The Future of Family Medicine: Research
A fifth threat is the devaluing of research career paths, or even more generally, of academic career paths. Although this applies to all clinician scientists in an era when the emphasis in our medical schools is placed on how much clinical revenue can be derived, in many academic settings primary care physicians are particularly prone to being seen as cash cows.
The final threat is that we will be co-opted to study the unimportant, to focus on short-term outcomes research that can be turned around quickly for purposes of tenure and promotion, to carry out only what Godwin4 has called “navel-gazing” descriptive research about ourselves, or to engage in industrial clinical trials, many of which are thinly veiled marketing enterprises.
The future
Can we reinvent ourselves as family medicine researchers? In the new research environment, with the changes in our concepts of health and illness, there are tremendous opportunities for family medicine researchers—social scientists, economists, and behavioral scientists working in family medicine settings, as well as physicians. Family physicians truly provide a bridge between patients and communities and traditional academic settings. We have the opportunity to change the questions to be asked and to test the relevance of answers in the crucible of family practice.
As research broadens to examine systems and population groups, it is essential that communities know their rights and are able to ask their own questions and to work with researchers in collaborative partnerships. Family physicians are well placed to ensure that those who do research in communities honor the principles of participatory research.
In the world I now inhabit as dean, I hear basic scientists getting excited about cross-disciplinary research, such as the biochemists recognizing their need for physicists and chemists; the blurring of boundaries between physiologists, biochemists, pharmacologists as they study mechanisms; and the genomics folks wanting laboratories next to the proteomics folks, so they can do integrated work on particular genes and their expressed proteins. I hear an emphasis on integration and valuing groups of researchers whose questions span from the molecule to the community. This emphasis is reinforced by granting agencies’ increasing attention to a broader view of research than the traditional biomedical one. Family medicine researchers have an important role to play in this integrated research community.
It is imperative that we study what matters: major cost drivers in diagnosis and treatment; prevalent and serious illnesses; fundamentals of how decisions get made, how patients and doctors learn, the nature of relationships, and how to teach physicians about decision making and relationships; and the impact of the changes in health and illness on individual patients and families, on family physicians and other health care providers, and on the patient-physician relationship. We need to study what family physicians in the 21st century will have to know, and we need to ensure that the communities of patients with whom we interact are partners in research and never exploited. Perhaps most important, we have the opportunity to build theory in the area of behavioral health research and health care relationships. If we do this, family medicine research has a future.
An expanded version of this paper was presented at the North American Primary Care Research Group 2000 Plenary, Amelia Island, Florida, November 5, 2000. All correspondence should be addressed to Dean C.P. Herbert, Faculty of Medicine & Dentistry, University of Western Ontario, Health Sciences Addition, London, Ontario, Canada N6A 5C1.
