wright et al. connects the ‘exodus’ of disenfranchised British doctors from the NHS to the instrumental role they played in maintaining Canada’s new universal health care system, at a time when Canada’s own home-grown supply of doctors was inadequate.16 This study exemplifies how aspects of the history of the NHS, in this case the political and economic discourses of medical manpower in the UK, can be contextualised in a global market for doctors offering competing models of health care delivery. The analytical approach adopted in this article takes its cues from literature on medical immigrants and refugees, and the study by Wright et al. This article presents a case study of the transnational medical lives of a group of sixteen Bristol graduates, most of whom were general practitioners, who migrated to Australia. It traces and contextualises the lives of these doctors—from their war experiences to medical school, as early graduates in the NHS to their decision to migrate, and their subsequent transition and careers in Australia. This case study offers three contributions to the history of medicine and health in Britain and Australia. First, it adds to the literature on how British medical migration has been understood, and favours an interpretation that emphasises the complicated nature of these decisions. Second, it demonstrates the role medical networks can play in influencing choice of destination and experiences of migration—in this case, networks formed at university.17 In doing so, it highlights the potential of a prosopographical, transnational approach in revealing these networks. Finally, the medical careers of this group offer initial evidence and insight into the important role some British medical graduates had in maintaining primary health services in post-war rural Australia. Finding the Bristol Group: Context and Methods The Bristol group emerged as a cohort from a prosopographical study exploring European medical graduates first registered in the Australia state of Victoria between 1930 and 1960. Since British and Irish arrivals account for most of these practitioners—563 out of 735—a random sample, stratified by gender, was drawn for detailed analysis (Table 1).18 Dr Charles Gawthorn was one of the British graduates in this sample. He completed his finals at the University of Bristol in July 1952, and left for Australia later that year. In an autobiographical reflection he wrote for the Royal Australian College of General Practitioners decades later, he recounted that he saw 16 fellow students from the University of Bristol in Australia.19 How Dr Gawthorn defined classmates is debatable—did he mean the group of students he started medical school with? Or those who graduated in the same year as he did? Table 1. Overseas medical graduates registered in Victoria, 1930–60 Brit & Irish women Brit & Irish men Other European Rest of world ALL Sample ALL Sample Women Men Women Men 1930-45 23 14 66 13 2 25 3 13 1946-60* 88 41 386 73 17 42 9 61 Total (% in sample) 111 55 (50%) 452 86 (19%) 19 (100%) 67 (100%) 12 74 Brit & Irish women Brit & Irish men Other European Rest of world ALL Sample ALL Sample Women Men Women Men 1930-45 23 14 66 13 2 25 3 13 1946-60* 88 41 386 73 17 42 9 61 Total (% in sample) 111 55 (50%) 452 86 (19%) 19 (100%) 67 (100%) 12 74 *The numbers for 1960 is incomplete, and only includes those registered before the list went to press in Jan 1960. Source: Victorian medical registers, 1931–1960. Table 1. Overseas medical graduates registered in Victoria, 1930–60 Brit & Irish women Brit & Irish men Other European Rest of world ALL Sample ALL Sample Women Men Women Men 1930-45 23 14 66 13 2 25 3 13 1946-60* 88 41 386 73 17 42 9 61 Total (% in sample) 111 55 (50%) 452 86 (19%) 19 (100%) 67 (100%) 12 74 Brit & Irish women Brit & Irish men Other European Rest of world ALL Sample ALL Sample Women Men Women Men 1930-45 23 14 66 13 2 25 3 13 1946-60* 88 41 386 73 17 42 9 61 Total (% in sample) 111 55 (50%) 452 86 (19%) 19 (100%) 67 (100%) 12 74 *The numbers for 1960 is incomplete, and only includes those registered before the list went to press in Jan 1960. Source: Victorian medical registers, 1931–1960. To answer these questions, it was necessary to trace all Bristol medical graduates for that period. In total, 75 students are listed as completing their finals between December 1951 and December 1952.20 Of these, 16—representing approximately 20 per cent of the total number—did arrive in Australia between 1952 and 1965. One doctor partially completed his finals at Bristol but never graduated, qualifying instead with the English conjoint, and another’s wife had graduated from Bristol earlier in 1951—totalling 18 individuals including himself that Dr Gawthorn may have been referring to.21 In the full Victorian migrant sample alone, eight of the ten Bristol graduates registered in 1950–54 had graduated in 1952 (highlighted in Table 2). No such discernible pattern has been found for British graduates arriving in Victoria from other medical schools, despite them outnumbering Bristol graduates (Table 2). However, it does raise the possibility that similar cohorts might be found if the analysis was extended to all Australian states. Table 2. British and Irish medical graduates registered in Victoria, Australia, by year and place of graduation (n = 563) Year/Place of grad <1920 1920-24 1925-29 1930-34 1935-39 1940-44 1945-49 1950-54 1955-59 Total London London* 0 1 11 2 3 7 27 23 12 86 England** 8 8 13 13 17 23 19 16 3 120 Rest of England Birmingham 0 0 0 0 2 1 2 3 4 12 Bristol 0 0 0 0 0 1 2 10 (8) 1 14 Cambridge 0 0 1 1 2 2 6 3 5 20 Durham 1 2 0 0 7 4 (3) 4 3 2 23 Leeds 0 1 0 0 2 4 0 1 0 8 Liverpool 0 0 0 0 0 2 4 8 (3, 3) 3 17 Manchester 0 1 1 2 0 0 4 (3) 3 3 14 Oxford 0 0 1 0 0 1 2 6 0 10 Sheffield 0 0 0 0 0 1 1 1 1 4 Scotland Aberdeen 1 1 2 0 2 2 4 4 1 17 Edinburgh 2 0 6 3 11 (4, 3) 7 (3) 12 (3,3,4) 3 4 48 Glasgow 2 4 (3) 3 2 4 4 5 3 4 31 St Andrews 0 4 4 1 1 2 2 2 0 16 Scotland ^ 4 2 4 7 14 7 2 4 0 44 Wales Cardiff 0 0 0 0 0 0 2 1 1 4 N. Ireland Belfast 0 1 0 1 4 2 3 4 3 18 Ireland Dublin 1 0 2 2 2 2 5 6 (3) 2 22 Ireland ^ ^ 6 2 1 1 4 4 5 8 2 33 Yr reg in VIC, AUS 19 33 35 63 146 267 563 % <7 yrs from grad 47% 61% 31% 37% 41% 54% % <10 yrs from grad 68% 85% 66% 73% 75% 87% Year/Place of grad <1920 1920-24 1925-29 1930-34 1935-39 1940-44 1945-49 1950-54 1955-59 Total London London* 0 1 11 2 3 7 27 23 12 86 England** 8 8 13 13 17 23 19 16 3 120 Rest of England Birmingham 0 0 0 0 2 1 2 3 4 12 Bristol 0 0 0 0 0 1 2 10 (8) 1 14 Cambridge 0 0 1 1 2 2 6 3 5 20 Durham 1 2 0 0 7 4 (3) 4 3 2 23 Leeds 0 1 0 0 2 4 0 1 0 8 Liverpool 0 0 0 0 0 2 4 8 (3, 3) 3 17 Manchester 0 1 1 2 0 0 4 (3) 3 3 14 Oxford 0 0 1 0 0 1 2 6 0 10 Sheffield 0 0 0 0 0 1 1 1 1 4 Scotland Aberdeen 1 1 2 0 2 2 4 4 1 17 Edinburgh 2 0 6 3 11 (4, 3) 7 (3) 12 (3,3,4) 3 4 48 Glasgow 2 4 (3) 3 2 4 4 5 3 4 31 St Andrews 0 4 4 1 1 2 2 2 0 16 Scotland ^ 4 2 4 7 14 7 2 4 0 44 Wales Cardiff 0 0 0 0 0 0 2 1 1 4 N. Ireland Belfast 0 1 0 1 4 2 3 4 3 18 Ireland Dublin 1 0 2 2 2 2 5 6 (3) 2 22 Ireland ^ ^ 6 2 1 1 4 4 5 8 2 33 Yr reg in VIC, AUS 19 33 35 63 146 267 563 % <7 yrs from grad 47% 61% 31% 37% 41% 54% % <10 yrs from grad 68% 85% 66% 73% 75% 87% Numbers in parentheses indicate clusters that shared year of graduation. * Includes all London medical schools. ** Includes qualifications conferred by both Royal Colleges of Physicians and Surgeons, and the Society of Apothecaries.  ^ Only the Scottish double or triple issued by the Royal Colleges of Edinburgh and Glasgow.  ^ ^ Includes qualifications conferred by both university medical schools and the Royal College of Physicians in Ireland. Sources: Victorian medical registers and General Medical Council lists. Table 2. British and Irish medical graduates registered in Victoria, Australia, by year and place of graduation (n = 563) Year/Place of grad <1920 1920-24 1925-29 1930-34 1935-39 1940-44 1945-49 1950-54 1955-59 Total London London* 0 1 11 2 3 7 27 23 12 86 England** 8 8 13 13 17 23 19 16 3 120 Rest of England Birmingham 0 0 0 0 2 1 2 3 4 12 Bristol 0 0 0 0 0 1 2 10 (8) 1 14 Cambridge 0 0 1 1 2 2 6 3 5 20 Durham 1 2 0 0 7 4 (3) 4 3 2 23 Leeds 0 1 0 0 2 4 0 1 0 8 Liverpool 0 0 0 0 0 2 4 8 (3, 3) 3 17 Manchester 0 1 1 2 0 0 4 (3) 3 3 14 Oxford 0 0 1 0 0 1 2 6 0 10 Sheffield 0 0 0 0 0 1 1 1 1 4 Scotland Aberdeen 1 1 2 0 2 2 4 4 1 17 Edinburgh 2 0 6 3 11 (4, 3) 7 (3) 12 (3,3,4) 3 4 48 Glasgow 2 4 (3) 3 2 4 4 5 3 4 31 St Andrews 0 4 4 1 1 2 2 2 0 16 Scotland ^ 4 2 4 7 14 7 2 4 0 44 Wales Cardiff 0 0 0 0 0 0 2 1 1 4 N. Ireland Belfast 0 1 0 1 4 2 3 4 3 18 Ireland Dublin 1 0 2 2 2 2 5 6 (3) 2 22 Ireland ^ ^ 6 2 1 1 4 4 5 8 2 33 Yr reg in VIC, AUS 19 33 35 63 146 267 563 % <7 yrs from grad 47% 61% 31% 37% 41% 54% % <10 yrs from grad 68% 85% 66% 73% 75% 87% Year/Place of grad <1920 1920-24 1925-29 1930-34 1935-39 1940-44 1945-49 1950-54 1955-59 Total London London* 0 1 11 2 3 7 27 23 12 86 England** 8 8 13 13 17 23 19 16 3 120 Rest of England Birmingham 0 0 0 0 2 1 2 3 4 12 Bristol 0 0 0 0 0 1 2 10 (8) 1 14 Cambridge 0 0 1 1 2 2 6 3 5 20 Durham 1 2 0 0 7 4 (3) 4 3 2 23 Leeds 0 1 0 0 2 4 0 1 0 8 Liverpool 0 0 0 0 0 2 4 8 (3, 3) 3 17 Manchester 0 1 1 2 0 0 4 (3) 3 3 14 Oxford 0 0 1 0 0 1 2 6 0 10 Sheffield 0 0 0 0 0 1 1 1 1 4 Scotland Aberdeen 1 1 2 0 2 2 4 4 1 17 Edinburgh 2 0 6 3 11 (4, 3) 7 (3) 12 (3,3,4) 3 4 48 Glasgow 2 4 (3) 3 2 4 4 5 3 4 31 St Andrews 0 4 4 1 1 2 2 2 0 16 Scotland ^ 4 2 4 7 14 7 2 4 0 44 Wales Cardiff 0 0 0 0 0 0 2 1 1 4 N. Ireland Belfast 0 1 0 1 4 2 3 4 3 18 Ireland Dublin 1 0 2 2 2 2 5 6 (3) 2 22 Ireland ^ ^ 6 2 1 1 4 4 5 8 2 33 Yr reg in VIC, AUS 19 33 35 63 146 267 563 % <7 yrs from grad 47% 61% 31% 37% 41% 54% % <10 yrs from grad 68% 85% 66% 73% 75% 87% Numbers in parentheses indicate clusters that shared year of graduation. * Includes all London medical schools. ** Includes qualifications conferred by both Royal Colleges of Physicians and Surgeons, and the Society of Apothecaries.  ^ Only the Scottish double or triple issued by the Royal Colleges of Edinburgh and Glasgow.  ^ ^ Includes qualifications conferred by both university medical schools and the Royal College of Physicians in Ireland. Sources: Victorian medical registers and General Medical Council lists. The remainder of this article will primarily focus on the 16 Bristol graduates—thirteen men and three women—who qualified between December 1951 and 1952, and eventually moved to Australia (Table 3).22 This group of 1952 Bristol graduates are clearly unique because of their shared university education and their subsequent choice of destination. (Only a further seven of the 75 Bristol graduates who graduated in 1952 spent a portion of their medical career overseas in the first 20 years after graduating.23) I do not argue that the experiences of this Bristol group are wholly representative of British medical graduates in Australia. However, they are representative of a significant post-war migrant doctor profile, especially with respect to their war experience; marital status; migration ten or less years from graduating (Table 2); and their status as general practitioners. Therefore, the Bristol group’s experiences and their career trajectories once in Australia offer a distinct, convenient sample with which to explore and contextualise professional networks, factors that influenced British graduates to leave the UK, their choice of Australia as a destination, and their professional lives once there. Table 3. 