Synergy in Practice: Being a GP and a Clinical Academic

Sonia Saxena is a General Practitioner (GP) at Chartfield Surgery in Putney, London and Professor of Primary Care at 英国帝国理工学院 .

For #ShapeTheFuture, Sonia told us about the benefits and challenges of combining academia with her work as a GP. She shares her advice for anyone considering a career as a clinical academic.

Starting out

I set up my research group the Imperial Child Health Unit in 2012 with funding from a career development fellowship award. My work began with small-scale exploration examining how children’s health can be improved through better primary care. The group has since expanded its remit to improve children’s and young people’s primary care and public health. The unit now includes staff and students from many disciplines from GPs, paediatrician academics and researchers and data scientists.

I have continued to practise as a GP in London throughout this time and test out some of the ideas for new research with local communities and my practice colleagues from the local health sector.

The major milestones have been getting into medical school and my apprenticeship - first in hospitals and then vocational training in the community. I studied for and sat my professional membership exams as a GP trainee in 1995.

Career development support

I was fortunate enough to get support from the NHS in my early days as a GP on a regional fellowship, then a studentship that enabled me to start out as a researcher and further my knowledge of research methods by completing a Masters in Epidemiology at the London School of Hygiene in 1998.

I was also among the first trainees to receive an award from NIHR to complete my doctoral research in social and ethnic health inequalities and have held three successive fellowships for research into community child health and data science. I was made a fellow of the Royal College of General Practitioners in 2009 and this year was awarded NIHR Senior Investigator.

Challenges along the way

Among the most difficult things was being part-time and juggling clinical responsibilities and the demands of academic work. I worked part-time to make space in my life for raising my two young children, supporting my husband who was busy establishing his own career as a consultant in a busy teaching hospital.

I enjoyed escaping into the world of science and the intellectual stretch this brought but found that academia required a new set of skills - logical thinking skills, learning to code, the logistics of painstaking detailed data analysis and scientific writing.

The hardest aspect of an academic career for me is about becoming independent. Applying for funding tends to be stressful and you need to hone your skills in planning, organising and putting together the various elements that make a great research project. I am pleased to have built a vibrant and unique research group from scratch over the past decade that I hope will now stand on its own two feet. In practice, this means that new members will develop into research leaders. It all starts with identifying great research questions and methods to answer them well. But you must dig deep to keep going at times - deal with failure and somehow find the strength to persist.

Having continuous support from the NIHR, my main funder through fellowships throughout my career, has been the bedrock of my development as a researcher.

The training and mentorship have been invaluable, and I have learnt so much. One big turning point was joining the Oxford Primary Care Leadership Programme, after that I learnt that it is as important to invest regularly in developing yourself and the team as it is delivering the work.

My role

I am trying to answer questions about how society, practice policy and individuals can help to improve health for all children. This is a dynamic process of developing an ongoing dialogue with patients and the public to understand their goals and emerging problems. From here there is a further step of refining the problem and systematic inquiry including searching widely in science and medical literature and identifying a more specific question to answer.

Over the past decade I have built expertise in my team in designing studies using data held in electronic clinical records coupled with collection of some information directly from patients and the public. I then analyse the data to test these ideas and write about the results I find in scientific articles and research summaries so the information can be used to develop clinical guidelines and policies to support child health.

A major part of what I do is to help research staff and students access the tools and techniques that allow them to lead their own research and develop their own research career.

The best part of my job

I am curious by nature, so for me it is trying to answer questions that come from everyday encounters with patients, practitioners, and the public. These are often big questions that have not been tackled in conventional approaches to science. The team spirit that comes from meeting many curious minds is hard to beat, and it is really satisfying to see your work resonate with others.

Research complements my clinical practice because I am constantly answering questions and applying what I learn in the academic field to my practice.

I lead audits using real-world data and apply evidence to all that we do in my practice. The flip-side is that my clinical colleagues, patients and local authority partners often get drawn into helping with research projects. These are the people who ask the best questions. We also seize opportunities to spend time as a team together from Parkrun, book clubs, comedy or quiz nights or just partying hard on any and every occasion.

I have had great support from my peers and mentors in developing my own academic career. This has come in many ways from practical advice and funding support to simply being there to celebrate success, failure or offer constructive ideas. I feel at this stage of my career I get the most satisfaction from helping the next generation of practitioners to get involved with scientific inquiry and develop their own career.

Workload and staffing challenges

There are major challenges for the NHS and huge workload and staffing challenges within my own discipline. It can be extremely challenging to find GPs who are willing to meet the demands of clinical work and pursue the training and identify protected time needed for research.

Obtaining funding is a very competitive space. You have to be responsive to change, seizing opportunities can be stressful. You might have worked hard to develop a plan for the medium term but then the landscape changes. It is important to incorporate the ability to flex and respond to emerging priorities so that when opportunities arise, you have the capacity to reach for them.

What’s next for me?

I am challenged by discrimination within my profession and poor representation in science for minority and underrepresented groups. I would like to advocate to remove some of the structural barriers that exist in science careers. This could mean taking more training in becoming a more effective leader, but also finding ways of making positive changes such as seeking to influence decision making committees.

My advice to anyone considering a career in academia as a clinician

• Embrace any fear you may have and do it anyway
• Develop your academic skills at every opportunity
• Work with the best people you can find in the field you are interested in
• Find a mentor to help you to actively work on the stepping stones in your career path
• Build your research identity and communicate this consistently
• Don’t underestimate accidental journeys or interesting stops along the way, you will learn from them
• Make time for yourself and your family
• Travel, have fun and enjoy the journey

Simple, ordinary pleasures

When I’m not working, I love listening to music from around the world, cycling or taking long walks in nature with my camera, spending time with family and friends, sharing delicious food followed by long sleeps, yoga and meditation, ideally all on the same day.

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Sonia is also Director for Child Health, President of Child and Adolescent Health, European Public Health Association and ARC Northwest London Child Population Health theme lead.