Academic GPs combine clinical work with research and teaching
Academic general practitioners enjoy the contrast between the three main components of their career: clinical practice, research and teaching.
A typical week for Associate Professor Marie Pirotta, from the department of general practice at the University of Melbourne, could include teaching medical students and GP registrars, consulting in a suburban general practice, conducting research on the use of complementary medicines in primary care, or advising the Therapeutic Goods Administration on complementary medicines.
Professor Pirotta loves the variety of her work and that her various roles operate on different schedules. For instance, she switches between the 15-minute patient consultations of general practice to the multiyear time scale of large research projects.
Being an academic GP has also allowed her to develop a wide range of additional skills, such as project design, statistical analysis and qualitative research techniques.
Most importantly, she has had the chance to have an impact on patient care beyond the consulting room. For instance, her PhD research, which she completed in 2005, found that probiotics were ineffective against postantibiotic vulvovaginitis, contrary to popular belief.
“I’ve had the chance to develop new knowledge and evidence for or against treatments that will directly help other GPs and their patients”, she says.
Professor Mark Harris, professor of general practice at the University of NSW, says academic general practice can be particularly satisfying when research is taken up in practice.
“We’ve done a lot of work showing that having an organised system of care for people with diabetes is associated with better disease control”, he says. “Seeing that translated into guidelines and policies, and linked to practice incentive payments, is very rewarding.”
Professor Harris says the career also offers considerable flexibility, with doctors able to change their mix of clinical, research and teaching responsibilities over time. There are also plenty of part-time academic roles, and many female academics. Professor Harris emphasises there is also “not a huge glass ceiling” for female academic GPs interested in becoming professors of general practice.
Academic GPs say there is sometimes a misconception that all the exciting or important research is conducted in the non-GP specialties.
However, Professor Harris says general practice research is crucial because the patient population is different to the hospital population. “Things that might seem like a good idea in hospitals, such as a screening tool, may not be appropriate in general practice”, he says.
Professor Pirotta agrees, and gives the example of depression research. “If all the research is done in specialist or tertiary care patients who are more likely to be severely depressed, will that apply in general practice where most depressed patients are at the mild-to-moderate end?”
Professor Harris says general practice researchers are particularly well placed to study non-pharmacological interventions, such as cognitive behaviour therapy for simple depression.
The big issues
Professor Pirotta says there is a real need for increased research capacity in general practice. “GPs need to set the research agenda for our own discipline ... the vast majority of patient consults happen in primary care, but the vast majority of research doesn’t.”
She says additional funding is needed to encourage more GPs to add an academic component to their practice, and to establish a national general practice clinical trials network. In terms of this coordination, Professor Pirotta says general practice research is trailing other specialties, which makes it more challenging for GP academics to secure already limited research funding.
There is also a need for more clinically based general practice research. “The limited funds are focusing more on things like health services or e-health rather than the clinical questions that only GPs can ask and answer”, Professor Pirotta says.
Training as an academic GP
General practice registrars can complete an academic post as part of the Australian General Practice Training program. The 12-month, salaried position allows registrars to develop skills in research and teaching (see Registrar Q+A). More information is available at: www.agpt.com.au/TrainingPosts/AcademicPosts/
Other useful qualifications include a Masters of Public Health, another Masters degree with a research component, or a PhD.
The inside story
What are the insider tips to kick start your career in academic general practice? Professors Pirotta and Harris suggest that anyone considering this career needs to find a mentor.
Professor Harris says it is often as simple as emailing an academic GP at a university department of general practice and expressing your interest. “Most senior academic GPs are delighted to help mentor younger GPs who are interested in academic work”, he says. This is especially true because the increase in medical schools means there’s a need for more academic GPs.
Professor Harris also advises budding academic GPs to introduce an academic component to their practice early on, although he says there is no need to get too ambitious. For example, registrars could get involved in a research network or pursue part-time lecturing rather than attempting to start their own research project. “Clinical experience counts in GP academia, so you don’t have to go straight from being a registrar to being an academic”, he says.
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