1952 Bristol graduates—career summary before leaving UK Yr left UK Name Est. age on grad Military service (rank if known) House jobs (after graduation) Further career in UK (before leaving) Marital status on leaving UK 1952 Gawthorn, Charles 29 Fleet Arm Pilot, Royal Navy, 1940-46 None – Married (1944) with children 1952-3 Lowther, Gordon – Unknown Unknown Unknown Unknown – presumed unmarried 1954 Appelbe, Frederick 33 Navigation Officer, Royal Navy, 1940-46 Frenchay Hospital, Bristol GP, Bristol Married (1951) with children 1954 Martyn, Sheila 25 Unknown Southmead Hospital (Bristol) – Unmarried 1955 Bennett, Bernard 34 Staff Captain, RAMC, 1940-1946 Newton Abbott hospital, Devon GP, Devon Married (1946) with children 1955-6 Smith, Herbert 27 Unknown St Charles Hospital, London – Married 1955 Walker, Henry 28 Pilot, RAF, c. 1943-47 Southmead Hospital, Bristol GP (Locum work), location unknown Married (1950) with children 1956 Edmondson, Kenneth 23 RAMC, 1953-55 Royal Bristol Infirmary Dorchester Hospital; GP, Bristol Married (1954) 1956 Sherwood, Denise 23 None Royal Bristol Infirmary – Married (1952) to Peter Sherwood, with chidlren 1956 Sherwood, Peter 24 RAMC, 1953-55 Southmead Hospital, Bristol & Royal Devon and Exeter Hospital GP (Locum work), Bristol Married (1952) to Denise Sherwood, with chidlren 1956-7 Walker, Andrew 29 Pilot, RAF, 1939-45& RAF (Aux), 1945-53 None declared Paediatrician, Dept. of Health, Gloucester; Divisional Surg., St John’s Ambulance Unknown 1957 Hillier, Geoffrey 26 Captain RAMC, 1953-55 Royal Bristol Infirmary Senior House Surgeon, Royal Bristol Infirmary Registrar (Surgery), Cossham Memorial Hospital, Bristol Married (1949 – wife a doctor) with children 1959 Gear, Douglas 28 Unknown Royal Bristol Infirmary Registrar, Royal Gloucester Hospital, Gloucester; GP, South Petherton Hospital, Somerset Married (1948) with children 1959 Palmer, Ian 22 Captain RAMC, 1954-56 Royal Bristol Infirmary & Nobles Hospital, Isle of Man House Surgeon, then Obstetric Officer, Royal Victoria Hospital, Bournemouth Married (1958, wife a doctor) 1962 Jarvis, David 24 Medical Officer RAMC, 1953-55 Croydon General Hospital, London Demonstrator in Pathology, University of Bristol Married 1965 Fox, Audrey 25 None Royal Gwent Hospital, Newport Senior Resident Medical Officer, Bruce Melville Wills Memorial Hospital (Bristol); then GP, Bristol* Married with children Yr left UK Name Est. age on grad Military service (rank if known) House jobs (after graduation) Further career in UK (before leaving) Marital status on leaving UK 1952 Gawthorn, Charles 29 Fleet Arm Pilot, Royal Navy, 1940-46 None – Married (1944) with children 1952-3 Lowther, Gordon – Unknown Unknown Unknown Unknown – presumed unmarried 1954 Appelbe, Frederick 33 Navigation Officer, Royal Navy, 1940-46 Frenchay Hospital, Bristol GP, Bristol Married (1951) with children 1954 Martyn, Sheila 25 Unknown Southmead Hospital (Bristol) – Unmarried 1955 Bennett, Bernard 34 Staff Captain, RAMC, 1940-1946 Newton Abbott hospital, Devon GP, Devon Married (1946) with children 1955-6 Smith, Herbert 27 Unknown St Charles Hospital, London – Married 1955 Walker, Henry 28 Pilot, RAF, c. 1943-47 Southmead Hospital, Bristol GP (Locum work), location unknown Married (1950) with children 1956 Edmondson, Kenneth 23 RAMC, 1953-55 Royal Bristol Infirmary Dorchester Hospital; GP, Bristol Married (1954) 1956 Sherwood, Denise 23 None Royal Bristol Infirmary – Married (1952) to Peter Sherwood, with chidlren 1956 Sherwood, Peter 24 RAMC, 1953-55 Southmead Hospital, Bristol & Royal Devon and Exeter Hospital GP (Locum work), Bristol Married (1952) to Denise Sherwood, with chidlren 1956-7 Walker, Andrew 29 Pilot, RAF, 1939-45& RAF (Aux), 1945-53 None declared Paediatrician, Dept. of Health, Gloucester; Divisional Surg., St John’s Ambulance Unknown 1957 Hillier, Geoffrey 26 Captain RAMC, 1953-55 Royal Bristol Infirmary Senior House Surgeon, Royal Bristol Infirmary Registrar (Surgery), Cossham Memorial Hospital, Bristol Married (1949 – wife a doctor) with children 1959 Gear, Douglas 28 Unknown Royal Bristol Infirmary Registrar, Royal Gloucester Hospital, Gloucester; GP, South Petherton Hospital, Somerset Married (1948) with children 1959 Palmer, Ian 22 Captain RAMC, 1954-56 Royal Bristol Infirmary & Nobles Hospital, Isle of Man House Surgeon, then Obstetric Officer, Royal Victoria Hospital, Bournemouth Married (1958, wife a doctor) 1962 Jarvis, David 24 Medical Officer RAMC, 1953-55 Croydon General Hospital, London Demonstrator in Pathology, University of Bristol Married 1965 Fox, Audrey 25 None Royal Gwent Hospital, Newport Senior Resident Medical Officer, Bruce Melville Wills Memorial Hospital (Bristol); then GP, Bristol* Married with children Source: Fallon Mody database 2017. Table 3. 1952 Bristol graduates—career summary before leaving UK Yr left UK Name Est. age on grad Military service (rank if known) House jobs (after graduation) Further career in UK (before leaving) Marital status on leaving UK 1952 Gawthorn, Charles 29 Fleet Arm Pilot, Royal Navy, 1940-46 None – Married (1944) with children 1952-3 Lowther, Gordon – Unknown Unknown Unknown Unknown – presumed unmarried 1954 Appelbe, Frederick 33 Navigation Officer, Royal Navy, 1940-46 Frenchay Hospital, Bristol GP, Bristol Married (1951) with children 1954 Martyn, Sheila 25 Unknown Southmead Hospital (Bristol) – Unmarried 1955 Bennett, Bernard 34 Staff Captain, RAMC, 1940-1946 Newton Abbott hospital, Devon GP, Devon Married (1946) with children 1955-6 Smith, Herbert 27 Unknown St Charles Hospital, London – Married 1955 Walker, Henry 28 Pilot, RAF, c. 1943-47 Southmead Hospital, Bristol GP (Locum work), location unknown Married (1950) with children 1956 Edmondson, Kenneth 23 RAMC, 1953-55 Royal Bristol Infirmary Dorchester Hospital; GP, Bristol Married (1954) 1956 Sherwood, Denise 23 None Royal Bristol Infirmary – Married (1952) to Peter Sherwood, with chidlren 1956 Sherwood, Peter 24 RAMC, 1953-55 Southmead Hospital, Bristol & Royal Devon and Exeter Hospital GP (Locum work), Bristol Married (1952) to Denise Sherwood, with chidlren 1956-7 Walker, Andrew 29 Pilot, RAF, 1939-45& RAF (Aux), 1945-53 None declared Paediatrician, Dept. of Health, Gloucester; Divisional Surg., St John’s Ambulance Unknown 1957 Hillier, Geoffrey 26 Captain RAMC, 1953-55 Royal Bristol Infirmary Senior House Surgeon, Royal Bristol Infirmary Registrar (Surgery), Cossham Memorial Hospital, Bristol Married (1949 – wife a doctor) with children 1959 Gear, Douglas 28 Unknown Royal Bristol Infirmary Registrar, Royal Gloucester Hospital, Gloucester; GP, South Petherton Hospital, Somerset Married (1948) with children 1959 Palmer, Ian 22 Captain RAMC, 1954-56 Royal Bristol Infirmary & Nobles Hospital, Isle of Man House Surgeon, then Obstetric Officer, Royal Victoria Hospital, Bournemouth Married (1958, wife a doctor) 1962 Jarvis, David 24 Medical Officer RAMC, 1953-55 Croydon General Hospital, London Demonstrator in Pathology, University of Bristol Married 1965 Fox, Audrey 25 None Royal Gwent Hospital, Newport Senior Resident Medical Officer, Bruce Melville Wills Memorial Hospital (Bristol); then GP, Bristol* Married with children Yr left UK Name Est. age on grad Military service (rank if known) House jobs (after graduation) Further career in UK (before leaving) Marital status on leaving UK 1952 Gawthorn, Charles 29 Fleet Arm Pilot, Royal Navy, 1940-46 None – Married (1944) with children 1952-3 Lowther, Gordon – Unknown Unknown Unknown Unknown – presumed unmarried 1954 Appelbe, Frederick 33 Navigation Officer, Royal Navy, 1940-46 Frenchay Hospital, Bristol GP, Bristol Married (1951) with children 1954 Martyn, Sheila 25 Unknown Southmead Hospital (Bristol) – Unmarried 1955 Bennett, Bernard 34 Staff Captain, RAMC, 1940-1946 Newton Abbott hospital, Devon GP, Devon Married (1946) with children 1955-6 Smith, Herbert 27 Unknown St Charles Hospital, London – Married 1955 Walker, Henry 28 Pilot, RAF, c. 1943-47 Southmead Hospital, Bristol GP (Locum work), location unknown Married (1950) with children 1956 Edmondson, Kenneth 23 RAMC, 1953-55 Royal Bristol Infirmary Dorchester Hospital; GP, Bristol Married (1954) 1956 Sherwood, Denise 23 None Royal Bristol Infirmary – Married (1952) to Peter Sherwood, with chidlren 1956 Sherwood, Peter 24 RAMC, 1953-55 Southmead Hospital, Bristol & Royal Devon and Exeter Hospital GP (Locum work), Bristol Married (1952) to Denise Sherwood, with chidlren 1956-7 Walker, Andrew 29 Pilot, RAF, 1939-45& RAF (Aux), 1945-53 None declared Paediatrician, Dept. of Health, Gloucester; Divisional Surg., St John’s Ambulance Unknown 1957 Hillier, Geoffrey 26 Captain RAMC, 1953-55 Royal Bristol Infirmary Senior House Surgeon, Royal Bristol Infirmary Registrar (Surgery), Cossham Memorial Hospital, Bristol Married (1949 – wife a doctor) with children 1959 Gear, Douglas 28 Unknown Royal Bristol Infirmary Registrar, Royal Gloucester Hospital, Gloucester; GP, South Petherton Hospital, Somerset Married (1948) with children 1959 Palmer, Ian 22 Captain RAMC, 1954-56 Royal Bristol Infirmary & Nobles Hospital, Isle of Man House Surgeon, then Obstetric Officer, Royal Victoria Hospital, Bournemouth Married (1958, wife a doctor) 1962 Jarvis, David 24 Medical Officer RAMC, 1953-55 Croydon General Hospital, London Demonstrator in Pathology, University of Bristol Married 1965 Fox, Audrey 25 None Royal Gwent Hospital, Newport Senior Resident Medical Officer, Bruce Melville Wills Memorial Hospital (Bristol); then GP, Bristol* Married with children Source: Fallon Mody database 2017. The professional careers and experiences of this ‘Bristol group’ have been reconstructed from interviews with surviving members of the group and their immediate family, and from published and private autobiographical accounts, to supplement the employment histories declared in the medical directories of Australia and the UK. Additional information was collected from archival collections held at the National Archives of Australia and the UK, the Public Records Offices of Australian states, the Victorian medical registers published in the Victorian Government Gazette, annual medical registers published by the General Medical Council of the UK, obituaries published in medical journals and newspapers, and records held by local councils in Australia. This article focuses primarily on themes that influenced the career trajectories of this Bristol group. The role that other social factors will have played in each of these individual’s lives is undeniable. The accounts of the Bristol group touch on a number of social and cultural issues relevant to nuancing their decision to leave the UK and their subsequent Australian migrant experience, particularly, social adjustment after the war, familial relationships, and perceptions of Australia. This article explores the individual and collective experiences of the politics and practice of medicine and health care in both countries through a case study of this one inter-linked group.24 They highlight the myriad of ways the rank-and-file doctor experienced the policies and politics of health care delivery in the early NHS, and the particular problems faced by recent graduates in general practice in Britain. This exploration of the careers of this Bristol group in Australia, whilst limited in size, highlights how their experiences and assessment of the NHS prompted their emigration. Once in Australia, this study discusses the ways in which the group’s British training and experience shaped how individuals navigated opportunity in Australia. They sought fairer terms, higher income, a better life for their families. However, in doing so, their experiences challenge the assumption that British migrants had a seamless transition into the medical profession in Australia—on the contrary, their inexperience, lack of capital and local networks meant they had to work hard, often in remote areas to establish themselves. This article offers the first, and therefore necessarily exploratory interpretation, of