Executive Dean, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, and adjunct Professor of General Practice in the School of Population Health at UNSW Sydney.
Nick has been a GP for more than 30 years and continues to work part-time in clinical practice. His research interests are on prevention and management of chronic diseases with a focus on respiratory illness. He also has a long-term clinical, teaching, and research interest in travel medicine and is chair of the RACGP Travel Medicine Specific Interest Group . Nick is the immediate past chair of the National Asthma Council Guideline Committee and the RACGP Smoking Cessation Guidelines Expert Advisory Group. Other positions include: Member Executive Committee RACGP Preventive Guidelines, Member Lung Foundation Australia COPDX Guideline Committee, Board member Gold Coast Hospital and Health Service. When not at work Nick might be seen trying to catch a wave at Burleigh Heads.
Grant Russell, is Professor of Primary Care Research and Director of the Southern Academic Primary Care Research Unit (SAPCRU) within the Department of General Practice at Monash University. He was greatly influenced by his time spent with Moira Stewart and Bill Hogg in Canada. “I’m still a true believer in family medicine/ primary care and I think that there is a very wonderful career that can be forged.”
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“… you got to see things from a GP perspective, which was eye-opening. Then I went to a general practice workshop and I spoke with others having the same experiences. It felt like I’d found my tribe.”
Grant Russell: My name’s Grant Russell, and welcome you to MedicsVoices.com, where we talk to the key opinion leaders in health, medicine, and in particular, primary care. Today we’re in Australia, and I’m talking to Professor Nick Zwar. Nick and I go back a long way—but maybe that’s for another day. Thank you for joining us. I wonder if we could go right back to the beginning. Could let us know where this journey started—where you grew up, and what your path was through school to medicine?
Nick Zwar: Yes, we do go back a long way, but not quite that far. I grew up in Canberra, the capital city of Australia, one of those purpose-built places when Sydney and Melbourne couldn’t agree on where the capital should be, so they chose somewhere in between. When I was growing up in Canberra, there was no medical school. The Australian National University didn’t have one at that stage, so people from Canberra had to look elsewhere. I didn’t have a lot of medical role models, so my closest understanding of a doctor was our local GP, who was a wonderful man—a wonderful doctor, one of those people who could do everything.
Unlike a lot of people I later met in medicine, who had relatives who were doctors, I didn’t really have that background. So I was going into medicine without knowing a lot about it, to be honest. But I thought it would have a human aspect as well as a scientific aspect. I very much enjoyed English and History—I was probably more arts-focused as a school student rather than science-focused. But I had to do science as well, and I thought medicine might bring those two together. I think that was broadly right.
So that’s how I went into medicine and, without knowing much about it, really, I went off to the University of Adelaide and started in first year, as you did.
GR: One of the things about Australia—certainly when we were at that stage—is that you could go straight from school into medicine. So there were a lot of 16-year-olds needing to make big decisions about where they were going.
NZ:, We had a saying that instead of going through puberty, you went to medical school. It was very structured, and it gave you time to grow up—that six-year program. So it wasn’t all bad from that point of view. By the time you became an intern, you just looked old enough not to seem ridiculous.
GR: So your internship was in Adelaide?
NZ: Yes, in the Royal Adelaide Hospital. And that was—as internships still are—challenging and interesting. In those days we wore white coats. You put it on the first day, had a large beeper in your pocket, your stethoscope, your little pocket guide, your notebook—and you thought, this can’t be true. Surely they’re not giving me these responsibilities. Someone’s going to come along any moment and say, “Don’t be ridiculous,”.
GR: Those imposter syndromes start very early, don’t they? A lot of your colleagues would have gone into specialty training programs, and it was about the time that professional training for general practice was just beginning to get started in Australia. I just wondered why you went down the general practice road.
NZ: I went back to Canberra after intern year and did my GP training in the Australian Capital Territory. That was partly a family decision—my mother wasn’t that well—and partly because I couldn’t make up my mind. I enjoyed various specialties. I liked paediatrics, I quite liked medical rotations. I think generalism appealed, even if I didn’t fully understand the concept at the time. I liked the breadth. During GP training, you had rotations out of hospital, so you got to see things from a GP perspective, which was eye-opening. Then I went to a general practice workshop and I spoke with others having the same experiences. It felt like I’d found my tribe. I realised that the challenges I was facing—adjusting from a six-week-old baby to an 85-year-old man on multiple medicines—were what everyone was experiencing. That helped me realise I wasn’t alone. General practice, primary care—it’s not an easy specialty to be good at.
“…once I got into academia, I really enjoyed it—the teamwork, working with people with diverse skills on problems that mattered. There’s a creative process in developing research, getting funding, and trying to influence policy or practice. Once you start doing it, you tend to like it.”
GR: You started in the training program when it was only just being formulated in Australia. General practice is the largest medical specialty by numbers, but you’ve carved out a niche in academic family medicine. Could you trace that journey from being a trainee to doing a PhD and the career you’ve had?
