Family Practice Advance Access originally published online on May 16, 2005
Family Practice 2005 22(4):355-357; doi:10.1093/fampra/cmi017
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Editorial |
The integral role of non-clinical academics in meeting the goals of primary care training and research
a Department of Primary Care and General Practice, University of Birmingham, Birmingham B15 2TT, UK, b Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina, USA, c General Practice and Primary Care, University of Glasgow, Glasgow G12 9LX, UK and d General Practice and Primary Care Research Unit, University of Cambridge, Cambridge CB2 2TU, UK.
Correspondence to Sue Wilson, Department of Primary Care and General Practice, University of Birmingham, Birmingham B15 2TT, UK; Email: s.wilson{at}bham.ac.uk
Received 14 October 2004; Accepted 28 December 2004.
Wilson S, Mainous III AG, O'Donnell C and Bateman H. The integral role of non-clinical academics in meeting the goals of primary care training and research. Family Practice 2005; 22: 355–357.
Non-clinical academics in primary care
In much the same way that there has been an increasing recognition of the utility of a team of professionals working together for managing chronic diseases in primary care, the advantages of providing multidisciplinary teams for primary care education and research have also become apparent.1,2 Successful researchers have long recognized the limits of their knowledge and the advantage of having the input and collaboration of professionals with different training and skill sets to attack and investigate research questions. In fact, multidisciplinary team-based research is more the rule than the exception.
Non-medically trained individuals with advanced training have become valuable contributors to academic primary care units as these units seek to successfully meet their goals of achieving excellence in training and research. Academic primary care is now a discipline that encompasses a range of specialties including epidemiology, statistics, clinical medicine, social sciences, psychology and health economics. Reports have frequently emphasised that academics who are not medically qualified contribute essential knowledge and expertise from kindred disciplines to academic general practice.3–5 The importance of developing the non-clinical academic workforce has been well recognised.6 Academic primary care has moved from departments that employed exclusively GPs towards staffing mixes that reflect the multidisciplinary nature of modern primary care. This is, in part, due to the increasing sophistication and quality of the teaching and research undertaken in primary care.
How might academic primary care better adopt this model of a multi-disciplinary professional workforce?
Successful collaborative teams of professionals have to have a shared commitment to the goals, in this case primary care training and research. Although a hierarchy may be necessary for distribution of responsibility for tasks, mutual respect for the intellectual contributions of each member of the team is necessary to build cohesiveness and ‘buy-in’ by all participants. It is important to acknowledge that each team member brings a unique but equally essential training and perspective to help the team address the shared goal. The qualifications of leaders of specific projects should presumably vary based on the tasks required. For example, even though both GPs and psychologists may be part of a research team, the leader of a research project investigating the psychological sequelae of diabetes might work best if it were led by a psychologist rather than a GP. While other projects in the same area may have as a secondary aim a focus on psychological aspects and thus the GP would be better suited as the project leader. A shared language and agreement of the shared goals is necessary by physicians and other non-clinical departmental professionals for success.
However, just as GPs may need to adjust their orientation and attitudes to the value of non-clinical staff in this strategy to achieve departmental success, if non-clinical staff wish to be seen as an integral part of academic primary care then they need to pursue opportunities to be seen as respected leaders and show a commitment to primary care. It is important that non-clinical staff emphasise an interest in primary care topics and the success of the goals of the primary care department. It can be potentially alienating to primary care physicians for a doctoral level colleague to stress that academic primary care is not their academic home.
International experiences
The issues related to the integration of non-clinical professionals into academic primary care are not unique to any one country. In the UK, almost one-third (32%) of the staff employed in academic Departments of Primary Care are non-medical and a number of Departments now have non-clinical staff in professorial positions.5 In the United States and Canada, most family medicine departments have non-clinical professionals on the faculty. In fact, many departments have non-clinical professionals with senior faculty positions (Associate Professor or Professor), although it is unusual for there to be more than one individual per department. Family medicine organizations in the US have been relatively open and inclusive. For example, of the 32 elected Presidents in the history of the Society of Teachers of Family Medicine (1968–2004) four have been non-clinicians. In fact, the current President-elect is a non-clinically trained educator. Further, the North American Primary Care Research Group, an international research association has as its current President a non-clinician faculty member from a Canadian university's family medicine department. Yet another example on an organizational level is the inclusion of non-clinician faculty members in family medicine as eligible for the ‘Grant Generating Project’, an investigator development program run out of the University of Missouri's Department of Family and Community Medicine with support from family medicine organizations in the US and Canada to develop researchers in family medicine (http://www.fcm.missouri.edu/research-ggp.htm). The rationale of having both physicians and non-physicians in the program is recognition of the role of non-physician investigators as key players in developing primary care research.