post-war British medical graduates in Australia. The focus on the complete medical careers of a single cohort, using a mixed method approach, provides a qualitative update to what has so far been a statistical footnote in the historiography. Military Service, and on Becoming Doctors All but one member of the Bristol group entered university at the end of the war, between 1945 and 1946.25Table 3 summarises the group’s military service where traceable, and this immediately stratifies the cohort into those who had and those who had not served during the Second World War. The five men who were 29 years or older on graduating had all seen active service—two in the Royal Navy, in the Royal Army Medical Corps, and two in the Royal Air Force. The younger men and the women had an unbroken pathway from secondary to medical school. Although some form of mandatory military service was maintained in the UK until 1960, students were among those allowed to postpone it. The younger men in the cohort took advantage of this—four of them completed their two years of service after graduating in 1952. The ages of the Bristol group, as we will see, was a deciding factor in their choice of medical career, and arguably indirectly influenced their choice to migrate to Australia. However, for the mature students, their initial pathway to medicine was a direct consequence of their war experiences, and in some cases was a conscious effort to lift their social status. Dr Frederick Appelbe, for example, was born into an Irish farming family in west county Cork, Ireland. He was the last of eight children, and attended the local state school, and later a private school until he was 16. His parents could not afford to buy him a farm of his own, instead he was sent to Dublin to prepare for the British Civil Service exam, which he passed in 1938. His appointment in the Department of Customs and Excise in London was interrupted by the outbreak of the war. Appelbe served six years in the Navy, working his way up from the lower deck of the HMS Comorin as a naval rating to a commissioned officer in 1943, which he describes as a personal ‘turning point’. Up till that time I had mixed with people of limited ambition for their future or their country. [Now] as an Officer I mixed with a different social group. They were men of middle class extraction. Many were from the business world. Others had plans to go to university after the War and study law, dentistry, medicine, accountancy. … Almost subconsciously I absorbed the idea that what they were doing, I also could and should do. Up until [then] I had taken for granted that at the end of the War (if I was still alive) I would go back to my previous job …26 Bennett was also a civil servant in the Department of Customs and Excise before the war. He was called up in 1940, and served initially as a stretcher-bearer in the Royal Army Medical Corps. He recounts realising that he was as intellectually capable as the army doctors he was working with, prompting his application to study medicine once demobbed in 1946.27 Bennett applied for entry to the University of Cambridge and the University of Bristol, and was originally accepted into dentistry at Bristol.28 Others, like Gawthorn and Henry Walker had had a middle-class upbringing and schooling. Gawthorn attended King’s Ely public school in Cambridgeshire. He claims no ambition to study medicine in school, and was diverted by his uncle from the priesthood to join the Navy.29 He recalls knowing that he would ‘do something worthwhile’ after the war, but decided that would be medicine only after meeting his future wife—a nurse—whom he married in 1944.30 Her father was a general practitioner whom Gawthorn used to accompany on house calls when on leave from active duty. From the outset, these older ex-servicemen knew their medical careers would at best be shortened by at least a decade, providing they passed their examinations and remained in good health. Their pathway to choosing medicine contrasts sharply with the more commonly cited childhood aspiration of the other men and women in the cohort, often influenced by early exposure to the profession, either from immediate family or admiration of their family doctor. It displays a more calculated choice, based on a desire to earn a better income after the war, or enter what they saw as a stable and respectable profession—understandable motivations in the austerity of post-war Britain. The University of Bristol offered a standard six-year medical degree, therefore the first members of the cohort graduated in January 1952. Some of the later members sitting their finals in December 1952 were among the first groups subject to the compulsory hospital pre-registration year introduced by the General Medical Council, starting in 1953. Prior to that, applying for hospital house jobs was at the discretion of each individual, but critical for those aspiring to consultant status and a hospital career.31 As summarised in Table 3, almost every member of the Bristol group undertook the two common six-month house jobs—most often at the Bristol Royal Infirmary. In the cases of the younger men, although deferred military service encroached on their early careers, they were drafted to work in their professional capacity. For example, Drs Palmer and Jarvis both served as medical officers in the Royal Army Medical Corps in Malaya after they had completed their house jobs. Dr Hillier served two years as a Junior Specialist in Surgery in the RAMC in the military hospital at Tidworth camp, in Wiltshire. Career Choices and Leaving the NHS The NHS had been operational for approximately four years when the Bristol group graduated in 1952–3. By the time they had graduated, half of the group were married, some with children. Dr Gawthorn recalled that being an older, ex-Naval officer with a wife and child on graduating meant a hospital house job with ‘four pounds per week with £3/5/0 deducted for keep, left only fifteen shillings for the family. General practice it had to be.’32 The additional time and training required to specialise—at a low income—was not conducive to supporting a family, and represented further uncertainty to those older servicemen whose careers were already attenuated by the war. The original NHS hospital career structure—or the Spens ladder—predicted a graduate would need seven years to reach consultant status. Between 1950 and 1961, this expectation was subjected to a number of readjustments as demand outstripped the availability of consultant posts.33 Additionally, hospital posts generally came with compulsory residency requirements and poor accommodation for married couples. Dr Bennett, who married the year he started at Bristol, chose a six-month initial house job at Newton Abbot hospital specifically because they offered married quarters.34 General practice, despite suffering from a lower status compared to a hospital career, offered mature graduates the opportunity to establish a steady income with a higher degree of independence. This tendency for the group towards general practice is why working conditions for general practitioners (GPs) will claim a central part of the remaining narrative. When the NHS was introduced, GPs had to spend 10 years in the system before they could claim a pension; the private sale of practices including the sale of goodwill ceased; and professional ‘squatting’—setting up a new practice in an area, and building a patient list slowly—was only possible in severely under-doctored areas, as determined by local committees. Recent graduates had to look for assistantships ‘with a view’ to partnership in existing practices only—creating in those early years a flooded market of graduates with very little bargaining power.35 The British Minister for Health reported to the House of Commons in October 1952, that since the introduction of the NHS there had been a 206 per cent increase in the number of assistants in general practices.36 These questions arose in relation to a recent committee investigating GPs’ wages chaired by Mr Justice Danckwerts. The resulting 1952 ‘Danckwerts award’ was an increase in average gross income for partners in a general practice of almost 20 per cent, but conditions for assistants—now allowed 2,000 patients on their list, compared to 3,500 for partners—in terms of both income and partnership opportunities were still comparatively low. Dr Gawthorn describes the prospect of working as one such ‘poorly paid sweated assistant’ as one of his motivations for migrating.37 Abel-Smith and Gale’s study of 275 randomly selected doctors showed that 40 per cent of the departures between 1949 and 1962 had been a GP, (junior) House Officer in a hospital or, like Dr Gawthorn, had never held a position within the NHS on leaving.38 Ten members of the Bristol group fell into one of these categories, six of whom had been GPs.39 The study of British doctors in Canada by Wright et al. noted that although their interviewees were reticent to discuss their wages, they commonly cited wanting to improve their quality of life as one reason to migrate.40 Dr Bennett was one in the group who directly linked material dissatisfaction of assistantships to desired status-driven expectations for his future life. He had two children by the time he graduated, and had secured an assistantship ‘with a view’ in Bristol. He recalls one factor that weighed into his decision to migrate was his ability to afford private education for his children: the terms were pretty harsh. It was a partnership of two, I was on one third of the income going up one per cent each year. It was going to take 17 years to reach equality. … I couldn’t see ever being able to educate my children.41 Dr Appelbe left England in 1953. His private memoirs detail his unhappiness and professional discomfort with the assistantship he held with Dr AB in a husband-and-wife-partnership practice in Bristol. Having originally accepted a second house job offering a post in obstetrics in Haverfordwest in Wales, he soon returned to Bristol, back to his wife and child. He describes the working conditions in Dr AB’s practice as exploitative—the wife of Dr AB worked only two hours a week despite having a full list of patients whom Dr Appelbe was also expected to service, on top of his own list of 2,000. Their standard of practice was also contrary to his Bristol training: Dr AB was one of those General Practitioners whose skill included examining the chest without taking off the patient’s shirt, pullover or coat. … [He] held his evening surgery from 5 until 7 o’clock. He had no problem seeing sixty patients in that time. Most of them received no attempt at an examination; they were simply given a prescription. … While working for him I saw patients in what was, in fact, an old bicycle shed at the back of the premises.42 Dr Appelbe’s recollections echo some of the problems inherited from the old voluntary panel system introduced by the British National Health Insurance scheme in 1911; the mechanics of which were tweaked before it was expanded to define all general practice under the NHS.43 A GP’s income was directly proportional to the size of his patient list, since he was paid a fixed, annual capitation fee for each patient regardless of the quality of care or the practice setting within which it was provided. NHS historian Charles Webster labelled this as a set of ‘perverse incentives’ of the early NHS that rewarded GPs who maximized the size of their patient list and minimized their expenses.44 Recent graduates like Dr Appelbe keen to provide a better standard of care, had to temper their enthusiasm or risk losing their job. Dr Appelbe decided to migrate when the practice owner retracted his verbal promise of