NZ: There were opportunities throughout the training program to be involved in the Trainees Association. I realised early that I wanted to do more than just clinical work. I enjoyed clinical work, but it’s hard. At the end of the day, you’re worn out—you’ve used your brain, interacted emotionally with patients, dealt with complex situations. I enjoyed that, but I didn’t want to do it all day, every day forever. So I took opportunities to do other things. Dr Jill Gordon helped me get funding to do one subject in a Master of Public Health. That was very clever—it got me hooked. I finished the MPH, and then I was encouraged to do a PhD. So, essentially, I was conned into becoming an academic.
GR: Before you knew what was happening!
NZ: Exactly. But once I got into academia, I really enjoyed it—the teamwork, working with people with diverse skills on problems that mattered. There’s a creative process in developing research, getting funding, and trying to influence policy or practice. Once you start doing it, you tend to like it.
GR: It takes you from individual problem-solving in clinical practice to longer-term, often more complex problem-solving that involves teams.
NZ: And it’s also a great burnout prevention strategy—being involved in research or teaching keeps you thinking about why you’re doing things and gives you a sense of agency in shaping the future of primary care.
Nick at the WONCA World conference
GR: I was reflecting that many Australian GPs know you as “the travel doctor.” You had a long-running series on travel medicine. Could you tell us about that interest?
NZ: I realised I didn’t know much about travel medicine when working in inner Sydney, where many travellers came to the practice. I had almost no training in it. Travel medicine was just emerging as a discipline. I started reading about it and suggested to Australian Doctor magazine that they needed a travel medicine column—they agreed, and I ended up writing it. I wrote articles regularly for almost 30 years. I also joined the International Society of Travel Medicine, did the Certificate of Travel Health, and did research on vaccine behaviours among Australian travellers, which we published in the MJA. It became a long-term interest I now chair the RACGP Travel Medicine Specific Interest Group. About 85–90% of pre-travel medical advice comes from general practitioners, so it’s an important area—and a fun one.
GR: The conferences are good too, I understand.
NZ: Yes, they’re in interesting places, and you get to reconnect with colleagues from around the world.
“We see increasing sub-specialisation, which can be inefficient and can lead to poor communication, fragmentation, and care that doesn’t align with what patients actually value. Generalism offers a way to provide coordinated, whole-person care. Those core principles—first contact, continuity, coordination—are incredibly important.”
GR: It would be unfair to talk about your professional career without reflecting on your work in chronic disease care. You started with rational prescribing, and respiratory medicine and hypertension have been major focuses. With that as a background, I’d be really interested in knowing about some of the people who have influenced you and shaped how your career has evolved.
NZ: There have been many people. I was fortunate to meet icons of Australian general practice like Charles Bridges-Webb many years ago and received some very wise advice from him. I also met Neil Carson, Leon Piterman, and others. And Michael Kidd, who is more a contemporary of ours. Those early leaders had deep experience in practice and then came into academia, whereas people like us moved into academia earlier in our careers.
My interest in respiratory medicine partly came from seeing so much of it in practice—especially asthma in children and families in the late 80s and 90s. When I did my elective in Edinburgh, I saw many patients with COPD. That really brought home how serious and common the disease is. That led to an interest in smoking cessation. I worked with Robin Richmond and others at UNSW on programs to help clinicians improve their smoking cessation advice, and I ended up chairing the RACGP Smoking Cessation Guidelines Expert Advisory Group for many years, contributing to multiple editions.
GR: A few years ago a friend asked doctors she respected to give advice to her son-in-law, who was just starting out in medicine. I wonder if I could use that as a background to ask you—what advice would you give to someone just graduating, perhaps considering family practice?
NZ: First, I’d say to understand generalism as a really important part of healthcare delivery. We see increasing sub-specialisation, which can be inefficient and can lead to poor communication, fragmentation, and care that doesn’t align with what patients actually value. Generalism offers a way to provide coordinated, whole-person care. Those core principles—first contact, continuity, coordination—are incredibly important.
Secondly, be curious—be interested in your patients. But also look after yourself. Burnout is real. Many doctors try to do everything for everyone in a system that doesn’t always reward quality.
And finally, don’t believe everything you’re told. When I think about what I was taught in medical school, some of it turned out to be completely wrong. It was presented as fact but was really just theory at the time. So, maintain a healthy skepticism. Look at the evidence yourself where you can.
GR: You started in Canberra and now you’re on the Gold Coast—quite a change. What are your thoughts about the future?
NZ: I’m currently in the Executive Dean role, leading a faculty that includes medicine, allied health, and biomedical science. My focus now is on maintaining and growing the faculty and making sure I leave it in good shape for whoever comes next.
I’m also thinking about what I’ll do beyond full-time work—continuing some research projects, supporting colleagues and former PhD students, and perhaps doing more teaching.Teaching keeps you connected to younger generations and new ideas, which I think is really important. I’ll probably continue some clinical work and focus on the parts of work I enjoy most.
GR: Nick, it’s been a wonderful journey. On behalf of MedicsVoices, thank you for sharing it. You’ve embraced generalism, celebrated curiosity, and shown the importance of looking after yourself. I really appreciate your time today.
