Florian Stigler is GP and researcher with a passion for making Evidence-Based Family Medicine exciting and easy to understand.
Florian trained in Styria/Austria with postgraduate studies in the UK in Manchester (MPH) and London (DrPH). He works as a GP with focus on preventive medicine. He has a passion for new projects and created “Golden Nuggets of Family Medicine” – newsletter for busy GPs to provide exciting, practical, evidence-based and short insights. For free and without industry funding. He has been involved several professional organisations (AMSA, IFMSA, JAMÖ, WFPHA).
Watch the video of the interview below or on Youtube or  listen to the podcast on Spotify and all the major platforms
” There’s a lot of pleasure in caring for patients and I think every doctor knows this feeling. You might be having a bad day but then you see a handful of patients and you appreciate life”
Today we are in Austria and I’m talking to Florian Stigler who has created some really exciting and dynamic innovations in general practice communication…
I’d like to take you back to the very beginning, what got you interested in medicine?
Florian Stigler: I remember. I was 14 years old, and I was excited about running, and my father was always excited about running, and I stumbled upon a book from a former Olympic coach from New Zealand.  Reading this book, and a bit about the physiology, I enjoyed it. And this got me interested in this biological aspect of medicine. And then there were some people who inspired me. I remember one in particular. I was at the party when I was about 16, and one of the girl’s boyfriend was a medical student, and he was a very positive and enthusiastic young guy.  He was also an inspiration – he was working hard but enjoying life at the same time and that was something I looked up to. So, 3 or 4 months before medical school started, I made my decision. It was a tough one in the beginning but here I am many years later.
DMacA: You then went to medical school, tell us about your experience, did it live up to all your expectations?
FS:  It was a special experience because the system was changing and I was in the first cohort in a very different system.  We were the first year at every stage and we did not really know what to expect and that made it a bit difficult. And then after the first year in the hospital, I had my first kind of medical career crisis where I thought, I don’t want to work at the hospital and thinking, did I make the wrong decision?  But continuing on, I became involved in a medical student organization, the International Federation of Medical Students Association, a big global organization all over the world and I was very enthusiastic. I love to organize things, which I still like to do today. This was also the foundation of my later career. I got in contact with public health, which was something that seemed very unsexy in the beginning. It felt really boring, all about smoking and obesity, but then I became the local public health officer, doing projects, and I began to love it. I ended up being the public health director of the whole organization. Later my public health training also influenced me as my public health training was mainly about primary care and family medicine, about the systems perspective, about how we can change and improve our primary care systems.  When I look back now, it was partly a result of coincidences.
DMacA:  Let me take you back to your medical student days because you talk about your involvement with organizations. But, it wasn’t just involvement. You were a really dynamic influence in a number of different organizations. Tell us about that.
FS:  For about 20 years I’ve been involved in some type of voluntary work. In the beginning it was the medical student organizations, where I had a lot of passion. And this was about learning and seeing where my boundaries were and learning new skills. We believed we were changing the world but, in the end, we were more talking with each other, which was fine. But then I became involved with the Young Family Doctors organization in Austria, which was also interesting because I was once the Secretary-General of this young doctors association. But we had only four members. We had one meeting of our whole organization in one living room. And we decided who would take on the various roles and I said I would be the Secretary-General. Today it’s a very active organization and each year they have a meeting with about 150 participants so they are very active and growing since then. When this was over and I got involved with different fora and different ways of bringing people together. This idea of bringing people together and having conversations was something that started back then.
Florian with Barbara Starfield and her husband
“It was mainly hospital based training and shorter than in other countries and general practice was not defined as a specialty, and while it would have been possible to finish it only working in the hospital, I choose to work in the GP office for half a year at the beginning, and for a half a year in the end, but this was my own choice.”
DMacA: You qualified and, to begin, you trained in general practice. Tell us a little about the process of training and what it was like in Austria at that time.
FS:  I continued at first with doing a one year online master’s in public health. I remember it felt a bit boring sitting at home the whole time. GP training was still part of the old system of training and the system has changed in the meantime. It was mainly hospital based training and shorter than in other countries and general practice was not defined as a specialty, and while it would have been possible to finish it only working in the hospital, I choose to work in the GP office for half a year at the beginning, and for a half a year in the end, but this was my own choice. It was a good experience but the training itself was very tough and not the most fun experience of my life. In many ways, Austria is probably not the best country for teaching and training. In my mind I was also kind of living in the UK and the United States so a lot of my further influences were coming from other countries. The training was quite hard but it has improved. It’s longer now and it’s a mandatory component to work in family medicine, which is very important, especially for family doctors. Â
DMacA: Talking about your interest in public health and, very interestingly, about your mind being in the UK, you went on to do a doctorate in the UK with Nick Mays, a world renowned expert in health services research. Tell us about that experience.