making him an assistant ‘with a view’—with it, removing all hope of him improving the quality of the practice once an equal partner. Staying in England appeared untenable: If I left Dr AB’s practice I would probably have to go on the unemployment list, as indeed was the case with some of the students who had been in my year. … The truth of the matter is that basically I was not the migrating type. Though I had travelled the world for six years in the Royal Navy, I always regarded England and Ireland as home and expected to live there after the war.45 An immigrant doctor from Dublin observed in a letter to the British Medical Journal in 1968 that Australia has ‘a veritable army of us refugees from that crumbling socialist edifice—the British N.H.S.’46 The NHS was clearly divisive, and many immigrants evoked strong language when discussing it.47 However, there is little empirical evidence to support the suggestion that ideological opposition to socialised medicine was the sole or even primary motivator for these Bristol graduates, and for the recent graduates among migrating British practitioners generally. Three separate studies—of a random sample by Abel-Smith and Gale, of Birmingham medical graduates between 1959 and 1963, and of Aberdeen medical graduates from 1956 to 1958—independently discovered recurring themes identified by emigrating respondents.48 Namely: dissatisfaction with conditions of general practice within the NHS, lack of opportunity for higher incomes, the desire to increase the quality of life for their families, and reluctance to wait longer for consultant posts. These complex interrelated series of considerations are also borne out in the recollections of the Bristol group when examined as a collective. One member of the group when asked for their individual motivations for leaving England, replied with an assessment to describe the collective: Disillusionment was foremost—the future … seemed difficult and without good prospects; places in [general] practice were limited (and therefore the incumbents tried to get all they could from the enquirers). The world outside Britain seemed beckoning, and transfer to another country seemed easy: jobs were plentiful, the remuneration good, places inside and out of GP work was available, and British degrees were accepted too.49 What this and the previous statements capture is the complexity of each decision to migrate—the interplay between the social, professional, economic and political factors. Seaton’s recent analysis questions the importance placed on structural dissatisfaction at the expense of political opposition to the NHS.50 I argue, however, that it would be a trivialisation of the complicated matrix of factors described above to privilege ideological opposition in understanding the Bristol group’s drive to migrate; just as it would be an overgeneralisation to attribute the motivations expressed by this one group to all migrating British graduates. By 1959—less than eight years from graduating—all but two of the Bristol group had left for Australia (see Table 3). Half of them are known to have secured employment before they left, most commonly as GPs in country towns. A quarter of them arrived in Australia as free agents. Australia’s assisted passage scheme for British nationals, colloquially known as the ‘10 pound Pom scheme’, required families to be sponsored (typically by an Australian resident, local or state government, or a charitable organisation). Dr Gawthorn—the first who left—is known to have sponsored three of his classmates, starting with Dr Appelbe in 1953. Dr Bennett recalled that when Dr Gawthorn offered to sponsor him, he ‘did not know what that meant’.51 Bennett had also been considering Canada and Southern Rhodesia (Zimbabwe) as possible destinations. Gawthorn not only sponsored Bennett, he found the Bennetts a furnished house, and a four-month locum in the practice he worked in.52 Similarly, Gawthorn helped Appelbe secure his first assistantship in Australia; and Dr Edmondson also worked as a locum in Gawthorn’s practice when he first arrived.53 The recollections of the group around why they chose Australia in particular also noted its political stability—many members stated that a civil war in Southern Rhodesia seemed likely; better weather compared to Canada; cheap fares offered by the 10 pound scheme; and—especially for those who did not have a job on leaving—personal endorsement of career prospects from their fellow colleagues.54 The two Drs Palmers, for example, were childless and did not need to be sponsored, but they had corresponded with the Edmondsons about migrating, and were hosted by them when they first arrived.55 The Bristol group reflects the central role their professional networks and shared circumstances played in each individual’s decision to resettle in Australia. Just as conditions in the UK pushed thousands of practitioners to consider emigrating, Australia’s immigration policies allowed this particular group of graduates to leverage their individual professional networks when seeking better alternatives. Life in Australia, 1952–1990 What factors might have lead Dr Gawthorn, and other British doctors, to recommend Australia as an alternative? The culture and practice of medicine differed in significant ways, despite the strong influence of British medicine in Australia. All but three of the Bristol group started their working life in Australia as GPs (see Table 4), therefore, three interrelated comparisons between general practice are worth noting. First, the conditions governing provision of universal health care in the UK and Australia were in constant flux from their inception in 1948 and 1953 respectively. If you accept that the period 1948–66 was arguably the most challenging for GPs in the UK, the reverse is true for Australia.56 The Page health scheme implemented in 1953 was operational without significant revision until 1972. One of the most compelling and succinct descriptions of this scheme, which for this reason is often-repeated, comes from a former editor of The Lancet, Sir Theodore Fox. He described Page’s scheme as ‘private practice, publicly supported’, which essentially it was.57 British graduates arriving in the 1950s would have found a medical profession recently victorious in their lobby to preserve fee-for-service as the dominant model for private practice. In the late 1930s the Australian profession resisted multiple attempts by successive Labor governments to introduce a national health insurance scheme similar to Britain’s, and later, any bills that foreshadowed moves to introduce an Australian version of the NHS.58 The National Health Service Act passed in 1953 reduced but did not absorb the cost of health care to citizens. GPs and specialists could continue to charge a patient whatever they judged best, with the federal government paying a fixed rate back for all known medical services and procedures. Australians were encouraged to take out voluntary health insurance to cover the gap in costs. Pensioners (including war veterans) were the only Australian citizens entitled to an entirely free medical service. Table 4. 1952 Bristol graduates—career summary in Australia, 1952–present Yr arr. in Aus Name States regd in Pgrad quals & memberships Initial employment in Australia Further career in Australia Est. yr ret’d in Aus** Status on retirement Country of Death 1952 Gawthorn, Charles VIC then WA AMA#; FRACGP^ 1978 Locum, Brunswick (VIC – suburban) GP, Brunswick (VIC – suburban); GP, Perth (WA – suburban) 1987 Partner, group practice Aus c. 1952-3 Lowther, Gordon N/A* English conjoint ’53; DTM & H Liverpool ‘54; FFA RCS &I; DA ‘62 Department of Territories, (ACT – suburban) Left Australia N/A Specialist - anaesthetist Unknown 1954 Appelbe, Frederick VIC Dip. RCOG ’77 AMA, FRACGP GP - assistantship, Beaumaris (VIC – suburban) GP, Sandringham (VIC – suburban) 1994 Partner, group practice Aus 1954 Martyn, Sheila VIC FRCOG ‘73 House job - obstetrics, Royal Women’s Hospital (VIC – metro) Left Australia, c. 1958-9 1984 Specialist - obstetrician UK 1955 Bennett, Bernard VIC AMA, MRACGP^ GP - locum, Clayton (VIC – suburban) GP, Clayton (VIC – suburban) 1988 Partner, group practice – c. 1955-6 Smith, Herbert NSW – Unknown GP, Surry Hills & Maroubra (NSW – suburban) N/A Unknown Aus 1955 Walker, Henry WA AMA GP, Three Springs (WA – rural) GP, Midland (WA – suburban) 1989 Partner, group practice Aus 1956 Edmondson, Kenneth VIC then ACT Dip. Public Health, Syd ‘65; FRACMA, FFCM GP - locum, Brunswick (VIC – suburban) GP, Port Fairy (VIC – rural) Public Health roles (VIC & ACT – suburban) 1989 Sen. medical administrator – public health Aus 1956 Sherwood, Denise VIC then TAS Medical Defence Union GP - locum, Flinders Island (TAS – rural) GP, Westbury (TAS – suburban); MO (TAS – suburban) c. 1969 Medical administrator – public health – 1956 Sherwood, Peter VIC then TAS – MO, Ararat Mental Hospital (VIC – rural) MO/GP, Flinders Island (TAS – rural); Medical administrator – pvt hospital (TAS – suburban) c. 1970 Sen. medical administrator – private practice Aus c. 1956-7 Walker, Andrew NSW then SA AMA, Nat. Assoc. GPs. Aust, MRACGP Unknown MO, Royal Flying Doctors Service, Broken Hill (NSW – rural); GP, Glenelg (SA – suburban) 1989 Unknown Aus 1957 Hillier, Geoffrey NSW – GP, Broken Hill (NSW – rural) Deceased 1977 N/A Aus 1959 Gear, Douglas QLD then NSW AMA Unknown Medical administrator, Charleville (QLD – rural); GP & hospital sessional, Warialda (NSW – rural) Unknown Unknown Aus 1959 Palmer, Ian VIC then QLD Dip. RCOG ’58 AMA GP - locum, (VIC, NSW and QLD – suburban and rural) GP, Caloundra (QLD – rural) 1986 Partner, group practice – 1962 Jarvis, David VIC then ACT AMA, FRACGP Unknown GP, Ballarat (VIC – rural); GP, Macquarie (ACT – suburban) 1986 Unknown Unknown 1965 Fox, Audrey SA – MO, Mental Hygiene, Mt Pleasant (SA – rural) Unknown Unknown Unknown Aus Yr arr. in Aus Name States regd in Pgrad quals & memberships Initial employment in Australia Further career in Australia Est. yr ret’d in Aus** Status on retirement Country of Death 1952 Gawthorn, Charles VIC then WA AMA#; FRACGP^ 1978 Locum, Brunswick (VIC – suburban) GP, Brunswick (VIC – suburban); GP, Perth (WA – suburban) 1987 Partner, group practice Aus c. 1952-3 Lowther, Gordon N/A* English conjoint ’53; DTM & H Liverpool ‘54; FFA RCS &I; DA ‘62 Department of Territories, (ACT – suburban) Left Australia N/A Specialist - anaesthetist Unknown 1954 Appelbe, Frederick VIC Dip. RCOG ’77 AMA, FRACGP GP - assistantship, Beaumaris (VIC – suburban) GP, Sandringham (VIC – suburban) 1994 Partner, group practice Aus 1954 Martyn, Sheila VIC FRCOG ‘73 House job - obstetrics, Royal Women’s Hospital (VIC – metro) Left Australia, c. 1958-9 1984 Specialist - obstetrician UK 1955 Bennett, Bernard VIC AMA, MRACGP^ GP - locum, Clayton (VIC – suburban) GP, Clayton (VIC – suburban) 1988 Partner, group practice – c. 1955-6 Smith, Herbert NSW – Unknown GP, Surry Hills & Maroubra (NSW – suburban) N/A Unknown Aus 1955 Walker, Henry WA AMA GP, Three Springs (WA – rural) GP, Midland (WA – suburban) 1989 Partner, group practice Aus 1956 Edmondson, Kenneth VIC then ACT Dip. Public Health, Syd ‘65; FRACMA, FFCM GP - locum, Brunswick (VIC – suburban) GP, Port Fairy (VIC – rural) Public Health roles (VIC & ACT – suburban) 1989 Sen. medical administrator – public health Aus 1956 Sherwood, Denise VIC then TAS Medical Defence Union GP - locum, Flinders Island (TAS – rural) GP, Westbury (TAS – suburban); MO (TAS – suburban) c. 1969 Medical administrator – public health – 1956 Sherwood, Peter VIC then TAS – MO, Ararat Mental Hospital (VIC – rural) MO/GP, Flinders Island (TAS – rural); Medical administrator – pvt hospital (TAS – suburban) c. 1970 Sen. medical administrator – private practice Aus c. 1956-7 Walker, Andrew NSW then SA AMA, Nat. Assoc. GPs. Aust, MRACGP Unknown MO, Royal Flying Doctors Service, Broken Hill (NSW – rural); GP, Glenelg (SA – suburban) 1989 Unknown Aus 1957 Hillier, Geoffrey NSW – GP, Broken Hill (NSW – rural) Deceased 1977 N/A Aus 1959 Gear, Douglas QLD then NSW AMA Unknown Medical administrator, Charleville (QLD – rural); GP & hospital sessional, Warialda (NSW – rural) Unknown Unknown Aus 1959 Palmer, Ian VIC then QLD Dip. RCOG ’58 AMA GP - locum, (VIC, NSW and QLD – suburban and rural) GP, Caloundra (QLD – rural) 1986 Partner, group practice – 1962 Jarvis, David VIC then ACT AMA, FRACGP Unknown GP, Ballarat (VIC – rural); GP, Macquarie (ACT – suburban) 1986 Unknown Unknown 1965 Fox, Audrey SA – MO, Mental Hygiene, Mt Pleasant (SA – rural) Unknown Unknown Unknown Aus *Registration was not required for some federal civil servant roles. **Retirement declared, or transitioned to minimal part-time/voluntary work. #AMA—Australian Medical Association, previously British Medical Association. F or M RACGP—Fellow or Member, Royal Australian College of GPs; RCOG—Royal College of Obstetricians and Gynaecologists. Source: Fallon Mody database 2017. Table 4. 