*Marta Wanat, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK, ORCID; *Patrick Redmond, Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland ORCID; Tomas Barry, UCD Centre for Emergency Medical Science, University College Dublin, Ireland ORCID; Samantha Chakraborty, Department of General Practice, Monash University ORCID; Tony Foley, Department of General Practice, University College Cork, Ireland, ORCID ; David Gonzalez-Chica, Discipline of General Practice, Adelaide Medical School, South Australia, Australia. ORCID; Rachel Johnson, Bristol Medical School ORCID; Jo-Anne Manski-Nankervis, Department of General Practice, University of Melbourne Vic 3010 Australia ORCID ; Brian D Nicholson, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK, ORCID; Helen Parretti, Norwich Medical School, UK, ORCID
*Joint first author
What does the future hold for academic primary care? Despite building world-leading research infrastructure,1 and responding to the COVID-19 pandemic;2 career pathways remain unclear,3 clinical credibility is questioned, and recruitment is challenging4 – potentially threatening the discipline’s future.5,6 As the latest cohort in the Oxford International Primary Care Research Leadership Programme, we present the ‘10 things we wish we had known’ for anyone considering a career in academic primary care.
1. “Real” doctors will be sceptical of you
There has long been tension between “real doctors” and “real academics,”7-9 with academic general practitioners (GPs) making up only a tiny fraction of all GPs.10 Remember that apart from your role in clinical practice, you can make a difference through contributions to education, research, health policy, and service development.11 Sustained advocacy for the discipline is required in partnership with clinicians and patients.
2. There is so much more to Academic Primary Care than academic GPs
Primary care is no longer a homogenous entity12 and this diversity is also represented in academic primary care. You can fully embrace the complimentary skillsets and synergies between clinical and non-clinical academics, recognising the value of different approaches to research and care. This builds strong research teams incorporating diverse voices and methodologies.
3. There is no one journey
A career in academic primary care may span research, policy, education, clinical roles, and advocacy.13 The journey is rarely linear – with the ebbs and flows of career and life goals. Direction and focus are inevitably required to deliver ambitious research, gain promotion, or achieve policy changes. Discuss your journey with colleagues, and mentors from early in your career to ensure that whatever you choose, must be enjoyable to you!
4. You need plenty of support
Building a career in academic primary care can be arduous. It requires considerable time, effort and resilience to develop momentum, achieve work-life balance and feel successful. Family, professional, and peer support will be fundamental to protect yourself from burnout on this journey.
5. You need to understand academic metrics
To succeed in academic primary care, we need a variety of skills going beyond research, teaching and management, such as engaging in academic citizenship, (social) media, or policy-work. Choosing a selection of these activities in individual pathways may be difficult but they can all provide a rewarding platform for collaboration.
6. The paradox of “generalism”
Bringing the “generalist” perspective from the clinical world to academic primary care can be a powerful tool, allowing us to bring clinical insights that can feed research ideas and provide essential contextual knowledge. However, a career in primary care is often built on clearly carved-out research themes. Thus decisions need to be made on how to balance clinical generalism with delivering a consistent thread of research activity.
7. Rejection is everywhere
Rejection is one of the common academic experiences “no one talks about”. Consider how to persevere when your “work falls short of someone else’s standards”.14 Using self-reflection, finding and learning from feedback, and always celebrating successes are essential and healthy behaviours.
8. You will feel you are not good enough, even if you are
You are not alone. Imposter syndrome is an almost universal experience.15 There is a risk though of not being able to truly appreciate success. To combat this, you need to constantly remind yourself you are good at what you do, get honest support from peers, mentors and friends, and reframe failure as constructive feedback.
9. It is (not) a competition
Inevitably, a career in research will involve applying for funding, and thus competing against others, sometimes colleagues in the same institution. Yet, academic primary care is stronger when united, where collaboration across groups, departments, regions, and countries brings a critical lens through which to examine current evidence. Aim to avoid rivalry, focussing instead on how to most effectively achieve the greater goals of your resarch.
10. Learn to lead
Skilled leadership is required to secure and sustain investment, nurture talent, and prioritise the most important topics for the discipline.16 Take opportunities to learn about leadership even before you lead – there are many styles of leadership and there will be at least one that suits you.
- Mughal F, Atherton H, Reeve J, Mallen CD. Academic primary care: challenges and opportunities. Br J Gen Pract. 2022 Mar 24;72(716):104–5.
- Yu L-M, Bafadhel M, Dorward J, Hayward G, Saville BR, Gbinigie O, et al. Inhaled budesonide for COVID-19 in people at high risk of complications in the community in the UK (PRINCIPLE): a randomised, controlled, open-label, adaptive platform trial. Lancet. 2021 Sep;398(10303):843–55.
- Cheraghi-Sohi S, Perry M, Wallace E, Wallis KA, Geraghty AW, Joling KJ, et al. A future in primary care research: a view from the middle. Br J Gen Pract. 2018 Sep;68(674):440–1.
- Driel M van, Deckx L, Cooke G, Pirotta M, Gill GF, Winzenberg T. Growing and retaining general practice research leaders in Australia: How can we do better? Aust Fam Physician. 2017 Oct;46(10):757–62.
- Calitri R, Adams A, Atherton H, Reeve J, Hill NR. Investigating the sustainability of careers in academic primary care: a UK survey. BMC Fam Pract. 2014 Dec 14;15(1):205.
- JONES R, LAMBERTS H. Research in General Practice: Dutch Problems, European Solutions? Fam Pract. 1994;11(3):330–2.
- Howie JG. Academic general practice: reflections on a 60-year journey. Br J Gen Pract. 2010 Aug 1;60(577):620–3.
- Hobbs R. Is primary care research important and relevant to GPs? Br J Gen Pract. 2019 Sep 29;69(686):424–5.
- Horton R. Offline: How to save primary care research. Lancet. 2014 Sep;384(9948):1082.
- Campbell J, Hobbs FDR, Irish B, Nicholson S, Pringle M, Reeve J, et al. UK academic general practice and primary care. BMJ. 2015 Jul 31;h4164.
- Waas V. By choice — not by chance: supporting medical students towards future careers in general practice. London; 2016.
- Nelson P, Martindale A-M, McBride A, Checkland K, Hodgson D. Skill-mix change and the general practice workforce challenge. Br J Gen Pract. 2018 Feb;68(667):66–7.
- Adams A, Lester H, Reeve J, Roberts J, Wilson A. Investigating the sustainability of careers in academic primary care in the United Kingdom. Prim Health Care Res Dev. 2014 Jul;15(03):331–5.
- Jaremka LM, Ackerman JM, Gawronski B, Rule NO, Sweeny K, Tropp LR, et al. Common Academic Experiences No One Talks About: Repeated Rejection, Impostor Syndrome, and Burnout. Perspect Psychol Sci. 2020 May;15(3):519–43.
- Hutchins HM, Rainbolt H. What triggers imposter phenomenon among academic faculty? A critical incident study exploring antecedents, coping, and development opportunities. Human Resource Development International. 2017 May 27;20(3):194-214.
- Furler J, Cleland J, Del Mar C, Hanratty B, Kadam U, Lasserson D, et al. Leaders, leadership and future primary care clinical research. BMC Fam Pract. 2008 Dec;9(1):52.