Avec Michelle Setlakwe, Députée de Mont-Royal – Outremont. Jeannie Haggerty who was awarded the Médaille de la députée by the National Assembly of Quebec for her outstanding contributions to advancing patient-centered primary healthcare services in Quebec
Jeannie Haggerty is a professor in the Department of Family Medicine of McGill University in Montreal and first holder the McGill Research Chair in Family and Community Medicine Research, based at St. Mary’s Hospital Centre.
Trained in Epidemiology & Biostatistics, she is a health services researcher whose domain of research is the factors related to continuity, accessibility and quality of primary care. She has developed and validated measures of the patient experience of patient-centered health care, access and continuity, and how these measures relate to changes in organizational and professional practices. In recent years she has focused more particularly on socially vulnerable populations. She was recognized as 2018 Researcher of the Year by the College of Family Physicians of Canada.She was president of the North American Primary Care Research Group (NAPCRG, 2008-2010), the founding Scientific Director of the Quebec Knowledge Network in Integrated Primary Health Care (Réseau-1 Québec 2013-2017), and Scientific Director of the McGill Primary Care Practice Based Research network (2016-2024). She has been active in engaging patients as partners in researcher and quality improvement.
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“I say yes easily and then I jump in with my whole heart and when I’m there, I’m just a doer. I’ll just do anything… And I think I was too naive to be as terrified as I should have been of certain things and that took me a long, long way.”
Chris Salisbury is Emeritus Professor of Primary Health Care at the University of Bristol. He describes himself as having had three overlapping careers: as a full time GP for more than 10 years, then as an academic doing research and teaching alongside general practice, and finally as a leader and manager. His academic work has focused on how to ‘do family practice better’
Hello, I’m Chris Salisbury, and today I’m talking to Jeannie Haggerty. Jeannie is the first chair in Family and Community Medicine at McGill University in Canada. And she’s had a very influential career as one of the leading primary care researchers in North America, including a stint as President of the North American Primary Care Research Group (NAPCRG).
I’d like to talk about some of your career highlights, but let’s begin by hearing a bit more about how you got into this field. How did you get involved in family medicine? I think you started with a master’s degree in epidemiology and biostatistics…
Jeannie Haggerty: Yes, I did have a master’s in epidemiology and biostatistics, which was itself kind of an accident. And then, my master’s supervisor was contacted because there was a project in Costa Rica and they had contacted the chair of family medicine at McGill to see if they would be interested in helping them establish a family and community medicine residency in Costa Rica. My supervisor was not in a position to do that but he said he could recommend somebody. They were looking for somebody who spoke Spanish, who kind of knew the field, and the other requirement was somebody who would be able to raise the money for it. Being told that I could do any of that was a total lie. But, as I reflect on my career this was actually just somebody who championed me, or being put forward by people who see things in me that I didn’t see in myself. The fact that I spoke Spanish, for instance, was just part of who I am, but I didn’t think of that as a strength or a particular asset. I had been a good student and I guess there were just things that he saw in me that I could do. So, I was launched into this project in Costa Rica as the coordinator and the deal was that if I did this job and if I got the money, that I would go there and just be the coordinator. I didn’t have any greater pretentions. We got the money and I was involved in this project in Costa Rica for five years, and that was like my inside track into family medicine. The director of the department at the time, Bill Davis, gave me incredible exposure to family medicine in order to prepare me to go and to do my job. So I began observing how things were set up. I participated, I overheard interviews with people who were applying to family medicine residencies at the time, I went to meetings, I went to scientific sessions, I looked at how supervision was done. He even gave me architectural drawings of what you wanted to have in a practice unit, how you needed to set it up for a teaching unit. And so I had incredible training and foundation in how to run a program. Then I was in Costa Rica and it was full on but it was awesome. And I have to say, I think I fell in love with the discipline, and it was a young discipline at the time. That was in the mid 80s.
CS: Saying that someone saw something in you that hadn’t seen in yourself, have you any reflections on advising younger academics starting now?
JH: Well, I think it is the importance of having a good mentor, a mentor who is willing to promote you. I don’t know if my mentor at the time could have articulated to me what my strengths were but I think that would have been helpful. His theory of professional development was to throw them in the deep end, and if they swim, that’s great. I would have been better served by somebody who would’ve been able to articulate those things but it did build a kind of a ‘know how’ in me that was that was really helpful.