1952 Bristol graduates—career summary in Australia, 1952–present Yr arr. in Aus Name States regd in Pgrad quals & memberships Initial employment in Australia Further career in Australia Est. yr ret’d in Aus** Status on retirement Country of Death 1952 Gawthorn, Charles VIC then WA AMA#; FRACGP^ 1978 Locum, Brunswick (VIC – suburban) GP, Brunswick (VIC – suburban); GP, Perth (WA – suburban) 1987 Partner, group practice Aus c. 1952-3 Lowther, Gordon N/A* English conjoint ’53; DTM & H Liverpool ‘54; FFA RCS &I; DA ‘62 Department of Territories, (ACT – suburban) Left Australia N/A Specialist - anaesthetist Unknown 1954 Appelbe, Frederick VIC Dip. RCOG ’77 AMA, FRACGP GP - assistantship, Beaumaris (VIC – suburban) GP, Sandringham (VIC – suburban) 1994 Partner, group practice Aus 1954 Martyn, Sheila VIC FRCOG ‘73 House job - obstetrics, Royal Women’s Hospital (VIC – metro) Left Australia, c. 1958-9 1984 Specialist - obstetrician UK 1955 Bennett, Bernard VIC AMA, MRACGP^ GP - locum, Clayton (VIC – suburban) GP, Clayton (VIC – suburban) 1988 Partner, group practice – c. 1955-6 Smith, Herbert NSW – Unknown GP, Surry Hills & Maroubra (NSW – suburban) N/A Unknown Aus 1955 Walker, Henry WA AMA GP, Three Springs (WA – rural) GP, Midland (WA – suburban) 1989 Partner, group practice Aus 1956 Edmondson, Kenneth VIC then ACT Dip. Public Health, Syd ‘65; FRACMA, FFCM GP - locum, Brunswick (VIC – suburban) GP, Port Fairy (VIC – rural) Public Health roles (VIC & ACT – suburban) 1989 Sen. medical administrator – public health Aus 1956 Sherwood, Denise VIC then TAS Medical Defence Union GP - locum, Flinders Island (TAS – rural) GP, Westbury (TAS – suburban); MO (TAS – suburban) c. 1969 Medical administrator – public health – 1956 Sherwood, Peter VIC then TAS – MO, Ararat Mental Hospital (VIC – rural) MO/GP, Flinders Island (TAS – rural); Medical administrator – pvt hospital (TAS – suburban) c. 1970 Sen. medical administrator – private practice Aus c. 1956-7 Walker, Andrew NSW then SA AMA, Nat. Assoc. GPs. Aust, MRACGP Unknown MO, Royal Flying Doctors Service, Broken Hill (NSW – rural); GP, Glenelg (SA – suburban) 1989 Unknown Aus 1957 Hillier, Geoffrey NSW – GP, Broken Hill (NSW – rural) Deceased 1977 N/A Aus 1959 Gear, Douglas QLD then NSW AMA Unknown Medical administrator, Charleville (QLD – rural); GP & hospital sessional, Warialda (NSW – rural) Unknown Unknown Aus 1959 Palmer, Ian VIC then QLD Dip. RCOG ’58 AMA GP - locum, (VIC, NSW and QLD – suburban and rural) GP, Caloundra (QLD – rural) 1986 Partner, group practice – 1962 Jarvis, David VIC then ACT AMA, FRACGP Unknown GP, Ballarat (VIC – rural); GP, Macquarie (ACT – suburban) 1986 Unknown Unknown 1965 Fox, Audrey SA – MO, Mental Hygiene, Mt Pleasant (SA – rural) Unknown Unknown Unknown Aus Yr arr. in Aus Name States regd in Pgrad quals & memberships Initial employment in Australia Further career in Australia Est. yr ret’d in Aus** Status on retirement Country of Death 1952 Gawthorn, Charles VIC then WA AMA#; FRACGP^ 1978 Locum, Brunswick (VIC – suburban) GP, Brunswick (VIC – suburban); GP, Perth (WA – suburban) 1987 Partner, group practice Aus c. 1952-3 Lowther, Gordon N/A* English conjoint ’53; DTM & H Liverpool ‘54; FFA RCS &I; DA ‘62 Department of Territories, (ACT – suburban) Left Australia N/A Specialist - anaesthetist Unknown 1954 Appelbe, Frederick VIC Dip. RCOG ’77 AMA, FRACGP GP - assistantship, Beaumaris (VIC – suburban) GP, Sandringham (VIC – suburban) 1994 Partner, group practice Aus 1954 Martyn, Sheila VIC FRCOG ‘73 House job - obstetrics, Royal Women’s Hospital (VIC – metro) Left Australia, c. 1958-9 1984 Specialist - obstetrician UK 1955 Bennett, Bernard VIC AMA, MRACGP^ GP - locum, Clayton (VIC – suburban) GP, Clayton (VIC – suburban) 1988 Partner, group practice – c. 1955-6 Smith, Herbert NSW – Unknown GP, Surry Hills & Maroubra (NSW – suburban) N/A Unknown Aus 1955 Walker, Henry WA AMA GP, Three Springs (WA – rural) GP, Midland (WA – suburban) 1989 Partner, group practice Aus 1956 Edmondson, Kenneth VIC then ACT Dip. Public Health, Syd ‘65; FRACMA, FFCM GP - locum, Brunswick (VIC – suburban) GP, Port Fairy (VIC – rural) Public Health roles (VIC & ACT – suburban) 1989 Sen. medical administrator – public health Aus 1956 Sherwood, Denise VIC then TAS Medical Defence Union GP - locum, Flinders Island (TAS – rural) GP, Westbury (TAS – suburban); MO (TAS – suburban) c. 1969 Medical administrator – public health – 1956 Sherwood, Peter VIC then TAS – MO, Ararat Mental Hospital (VIC – rural) MO/GP, Flinders Island (TAS – rural); Medical administrator – pvt hospital (TAS – suburban) c. 1970 Sen. medical administrator – private practice Aus c. 1956-7 Walker, Andrew NSW then SA AMA, Nat. Assoc. GPs. Aust, MRACGP Unknown MO, Royal Flying Doctors Service, Broken Hill (NSW – rural); GP, Glenelg (SA – suburban) 1989 Unknown Aus 1957 Hillier, Geoffrey NSW – GP, Broken Hill (NSW – rural) Deceased 1977 N/A Aus 1959 Gear, Douglas QLD then NSW AMA Unknown Medical administrator, Charleville (QLD – rural); GP & hospital sessional, Warialda (NSW – rural) Unknown Unknown Aus 1959 Palmer, Ian VIC then QLD Dip. RCOG ’58 AMA GP - locum, (VIC, NSW and QLD – suburban and rural) GP, Caloundra (QLD – rural) 1986 Partner, group practice – 1962 Jarvis, David VIC then ACT AMA, FRACGP Unknown GP, Ballarat (VIC – rural); GP, Macquarie (ACT – suburban) 1986 Unknown Unknown 1965 Fox, Audrey SA – MO, Mental Hygiene, Mt Pleasant (SA – rural) Unknown Unknown Unknown Aus *Registration was not required for some federal civil servant roles. **Retirement declared, or transitioned to minimal part-time/voluntary work. #AMA—Australian Medical Association, previously British Medical Association. F or M RACGP—Fellow or Member, Royal Australian College of GPs; RCOG—Royal College of Obstetricians and Gynaecologists. Source: Fallon Mody database 2017. Secondly, expected incomes for Australian practitioners were much higher than their British counterparts. For example, in 1955 the average GP in Australia could expect to net between £4,000 and £6,000 a year after expenses. This still compared favourably to the projected increase from the 1952 Danckwerts award that raised GPs’ incomes for the first time since 1939.59 By 1961, a GP in the NHS with a full panel of 3,500 patients could expect to earn £2,055.60 Effectively, there was a more proportional relationship between the hours of work and rate of remuneration in Australia. Frequent discussion and comparison of the two systems—particularly in the correspondence columns—in the British Medical Journal and The Lancet tended to focus on the benefits of working in a social system like the NHS compared to the more ‘commercial’ fee-for-service system in Australia. Success for the latter relied on non-medical aspects of practice management that had troubled GPs’ private practices before the introduction of the NHS, including persistent debt collection.61 Although as one British correspondent pointed out, it appeared to be a trade-off between the indignity of ‘constantly squabbling with the Government of the day over pay’ or ‘asking sick patients to sign an out of hours certificate’ in the NHS.62 Finally, the higher incomes were related to the scope of work undertaken by Australian GPs.63 There was little overt regulation of specialist practice in Australia, which in Britain started in the 1930s.64 The state of Queensland introduced a specialist register in 1939. South Australia was the next state to introduce one, in 1966. For all other states, the scope of GP-work was limited by what an individual practitioner felt competent—and was sometimes qualified—to undertake. For example, a literature review of services provided by GPs in Australia showed that in 1971 they still held honorary hospital appointments, had access to hospital beds, and between 48–64 per cent of them reported performing surgical procedures, including appendectomies and curettages.65 In 1977, 76 per cent of GPs surveyed reported that even though they were no longer practising obstetrics, they had done so in the past 30 years.66 The historiography on the scope and acceptance of the role of a GP in the NHS agree that most GPs in Britain accepted their role as ‘family doctors’ in the late 1940s; a situation Rosemary Stevens described as ‘most singular’.67 For the Bristol group with experience of general practice in the NHS, the expectation was to refer cases to hospitals. Referral underpinned the success of the bi-modal structure of the NHS. Irvine Loudon and Mark Drury highlighted the challenges GPs faced in the 1950s to access even diagnostic services from hospital pathology and radiology departments, based on a prevailing belief that the patient should be referred to the local hospital at that point.68 Overwhelmingly, the accounts from the Bristol group suggest how their British training and expectations of the scope of a GP’s work in the NHS made them more conservative in their Australian careers. One member of the group recounted a particularly negative experience they had assisting in an appendicitis operation by another, older British graduate in Australia, where the latter spent ‘two hours poking around, pulling out loops of bowel in a vain search for the missing appendix’.69 Dr Peter Sherwood accepted a position with Tasmania’s district medical service after working at a country Victorian mental health hospital. The Tasmanian service paid GPs to work in areas too small to support private practice. His recollections typify the variable demands placed on a country GP, and on the reliance for each individual to judge the scope of their competence: I cover the Furneaux group of Islands [Palana, Flinders and Cape Barren in Tasmania], about the size of a small English county, with a total population no greater than that of a large village. … I am physician, surgeon, medical officer of health, school medical officer, sanitary inspector, pharmaceutical chemist, radiographer and last but not least, dentist (extractions only, no fancy stuff).70 Dr Sherwood’s role and account also signals the great and immediate demand for doctors in Australian country towns. This suggests that the fact that ten members of the Bristol group worked in country areas at some point in Australia—as detailed in Table 3—was not coincidental. Dr Palmer and his wife undertook a series of locums across country and suburban Victoria and New South Wales before Ian Palmer bought a private practice in the small country town Caloundra, with a population of 2,807 