Finding your tribe as a GP and academic

I never enjoyed hospital work.
 
I found it frustrating that we were often providing band-aid solutions for a chronic condition. You would see people treated for a heart attack and then come back in a week later. I thought, ‘If we managed their risk factors, would they be in the same place?’
 
When I started general practice training in 2011, I knew that I had found my tribe. I simply love clinical general practice. The fact that you’d see people in their own clothes, talking to them like a person and not a patient in a gown. You see people as a person, you think about their family, their community, and how they live day to day. And the variety drew me in. No day is ever the same. My specialist friends in hospital find the idea terrifying, but GPs like it.
 
More recently, I have extended my tribe into primary care research and over the last three years, as I’ve worked on completing a PhD on obesity management in Australian general practice, many colleagues have asked me – why? Why go back for more study? What’s the appeal?
 
I love research because I like being curious about things and asking questions. The great thing about research is that you can ask questions – and actually find out answers. You can find out things no one knows. You produce new information.
 
In general practice, we often think everything already has been done and we already know the answers. But there is still a lot we don’t understand about why general practice works so well.
 
I was trained by amazing clinicians in Canberra who look after patients so well and handle the trickiest problems with expertise. Being trained by these excellent GPs has shown me exactly how good general practice can be. I have seen it with my own eyes. And that makes me look for ways to strengthen it to work for all patients and GPs in the system. That’s what drives me.
 
Academic and clinical work complement each other exceptionally well. My clinical work helps me think about the questions that really matter for patients, and academic practice can help clinical practice with things like quality improvement projects. If you have good understanding of research methods, you can bring that to the practice, discuss how we investigate problems and make it better.
 
How did I get there?
Therein lies a tale.
 
I am not from an academic family. I am the first of my immediate family to receive a PhD. It really wasn’t something I thought I could do, and I simply could not have done it without the support and encouragement of senior colleagues, who play a really important role in encouraging more junior people to take up opportunities. Sometimes you cannot see it yourself – you need someone to show you the door and give you a gentle shove through it.
 
For me, the first important colleague was Associate Professor Katrina Anderson, who encouraged me to start with an academic post during my clinical training. Before her, I didn’t know such options existed.
 
I was soon exposed to teaching, research, curriculum development, and academic life. Without an academic post, I would never have started this journey to being an academic GP.
 
The next turning point was being awarded an RACGP Foundation grant, with that work leading to a successful grant application.
 
The RACGP Foundation is essential for funding early research projects in general practice; funding for primary care research has been in a miserable state over the last five years, but the Foundation continues to play an essential role in ensuring research on GP-important topics is done. We would be a million miles more behind without the RACGP Foundation.
 
Professor Kirsty Douglas was the person who encouraged me to do a PhD. ‘If you are doing all this work for the grants, you may as well make it into a PhD,’ she told me. And she was right.
 
Doing a PhD opens doors to connect with senior researchers and learn new methods. I would never have signed up for a PhD without Kirsty’s encouragement.

Dr Liz Sturgiss (right) says she never would have pursued her PhD without the encouragement of Professor Kirsty Douglas.
 
For the PhD, I chose an area that fascinated me in my clinical work: I wanted to explore how GPs can best care for people with obesity.
 
One of the problems in dealing with a chronic relapsing condition like obesity is that GPs are often left out of the conversation, and it makes us feel like we can’t offer anything. But we found that a program we trialled with GPs in our local area really improved their confidence in managing obesity, from talking to patients to offering advice that fit with their lives and where they were at.
 
And because GPs often have a long-term relationship with patients, they can continue to talk about these changes in a sustainable way over a long period of time, rather than fad diets or rapid changes over a short period that don’t last.
 
Now, everyone talks about PhD hell and, for me, that was the last three months. When you can see the light at the end of the tunnel, pushing through is really, really hard. What helped was my academic colleagues who supported me to pursue it, we well as my partner and kids, who all understood I’d be really busy to get it over the line. It wouldn’t have been possible without them.
 
The good outweighs the bad
Would I encourage others to think about the academic path? Absolutely. There have been far more pros than cons.
 
The things I love most about academic work are meeting new people, finding answers to big questions, and working on problems that are affecting people right now. We are relatively broke compared to my doctor mates, but we’ve have had amazing experiences – my kids are always asking when we will next visit a new place.
 
Many general practice registrars who are considering academic work are told this would be a waste of their time: why do we train clinical GPs who then do non-clinical work? The problem with that argument is without relevant, high-quality, general practice research, healthcare decisions are going to be made without GP input.
 
The critical role of GP–researchers is recognised in other specialties. GPs have an important role to play in the development and understanding of our specialty. Do we really want research into general practice with no GP–academics at the table?
 
GP–researchers bring something unique to research. Given we still work in general practice, we bring an understanding about how things work in the real world. We are able to able to connect with GP colleagues leading to more relevant research questions and, often, fast recruitment for projects.
 
At the moment, we really need attention and support for primary care research in Australia. It has been really sad to see what’s happened in the last five years. There has been an erosion of everything. But I know the National Health and Medical Research Council is looking at ways to better support GP–researchers, which would include GP–academics. That’s promising, to see they recognise that GP–researchers have a big role to play in improving Australia’s health systems. It’s important we don’t forget primary care research.
 
To be honest, primary care research is still often seen as the little brother of hospital medicine. People are surprised when I say I do general practice research. Some are even surprised you can publish papers on primary care. But primary care research has so much to offer, and it is well worth supporting.
 
You can see it in the existing literature. That’s how we’ve shown that continuity of care is really important for patient outcomes. Other medical specialties are just now recognising the importance of person-centred care, but primary care researchers have been working on that for more than three decades, and there is a huge body of literature there on what it is and how to do it properly.
 
So, in fact, far from being the little brother, it means primary care research has a lot to offer other specialties. And we can all be proud of that.

For GPs undertaking a PhD – or thinking about it – there is now the ‘PhD Peer Support Group’ in shareGP. There are 25 of us on there; it’s a great group with which to ask questions and celebrate successes, and makes you feel much less alone. Come say hi.

academic research general practice research racgp foundation