Australian general practice research is nearing crisis point

Liz Sturgiss

17/05/2018 1:33:38 PM

It’s a hard time to be a general practice researcher in Australia, GP Dr Liz Sturgiss writes for newsGP.

Dr Sturgiss believes it is no overstatement to say that Australian general practice research is verging on crisis.
Dr Sturgiss believes it is no overstatement to say that Australian general practice research is verging on crisis.

The Federal Government completely ceased funding for its Primary Health Care Research, Evaluation and Development (PHCRED) in 2015. The 2017 World University Rankings for primary care research doesn’t feature a single Australian university in the top 10 and, without adequate funding, there’s no chance we’ll ever get there.
What are the implications for Australia and its excellent primary care system?
Here’s a sample. Our team at Australian National University (ANU) recently published a scoping review of obesity management in primary care. One of our most surprising findings was that the evidence was overwhelmingly from America – a nation with a very different healthcare system in terms of governance, funding and outcomes achieved.
If Australia’s evidence for general practice is based on the American primary care system, there are likely to be issues we are missing or misunderstanding.
This is a real concern.
Without strong general practice research, we have no basis for contributing to practice guidelines, we cannot talk to policy makers about the strength of general practice, and we cannot continuously improve practice for the benefit of our patients.
It’s no surprise as to why this is the case. America has a very strong philanthropic culture.
I recently ran into a junior doctor I once taught who now works as a family doctor academic in the US. When I asked him if he would ever come home, his reply was stark: ‘Absolutely not’. Over there, he has no trouble finding research funds and has a strong network of support as an early career researcher. Over here, it’s different.
The RACGP recently held a dedicated research day in Melbourne that saw many of Australia’s top general practice researchers come together. What became quickly clear, based on a number of conversations, was that there are significant barriers to building careers in general practice research. However, this sentiment was balanced by the clear enthusiasm and passion of the group.
Australia’s general practice research community is small. Researchers starting out in their careers face high-pressure funding environments and direct competition with wet-lab scientists for the same pool of money.
The numbers of researchers affiliated with the Australasian Association of Academic Primary Care have been dropping since 2015, when the Federal Government ceased supporting primary care research. Simply put: fewer people are choosing this as a career.
In budget submissions over the last three years, the RACGP has called on the Federal Government to properly support general practice research. But alas, the recent Federal Budget did not contain a single cent for general practice research.
There is an urgent need for the Government to restart investing in general practice and primary care research.
A 2017 study by members of the RACGP Expert Committee – Research (REC–R) on general practice researchers in Australia found that a common concern cited by GPs undertaking a PhD was the insecurity of career pathways. Many stated that there was a ‘lack of a long-established research culture in general practice’, which meant much research operated more like a ‘hobby’ – unfunded and done from home.
It’s not all bad news, though. The fundamentals for success are there. The RACGP Foundation has been essential to ongoing research capacity with its seed funding. And the GP Academic Registrar posts are a fantastic opportunity to experience what academic life is like – without them, I would not have considered a research career.
While we wait and hope for increased funding, there is more that can be done.
For instance, a structured support program for new general practice researchers would be ideal. The RACGP’s REC–R is in the early stages of looking at how we can connect GPs doing doctoral research in order to help people feel less isolated.
Making visible the opportunities for conference presentations, editorial responsibilities, and representative spots would also help early researchers strengthen their chances of high-level research funding.
Whenever I hear RACGP President Dr Bastian Seidel describe this organisation as an ‘academic college’, I feel a surge of pride. But as we look to the future, this will only be possible with a strong general practice research community.
If we don’t support general practice research, no one else will.

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Marguerite Tracy   18/05/2018 8:17:55 AM

Thank you for this excellent article. I am a new GP PhD student. I would love to have connections with others doing the same. The hardest part for me is battling criticism for the time taken out of clinical work.
Let me know if I can help.

Tim Staunton Smith   18/05/2018 5:04:46 PM

Great article. Couldn't agree more.

Wendy Burton   18/05/2018 10:29:25 PM

Liz, absolutely! We have to fight for and support GP research. Without a strong research base, we are unable to provide the evidence to back our assertion that the care we provide is not just effective, it is efficient. We cannot underestimate the importance of a strong research base.

Scott Arnold   19/05/2018 12:53:02 PM

To Dr Liz Sturgiss,

Hi Liz I am a RACGP fellow of 20 years. The last ten of which have been spent in primary care skin cancer. Just this weekend I am filling in applications forms for a PhD through UQ examining dermoscopy and correlation with histopathological diagnostic thresholds for facial melanomas. So your article is of great interest to me.
I can be contacted at ********
Warm regards
Scott Arnold

Chris Hogan   23/06/2018 11:45:38 AM

Research should be embedded into routine practice.(see my article on mind/ mine your data). But it absolutely depends on data that is reliable, accurate, readily accessible, regularly used & that is valued by General Practices
Research can be defined as organised curiosity & as such has much to the clinical & logistic facets of General Practice
I spent a lot of my career firmly in clinical practice & explored a wide range of options as well, including Research. For 6 years, I ran a General Practice based research network for Victoria for RACGP .
One current Victorian GP based research network is VicReN based in the Dept of GP at Melbourne Uni where I am an Honorary member of staff.
Our website demonstrates the many options for the engagement & support of General Practice research . We have a lot of projects currently active.