at the time, in the northern state of Queensland. Dr Hillier was in general practice in an isolated mining town, Broken Hill in the outer western part of New South Wales (its population was c. 30,000), where incidentally, his fellow graduate Dr Andrew Walker worked out of a Royal Flying Doctor Service base, before moving to suburban South Australia. The choice of destinations by the Bristol group highlights a significant role adopted by British medical graduates: doctoring in country Australia. A report published in 1972 by the AMA study group on medical planning referenced previously unpublished findings that the doctor–patient ratios in country areas of Victoria had been maintained due to foreign medical graduates.71 Graduates from the UK had increased in rural areas by 29 per cent between 1964 and 1970 compared to 1.3 per cent of Victorian graduates, and a decrease of 4.7 per cent of graduates from other states.72 This is confirmed in my own analysis: a quarter of the post-war British graduates sampled were working in an Australian country town in 1966.73 By 1978, this distribution had not changed. Australian doctors were not unique in their reticence to work in rural areas; the World Health Organisation published a report in 1968 that found this to be a global problem.74 In Australia, sustaining a profitable rural practice required significant travel, especially in sparsely populated yet geographically vast areas.75 Even in country towns that could support private practice, holidays were difficult to take because locums were hard to find, continuing professional education was difficult to pursue consistently, and city life was often 50 or more miles away. Queensland, Tasmania and Western Australia in particular used a variety of initiatives to cope with the challenge of providing adequate services to their country areas. Western Australia and Tasmania were the last states to establish medical schools in 1956 and 1965 respectively. Until their first classes graduated, these states relied heavily on the willingness of graduates from other parts of Australia to move there. These two states also controversially retained wartime legislation to place ‘alien’ European medical graduates in rural areas due to a shortage of supply.76 The pattern of the Bristol group to settle in country areas extends to initial findings of the broader British medical graduate cohort sampled. One interpretation could be that those young or recent graduates, with little capital, wanting to establish themselves as private practitioners in Australia found it easier to do so in less-competitive, country areas. Repeated attempts to describe the distribution of practitioners in Australia suggested a disproportionate density of practitioners in urban areas.77 Politically, the BMA in Australia represented this as an overcrowding of the profession generally, and fought several attempts to increase the supply of doctors in the 1950s in particular.78 The estimated proportion of doctors in metropolitan private practice in all Australian states reduced from one doctor for 1,240 people in 1947, to 1:1,084 in 1954.79 This was much lower compared to country areas, where the ratio had reduced from one doctor for 2,116 people in 1947, to one doctor per 1,973 people seven years later.80 By 1961, it appears doctors were responding to the competition in cities, as the ratio in country areas improved to one doctor for every 1,787 people (compared to the marginal change to 1,031 people in metropolitan areas).81 Dr Appelbe wrote that it was sheer luck that led his medical agent, Roger Van Asche, to offer the Victorian suburban practice in Sandringham to him: My choice was limited as we had virtually no finance behind us except our clothes and one small car. … Van Asche sensed that he had got an inexperienced novice from England and started off by sending me to various practices which were hopeless prospects. … These were practices he could not sell as no Australian doctor would be so naïve as to buy them. Thus I got into the routine where each weekend I would visit one practice, usually in the country …82 Dr Edmondson worked as a country GP in a Victorian country town, Port Fairy for five and a half years—a similar opportunity Appelbe originally turned down as unsuitable because the practice income as he was presented it, was less than the rent.83 Bristol graduate Dr Henry Walker settled in Three Springs, Western Australia. Once more, my initial exploration suggests that, similar to Victoria, British medical graduates propped up Western Australia’s country medical service. For example, British medical graduates comprised 36 per cent of all country practitioners in 1966.84 For 21 out of 58 of these country towns, they were the only practitioners listed.85 Dr Walker worked in Three Springs from 1955 to 1963. In an interview with local historian Jill Tilley in 2006, Dr Walker recalled the circumstances that brought him there: As there were no jobs in the UK, I applied for Three Springs and was flown out by Dr Couch within two months of applying. … When I arrived I had only £30 altogether. I had to buy into the practice, but as I didn’t have any money I paid over time and with interest …86 Dr Walker recalled spending 18 months as a solo practitioner after Dr Couch retired owing to the lack of interest in the post. He said he ‘advertised but didn’t get a single reply. Doctors were afraid to come up to the bush’.87 Buying into or entering general practice ‘with a view’ offered the quickest, most lucrative pathway to a stable income source. Six of the sixteen transitioned from their country practices to suburban ones as they came closer to retirement, and when they were able to afford to (Table 4). An alternative interpretation would be that British graduates saw the opportunity of Australian country towns, where for example, they would have greater scope to pursue their specialist interests, and insert themselves more easily in country hospitals in honorary positions, to maximise their income but also maintain future opportunities to specialise.88 The career trajectories of the Bristol group in particular do not bear the latter suggestion out—only Dr Edmondson left general practice for a public health role, and completed a Diploma of Public Health at the University of Sydney. The rest of the group showed postgraduate qualifications consistent with career GPs, most prominently membership (and later fellowship) of the Royal Australian College of GPs (Table 4). My initial analysis of the larger cohort of British graduates suggests that a high proportion of them who stayed were able to specialise in Australia—particularly in anaesthesia, dermatology, radiology and surgery.89 This difference is arguably linked to the immediate demands of the Bristol group who had families, and as mature medical students, career goals that were aligned to their responsibilities. It certainly warrants further investigation. A second fresh perspective offered by the Bristol group is one of intention. It was clear from the interviews and surveys they conducted that doctors who left the UK intending to migrate permanently returned and vice versa.90 Others left Australia only to return again, and yet others spent the rest of their careers overseas, and returned to the UK only to retire. An obvious limitation encountered by contemporary studies of emigrating British doctors, like that of Abel-Smith’s and other researchers in the 1960s and 1970s, was trying to ascertain or predict intention. The Bristol group mirror the broader trends of immigrant doctors in Victoria, and with the benefit of hindsight, provides an update to the older body of literature regarding what doctors who migrated to Australia actually did.91 For example, of the 86 male doctors in the Victorian sample, 60 spent most of their career in Australia, and 37 are known to have died there.92 This indicates that a high proportion of those migrating to Australia stayed, whether they originally intended to or not. Of the 16 in the Bristol group, only two returned to England permanently.93 Dr Sheila Martyn moved to Melbourne for a second house job in obstetrics at the Royal Melbourne Hospital. On returning to Bristol, she married a GP, and together they moved to Guernsey in the Channel Islands where she continued to practice obstetrics for the remainder of her career.94 Gordon Lowther briefly worked in Los Angeles as a Burroughs Wellcome Fellow in Anaesthetics before permanently returning to the UK. With the exception of Dr Edmondson, who was posted in London while working for the Australian federal Department of Health, the rest of the Bristol group spent the remainder of their traceable careers in Australia. Thirteen of the 16 died or still reside in Australia as outlined in Table 3. None of the members of the Bristol group or their family interviewed (seven in total) seriously considered returning to the UK. Conditions for GPs—which proved to be critical in prompting emigration from the UK—changed gradually but considerably for Australian-based practitioners. There was a shift in the balance between GPs and specialists in Australia. This was prompted by government-led changes to the health care scheme, greater access to local postgraduate education, and by the rapidity with which medical research outputs and diagnostic technology was changing the practice of medicine globally. In Australia, the 1960s can be seen as the beginning of the end of the hybrid or self-styled GP specialist. A government committee published findings (the Nimmo Report) in 1968 that found that the Page health scheme was unnecessarily costly to the government and to citizens, and was being exploited by practitioners.95 It controversially recommended a schedule of common fees, with GPs being paid less for the same procedures as specialists; and the establishment of a national board to accredit specialists. In political terms, general practitioners exploded. This was seen as an assault on the very necessity of general practitioners in Australia.96 Despite heavy lobbying, the recommendations of the Nimmo committee were passed in 1970 and spelled a slow decline as practitioners were forced to choose.97 This shift is compellingly reflected in the statistics: in 1961 it was estimated there were 2,758 specialists compared to 5,805 GPs. By 1971, the specialist figure had almost doubled to 5,007 compared to the GP figure that modestly increased to 7,376.98 By 1976, the same source was reporting almost equal numbers of GPs and specialists practising in Australia. The changes created an artificial shortage of GPs as they rushed to be reclassified as specialists. Although politically prominent issues, the Bristol group did not dwell on later Australian working conditions in any great detail, like they did the NHS. Nor did they associate it with a consideration to return to the UK. This is particularly notable since the proposed changes to the scope and income of GP work in Australia appeared to mirror frustrations with the NHS that prompted their migration initially. This suggests that on an operational level, these later changes in Australia had less material impact on this group. Most of the Bristol group were firmly committed to being career general practitioners by this stage, therefore, they were arguably the least affected. They had had at least a decade to establish themselves and their families in Australia. Of the remaining 14, by the mid-1970s five are known to be partners in group practices, and four more were in secure, salaried positions as outlined in Table 4. In this they mirror the broader post-war British settlers in Australia, few of whom expected to raise their social status by migration.99 Rather, they