CS: And you have been successful at getting money and getting projects off the ground, even if that wasn’t your original expectation.
JH: It was interesting because it started small. For that, I do have to say that my mentor was extremely helpful, just giving me tips and saying, we’ll try this, do it small. He was awesome at getting money so I think that he did actually mentor me very specifically in that area.
“I came of age academically, I would say, in my master’s at the apogee of evidence-based medicine. I was really interested as it was all about the rigour of the science.”
CS: Your particular area of interest is accessibility, the quality of primary care, and the impact of health system policies. How did you get into that?
JH: I came of age academically, I would say, in my master’s at the apogee of evidence-based medicine. I was really interested as it was all about the rigour of the science. My first job after my Masters was to be the coordinator of the Canadian Preventive Services Task Force. They did literature reviews to make guidance about preventive services and so on. It was a really rigorous background but it was clear that this was not the most important thing in how people were making decisions and so I was very interested in what it was that affects medical decision making. And so that was one of the reasons that I pursued my doctoral studies. I was really curious because after observing in Costa Rica that even the way that decisions were made about who was a good doctor who wasn’t a good doctor, it seemed to me that something else was happening. I was really curious about what the other factors were and, in fact, in my research for my dissertation for my doctoral studies, I looked initially at the relationship between licensing scores in the medical exam and future behaviour. I was looking specifically at how students scored on the preventive part of the exam at the end of their training and mammography screening behaviour. And, the factor that was the most influential in mammography screening was continuity of care. This is in the early stages in doctors’ practice and not in established practice. Once it was clear that they were able to establish an ongoing relationship with women, they were more likely to have better mammography behaviour. I was really curious about, what is it, and what affects continuity. And that’s why became interested in the policies that create or support things like concentrations of care or decisions to work in certain areas and so on. So, that was my main interest for a while.
CS: That gives me a neat introduction to the topic of continuity of care, which is probably what you’re best known for in the UK although I don’t know if that’s true in North America.
It’s a topic that seems to me to wax and wane in policy. It becomes fashionable to talk about it, then it disappears again, and then it comes back. What do you think are the key things we’ve learned?
JH: If I can just say, I think that we’re not always well-served by using the word ‘continuity’. In primary care, we sort of have a sense of what that means in that it is about establishing this longitudinal relationship over time, but it is used differently in other disciplines.
I guess that I did my postdoctoral work looking at how continuity was used in other disciplines. It was like a cross disciplinary review. And I think that the idea of continuity is defended by everybody. But the ‘how to’ of continuity becomes a bit wobbly. Sometimes in primary care, there’s a little bit of a disconnect between our understanding that that longitudinal relationship is actually critical to diagnostic sensitivity, and person-centred therapeutic design, and so on. Just saying that it’s continuity of care kind of minimizes it to something that is less than the whole thing. We haven’t always known how to speak about it and defend the underlying principle of what it actually is – that this is a clinically competent, relationally savvy, highly specialised skill set that underlies the whole thing.
It’s not only about continuity but it is an important mechanism and the evidence is so strong for it. I keep looking at the evidence and it is so strong. It is unbelievably strong.
“The fact that in continuity of primary care, it’s the relational piece that pulls everything else together, that pulls in the management and the information. Its much bigger than just the different pieces of it.”
CS: One of the things that you have contributed to was in helping us to disentangle these different concepts, and it concerns me that sometimes people think that management continuity or information continuity is the same thing. And I think that it’s the relationship that matters. You can have information about somebody, but that’s not what we’re talking about.
JH: The fact that in continuity of primary care, it’s the relational piece that pulls everything else together, that pulls in the management and the information. Its much bigger than just the different pieces of it.
CS: And as you say, longitudinal continuity is a means to an end. It’s a mechanism. It’s not the end itself, which is the relationship, but it’s how to measure the relationship. It’s much easier to measure whether they saw the same doctor.
JH: But still the evidence is so compelling for that continuity of care in one trusted provider. It baffles me that we have to keep reminding policymakers about the evidence. Just recently with my friend Mylaine Breton we were able to actually come up with a document because the obsession was about access in policy. But in fact, if you have access to n’importe quoi, as they say in French, to anything, it’s that you need to have access to the right things. Just being able to come back to that and remind the policymakers about the strength of the evidence and how much this matters and that it is actually political because it matters to the population and it matters to the clinicians. It’s not like a lot of other evidence, this really matters. It’s important.
