A patience of professors

The most frequently cited reason for becoming an academic was "a desire to make a difference". Most of us wished to produce more holistically oriented doctors whose work would encompass a community perspective, in addition to their diagnostic and therapeutic roles. We saw future doctors helping to alleviate the burden of ill health in the community by addressing areas such as poverty and dispossession, which contributed to that ill health.

All of us had an interest in the intellectual underpinnings of medicine and healthcare, enjoyed teaching, and thought that work in a medical faculty would provide us with the opportunity to become involved in a mix of social medicine, clinical practice, and innovations in health policy.

Three of the professors had developed an interest in teaching by having students attached to their general practice. This had led to a strong involvement in educational matters within the RACGP. The advent of chairs of general practice/community medicine provided them with the opportunity to move into academia on a full-time basis. One foundation professor chose academic general practice because it provided the opportunity to pursue his long-term research interests and further his already substantial achievements in general practice epidemiology.

All the foundation professors regarded our most significant accomplishment as having broadened the scope of existing medical curricula. Innovations included the use of video feedback in teaching consultation and communication skills, computer-based learning laboratories, and multidisciplinary and community-based education where students could learn about the effects on health of non-medical factors such as poverty, isolation and ageing. Other achievements included the introduction of a postgraduate Diploma and a Masters in General Practice (now completed by over 500 GPs), and courses on teaching to assist GP preceptors.

Five of the professors published regularly (averaging 2.5 Medline cited papers per year), covering general practice epidemiology, cancer epidemiology and palliative care, the aetiology of disease, the needs of the elderly, rural workforce issues, Aboriginal health and medical education.

Four professors reported significant accomplishments in setting up teaching health centres, hospital-based teaching units and community health services. They were also proud of raising the image of general practice in their university by taking over the organisation of final MB BS examinations, chairing academic councils, influencing Commonwealth or state healthcare policies through involvement with a variety of non-university advisory committees, and having set up a university department and finding the resources to nurture a future generation of academic GPs.

Recognition of these achievements has included awards in the Order of Australia to seven of the nine foundation professors.

The most commonly reported missed opportunity was learning to find one's way about the medical school and university, especially in search of teaching and research funding. Even those who thought they understood the system were never able to achieve any equality of funding with the more established departments. This lack of funding resulted in understaffing and an inability to provide for much needed faculty development of junior staff.

Other missed opportunities were thought to be:

• failure to develop a research theme, or a greater research presence;

• failure to achieve vertical integration of undergraduate and postgraduate education; and

• failure to set up or to maintain a clinical base in which high-quality general practice could be modelled, demonstrated and used as part of a research base.

The main reasons for these missed opportunities were a failure to obtain support from our state branch of the RACGP, expending too much energy and time fighting for a place in the academic sun, and sitting on too many university, federal, state and professional committees.

The greatest joy was in "helping and watching medical students and junior academic staff grow". This included setting up curricula and learning opportunities which helped students to acquire the important skills of diagnosis, but also broadened their horizons from a narrow focus on disease to a broader understanding of the meaning and expectations that the illness had for patients, their family and the wider society.

The next most common pleasure was the opportunity for scholarship and intellectual stimulation. This occurred mainly through the opportunities afforded by sabbaticals and long service leave. Other satisfactions were the ability to pursue research, the opportunities for publication, and the collegiality afforded by a cohesive department and being part of an international "brotherhood" of GP researchers.

Two of the professors, completely new to university life, gained considerable entrepreneurial satisfaction in learning to access external funding. They believed that their universities regarded this as a greater measure of their success than the conventional pursuits of teaching and research.

All nine foundation professors bemoaned their lack of curriculum time, staff, accommodation, research and teaching money, and their inability to get a fair share of the resources available to the longer-established and "more mainstream" departments and their faculties. Two of the professors were very conscious of a lack of collegiality from members of other departments, describing these established academics as "resource bullies". Professor Eric Saint, then Dean of the Faculty of Medicine at the University of Queensland, made similar remarks in his 1981 review of the new departments, commissioned by the Tertiary Education Commission. He thought the solution lay with the existence of a friendly dean.14 Most of the professors found their deans helpful and supportive, but three found them disinterested or even hostile to general practice and community medicine.

Four of the professors commented on departmental instability due to personalities "adept at the art of white-anting" (ie, undermining). Also, three hybrid departments had structural difficulties that led to disagreement about aims and resources. One professor described his experience as "cruelly caught between the sociologists on the left and the GPs on the right".

The foundation professors were asked about the effects of their jobs on personal and family life. Five reported intermittent periods of depression and anxiety, or just plain exhaustion brought on by the chronicity of the previously mentioned conflicts, a lack of academic and support staff and the need to work long hours.

Three of the professors said they took their troubles home, with negative effects on their spouse and children. A further three reported their job as all consuming. But for two, this enhanced their life through intellectual challenge and the opportunity to meet people and be involved in a wide variety of organisations, and thereby influence public health policy.

Three of the five professors who had been in rural practice appreciated the more predictable and regular hours of academia, while two found the calls on their time to be greater. This was largely due to their desire to maintain a commitment to clinical practice, including after-hours calls, and the frequency of meetings held at night and on weekends.

The foundation professors stressed that understaffed community-based academics cannot be good at everything and therefore have to focus on two or three areas of activity. These activities were to maintain credibility as a clinician, pay serious attention to university politics, provide good leadership and role modelling, and facilitate a good research and teaching program.

The foundation professors advised their successors to spend at least three sessions a week practising medicine. This was to maintain credibility as a skilled GP and role model for students. It was also to maintain credibility with "the bag-carrying GP". They stressed the need to "do all you can to prevent a gulf between 'working' and academic GPs" and advised new professors to visit their GP teachers as often as possible, and to serve on various committees of their Division and State Faculty of the RACGP.

Most of the foundation professors saw their main role as one of leadership. They advised their successors that establishing a reputation as a good leader and manager was as important (if not more so) as establishing a reputation in research. They stressed that this leadership should include a role as an advocate for the weak, deprived and medically underserved people in communities, both in Australia and in its near neighbours.

The next most frequent piece of advice concerned the need to pay attention to internal and external university politicking, and to attend all university meetings to avoid the risk of losing the department's funds. Three of the professors advised "developing eyes in the back of one's head, learning to recognise hostile academic 'colleagues' and developing the ability to deal with them".