How might universities and governments help in encouraging a multi-disciplinary workforce in primary care?
If universities and governments wish successful collaborations and multidisciplinary research teams to thrive then they must reward all members of the team proportionately (i.e. according to their research, leadership and management skills). These rewards may be financial, but security of contract, tenure and status are just as, if not more, important. The research strengths of many of successful primary care departments is reflected in high ratings, for example in the UK Research Assessment Exercise (RAE), and academic GPs are increasingly moving into positions of influence and leadership in medical schools. Overall, of the 11 435 staff employed within university clinical departments on research only contracts, 9215 (81%) have non-clinical contracts.7 However, most senior academic staff are clinically qualified whilst most non-medical research staff are contract research staff on short-term contracts.5 Only 12% of non-clinical academic staff are on the senior lecturer or professorial grade whereas 44% of clinically qualified staff have achieved these grades.5
The importance of continuing to attract and retain these academics is recognized. Particular concerns have been expressed about the position of the many non-clinical researchers employed on short-term contracts.6 Researchers who are reaching the end of their current contract may be forced to leave a project early (to take up a new contract elsewhere) or to spend valuable time preparing grant applications or pursuing new posts in other institutions. This has serious implications for completion of projects and for the development of a cadre of skilled, committed and experienced professional (non-clinical) researchers.
Although resolving some of these concerns requires significant changes in organizational and funding policies it seems that for academic primary care to progress and successfully address the challenges of education and research, new ways of thinking about the academic primary care workforce are necessary.
| BOX 1 Summary of recommendations from published reports3,6 Increase the visibility of the contribution of non-clinical researchers by naming and crediting their contribution wherever possible. Consider appropriate titles for non-clinical researchers such that they are not disadvantaged by the title given to their job grade. (For example, ‘research assistant/associate’ may not reflect the responsibilities and status associated with a role. ‘Research fellow’ is preferred. Alternatively, referring to the individual as the ‘research recruitment manager’ or the ‘clinical trial co-ordinator’ might offer both enhanced status and greater ‘transportability’ when applying for subsequent posts). Provide early opportunity for frank discussion about what is realistic for the individual non-clinical researcher in terms of aspirations and further opportunities in research with a view to supporting and retaining those most able and enabling others to move to appropriate new posts/fields. Support the non-clinical researchers in identifying relevant training (e.g. in project management or leadership skills) and/or experience (e.g. in networking with the wider primary care research community) which will help them to position themselves appropriately for a future role towards which they may realistically aim. Encourage universities to move staff who have had more than one short term contract onto permanent contracts. Consider whether planned use of ‘bridging’ funds can ameliorate the uncertainties arising between fixed-term contracts. Consider the pathways available to non-clinical researchers and the extent to which the fellowship schemes that do exist are made accessible and attainable to non-clinical researchers.
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Declaration
Funding: Sue Wilson is supported by a Department of Health Career Scientist Award.
Ethical approval: not required.
Conflicts of interest: none.
References
1 Bower P, Campbell S, Bojke C, Sibbald B. Team structure, team climate and the quality of care in primary care: an observational study. Quality and Safety in Health Care 2003; 12: 273–279.
2 NAPCRG Committee on Building Research Capacity and the Academic Family Medicine Organizations Research Subcommittee. What Does It Mean to Build Research Capacity? Fam Med 2002; 34: 678–684.[Web of Science][Medline]
3 Mant D. National Working Group on R&D in Primary Care: final report. London: NHS Executive; 1997.
4 Howie J, Hannay D, Stevenson J. The Mackenzie Report—General Practice in medical Schools of the United Kingdom. Edinburgh: Macdonald Printers; 1986.
5 New Century, New Challenges: a report from the Heads of Departments of General Practice and Primary Care in the Medical Schools of the United Kingdom. Oxford: SAPC; 2002.
6 Academy of Medical Sciences. Non-clinical scientists on short term contracts in medical research: a report on career prospects and recommendations for change. London: The Academy of Medical Sciences; 2002.
7 HESA Individualised Staff Return 2002/03. Higher Education Statistics Agency Limited; 2004.
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