CS: It’s interesting that this research has built up over roughly 50 years and, as you say, there is lots of evidence of benefit. And yet in the UK continuity has almost disappeared. I don’t know whether that’s true in Canada as well but why do you think, given all the evidence of benefit, that it’s disappearing.
JH: I don’t think that the profession defends it quite enough. I don’t know about the UK situation but certainly even in Canada, defending continuity calls clinicians to a higher standard. Then it’s not just a job, it is actually a relational healing. I think there is a bit of ambivalence even within the profession, as to whether they want to defend it because it’s not an easy call.
CS: It’s demanding, and it does require a certain level of access to make it possible to provide continuity.
JH: When I was looking at continuity and how it was practiced in Quebec, there were practices that were organized around access and practices that were organized around continuity, and they seemed not be able to do both. Doing both seems to be really hard.
Politically, there is more energy going towards access than there is towards what people get once they get their access.
CS: And I guess that’s because people complain if they can’t get to see a doctor and they need to be able to see a doctor. But they also want continuity, don’t they? I know you’re particularly interested in access to care for vulnerable people. Would you like to say anything about that?
JH: I think it’s because as I was looking at the state of primary care, there were groups that kept on recurring that regardless of other factors, were just getting less access, less continuity, more hospitalizations and so on. It began to bother me, and I thought that we needed to attend to that. This was partly because, at the same time, there was this movement towards self-management – that the patient needs to take responsibility. I totally agree with that but there is a segment of the population that simply needs support.They need strong advocacy. They need good information, and the online world doesn’t serve them well. So, I just wanted to raise awareness because I could just see that for about 15% of the population it consistently feels like they’re falling far behind.
“…NAPCRG was a place where it was safe to ask questions…like a gift economy where people were just exchanging information and helping one another. And I think that that made a huge difference in the way that I wanted to live out my career and where I wanted to contribute..
CS: You’ve also been very involved in medical politics and professional development, which led to you becoming President of NAPCRG in 2009. What was your experience of being President, what did you learn from it?
JH: if I can just go back a little bit further about my relationship with NAPCRG, because I was introduced to NAPCRG when I was a doctoral student. I kind of discovered my tribe there and immediately just got involved. It was awesome to go there and meet the who’s who of primary care research. It was unbelievable. And the attitude and the ethos of NAPCRG is welcoming. It’s bringing people in. So, it was like it was my tribe. I was involved on the program committee for a long time. I was the number one fan. So, I think that that’s how I came into leadership. It was a total surprise. But being at the leadership level was really amazing because I thought I knew a little about family medicine, but it was only at that level where I realized, wow, it’s organized so differently everywhere in the world. To get this kind of global sense of how complex it is to organize, was really something.
I’m reflecting on my career a lot these days and I realize that not just NAPCRG but there were lot of alternate communities that kind of fed me in ways that academia did not because academia can be pretty cut throat sometimes. But NAPCRG was a place where it was safe to ask questions. It was safe not to know. And above all, it felt like a gift economy where people were just exchanging information and helping one another. And I think that that made a huge difference in the way that I wanted to live out my career and where I wanted to contribute.
CS: I’ve observed several times that in primary care academia, most of the leaders are doctors rather than not doctors, and probably most of them are male. And yet most of the people who work in academic departments or primary care doing research are not doctors and are female. What was your experience of not being a doctor and being female and going into that position of leadership. Was that particularly difficult and have you got any advice for younger female academics starting out now?
JH: First of all, I think that things have changed for younger female academics. I think that things are better now. But yes, it was an issue. And in fact, in my first university appointment, I was told explicitly that I would never be able to assume any position of leadership within the Department of Family Medicine because I was not a doctor, and everywhere I would go, I was always the ‘non’ in the room, like the ‘non’ physician. I just felt that it was very strange to be characterized principally as a ‘non’ something. That has changed now, and I just don’t feel it as patent anymore. But it was kind of difficult at the beginning and I had to overcome that script in my own mind. And again, this is where I go back to being recognized by others who bring you forward for your skill set I did have, regardless of the fact that I did not conform. The container was different, but I think that I had certain skill sets and ultimately it’s the mentor and that really matters at the end of the day.
CS: So what are the skill sets that you think you’ve particularly got?