FS: For me it was amazing. Its been a long story. My mind was drawn to these countries because there is so much knowledge and history and engagement, and with so many people working in public health and primary care or both, which did not exist in Austria. The first Master in Public Health was introduced in Austria a little more than 20 years ago so there wasn’t even Master’s level education. Now we have a public health community, so it’s growing, but we are still looking up to those other countries. I remember when I was doing my doctorate, I was around 30 years old and I lived in London for a year, and this was definitely my most exciting time. I was going to lectures almost every evening. I felt I was where I belonged, and I learned a lot. I had a research mindset before but, of course, I learned much more about research and, it was an exciting time. I also have to say I also had a strong mentor in Austria who was called Martin Sprenger. He was the head of the first public health school in Austria, and he was also interested in primary care.  We had many discussions over many years about public health, looking at public health from as many perspectives as possible, which was a bit different than the UK where there were vertical experts, usually on one topic. I’m happy that I was trained with such a generalist approach because I would consider myself as a kind of a generalist now. But, the UK was very important for my professional development in many ways.
DMacA: The subject of your doctorate is very topical at the moment…
FS: Yes. And I think it also fitted very well to Austria. My topic was broadly about primary care in Austria but comprised different studies. In one study I compared diabetes care in primary care between Austria with the UK, which was really interesting because those two countries are so different. Then I looked at the family doctor shortage in Austria using a qualitative research method. I interviewed many different experts from different perspectives, which was really, really interesting.
My master’s thesis  was also interesting in this way as I was kind of replicating Barbara Starfield’s past international work by repeating it in Austria so I could compare it with her data. And it was the first study which showed that we have a weak primary care system in Austria and later this big European study confirmed that, yes, Austria has a weak primary care system. So decision makers were becoming aware of this issue and then initiated a reform. I think there were many influences, not just those two studies, but, it was interesting to see that system reform began ten years ago and is still continuing today. My doctorate and my research has been really helpful in this way. And family doctor shortages, are of course, not just an issue in Austria but also internationally. We also did a study of what you can do to address this and we found 95 measures, so I learned a lot.
“I much more enjoy reading an exciting study, summarizing it and communicating the findings to other people…It was a switch, more in the mind than in reality, because I needed those years of being a proper researcher to learn the principles and the quality standards underpinning research.”
DMacA:  You’ve completed your doctorate and now you’re back in Austria. Tell us now about your current career and how it’s developed.
FS: I’m currently working part time as a doctor and part time as a researcher/manager who is interested in primary care and I would like to retain this balance. Also, to work on a systems level, as someone who wants to support primary care reform. I still have my other side projects, which are voluntary and this has developed in the past year. I work as a general practitioner with a focus on preventive medicine in a health center in Graz. I did research work in the family medicine department, and now I work in the Austrian Public Health Institute as the Scientific Officer to improve research quality in the institute. I have these different roles of being a doctor, being a researcher, or having a research mind. And, I still want to do my organisational work.
DMacA: Â So you have these components, including your clinical work and your academic work. Tell us a little bit more about that academic work before we move on to your other projects
FS: I always had an interest in research. Then I had my research training, I did my scientific studies, and I got them published. I also had some opinion pieces published in the major journals like Lancet and NEJM. I was working as a researcher for some time before Covid but in the last five years, this has kind of stopped. I remember that my professor, who was leading the family medicine department, once told me – you are a kind of medical journalist. I remember that I was a bit angry at the time about what she said but, actually, she was completely right. I think I am more of a research journalist than a classical researcher because I much more enjoy reading an exciting study, summarising it and communicating the findings to other people. I find this much more satisfying than working for 2 or 3 years on collecting data, analyzing data, and writing up the articles. So I’ve changed my direction somewhat which fits with my blog and newsletter really well. It was a switch, more in the mind than in reality, because I needed those years of being a proper researcher to learn the principles and the quality standards underpinning research.
DMacA: You’re still involved in a number of political organizations, including young GP’s group in Austria. Tell us about that continued work.
