Professor Parker Magin is Senior Academic Advisor, Royal Australian College of General Practitioners GP Training Research Unit, Newcastle, Australia; Conjoint Professor, the University of Newcastle; and Adjunct Professor, the University of New South Wales. He has been an NHMRC Medical Postgraduate Scholar 2003-2006; and 2007-cohort member, International Primary Care Research Leadership Programme, University of Oxford. His main research interests are the in-consultation experiences of GP registrars; antimicrobial stewardship; medicines use and deprescribing in older patients; and dementia.
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“There were giants in the land in those days. There were truly impressive people who were making a difference in a discipline that was ripe for a difference to be made. It was an exciting time to be watching from the sidelines…”
Today, I’m talking to Parker Magin, who’s a professor in the University of Newcastle in Australia and works for the Royal Australian College of General Practitioners. Let’s bring it back to the very beginning. What started your interest in medicine?
Parker Magin: Like much of what I’ve done in my career, there was no plan. I didn’t intend or plan to do medicine when I started university. I started a science degree but when I was doing that, living in a university residential college with a number of people who were doing medicine and talking to them, it seemed really interesting. So I changed course at the end of the first year of university.
DMacA: You were a scientist at heart, but you subsequently went into general practice?
PM: Again, it was not planned. I was part of a physician training program in Newcastle. But, I was finding that pretty restricting, the kind of hours, and the hospital work wasn’t in some ways exactly what I wanted to do. And, I wanted to spend more time with my wife. I wanted to play cricket. And so I thought it’d be an easier option to do general practice. That wasn’t really how it turned out. It turned out that they were quite long hours, but really rewarding.
DMacA: That was a really exciting time to be in general practice, with a whole generation of GP’s who were dynamic, enthusiastic, and committed.
PM: Yes, and I was reading the GP journals. There were giants in the land in those days. There were truly impressive people who were making a difference in a discipline that was ripe for a difference to be made. It was an exciting time to be watching from the sidelines at that stage.
DMacA: That clearly had an influence on you because, after some time in practice, you headed in an academic direction.
PM: I’d been working as a full time clinician for some years- probably the best part of a decade. And then I gradually moved into academic work. Initially, I had a very part time position, mainly teaching. But when you are teaching in an academic department, you hang around with people who are doing research and you become interested. You start to tag along and learn and become committed to that.
“There is a trend now, and we’re trying to encourage young GP’s, to become involved in research early, and to do a PhD early. There is certainly a need for those people in terms of academia and a great need for clinician researchers in general practice.”
DMacA: You’ve had a fantastic research career, and developed skills in both quantitative and qualitative research, a combination that we don’t often see now. Tell us about your research career.
PM: I started off very much tagging along with a couple of studies being done in the department, which the head of the department, Dimity Pond, (https://www.healthed.com.au/meet-our-experts/prof-dimity-pond/)
was leading and that really interested me. So, I did a graduate diploma in epidemiology, and from there went on to do a PhD. The usual path was to do an extra year added to the diploma to get a master’s degree with a research project. But the project I wanted to do was a bit complex and so, rather than doing the year with the master’s research, I did a PhD, and my research was on the psychological and psychiatric impact of skin disease, which interested me clinically at the time.
DMacA: You’ve done lots of other things as well. Tell us about some of the other things…
PM: I think I’m pretty much a GP still at heart. And so the topics that I got involved in cover a wide range. Topics like, TIA and minor stroke in the community, community management and ascertainment of mild stroke and TIA. I did quite a bit of work on that and continued to do quite a bit of work on potentially inappropriate medicines in older patients, and in dementia prevention. I’ve been involved in a wide range of things for the past 15 years. A big focus has been on the epidemiology of GP registrars’ in-consultation practice. And that’s taken up a big part of my work in the past 15 years.
DMacA: I’m going to ask you about that later, but let’s go back a little bit. Your academic track trajectory is slightly unusual nowadays as most people go straight into an academic career. You did it differently. Which do you think is the best option?
PM: It’s hard to say. That’s just the way the cards fell. I think that general practice is a little bit different to the subspecialties where the career path is clear- do some research and often a doctorate as a carry-on from specialty training. And I think, certainly for my generation, there was a tendency to remain in practice longer before going into academic practice. There is a trend now, and we’re trying to encourage young GP’s, to become involved in research early, and to do a PhD early. There is certainly a need for those people in terms of academia and a great need for clinician researchers in general practice.
I think it’s sometimes a little bit difficult, and a little bit different, in general practice because the craft is so hard and so long. For subspecialists their clinical work is often very narrow and specialized and very close to their research. For GP’s it often takes longer to become, or to begin to feel, confident as a practitioner. And by definition, it’s pretty hard to limit your clinical practice to a small area so that you can concentrate on research within that area as well. So again, I think there are reasons we want to encourage registrars and early career GP’s early to do research but it may not be quite the best path for some people.
“That was a really influential part of my career. It was a program based in Oxford and funded by the National Institute of Health Research. It brought fairly early post-doctoral people together from different countries and it was around research leadership.”
DMacA: There was another pivotal moment in your career because you were part of the Brisbane group, which I think is called the Oxford Group now. Tell us about that.
PM: The “Brisbane Group” was a really influential part of my career. It was a program based in Oxford and funded by the National Institute of Health Research. It brought fairly early post-doctoral people together from different countries and it was around research leadership. There was quite a bit on leadership with people coming to talk to us; research leaders and people who researched leadership. But the big influence, I think, was just getting to know and work with people within our cohort and, then, other cohorts. We’ve done quite a bit of collaborative work together and that was a great help, finding like-minded people with common interests and working together. It was really supportive and I would recommend anyone who has a chance to look into doing it.