JH: Well, for instance, having several languages is really helpful. And again, this is something that seemed normal to me and not particularly like an asset. So, I speak English, Spanish and French and to be able to work in those languages was really helpful. And I would say, looking back, I’m a bit of an enthusiast. I say yes easily and then I jump in with my whole heart and when I’m there, I’m just a doer. I’ll just do anything. And I think that that’s probably what set me apart as a student. I didn’t realize it at the time. I thought that was just the way everybody was. But now, looking back and looking at my own students, I realize, that’s pretty rare- where somebody just jumps in says okay, I’ll do that. And I think I was too naive to be as terrified as I should have been of certain things and that took me a long, long way. I would just start doing it before I actually thought what does this involve and what does this mean. I felt overcommitted a lot of the time, in over my head. But I think that that was also one of the personality traits that got me ahead.
CS: You’ve achieved a huge amount professionally, and I know that that must mean you work very hard, but what do you do to switch off?
JH: Looking back, I realize that there were alternate communities and that having other places that did not value me by the same things as academia were super critical. So, first and foremost was my family. You come home and you’re the one who’s making supper and doing laundry and being valued on that level. My church community was really critical to me because it was a very level playing field were, it’s being valued for different things. And then NAPCRG, as I said, was also this alternate place. And I’m married to an artist so I don’t come home and talk shop and he has also introduced me to a world of creativity and craft. I’m not anywhere near artistic but some of the planning that we do together is about doing crafts and making things and all of which is of absolutely no consequence to me because I can just make a mess of things, but it’s still great fun. So I would say that probably that kind of, and I’m reluctant to call it, a creative component. Within my academic world, it could be characterized as a creative component, although not in the artistic world.
“I’m coming at it with such a sense of gratitude and I have this feeling, this sense, that I was carried…. and I can see in retrospect the commonality and the coherence but, at the time there was so little planning and I was so freaked out.”
CS: But it helps to have something outside medicine and somebody who’s outside medicine that keeps you grounded. You were telling me that you’re coming up to retirement soon and you’ve been reflecting on life, so anything else you want to say about that?
JH: I just feel so grateful. Looking back, as I’m going through all my archives deciding what needs to go and so on, I have such a feeling of gratefulness for the people I’ve worked with. I also want to say that particularly to the research assistants that often don’t get the kind of credit and value. I’m just in awe of the work that they do. I’m coming at it with such a sense of gratitude and I have this feeling, this sense, that I was carried, that I did not plan but was invited into opportunities. I just kind of followed my nose a little bit and I can see in retrospect the commonality and the coherence but, at the time there was so little planning and I was so freaked out. Most of the time I was scared and running and wondering am I ever going to make it. I just wish I had calmed down a teeny bit more.
CS: It’s interesting, isn’t it? It’s so easy to spend all your time thinking, I’ve got to have a big career strategy plan. But many people don’t do that. They just do the thing that excites them. And if they get bored with it, they do something different.
JH: if I can just say one last thing in terms of academic communities like NAPCRG, I was able to go to the Society for Academic Primary Care (SAPC) and UK meetings a few times and that is an awesome group. I was also surprised by how different the tone was, and the nature of the research that’s done in the UK versus what is done in North America. A lot of the really foundational work comes out of the UK – looking at things like what creates relationships and so on, whereas we’re much more obsessed with the health system in North America and with the biomedical clinical part of it. I would certainly encourage anybody who’s involved in SAPC, that you’re part of an incredible society there, and to just keep going. And, what a privilege it’s been to know people like you, like George Freeman, Martin Roland, John Campbell. These are people who I have looked up to so much, and then to meet them, and you’re actually real people. What a privilege that is to have.
CS: That’s a testament to the importance of community and doing research and it’s not just a lonely furrow. It’s been a real pleasure, as always, to talk to you. Thank you so much for giving up your time.
Remerciement; Département de médecine de famille
Jeannie Haggerty est professeure titulaire au Département de médecine de famille de l’université McGill, et titulaire de la chaire de recherche McGill en médecine familiale et communautaire, basée au centre de recherche de l’hôpital St Mary. Elle a été la directrice scientifique fondatrice du Réseau-1 Québec et la directrice du RRAPPL de McGill. Après une longue carrière en recherche sur les soins primaires, elle amorce un retrait progressif pour prendre sa retraite à l’été 2025. Réseau-1 Québec a discuté de sa carrière et de son rôle au sein de l’organisation.