aimed to improve the quality of their life and the conditions of their employment.100 Return migration to the UK would now have presented a risky, expensive and disruptive alternative, especially to those originally older graduates who were closer to retirement. Conclusion The historiography of British medical migrants in post-war Australia is fragmented, and the contribution the rank-and-file migrant made to medicine and health is poorly understood. Although there is a rich body of literature on the National Health Service in Britain, the tendency by historians to focus on the pivotal and symbolic role of the NHS in post-war Britain, particularly influenced by a myriad of inquiries and reports, has meant that emigrating British graduates are often a footnote in these narratives. This case study of 16 Bristol graduates, and their journey from university to Australia highlights how, too often, the constraints of national boundaries means we miss or dilute opportunities to understand historical events. Using a transnational approach—connecting the historiographies of the NHS in the UK and its counterpart Australian health scheme—was integral to revealing how medical practitioners were able to leverage their networks in a Commonwealth market for medical education and experience. The experiences of this Bristol group challenge the assumption that British doctors transitioned seamlessly into the Australian profession. Their privileged status in Australian medical legislation only translated into professional success by a complex mix of deploying their own British professional network, a willingness to be flexible and mobile once in Australia, and adapting their British medical training and expectation of conditions in Australia to viably fulfil their own standards and economic goals. This case study suggests the potential of a transnational, comparative and collective biographical approach for future research into the operation of medical networks in understanding British medical migration. Secondly, there is scope to further analyse the role war experience might have on had on the post-war mobility of medical practitioners. Recently, historians have revisited the question of what motivated this post-war medical emigration from Britain. The transnational approach, drawing on oral histories, adopted by Wright et al., portrays a complex array of social and professional considerations in each individual’s decision to migrate (to Canada).101 Seaton’s account of an anti-NHS group—The Fellowship for Freedom in Medicine—in contrast, aims to recover the significance of political opposition to the NHS, including our understanding of post-war medical migration. He argues this ‘anti-NHS’ sentiment was more pervasive and influential than has been portrayed in historical analyses (including of British medical migration).102 The evidence presented in this paper does not bear out the latter interpretation. Rather, it extends the emphasis on pragmatic considerations—the inescapable link between family responsibilities, individually determined social and professional goals, and the structural and economic realities of the early NHS for GPs—in understanding the medical migrant journeys of the Bristol group to Australia. However, it does point to an avenue for future research. What Seaton’s analysis suggests is the need to stratify medical migrant cohorts, to demonstrate the possible disconnect in motivations for migration between older, experienced GPs (arguably more representative of members of the Fellowship for Freedom in Medicine, for example), and more recent British graduates (including the Bristol group). Finally, the methodological approach adopted in this study also enabled a demonstration of how rank-and-file medical migrants can assume a critical role in their new environment. The case study of this Bristol group suggests those ‘wasted’ British general practitioners, fleeing to Australia in search of an alternative to the conditions of the early NHS, might also collectively be remembered as a group who played an important part in providing valued primary care when and where Australia needed it most. Acknowledgements I wish to thank Dr James Bradley, Dr Eureka Henrich and Dr Katherine Foxhall for their feedback and advice on early drafts of this article; and also all three reviewers for their insightful comments. Fallon Mody is a PhD candidate in the Department of History and Philosophy of Science at the University of Melbourne. She is currently researching the professional lives of European medical graduates in Australia, c.1930–1960. Funding This work was supported by a National Archives of Australia and Australian Historical Association postgraduate scholarship. Footnotes 1 Martin Gorsky, ‘The British National Health Service 1948–2008: A Review of the Historiography’, Social History of Medicine (SHM), 21, 437–60. For a review of historical interpretations of the state of general practice, see Rosemary Stevens, ‘Fifty Years of the British National Health Service: Mixed Messages, Diverse Interpretations’, Bulletin of the History of Medicine, 2000, 74, 806–11. Together, these authors’ reviews cover the three main histories of the NHS that include significant sections on general practice: Irvine Loudon, John Horder and Charles Webster, eds, General Practice under the National Health Service, 1948–1997 (London: Clarendon Press, 1998); Charles Webster, The National Health Service: A Political History (Oxford: Oxford University Press, 1998) and Geoffrey Rivett, From Cradle to Grave: Fifty Years of the NHS (London: King’s Fund, 1998). For influential contemporary accounts of general practice, see Joseph Collings, ‘General Practice in England Today—A Reconnaissance’, The Lancet, 1950, 255, 555–79; and Michael Balint, The Doctor, His Patient and the Illness (London: Churchill Livingstone, 1957). 2 This amounts to approximately 390–400 practitioners annually; most estimates start from 1955. The best known, and most cited, contemporary analyses of rates of medical emigration include: Brian Abel-Smith and Kathleen Gale, British Doctors at Home and Abroad, Occasional Papers on Social Administration No. 8 (Hertfordshire: Cordicote Press, 1964); John Seale, ‘Medical Emigration from Britain’, British Medical Journal (BMJ), 1962, 782–5; and a later revision, also by John Seale, ‘Medical Emigration from Great Britain and Ireland’, BMJ, 1964, 1, 1173–8. 3 British and Irish medical qualifications were included in most Australian state medical acts around 1905 at the instigation of British authorities keen to protect British interests. See Moira Salter, ‘Prejudice in the Professions’, in F. S. Stevens, ed., Racism: The Australian Experience (NSW: Hobgin Poole, 1974), 67−75. 4 James Last, ‘Migration of British Doctors to Australia’, BMJ, 1963, 2, 744–5; John Seale, ‘Migration of British Doctors to Australia’, BMJ, 1964, 2, 994. The discrepancy between these figures is due to differing methodology employed by Last and Seale—particularly adjustments made to account for return migration, and those doctors who registered in one or more states in Australia. I have used Seale’s 1964 paper, since he significantly revises his 1962 findings in the face of criticism of his original methodology. 5 Hugh Poate, ‘The Capacity of the Medical Profession in Australia to Absorb New Members’, Medical Journal of Australia 1953, 16, 616−21. 6 See for example, James Gillespie, The Price of Health: Australian Governments and Medical Politics 1910–1960 (Cambridge University Press,1991), 181 and 191; Janet McCalman, Sex and Suffering: Women’s Health and a Women’s Hospital: The Royal Women’s Hospital, Melbourne, 1856–1996 (Melbourne University Press, 1998), 247–51. 7 For example, Egon Kunz, The Intruders: Refugee Doctors in Australia (Canberra: ANU Press, 1975); Suzanne Rutland, ‘An Example of Intellectual Barbarism: The Story of Alien Jewish Medical Practitioners, 1933–56’, Yad Vashem Studies, 1987, 18, 233–57; John Weaver, ‘A Glut on the Market: Medical Practice Laws and Treatment of Refugee Doctors in Australia and New Zealand, 1933–1942’, ANZ Law & History E-Journal, 2009, 1–38; and Peter Winterton, ‘Alien Doctors: The Western Australian Medical Fraternity’s Reaction to European Events 1930–50’, Health and History, 2005, 7, 67–85. 8 Paul Weindling, ‘Medical Refugees and the Modernisation of British Medicine, 1930–1960’, SHM, 2009, 22, 489–511, 456. 9 Laurence Monnais and David Wright, eds, Doctors Beyond Borders: The Transnational Migration of Physicians in the Twentieth Century (Toronto: University of Toronto Press, 2016), 3–4. 10 Apart from the special issue on the subject published in Social History of Medicine in 2009, see for example, Julian Simpson, Aneez Esmail, V. S. Kalra and S. J. Snow, ‘Writing Migrants back into NHS History: Addressing a “Collective Amnesia” and its Policy Implications’, Journal of the Royal Society of Medicine, 2010, 103, 392–6; Joanna Bornat, Leroi Henry and Parvati Raghuram, ‘The Making of Careers, The Making of a Discipline: Luck and Chance in Migrant Careers of Geriatric Medicine’, Journal of Vocational Behavior, 2011, 78, 342–50; John Zamet, ‘Aliens or Colleagues? Refugees from Nazi Oppression 1933–1945’, British Dental Journal, 2006, 201, 397–407; and Karola Decker, ‘Divisions and Diversity: The Complexities of Medical Refuge in Britain, 1933–1948’, Bulletin of the History of Medicine, 2003, 77, 850–73. 11 For discussion of structural problems with the NHS, see David Morrell, ‘Introduction and Overview’, in Loudon et al., General Practice under the NHS, 5. For ‘brain drain’: Matthew Gowin, Jane Gregory and Brian Balmer, ‘The Anatomy of the Brain Drain Debate, 1950s–1970s: Witness Seminar’, Contemporary British History, 2009, 23, 35–60; this paper offers an historical overview of the ‘Brain Drain’ debate of the 1960s. The term ‘wastage’ is typically in the context of medical manpower planning and the ‘wastage’ of state-funded medical education. One of the first official reports to use the term is the Willink report, see: Ministry of Health, Report of the Committee to Consider the Future Numbers of Medical Practitioners and the Appropriate Intake of Medical Students (London: HMSO, 1957), 30. Finally, for the inflow of migrants into the system, see Oscar Gish, Doctor Migration and World Health, Occasional Papers on Social Administration No. 43 (London: Cordicote Press, 1971). 12 Andrew Seaton, ‘Against the “Sacred Cow”: NHS Opposition and the Fellowship for Freedom in Medicine, 1948–72’, Twentieth Century British History, 2015, 26, 424–49. 13 Ibid., 446. 14 David Wright, Sasha Mullally and Mary Colleen Cordukes, ‘“Worse than Being Married”: The Exodus of British Doctors from the National Health Service to Canada, c.1955–75’, Journal of the History of Medicine, 2010, 65, 546–75. 15 Ibid., 553. 16 Wright et al, ‘Worse than Being Married’, 573. 17 For a discussion of the role of ‘informal interpersonal networks’ in understanding migration of New Zealand doctors to Britain for specialist training, see John Armstrong, ‘A System of Exclusion: New Zealand Women Medical Specialists in International Medical Networks, 1945–1975’, in Monnais and Wright, Doctors Beyond Borders, 118–41. 18 Cited as ‘Fallon Mody database 2017’ throughout this paper. 19 Why and how I became a general practitioner--and other observations, Edward Charles Gawthorn, 1987, <www.racgp.org.au/yourracgp/organisation/history/biographies/gawthorn/> (accessed on 8 March, 2017). 20 ‘Universities and Colleges’ section in: BMJ, 1952, 1, 52–3; BMJ, 1952, 2, 167–70; and BMJ, 1953, 1, 108–11. 