Mind The Gap!

I wrote an editorial for the Aspetar Sports Medicine Journal called 'divided we stand' you can read it here. In this, I discuss barriers and divisions that I've encountered between academics and clinicians working together. This has created a lot of debate and discussion and is exactly the reason why I wrote the piece.

However, unfortunately, most of this debate has been focused around my so-called offensive style and tone rather than the issues I raise, with accusations of me having an agenda, being negative, even anti-academic.

First things first, I am NOT anti-academic. But I am anti-egotistical, anti-hierarchical, and anti-progressive with those who try to prevent others from highlighting issues, asking questions, or challenging ideas. I do appreciate that my views agitate some, but to complain about my tone or to accuse me of ulterior motives is a diversion from the main point I am making 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 academics and so-called 'clinical academics'. These individuals have managed to obtain some fantastic job roles which are able to combine research and clinical time.

These roles are a split between paid research and teaching time, usually attached to a university or other academic institution, and paid clinical patient contact time.

However, these roles are rare, and the individuals in these roles appear to have a rather skewed view on what is happening outside of their utopia. I have no doubt that they do see 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 don't do any clinical work. Most academics 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!" or "not at all"

Most academics I speak too are usually tired and frustrated of clinical work and have no intention of going back either due to the workload, financial constraints, the environment, or the lack of results and outcomes, and I can understand and empathise with this.

This is not to say all academics are this way inclined. Some do still see patients and enjoy the challenges of both clinical and research work as well as helping and supporting others do the same. And this gets nothing but my utmost respect and admiration, but again I will state that this is not common.

Most clinicians 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 or fruitless with no financial gains or reimbursement during their time.

So I will say again just as I did in my original editorial that it is these differences between academics and clinicians that are some big barriers to the future progress of trying to implement research into clinical practice. This needs to change, and yet again is why I also wrote the editorial.

What we need is more clinical academic posts, we need more paid, well-supported posts that 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. Myself included. I have over the last few years been dabbling in some clinical research, and its been hard work.

It's not that I expected it to be easy or a walk in the park, I knew I would have to sacrifice time, energy, and some money to do this. I just wasn't expecting how much. For example just to get one ethics board to review one submission of a trial I was working one last year it was £1500. 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 wasn't expecting many of the other barriers I also came across, such as being ignored by some institutions as well as by some well-respected academics when I reached out for some help and guidance, even receiving a few short sharp 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 what I have experienced.

I try to point out 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. But I also highlight some flaws in some of the clinicians I have also come across, such as being too lethargic to get involved in research, having a poor understanding of the scientific principles, and being 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. And I finish off by saying let's get our shit together, put aside the egos and hierarchy and start working together better.

This has created a lot of feedback 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 quite a lot of complaints mainly from academics who seem to think I have created more barriers with this editorial.

I just think this is nonsense from a few bruised egos. 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!

Summary

"Rome wasn't built in a day" is a saying that is often used to describe issues that take time to resolve. Change and progress takes time, but to move forward we need to highlight issues and barriers. And although Rome wasn't built in a day, there is also another saying "there are many ways to Rome" to highlight that if current progress is stalled, take a different route!

I don't know about you, but I'm ready to move forward and take another road because the one we are on doesn't seem to be going anywhere.

As always, thanks for reading

Adam