Why do you need to invest early and why do we need to invest in trainees when they’re still undergoing their vocational training? It’s because if we can inspire and expose them to academic careers, they will see this as a long-term career option that otherwise they may not get an opportunity.
– Dr Pallavi Prathivadi, 11 Nov 2025

Last November at GP25, the The Royal Australian College of General Practitioners (RACGP) annual conference, I had the great pleasure of interviewing Dr Pallavi Prathivadi, the GP Lead of the GP academic post program, about the recently announced expansion in positions for academic GP registrars, as well as the critical importance of primary care research, and building the capacity of the future GP clinical academic workforce.

The interview is part of my “Blitz Chess Chats” series on my chess YouTube channel, and Dr Parathivadi is hilarious if you want to watch the 9-min game of blitz chess that I use as an interview ice-breaker! Otherwise, you can dive straight to the interview with the interview-only cut! 😊

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Interview transcript

Dr Michael Tam

But to follow on the question, you’re a… you work part-time for the Royal Australian College of General Practitioners. And have some leadership over the Academic Post program. So, can you tell me a little bit about that program?

Dr Pallavi Prathivadi

Yes. So, maybe for your non-medical fans. We are both general practitioners, so family medicine physicians. And a subspecialty within that, or a special interest, is academic general practice. We combine seeing patients clinically, with interests in research or medical education, or both, or related fields like academic publishing, writing, journal work.

Within the Royal Australian College of General Practitioners, we have a structured 12-month program for our trainees. So, on their way to becoming specialist general practitioners, and as part of their training, they combine part-time clinical practice with a 12-month part-time academic post. In the academic post, they have a university appointment at any university medical department in the country, and they undertake a small research project usually in a topic that’s very grounded clinically, and has come from some moment of frustration and clinical practice, or a clinical interest. They teach medical students and a lot of them who are interested in medical education will be involved with curriculum design, assessments, marking OSCEs, so they get a taster of what life is like for you and me as GP academics.

Dr Michael Tam

And for the North Americans, the academic general practice program in Australia would be like a family medicine residency. So, fully qualified doctors trained to become specialist family physicians.

Why is it important from your perspective that we invest in research and in junior researchers in family medicine, in general practice?

Dr Pallavi Prathivadi

There are endless reasons to this. So, if we break it down into why do you need to invest early and why do we need to invest in trainees when they’re still undergoing their vocational training, it’s because if we can inspire and expose them to academic careers, they will see this as a long-term career option that otherwise they may not get an opportunity to. And so that’s the point of the program, is to give a taster of what life is like.

We need to have research done for GPs, by GPs. How we get inspired for research so often is because of some clinical problem that we’ve seen in general practice. Or we have checked guidelines and they don’t match with what we’ve seen in clinical practice. Or there is some conundrum that we’re trying to solve, some way we’re trying to treat a patient and we don’t know what the best way is. So then we need to find out what is the best way. How do we provide the best, safest care?

All of that comes from research. We need to do really investigative work. That’s what research is right? To answer a problem so that you can solve the problem and translate that into better patient care, which is what our job is.

Dr Michael Tam

Sometimes, I think people can lose a little bit of sight of the words between research and science, but this is part of the scientific method, you know, observation of some interesting phenomenon. So for us as doctors, as clinicians, that might be problems and issues we see in our delivery of care with patients.

Sometimes some of those issues and questions are not answered and they become the best research questions because they directly, potentially, benefit the people we’re actually providing care to, if we’re able to find an answer.

Dr Pallavi Prathivadi

Exactly. And if we can’t find an answer, that’s helpful too, because it means that we don’t have that kind of convincing body of evidence. And so then we contribute to showing, either way, by seeing equivocal results.

Dr Michael Tam

One of the things that I’m interested in also is that there’s an inverse pyramid of scientific evidence. That almost all medical care is provided in the community by primary care teams, including family doctors, us GPs, family physicians, and yet the evidence generation is often in hospital systems. Now hospitals are very important, but for the most part they’re very rare events in people’s lives. And what we know is that human body, biology, healthcare, it’s actually very complicated and evidence generated in a particular context, like a hospital context, not uncommonly can’t be transferred into community practice, at least not without some major adaptation. It’s not as simple as, “it works here, thus it definitely will work in the community”. Often it doesn’t work in a community.

Dr Pallavi Prathivadi

Well, often, Michael, when they test these things in hospitals, let’s say the effectiveness of a drug in a hospital, those trials are so tightly controlled. They will accept certain ages, certain conditions, certain parameters to try and minimize any extraneous variables to try and get the most data on does this drug work or not. The truth is that’s not necessarily how real life is. That’s not how our patients are. Whether a drug works or not is dependent on so many things, including the very basic, are they taking the drug? If it’s an effective drug in the human body, but it’s not getting into a human body, it’s not effective.

So, the translation you’re talking about in how we practice and the majority of healthcare in primary care is dependent on affordability of treatment, access of treatment, housing, finances, health literacy, every single phenotype that varies, every age that varies, the sex that varies, ethnicities of our bodies. Drug effectiveness is going to vary across all of that. So, the very simple, “does this drug work?” is one question when it’s tested in the hospitals. And, you know, endless, n equals endless, when we test it.