FS:. I’m not involved with the Young GPs anymore. I’m too old and I’m therefore not allowed to be involved with them any more! But, I’m still involved with political work. I’m the Chair of the Global Forum on Universal Health Coverage and Primary Health Care, which is very interesting. This connects almost 600 international leaders from 80 countries. We try to learn from each other, to influence each other, and it sometimes involves research, sometimes political work and sometimes policy. And, for the last four years, I’m involved in the Austrian Public Health Institute, where we support the primary health care reform in Austria. Over the last ten years we’ve introduced a new model in Austria because before that we only had single handed GP’s. Ten years ago we introduced the idea of starting interdisciplinary primary health care teams, which was a huge reform. It needed new laws, it needed the support of different stakeholders, and it began very, very slowly. But it now has momentum and is going much faster than in the beginning, thanks to support from the European Commission. We got €100 million to fund half of these new buildings and this continuing reform is very exciting. We are a team of maybe ten people doing different projects to support this reform and I’m very involved in the technical aspects. In the past I was very active with respect to tobacco control from a political perspective but that’s a different story.
Florian with Chris VanWeel
“I believe that change is possible from a top down perspective, by talking to politicians or journalists about how primary health care should change. I also believe change is possible from bottom-up by talking with the individual GPs themselves and I think this is a great platform that can inspire.” Â
DMacA:  Now let’s talk about a really exciting component of your work. And that’s your work in the communication of Evidence-Based Medicine in Primary Care.
FS:  I started a Family Medicine Newsletter called the “Golden Nuggets of Family Medicine”  which I send out to family doctors, and where I try to include only the most exciting and useful news and information in a very compact format. I still believe in email as a communication tool because everyone reads emails. Newsletters are often long and boring, and even I don’t usually open them because I know they are going to be long and boring. I believe they can be completely different and, from the feedback so far, I think I have achieved this. Every sentence in the email should be necessary, exciting or useful. It has got a lot of traction so far and I began almost exactly one year ago, although I’ve had the idea for ten years. I first had the idea when I was in London but first I had to finish my doctorate and finish my training to become a GP. Now, I have the time again so I was able to start.
For me, this is now a very exciting part of my work life. It takes a lot of time, but I’m excited about it. I have almost 2600 subscribers and it’s making progress. I would also like to organize an online conference for family doctors.  One day I hope that I can make it my part time job and that there may be some kind of revenue so that I can be paid for what I’m doing. This is the plan. But, I’ve found my niche because I love reading these research studies, I love to summarize them, I love managing the layout of the homepage, I like the marketing aspect and thinking about how to reach more GPs, and I like this organizational aspect.  I believe that change is possible from a top down perspective, by talking to politicians or journalists about how primary health care should change. I also believe change is possible from bottom-up by talking with the individual GPs themselves and I think this is a great platform that can inspire.  It’s mainly about clinical aspects, of course, because family doctors are more interested in clinical research studies but, from time to time, I try to include some issues related to policy reform. It’s still in the early stages but its a growing community and in many different countries all over the world. I believe it can be something really useful, something bigger and one day I hope to have funding and maybe even some employees to make it even more effective. I’m loving it. It’s kind of a startup.
DMacA:  My final question is slightly unusual, because as we were talking, I see a sign behind you that says “live a good life”. Tell us, what do you mean by “live a good life”?
FS:  It’s probably a mix of pleasure and meaning. The good thing about medicine and family medicine is that it can give you both. There’s a lot of meaning involved. We can really make a difference, no matter if we work on reform at the systems level or in caring for patients.  There’s a lot of pleasure in caring for patients too and I think every doctor knows this feeling. You might be having a bad day but then you see a handful of patients and you appreciate life. It’s also about doing what you really love and what’s inside you. And for me, it took some time to find my niche, but I tell everyone, don’t give up, be really persistent,  and don’t stop before you have found it.
DMacA: Â Florian, thank you very much for sharing so much of your life, your career, your enthusiasm, and your commitment to the future of family medicine. Thank you.
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“Golden Nuggets of Family Medicine” The Newsletter by GPs for GPs. Exciting, practical, evidence-based and short. For free, no industry funding.
https://family-medicine.org/golden_nuggets/
“8 Reasons Why Family Physicians are the Actual Stars of Medicine”
https://family-medicine.org/stars_of_medicine/
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