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At the heart of general practice since 1960

Life as an academic GP

Dr Robbie Foy describes the highs and lows of this diverse and challenging career

Dr Robbie Foy describes the highs and lows of this diverse and challenging career

I once attended an inaugural public lecture given by a new professor of general practice. Introducing him, the dean commented how impressive it was that the number of letters after the new professor's name was longer than the number of letters in his name. During questions later, I stood up and suggested that this academic feat could be achieved more easily by having a shorter name. Nobody laughed.

Roots

Many people can share the credit, blame or guilt for my relatively atypical career pathway towards academic general practice. I have benefited from several mentors, notably starting with my GP trainer who coached me in how to read research papers while preparing for the membership and gently nurtured my fragile confidence.

My first research opportunities came during public health training and coincided with the growth of the ‘evidence-based medicine' movement. Undertaking and teaching critical appraisal taught me that it was possible not only to build upon but also to challenge published research and received wisdom. I also benefited from good formative early partnerships with fellow researchers in designing and conducting research, and (continuing) tuition on effective writing. A Medical Research Council fellowship then enabled me to train as a health services researcher and do a PhD. After 10 years out of general practice, I returned to it as part of my current post.

Daily life

My job now mainly involves research and teaching at a university. A typical research day, if it exists, is divided between preparing grant applications to pull in the essential cash to do research, planning and overseeing projects, and wrestling with words to find the most interesting but honest way to report research findings. High-quality research requires collaborations across all sorts of clinical and academic disciplines, such as psychology, sociology and economics. I work with many talented and high achieving people, all of whom I naturally despise in secret. To add to my woes, the medical students I teach are remorselessly becoming brighter and more threatening.

Motivation

Working one clinical day per week does not make me a ‘real' GP, but it does allow insights into the challenges patients and colleagues face. It still requires an effort to keep up to date as this is disproportionate to the clinical time commitment.

I am acutely aware of shortfalls in my knowledge and abilities, and equally concerned about those I am unaware of. This is a great motivator for my research – which is about why doctors find it hard to deliver the same standard of care that they would want for themselves or their families. This should require neither heroics nor martyrdom. Humans are programmed for imperfection. Work done by both myself and others has repeatedly demonstrated that doctors' lack of awareness of what the right thing is to do is only part of the jigsaw; any effort to bring about substantial improvements in practice needs to consider the wider range of individual, team and organisational factors that make up the bigger picture.

US fellowship

My research goal – shared with many other collaborators – is to find out more about how we can create the right sort of conditions ‘where it is easier to do the right than the wrong thing'. That quote comes from an American doctor I met recently. I have just returned from a travelling fellowship year in the US, funded through the Commonwealth Fund (www.commonwealthfund.org) where I am examined the use of different approaches to improve quality of care in two major healthcare organisations.

And, believe it or not, some good things do happen stateside. For example, I have encountered strong partnerships between clinicians, researchers and managers as a central means of driving forward quality improvement. This approach helps ensure that research and quality are not simply seen as additional luxuries to the core ‘business' of providing healthcare – a lesson the UK could take note of.

I also met all sorts of movers and shakers in US policy and beyond. This included a rapid but memorable handshake with presidential hopeful Senator Barack Obama. He quipped during our group photo opportunity: ‘Can these people vote for me? No... Then why am I bothering?' My family and I also experienced US primary care while there. On one occasion, my partner developed a ballooning red ear, with a line of cellulitis preparing to march across her face. Of course, it was Saturday morning and we could not find a primary care physician; we ended up being financially penalised at the local ER. Perhaps Gordon Brown might like to go over and sort that one out too while he's reforming out-of-hours care in the UK.

Lessons and reflections

My advice to aspiring researchers is to be prepared to start small but think big. Look for any opportunities to learn how to critically appraise, and actually appreciate, research. I would also recommend seeking further formal educational opportunities (such as a master's degree) and talking to people whose research interests you.

Yet, this wonderful life does have pitfalls. For many GPs with an interest in research, it is difficult to identify funding and schemes that can support a structured career pathway. It takes time and validation from colleagues to develop a sufficiently rhinoceros-like hide to deal with rejected grant applications and manuscripts.

Like their clinical counterparts, many academics work long hours that blur the boundaries between work and personal life. My own tendencies to do so stem from a deeply held fear that I will be ‘found out' one day and disqualified from this line of work that gives me purpose, autonomy and diversity. Nevertheless, I will be able to cling on to a number of letters after my name that reads like a Russian mafia godfather.

Dr Robbie Foy is a clinical senior lecturer in primary care at Newcastle University and a 2006/7 Harkness/Health Foundation fellow in healthcare policy

Dr Robbie Foy has just returned from a travelling fellowship year in the USA Dr Robbie Foy has just returned from a travelling fellowship year in the USA

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