Dr Michael Tam

Yes. And that’s even for what is often a relatively simple intervention, like a drug. It is a matter of taking it and taking it at the right frequency. You sort of expect, at least the biology should mostly be the same, with the understanding that people are different. But a lot of health interventions are not simple like a drug. They are actually complex.

Let’s say we want to trial a program of care, or some sort of intervention where different healthcare providers provide some degree of doctor or clinician-patient interaction that can do something, plus access to maybe learning-type materials. For those sorts of interventions, what might work in hospital outpatients, for someone right after a very severe health episode, as compared to long-term preventive health in the community where people’s motivations may be very different… in fact, there’s no reason to believe that evidence in one setting will transfer to another setting.

Dr Pallavi Prathivadi

Yeah, that’s right. So, when I was studying my own PhD, it was around supporting GPs for evidence-based pain management for long-term pain conditions that weren’t related to cancer or end-of-life care and how we can make sure we’re prescribing meds like opioids, like morphine in the safest, most effective ways. And a lot of the time I was studying programs for low back pain, or these chronic musculoskeletal conditions that you and I see all the time. And you might know about the GLA:D program, which is a fabulous physiotherapy and education program, that people use to manage hip and knee osteoarthritis.

But one of the biggest barriers to people accessing those kinds of programs was they didn’t have money for it. They’re really expensive programs. And often, our public health care system doesn’t have the kind of funding to support a full engagement. So, that intervention, which is – I mean, you would argue it is a complex intervention even though it sounds relatively simple – it’s not necessarily going to work in the settings that you and I have because of all of these other factors.

So how do we improve? How do we improve patient care when that gets in the way? That’s when we start talking about things like, well, people are turning to pain meds because that is cheaper. That is easier. And that’s maybe more accessible than the physio programs.

Dr Michael Tam

Now, yesterday, we had a really interesting session that you and your colleague facilitated where this year’s academic post registrars presented their projects in a 3MT, so a three-minute thesis type event. I realised yesterday I shouldn’t have asked you to pick favourites on which one you like!

Dr Pallavi Prathivadi

You did ask me to pick a favourite!

Dr Michael Tam

But there was one project you found had an alignment to your own personal research. Can you talk a little bit about that project? Just as a bit of a taste of the sort of projects registrars undertake.

Dr Pallavi Prathivadi

Yeah, definitely.

Registrars watching: I did not pick a favourite! I got nearly tricked into this! 😂

I was explaining that a lot of our registrars, they have very clinically focused projects. And, so they study things like endometriosis management, intimate partner violence, miscarriage, things that we see day-in day-out during practice. And we do have a registrar this year, who I was delighted to see, is studying opioid prescribing practices of Australian GPs.

And when she joined as an academic post right at the start, I was really delighted to know that she knew some of my work. And it’s always nice to get a registrar who has a similar research interest. This was not a favourite thing [to audience]!

Dr Michael Tam

I was just remembering that project. So, she did an observational study, effectively, looking at temporal trends to opiate prescribing in Australia. And it was a very interesting question because I lived through that period when in Australia codeine was up-scheduled. So, you used to be able to get reasonably large doses of codeine over the counter at a pharmacy, and now they all need prescriptions. There was a fear that there was going to be the transfer of over-the-counter codeine to harder, more intense opiates on the prescription system. Very interestingly, that observation was not seen, which I think was probably contrary to expectation, actually.

Dr Pallavi Prathivadi

I think that’s true. There was a period of time, kind of really 2017 to 2020, when there was a whole suite of prescriber systems-level, patient-level interventions happening to try and reduce inappropriate opioid prescribing. What was really interesting was I started my PhD in 2018, studying this right at the heart of seeing actual live changes from massive policy efforts.

So, one of them was also the “nudge” letters. The top number of opioid prescribers in Australian general practice, so GPs, were sent a letter signed by the Chief Medical Officer or the Chief Health Officer saying, you are a “top prescriber” of opioids. We call this a nudge technique, and it’s a very effective behaviour change technique, particularly for doctors. Because, we know from understanding behavioural practices of doctors, particularly around problematic prescribing – opioids, benzodiazepines – that generally doctors want to be in the middle. They don’t really like knowing that they’re on extremes and that they’re not practicing the way their peers practice. This has been well established in different areas.

So, the nudge letters work because you’re pointing out that a doctor is outside of the norm. It does work to reduce those behaviours, but it’s also, it feels very punitive and it caused a lot of negative feedback, negative feelings, which I actually covered because I interviewed a lot of doctors who had received these letters. And they were say, well, “I see a lot of older people”, “I do a lot of palliative care”, “I have a special interest in chronic pain management”, “that’s why I’m a high prescriber”, “I don’t want another one of these letters, so I guess I’m not going to see this anymore”.

