I did an editorial recently for the Aspetar Sports Medicine Journal called ‘divided we stand‘ you can read it here. In this piece, I give my thoughts and opinions on some of the issues of trying to get research implemented into practice. In particular, I discuss the barriers and divisions that I’ve encountered between academics and clinicians working together. This has created a lot of debate and discussion which is exactly the reason why I wrote the piece. However, unfortunately, most of this debate has been focused around my tone and so-called offensive style rather than the issues I raise, with accusations of me having an agenda, being negative, even being anti-academic.
First things first I am NOT anti-academic, but I am anti-egotistical, anti-hierarchical, and anti-progressive by not being able to highlight issues, ask questions, or challenge ideas. I appreciate that my views can and do agitate some, and this is fine, but to complain about my tone or to personally accuse me and my motives is failing to stick to the points I make which is the continued gap that exists between most academics and clinicians working together better.
It appears that those who have taken the most umbrage with my editorial are those who have very enviable positions, the so called ‘clinical academics’. These individuals have managed to achieve with lots of hard work, heaps of determination, and I’m sure a little bit of luck, some fantastic job roles which are able to combine research and clinical time. These roles are usually a split between paid research/teaching time, usually attached to a university or other academic insitution and paid clinical patient contact time.
However, these job roles are rare, and the individuals in these roles do appear to have a rather skewed view on what is happening outside of their utopia. I have no doubt that they do see good, close, effective, productive, rewarding working relationships between academics and clinicians which is great, but again I will state, these are rare!
Most academics are full time!
Most academics I know don’t do any clinical work. Most academic posts focus on teaching and researching, and in my experience, most academics go into teaching and researching to ‘escape’ from patients. Having talked to many full time academics about clinical work and if they miss it I usually get a reply of “oh hell no!”. Most academics I speak too are usually tired and frustrated of clinical work and have no intention of ever going back either due to the workload, financial constraints, the enviroment, or the lack of results and outcomes, and I can understand this.
But thats not to say all academics are this way inclined. Some are still seeing patients and enjoying the challenges of clinical and research work as well as helping and supporting others do the same, such as Christian Barton who describes what he does in his recent blog in response to my editorial here. And this gets nothing but my utmost respect and admiration, but again I will state that this is in my experience not common place.
Most clinicans are full time!
Most physiotherapy clinics in the national health service and in private practice employ physios to do one thing. See patients. That’s it! The ever growing demands on hospitals and physio clinics mean most employers want their clinicians assessing and treating patients when ‘on the clock’. Most employers do not want their clinicians reading, researching, or doing what is usually seen as frivolous, fruitless, fannying about with no financial gains or reimbursement during their time.
So I will say again just as I did in my orginal editorial that it is these key environmental and personal differences between academics and clinicans that are the big barriers to our future progress of trying to implement research into clinical practice. But this needs to change, and yet again this is why I also wrote the editorial. What we do need is more of these clinical academic posts, we need more paid, well supported clinical academic posts to help implement and push research further and faster into practice!
The usual clinical academic!
Currently, if a full time clinician wishes to do some research the reality is they have to do it in their own time, using their own resources, without getting paid. And many, many do this. Me included. I have over the last few years been dabbling in some clinical research, and its been hard work. Now it’s not that I expected it to be easy or a walk in the park, I knew I would have to sacrifice some time, some money, and some energy to do this, I just wasn’t expecting how much. For example just to get one ethics board to review one submission was over £1500, and I estimate I’ve worked over 200+ hours unpaid, not to mention the countless late nights and weekends sat at my desk reading, researching, missing out on family and other social time.
I also wasn’t expecting many of the other barriers I came across, such as being ignored by some academic institutions as well as by some well respected academic individuals when I reached out for some help and guidance, even receiving a few short sharp flat out refusals from some.
In a nutshell
So when I was approached by Aspetar to write something on the issues around the difficulties of implementing and getting involved in research I thought this would be a perfect opportunity to highlight the issues I have faced. In a nutshell, I try to point out in my editorial some of the flaws in some of the academics I have come across. Things such as being too analytical, too hierarchical, too busy to help clinicians do research. I also highlight some flaws in some of the clinicians I have also come across, such as being to lethargic to get involved in research, having a poor understanding of the scientific principles, too busy to look up from constantly treating patients and realising things need to change.
I also discuss some of the barriers that these two groups have in working well together such as difficulties in communication, lack of time, resources, and funding. Finally I finish off by saying lets get our shit together, put aside the egos and hierarchy and start working together better. That’s it.
In general my editorial has created a lot of positive feedback mainly from the clinicians with many sharing their own frustrations and stories of issues and barriers they encountered when to trying to get involved in research. However, there has also been a quite a lot of complaints mainly from the clinical academics. They seem to think I have gone and created more barriers with this editorial and that the piece is harmful to generating and promoting future collaboration. What a load of crap! Highlighting issues and suggesting ways forward in my opinion doesn’t hinder progress. Bitching, moaning, and complaining about tone and offensive style whilst burying your head in the sand and refusing to accept or listen to others experiences does!
So in summary… “Rome wasn’t built in a day” is a saying that is often used to describe these issues between academics and clinicans, and I totally agree. Change and progress does take time, but we need to ensure it doesn’t stagnate by highlighting issues and barriers that some are having in trying to get involved research. So although Rome wasn’t built in a day, do not complain when someone tries to tell the builders to get a move on!
As always, thanks for reading