DMacA: You had some pretty high flying peers in that group. Tell us about them and what they’ve gone on to do.
PM: We had people in my group like Dan Lasserson who has been a leader in the interface between community health and hospital health with acute management of things that can be managed outside the hospital, but using hospital type resources which complement general practice. Chema Valderas has had a distinguished career and he’s now working in Singapore with a focus on patient reported outcome measures. I think of Mieke van Driel, who had just completed her PhD in Belgium when I met her in Oxford. She came to Australia soon after that. She is a very accomplished researcher and someone I’ve worked with in the 15 plus years since then. Those people have been really quite influential. I’ve worked with Dan and Chema and, especially, Mieke and have done a little bit of work with some people in the other cohorts.
“… there are more males doing part time work. And the approaches are probably quite different. . but from what we can see, part time practice probably has a little bit less influence on the development of a general practitioner in training than is maybe thought anecdotally. There are certainly differences. But they’re possibly not as great as you would imagine.”
DMacA: Having spoken about some of these influential people I’d now like to ask you about your own research because your research focuses on a number of key areas where general practice is changing dramatically. First, let’s talk about your work on transitions.
PM: This is work by a young GP academic from the University of New South Wales, Michael Tran, that I’m supervising at present. Michael is very interested in the process, the transition, of going from working in hospital practice to become a competent GP independent practitioner. And it’s a bit unclear just how those things happen. In the past, these transition periods would have been looked on as problematic barriers that have to be overcome. And there’s obviously something in that. But Michael is also been quite interested in how those can be formative positive experiences. We’re looking at data from an ongoing study, a longitudinal study of registrars over their three training terms and looking at how they change, and how those changes may group together. That’s a really interesting piece of research that we can’t tell you too much about yet. We don’t know what it’s going to find. It’s exciting trying to descriptively find out what’s happening.
DMacA: One of the other areas that has changed dramatically in general practice in our generation is the move to part time general practice, and you’ve studied how that has changed the nature of practice, and it’s not just women GPs, it’s men as well.
PM: Its not just females, there are more males doing part time work. And the approaches are probably quite different. Within the work that we’ve done, it’s been observational and we haven’t quite dissected out all the strands yet, but from what we can see, part time practice probably has a little bit less influence on the development of a general practitioner in training than is maybe thought anecdotally. There are certainly differences. But they’re possibly not as great as you would imagine. And there are other interesting things.We’ve done some work on what appears to influence doing qualifications beyond just basic GP qualifications, training, university qualification, etc.. And it’s contrary to what we might have thought, it’s not female gender that’s associated but, on multivariable analysis, the association is with having dependent children. Things are in flux and I think some of the some direct observations around gender are probably not borne out when you look closely. It’s more complex than just gender.
DMacA: And a third area that you’re researching, which really current at the moment, is recruitment and retention in rural practice. And it’s not just Australia, its right around the world.
PM: It’s a really big issue in Australia, and Australia is a particular case because of the demographics of the population, with it being such a large area but being a very strongly urban population. A large proportion is constrained in urban areas compared to a lot of countries. Similar to Canada, it’s a large country and there are particular issues related to rural practice. There’s been a lot of work on how to attract people to rural practices and the [GP] training program has workforce as well as educational functions. There’s an over representation of registrars in rural areas but the issue is the retention of those registrars. They form an important part of the actual workforce just by headcount but the big issue is if you can retain them after training. That’s a more complex issue. There’s a great deal of research now, not just our research, on what are the overall drivers of that whole process, that decision as a registrar as to where to go when you get your fellowship. We’ve certainly identified some associations but how causative those associations are, is another matter.
“There’s been a lot of work on how to attract people to rural practices and the [GP] training program has workforce as well as educational functions. There’s an over representation of registrars in rural areas but the issue is the retention of those registrars. They form an important part of the actual workforce just by headcount but the big issue is if you can retain them after training.”
DMacA: As part of all this work on education you have been very involved with the Australian College and, regarding education, the College has had a lot of challenges. Tell us about the challenges.
PM: There have been a number of changes in GP training over the past 20 years or so, and the most recent is that two years ago the Royal Australian College of General Practice and the Australian College of Rural and Remote Medicine took on the role of training, which had previously been the role of, I think, 9 or 11 regionally based not-for-profit educational organizations. Instead of just setting the curriculum, conducting the exams, setting standards of practice etc, the College actually took on the role of running training. That’s been an initially difficult process because it’s a very big job change but that all seems to be settling down now. So, we have a truly national program now although with strong regional flavour for education to suit the particular areas. But it’s still a national program.
DMacA: It’s great to hear you talk about education, and your research, and the future of our GP community with such enthusiasm. You said at the outset that one reason for going into general practice at the beginning was to further your interest in cricket. So let me ask one final rather mischievous question, how has your cricket career fared and what’s your current interest in sport?
PM: The cricket career was never going to be anything, I just enjoyed playing, but it was mainly for family and things like that [I left the hospital system] and that’s a long time ago now.
DMacA: It’s just been an absolute pleasure talking to you. Thank you very much for all your research on the future of our discipline. It’s been wonderful. Thank you very much indeed.
Some key publications:
https://academic.oup.com/pmj/article/100/1184/382/7595440
https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2021.791193/full
https://bjgp.org/content/71/713/e895
https://onlinelibrary.wiley.com/doi/abs/10.5694/mja16.01421
https://academic.oup.com/fampra/article-abstract/35/1/53/3976566?redirectedFrom=fulltext