Dr Michael Tam

Not to derail this conversation, but certainly there is potentially greater policy implications that perhaps the behavioural economics approach has ignored somewhat. I agree: I think very, very effective at that behaviour change, but the potential professional relationship that prescribers, clinicians have, the social licence of government and with regulation – I think that was quite damaged.

Dr Pallavi Prathivadi

We can also link it back by showing that a lot of the research that we do, and the work that we do, is not a “single arm” just looking at one… We consider so many things, which is impact to patients, impact to prescribers and doctors like us, but also impact of policy makers. That’s why we do qualitative and quantitative research because we capture a massive impact of medical research.

Dr Michael Tam

Now, where to next for the academic post program? I think this year was the first year it came back to the Royal Australian College of General Practitioners. Previously it was run by the Department of Health. There was some good news that was certainly emphasised in the conference, but I think it might have been released prior to the conference; tell us about the good news!

Dr Pallavi Prathivadi

Fabulous news! It’s really wonderful news.

We have generally had a cohort of up to 20 academic registrars per year. And from 2026, we actually have 27 registrars. We had 18 registrars this year [2025]. So, we’ve got a 50% increase in our cohort size, which is so exciting for the program. So great to see the interest and the increased funding for what I think is a phenomenal program.

Dr Michael Tam

So, I think twenty-seven; a 50% uplift, certainly excellent. In the context, however, there’s probably around about 2000 in round numbers, registrars, so family medicine trainees entering the program every year. It’s actually still quite a small percentage of the total cohort. My understanding is that the program has actually been quite competitive in so far that people wanted to join the program but not having a place.

Dr Pallavi Prathivadi

Correct.

Dr Michael Tam

Blue sky thinking: how many positions do you think would be really able to increase the capacity of primary care research in this country?

Dr Pallavi Prathivadi

Also, given that we’ve got a big bulk of GPs who are going to be retiring. So, we need to be mindful of filling that gap in the workforce, which will also extend to the research community.

Yeah, I agree that 27 is still small in the grand scheme of things. It is a win that we have had this expansion, but would we like to see the program expanded more. I’m sure everyone will say this. What we saw at the showcase yesterday was really phenomenal support for the program and for the registrars and it is inspiring academic careers, so the program’s working.

I think hopefully us continuing to demonstrate that there is a need and effectiveness of the program, and we would love to, I think, continue to expand it for sure. The other thing I’m very mindful of is it is a competitive program. It’s designed to be a competitive program. I think at some point it’s always going to stay as a competitive program. But we have demonstrated interest. Registrars are applying for this program, not everyone is being selected. So, that cohort of people who don’t get in is probably the cohort you’re talking about. How can we include them? Because, if they don’t get an academic post does it then demotivate them to continue in an academic pathway (so we’re losing these registrars)? Or, do they continue in an academic pathway anyway, in which case we really should be capturing these registrars?

So, I think this is, we’re just going to keep working on this, Michael. I don’t have a quick answer for you. Would I like to see it expanded? Yes. Until the funding you give out, we probably will keep expanding it.

Dr Michael Tam

Okay, simple numbers, simple slogans. I think I mentioned yesterday:  100 registrars in five years. I think that sounds pretty good!

Dr Pallavi Prathivadi

It will change the way we deliver the program completely, and it will really expand it. Probably that will be a good challenge for me in this role, a great career goal. But I think if you keep giving us funding for registrars, we will say yes.

Dr Michael Tam

Yeah. And you know, everything costs money, obviously. But in the grand scheme of things, when you look at the total size of the federal budget or even the health budget, it’s chump change. It’s rounding errors of changes in inflation, basically. So, I think it’s really important to have this capacity-building element to the program. You might be familiar with the paper, I think it was in Annals of Internal [sic] Medicine (correct: Annals of Family Medicine)… Bodenheimer’s paper on “The 10 Building Blocks of High-Performing Primary Care” (Bodenheimer et al. 2014). Right at the bottom is “engaged leadership”. We really need programs to build that leadership for young and upcoming trainees.

Dr Pallavi Prathivadi

Yep, and I’m actually grateful because this whole question is also you demonstrating that there is effectiveness in this program and value in this program, which we saw again yesterday. I think the more advocacy we get from senior leaders in the Australian general practice community saying this is a good program, keep funding it, keep expanding it, we will.

Dr Michael Tam

Thank you very much for the game and the interview! Yesterday you felt a little bit enthusiastic that you might play a little bit more chess. I’m not sure what your thoughts are after today’s game?

Dr Pallavi Prathivadi

No, it’s the same. I loved it. Clearly, as you can see, I could do with a little practice and not maybe make illegal moves!

Dr Michael Tam

It’s just meant to be fun.

Dr Pallavi Prathivadi

I always have fun.

Dr Michael Tam

Thank you very much, and I’m sure we’ll catch up again at a future conference.

Dr Pallavi Prathivadi

I really look forward to it. And thank you for the support of the academic post program.

Dr Michael Tam

No worries. All good.

Dr Pallavi Prathivadi

Thanks, Michael.

Dr Michael Tam

See you later.