A Guide to the Specialist Medical Colleges. List and Links Included.

The History of Medical Colleges

In Europe in the 18th century, unqualified people performed certain restricted medical tasks that other qualified practitioners viewed as quackary. This included procedures, such as “cutting out stone” a (a surgical incision to remove urinary calculi from the bladder) or “couching” (dislodging cloudy cataract lenses using pressure or a surgical instrument and pushing it to the back of the eye) as well as bone setting.

Noone knows for sure but it is possible that medical specialisation started in Paris in the wake of the French Revolution when hospital-based medicine started to coalesce around certain clinical conditions and pathologies that correlated. Doctors started to gain more experience in limited fields, and this expertise was encouraged as it appeared to lead to better health outcomes. According to Geffen. “By 1860, there were more than 66 specialty hospitals in London alone. The rise of the hospital system promoted the elite consultant, and specialisation flourished.”

Related Questions.

How many specialties are there in Australia?

The answer to this question is a little more complex than one might think. We have already discovered that there are 15 colleges. Perhaps 16 if we include the Dental College, which we really should as they include the oral-maxillofacial surgeons.  But we know that there are then a range of subspecialties and other programs housed within some of the colleges, in particular the RACP and RACS.  The Australian Medical Council in its role of accrediting specialty training programs (see below) currently recognises 25 programs.  This number captures all the colleges, as well as the additional programs that the RACP offer and two different programs for Intensive Care Medicine.  The former the Joint Faculty for Intensive Care Medicine is now a defunct program and will be removed at some point in lieu of the more recently established College of Intensive Care Medicine.  This is an example of how college evolve over time and new colleges arise. See below.

At last count according to the Medical Board of Australia there were around 64 recognised subspecialties in Australia.

But this doesn’t even compare to the United States, where the Association of American Medical Colleges lists 131 specialties.

How Many Specialists Are There?

According to the Australian Government health workforce data collection there were 57,031 medical specialists or more accurately 57,031 Fellows of colleges in Australia in 2017.

Is General Practice a Specialty?

In one word. Yes.

What was the First Specialty College?

Founded in 1518 by a Royal Charter from King Henry VIII, the Royal College of Physicians of London is the oldest medical college in England. It continues to play a pivotal role in raising standards and shaping public health today.

According to the Royal College of Physicians

In the 1500s medical practice in England was poorly regulated. Many ‘physicians’ were working with no formal training or knowledge, and almost certainly killed as many patients as they cured. The leading physicians of the early 16th century wanted the power to grant licenses to those with actual qualifications and to punish unqualified practitioners and those engaging in malpractice.

A small group of physicians led by the scholar Thomas Linacre petitioned King Henry VIII to establish a college of physicians on 23 September 1518. An Act of Parliament extended its powers from London to the whole of England in 1523.

Originally called the College of Physicians or the King’s College of Physicians, it only gradually became known as the ‘Royal College of Physicians of London’ during the 17th century. It was only with the restoration of the monarchy, that the RCP started referring to itself consistently as ‘royal’. But from the very beginning its members found their patients from the highest levels of society.

Royal College of Physicians “Our History”

What was the Second College?

The second College in England was the “Company of Barber-Surgeons”, which was established in 1540. It formed out of a trade guild and a London Livery Company that apprenticed and examined trainees within the City of London. As the name suggests, what we now refer to as the medical specialty of surgery arose out of those tradespeople who earned their living from performing haircuts and beard trims and shaves. This makes sense as these tradespeople worked with sharp objects that were good for cutting things other than hair. So its likely that some developed skills at other useful forms of cutting. Initially the barber members of the guild were the most senior members but in time the surgeons became more respected and sought to break away and establish their own identity.

Who Checks on the Colleges?

The Australian Medical Council is the body that checks the quality of the medical specialty colleges.  Amongst other things they check both on the quality of the specialty training program as well as the continuing professional development program for existing college members.  

Yes the one that also accredits Medical Schools in Australia and New Zealand as well as prevocational training programs and assesses International Medical Graduates through the standard pathway.

The AMC reports to the Medical Board of Australia, which has the final determination on college status.

Why are some called the Royal and others not?

Most of the earliest colleges in Australia were off-shoots of their respective college in England.  The specialist medical colleges in England all were given Royal Assent and the privilege of using the word Royal in the title.  This patronage was continued through with most of the original colleges in Australia.  You can tell which colleges have recently been established by virtue of the fact that they do not carry the word Royal in their title.  For example the Australasian College For Emergency Medicine and the Australian College of Rural and Remote Medicine are relatively new colleges in Australia.

How do you start a college?

From a review of the 15 (or 16) medical specialty colleges and 64 or so specialties and subspecialties one might consider that there is not really the need for another college.  But consider this. Medicine is always evolving and specialising. We can’t predict the future completely. But what we can probably predict is that over time certain doctors will probably organise as a new group around a set of health problems or ways of healing or working in health and eventually will want to establish their identity as a college.

There are a couple of ways that this can work. One is to set up an entirely new college.  Normally what happens is that a group of doctors who are already specialists in another college form a society first and over time build up membership, academic and professional development programs until the time that their is enough momentum for a new college.  This is a difficult and arduous process.  You can’t just call yourself a college and have your members start charging patients for their new specialty services.  There is a process you have to go through to get a college recognised which involves an application to the Australian Medical Council.  Even after you have convinced the AMC the Medical Board can refuse to accept your status and even then the Commonwealth does not necessarily have to agree that College members can access the important Medicare billing system for their patients.