21 The English conjoint diploma of the Royal College of Surgeons and Physicians of London (post-nominally recorded as MRCS LRCP) was a common entry-level medical qualification, recognised by the General Medical Council in the UK. 22 Two of these doctors arrived after 1960, and seven were registered in states other than Victoria—both technically are outside the remit of the larger project, but have been included in this article for completion. 23 Based on entries in medical directories of UK and annual General Medical Council lists for 1952–1972 inclusive. 24 There is no scope in this article to discuss the role of gender in understanding the experiences of medical migrants. However, the author aims to address this in a forthcoming article, provisionally titled: ‘“Have Stethoscope, will Travel”: British Migrant Medical Women in Australia, 1930–60’. 25 Dr Henry Walker commenced at Bristol, studied two years before joining the RAF in c. 1943, then returned in 1947 to complete his medical degree. 26 Frederick J. Appelbe, The Life and Times of a Man from Skibbereen (self published autobiography). A copy is held by Sandringham Library in Victoria. 27 Dr Bernard Bennett, interview with Fallon Mody, Melbourne, 15 January 2016. 28 Ibid. 29 Gawthorn, ‘Autobiography’, 1987. 30 Ibid. 31 David Hannay, ‘Undergraduate Medical Education’ in Loudon et al. General Practice under the NHS, 167–81 discusses the inadequacy of early post-war medical training in equipping graduates for general practice. 32 Gawthorn, ‘Autobiography’, 1987. 33 Ministry of Health, Report of the Joint Working Party on the Medical Staffing Structure in the Hospital Service (London: HMSO, 1961)—known as the Platt Report. 34 Bennett, interview. 35 The other option was to accept a position in the Trainee Assistants’ Scheme, however, this was not popular. See Loudon et al., General Practice under the NHS, 309—Table D2 reports under 370 trainees between 1952–1971; and ‘Trainee Assistants’ Scheme’, BMJ, 1952, 2, 482–3. 36 According to statistics reported in 1948, there were 17,438 GP partners and 562 salaried assistants working for them. In 1951 there were 18,195 partners and 1,724 assistants. General Practitioners (Danckwerts Award) HC Deb 30 October 1952 vol 505 cc2108–59 <http://hansard.millbanksystems.com/commons/1952/oct/30/general-practitioners-danckwerts-award> (Last accessed 26 September, 2017). 37 Ibid. 38 See Abel-Smith, British Doctors Abroad, 42, Table 21 Last Position held in Great Britain by Year of Leaving. 39 The status of general practice was especially low when the NHS was first introduced—this was not the most common career aspiration for young/recent graduates. See for example, Rosemary Stevens, Medical Practice in Modern England (New Haven and London: Yale University Press, 1966), 153–68. 40 Wright et al., ‘Worse Than Being Married’, 571. 41 Bennett, interview. 42 Dr AB’s name has been anonymised on request, Barbara Appelbe, in conversation with Fallon Mody, Melbourne,13 January 2016. The quote is from Appelbe, The Life and Times of a Man from Skibbereen. 43 This was parodied by A. J. Cronin in The Citadel. For an full academic analysis on the subject, see Anne Digby, The Evolution of British General Practice, 1850–1948 (Oxford: Oxford University Press, 1999). 44 Charles Webster, ‘The Politics of General Practice’, in Loudon et al., General Practice under the NHS, 20–44. Rosemary Stevens also identified similar problems with the income structure of the NHS for GPs, in Stevens, Medical Practice in Modern England, 127–38. 45 Appelbe, The Life and Times of a Man from Skibbereen, 87. 46 A. Clements, ‘Australia Next?’ BMJ, 1968, 1, 121–2. 47 Abel-Smith, British Doctors Abroad, 49–50. 48 Ibid.; A. G. W. Whitfield, ‘Emigration of Birmingham Medical Graduates 1959–63’, The Lancet, 1969, 293, 667–9; and D. Ogston, A. Dawson and G. M. McAndrew, ‘Present Employment of University of Aberdeen Medical Graduates 1956–58’, The Lancet, 1969, 294, 427–8. 49 Dr Denise Sherwood, email correspondence, 21 March 2016. 50 Seaton, ‘Against the “Sacred Cow”’, 424–49. 51 Bennett interview. 52 Ibid. 53 Jill Edmondson, letter to Fallon Mody, 21 January 2016. 54 Note that better weather dominated the general immigration propaganda in recruiting offices all over the UK. For a fuller discussion of perceptions of Australia in the UK, see for example, A. James Hammerton and Alistair Thomson, Ten Pound Poms: Australia’s Invisible Migrants (Manchester: Manchester University Press, 2005), particularly the chapters ‘Imagining Australia’, 28–47 and ‘Leaving Britain’, 48–95. Hammerton and Thomson also note the importance of direct endorsements of life and opportunities in Australia in prompting the decision to migrate. 55 Jill Edmondson letter. 56 This period before the introduction of the Family Doctors Charter in 1966 in the UK is identified in this way, and forms a dominant structural theme, in several chapters of Loudon et al., General Practice Under the NHS, particularly 4–6, 46–50, 120–1; 183–5. See also, Stevens, Medical Practice in Modern England, 311. 57 Sir Theodore Fox, ‘The Antipodes: Private Practice Publicly Supported’, The Lancet, 1963, 281, 988–94. 58 James Gillespie, The Price of Health: Australian Governments and Medical Politics 1910–1960 (Cambridge: Cambridge University Press, 2002), and Anne Crichton, Slowly Taking Control? Australian Governments and Health Care Provision, 1788–1888 (London: Allen & Unwin, 1990). 59 Stevens, Medicine Practice in Modern England, 131–3. 60 Paul Gemmill, Britain’s Search for Health: The First Decade of the National Health Service (Philadelphia: University of Pennsylvania Press, 1960). 61 Anne Digby and Nick Bosquanet, ‘Doctors and Patients in an Era of National Health Insurance and Private Practice, 1913–1938’, The Economic History Review, 1988, 41, 74–94. 62 P. B. Forbes, ‘Australia Next?’, BMJ, 1968, 1, 450. 63 There is very little historical analysis documenting the changing scope of general practice in Australia. One exception is: Bryan Gandevia, ‘A History of General Practice in Australia’, reprinted from Canadian Family Physician in Medical Journal of Australia, 2, 1972, 381–5. More illuminating accounts that highlight the gradual change in scope for GPs in Australia can be found in contemporary studies, see for example, General Practice and its Future in Australia—Report No. 1 of the AMA Study Group on Medical Planning (Sydney: Australasian Medical Publishing Company, 1972). 64 George Weisz, Divide and Conquer: A Comparative History of Medical Specialization (New York: Oxford University Press, 2006), 164–80. 65 Neville Andersen, ‘Services Provided’, in Neville Andersen, Charles Bridge-Webb and Alan H. B. Chancellor, eds, General Practice in Australia (Sydney: Sydney University Press, 1986), 49–52. 66 Ibid. 67 See, for example, Frank Honigsbaum, The Division in British Medicine (London: Kogan Page, 1979), 299–318. Stevens, Medical Practice in Modern England, 104. 68 Irvine Loudon and Mark Drury, ‘Some Aspects of Clinical Care in General Practice’, in Loudon et al., General Practice under the NHS, 103–110. 69 Citation anonymised. 70 Peter Sherwood, ‘Tasmanian Island Practice’, The Practitioner, 1958, 181, 199–204, 202. 71 General Practice and its Future in Australia, ‘The Scope and Method of Practice of the Future General Practitioner’, 21–9. 72 R. F. F. Harbison, unpublished data, The Melbourne Postgraduate Committee Conference on Continuing Medical Education in Country Areas of Victoria, 1971 in General Practice and its Future in Australia, Table 7.4, 48. 73 Of the 69 British graduates in the sample that arrived after the war, 30 were working in suburbs, 17 in country towns, 14 had left and 8 entries are unknown (Table 1). 74 WHO, World Health Statistics Report (Geneva: WHO, 1968). 75 In 1963, 52 of 138 shires in the state of Victoria reported less than 3,500 people. In the extreme, some shires had a population of less than 800. 76 Western Australia kept emergency war legislation and allowed ‘alien’ doctors to practise in regional areas; Tasmania introduced a system of hospital placements for foreign doctors in 1951. 77 See, for example: Committee on the Future of Tertiary Education, Tertiary Education in Australia [Martin Report] (Canberra: Government Printer, 1964), volume 2, chapter 12. 78 The official response of the BMA in Australia to a federal inquiry was published as: Poate, ‘Capacity … to Absorb New Members’, 621. Professional resistance to government intervention in medical school intakes is discussed in: Crichton, Slowly Taking Control, 89–91. 79 R. B. Scotton, ‘Medical Manpower in Australia’, MJA, 1967, 1, 984–90. 80 Ibid. 81 Ibid. 82 Appelbe, The Life and Times of a Man from Skibbereen. 83 Ibid. 84 Medical Directory of Australia (Sydney: Australian Medical Press Company, 1966). 85 Ibid. 86 Dr Henry Walker, interview with Jill Tilley for Carnarmah Historical Society, 24 November 2006. 87 Ibid. 88 The honorary hospital appointment system in Australia was dominated by a core group of medical elites. See, for example: McCalman, Sex and Suffering, 314–16; Anthea Hyslop, Sovereign Remedies: A History of the Ballarat Base Hospital 1850s to 1980s (London: Allen & Unwin, 1989), 248–61. 89 Based on published career trajectories for 71 UK male graduates and 39 UK female graduates. Initial exploration suggests these specialists were in particular demand in Australia, and this might account for attracting British graduates interested in specialising in these areas. 90 Oscar Gish and James A. Wilson, ‘Emigrating British Physicians’, Social Science & Medicine, 1970, 3, 495–511. 91 Historical accounts have acknowledged the lack of data on return migration. For example, Stevens, Medical Practice in Modern England, 245. 92 Defined by a Medical Directory entry that explicitly indicates retirement and/or the address provided in these entries. 93 Abel-Smith, for example, noted some reticence about return migration owing to uncertainty about being able to practise in the UK again. Abel-Smith, Doctors Abroad, 53–4. 94 Struan Robertson, ‘Sheila Anne Robertson (née Martyn)’, BMJ, 2004, 328, 1264. 95 For a detailed discussion of this report, see J. C. H. Dewdney, Australian Health Services (Adelaide: Griffin Press, 1972), 52–65; and the subsequent chapter for the profession’s reaction to the proposal of a common fee, particularly 68–73. 96 See for example, Ronald Winton, A Body’s Body: The First Twenty-one Years of the Royal Australian College of General Practitioners (Sydney: RACGP, 1983), 53–57; and F. Woodhouse, ‘Valuing the General Practitioner in Australian Society: A 50th Year Commemorative Essay of the Royal Australian College of General Practitioners’, published in 2008, <http://www.racgp.org.au/yourracgp/organisation/history/college-history/history-of-the-racgp> (accessed on 26 September, 2016). 97 This is not dissimilar to the position of specialist GPs when the NHS was introduced, and the SHMO role created to accommodate those GPs who failed to be assessed at consultant status. 98 These figures exclude salaried doctors in hospitals. R. B. Scotton, ‘Keynote Address’ in Medical Manpower and Training in Victoria—Proceedings of a Seminar held on 16 April 1983 (The Victorian Medical Postgraduate Foundation, 1983), 12–18, see Table 3, on 18. 99 See, for example: Reginald Appleyard, The Ten Pound Immigrants (London: Boxtree, 1988); Hammerton and Thomson, Ten Pound Poms, 214 and passim. 100 Ibid. 101 Wright et al, ‘Worse than Being Married’, 546–75. 102 Seaton, ‘Against the “Sacred Cow”’, 446. © The Author 2017. Published by Oxford University Press on behalf of the Society for the Social History of Medicine. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)

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Social History of MedicineOxford University Press

Published: Aug 1, 2018

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