One in three GP academics look set to retire in the next 15 years and there aren’t nearly enough younger ones to replace them, say experts concerned for the future of evidence-based practice.
Successive cuts to government funding for general practice research programs have deterred many from taking on the financial burden of pursuing PhDs and threaten to leave a “great big hole” in suitably-qualified personnel once the current researchers start to retire, Professor Geoff Mitchell, professor of general practice at the University of Queensland, said.
He said the flow-on effects for primary care would be “shocking”.
“Think of every other branch of medicine and how heavily reliant on research they are in making progress,” he said, joking that we would still be using leeches without such research.
The primary care body of knowledge still needed work, Professor Mitchell said.
Studies such as those by Australian GPs into the lack of benefit of antibiotics for acute otitis media in children had important and useful effects on practice, he said.
Without GPs at the helm, research risked coming from those in “ivory towers” who didn’t understand the practical realities of general practice or were driven by commercial interests that tended to present costly solutions such as medicines that weren’t necessarily better than what was currently available, he added.
Professor Gerard Gill, former chair of general practice for rural and regional Victoria, has been closely tracking the workforce shifts in the academic realm and was dismayed at the picture of the future.
“There are 74 level D or E [associate professor or professor] academics in Australia who the universities pay,” he said.
“An entry ticket to a university is a PhD, and in general practice at the moment we are producing about eight GPs with a PhD a year. Most of whom are 45 plus, so their academic career isn’t going to be very long.”
Without scholarships and financial help, it was harder for GPs to take on further study, compared with doctors in other specialties who earned enough to survive on a part time wage, he said.
Moreover, general practice was skewed female, and given the gender burden of childcare, this could impede greater uptake in academia, he said.
There was also a bias towards funding research at the basic scientific level, in biochemistry and pathophysiology, which got the lion’s share of the money, according to evidence-based medicine expert at Bond University Professor Chris Del Mar.
“We need to know about much more prosaic things than ‘is there a cure for cancer?’,” he said.
While that was important, a vital and yet overlooked area was research into health services and research that looked at translating evidence into practice.
This kind of research was vital for understanding new and better ways of managing disease that did not involve drugs, and improvements to the interface between GPs and allied health, Professor Mitchell said.
Professor Mitchell said the current ad-hoc approach to research in primary care wasn’t enough.
“What we need is a workforce of people interested in primary care, but also GPs with the academic training to drive that in a systematic way.
“Considering the place of primary care in the community, we could be doing with five to 10 times the number of academics and research that we have now.”