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THE EVOLUTION AND DEVELOPMENT OF HEALTH CARE ' OCCUPATIONS IN NEW SOUTH WALES. BY CHRISTOPHER RICHARDS Project report submitted for the Degree of Master of Health Administration in the University of New South Wales. 1979 DEDICATION For my Father, IToBl, who nurtured my interest in history and learning. and all those kind people who contributed information to use in this project. iij_ CONTENTS sm,it-IARY . iv I. INTRODUCTH,N . II. THE EMERGF:NC ~~ OF HEALTH C/\RE OCCUPf/flTC!!,'; 6 III. TRAINING SCHOOLS . .. IV. UNIVEF-?SITY ANIJ COLL1~Gf~ \1f<' AlJVA:Jc;~ll EDUCATION TT~AilHNG ,SCHCUIS . 81 V. STATE OCCUPATIONAL A~;seic IATIC;;\:0 . .. .. 98 VI. NATIONAL OCCUPATIOHA L J\.'~ ..c;c,c IA'l'IC: >JS 1 1 1 VII. LICENSING OF HEALTH CARI:: OCCUF'ATION.S . 125 ' VIII. CODES OF ETHICS . .. .. .. 140 IX. ANALYSIS OF THE EVOLUTION OF HEALTH CARE OCCUPATIONS IN NEW SOUTH \/AU;:,s 149 x. l'~VOLUTION OF HEALTH CAf-<E OCClJi!ATIC1NS - AN ECONOMIC AND SOCIAL INTERPRETATION 1 51 XI. CONCLUSION . 181 XII. REFERENCES . .. 184 XIII. APPENDIX . .. .. .. .. .. ?20 iv SUMMARY In this project the history of fourteen health care occupations in New South Wales were examined to determine if there was a common pattern in the emergence of certain distinguishing characteristics. The occupations studied were:- 1 • Dentistry 2. Dietetics 3. Hospital Administration 4. Medical Record Administration 5. Medicine 6. Nursing 7. Occupational Therapy 8. Orthoptics 9. Pharmacy 10. Physiotherapy 1 1 • Radiography 12. Rehabilitation Counselling 13. Social Work 14. Speech Therapy The characteristics examined were:- 1. The emergence of health care practitioners 2. The emergence of training schools 3. The emergence of university and collece of advanced education training programs 4. The development of state occupational associations 5. The development of national occupational associations 6. The introduction of licensinG acts and boards 7. The production of ethical codes It was found'that these characteristics were either present in the occupations under study or were characteristics that they desired. However the emergence of these features did not follow any common pattern, in contrast to America, where a fairly standard sequence of evolution has been detected amongst a group of eighteen occupations. An attempt was then made to explain why the characteristics of health service occupations should appear in the first place, and evolve the way they have. This was done using economic and social concepts, and the conclusion was reached that these occupations have attained their present features through the pursuit of status and economic gain. It was also concluded that the emergence of these features may not be directly related to the needs of patients or the rest of society. 1 • 1. INTRODUCTION The aim of this project is to examine the historical evolution of fourteen health care occupations in New South Wales, to see if they follow any common pattern of development in the emergence of major characteristics. The characteristics chosen for examination are those that were used oy Wilensky (1) when he studied the "sequence of professionalization" of eighteen occupations in the United States. Wilensky found the following sequence of events to be fairly standard as these occupations evolved:- 1. Practitioners start doing full-time the thing that needs doing. 2. First Training Schools appear. 3. University Training Schools appear. 4. Local Professional Associations appear. 5. National Professional Associations appear. 6. State Licensing Laws appear. 7. Ethical Codes appear. Each of these key events in the development of occupations is used as a chapter theme in this project. However several modifications have been made to make Wilensky's characteristics applicable to the Australian environment:- 2. 1.·The university training school chapter has been broadened to include colleges of advanced education (CAE'S) as these institutions are now major tertiary training centres in their own right in Australia, and have the power to issue degrees to successful undergraduates. 2. The chapter on local associations uses the word "state" instead of "local", as most of the early associations were state wide bodies, even though most of their members resided in Sydney. In America some associations began as regional or city groups. Later on these groups became local chapters of state-wide or national associations. 3. Wilensky follows the conventional wisdom of many sociologists in subscribing to the belief that professions are a distinct category of occupations with special features. He describes the emergence of these features as the "process of professionalization". But Roth (2) has superbly demonstrated that the sociological concept of a profession does not stand up to close scrutiny, and that a group of occupations cannot logically be considered different and special, and labelled as professions. For this reason the word occupation is used throughout this project in preference to the word profession. ') . Consequently the aim of this project differs from that of Wilensky. This v:, ;rk l.oo::s at the emergence of characteristics to detc:rrninc if a common pattern of evolution exists in He:w ;;outh Wales, whereas '.'/ilensky studied these characteristics in terms of occupationn dcvelopine into professions. If the emereence of the characteristits does not constitute a professionalization process then some other explanation must be provided. This ~mb;ject is taken up in Chapter Ten where an attempt is made to interpret the historical development of health care occupations in terms of social and economic theories. Much of the historical material was collected from secondary sources, such as journal articles and the growing number of books on the history of health service institutions such as hospitals. The available bibliographies led tu many articles on the history of medicine and some on the history of nursing, but these works give few leads in uncovering material on.other health care occupations. A Medlars search led to a similar result. It uncovered material on the history of Lledicine, but little of account about other occupations. For this reason Medlars is not a useful vehicle for locating historical material for inter­ occupational comparisons. Journals of occupational associations were a valuable source of information 4. but complete sets of journals are difficult to find. Hospital and training school libraries were invariably found to have many issues missing from their journal collections. Large collections of material on medical history are available at the Brownless Library at Melbourne University, and the library of the Victorian Branch of the Australian Medical Association. The College of Nursihg library in Melbourne has a good range of material on nursing history while the Lincoln College of Health Sciences library houses the journals of many health care occupations (which contain a few valuable historical review articles). Members of each occupation were also contacted and a request made for assistance in uncovering historical information. Assistance was invariably provided. In most cases the people contacted were occupational association officials and/or "elder statesmen" who had witnessed the growth of their occupation over many years. Because many people were kind enough to assist, I have not attempted to list them all through fear of missing an important informant. But the help of all these people was greatly appreciated. I had originally planned to cover a wider range of occupations and states other than New South Wales, but when the size of the collected material began to grow alarmingly the scope of the project had to be restricted. This meant that I could not use a large amount of the data that people had obligingly provided. I plan to use this material in 5. future projects. A problem which presented itself from the outset, was the conflicting evidence concerning the dating of major events in the evolution of many occupations. Secondary sources often gave conflicting dates as did members of an occupation. In some cases the reflections of informants conflicted with the secondary sources. Many of these problems may have been solved by examination of the archives of occupational associations and contacting a larger number of people in each occupation, but this would have extended the time for data collection beyond the limits available. The dates used are those that I consider are most probably the correct ones, but subsequent research may show that some are in error. Further research may also demonstrate that other material in this project needs revision (eg. evidence of a long forgotten occupational association may be uncovered) but this is unavoidable in a project which places heavy reliance on secondary sources and some personal interviews (with a limited number of people within each occupation). I would be glad to hear from any reader of this project who detects any factual errors of this nature. 6. II.THE Er·IERGEHCE OF HEALTH CA 1~1:;; OCCU~'ATTCU:; I;'JTRODUCTIOH. In this chapter the emergence '.1 f h,2al th care occupations in Hew South \'!ales is cliscus,,;eu.. The objective is to demonstrate hov,r particular activities were taken up by one occupation, and how these activities grew and became increasingly complex, thus leadinr, to a new ·occupation appearinri; to to. 1-:e: charge of these activities. It should be noted that until the late 1920'S there was only a small number of health care occupations in Australia. The increasing number of occupations to appear since that time is a maior characteristic of medical history in the last half century, and it is a trend which shows little sign of abating. I.DENTISTRY. The history of the dental profession is relatively short, as it was not until 1728 that Pierre Fauchard published in France the first complete treatise on dental practice. (3) Fauchard is now recognized as the "father of the dental profession". In the years immediately following the arrival of the First Fleet at Sydney Cove there were no dentists practis­ ing in the colony.

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