I think I wanted to do a PhD before I even applied to attend university as an undergraduate. I know, I know. This is very nerdy and how will people think I’m cool if I keep putting confessions like this out on the internet?

I love the idea of contributing new knowledge to this world. It seems like such a great legacy; to leave some novel idea or thought out there in the universe and see what other people might build upon it. One idea then another idea then another idea and this is how we developed IVF and antiretroviral medications. Research is cool! So, every opportunity I have had to engage in research- I have taken.

I completed an honours Bachelor of Medical Science after the third year of my medical degree and studied SIDS prevention at the Ritchie Centre. My supervisor at the time suggested I continue my research to receive the MBBS/PhD dual degree, but I just didn’t feel ready and wasn’t sure that SIDS research was my passion. In hindsight I am glad, because in the years after I graduated, I became increasingly interested in equitable pain management and palliative care. I completed a Master of Medicine (Pain Management) degree as a junior doctor, and undertook research about worldwide opioid access, availability and utilisation. Opioid prescribing quality improvement and policy is definitely what I wanted to study.

Here’s 5 quick facts that drives my interest in this:

1. 79% of the world’s opioids are used by 6 developed countries (including Australia)
2. 5 billion people live in countries with minimal or no access to opioids for pain management (particularly cancer and HIV/AIDS related pain) and palliative care
3. Over the last 3 decades, Australia has had dramatically increasing rates of opioid prescriptions, and related harm
4. Over half of all opioids in Australia are prescribed by GPs, and approx. half of these are for chronic non cancer pain (in which using opioids has serious risks of harm and modest therapeutic benefit)
5. An estimated 25% of patients on long term opioids in Australian general practice have an unrecognised opioid dependence

Let’s get back to my life story; as soon as I passed my RACGP Fellowship exams, I commenced my PhD studying opioid prescribing in Australian general practice. Okay, so now I’ve got a track record of degrees. Is that the same as a track record of funding or output? Unfortunately, not at all.

I’ve had a slightly atypical PhD journey; I actually enrolled in the degree prior to commencing an RACGP Academic registrar post in 2018. Same university, same research and same supervisors, but my first year of the PhD was funded as an RACGP Academic post (both salary and research costs!). This was a brilliant arrangement for me, as all the work I was doing in the academic post was credited as PhD research and Monash University mandatory professional development hours. The difficulty was when I completed this post and became a Fellow- now I was in the middle of the PhD with no funding, no scholarship and working as a consultant GP without the safety net of a training program.

Finally, I can answer your question; what is this article actually about? I needed PhD funding. I had 5 studies to complete and the Academic Post had only funded the first one. I applied and secured Australian government scholarships for tuition and stipend but needed money to actually undertake the research. My supervisor, Professor Danielle Mazza, suggested the RACGP Foundation grants. The Charles-Bridges-Webb memorial award was a small grant specifically given to academic registrars and was enough to fund my second study. It seemed ideal, so I applied.

It was the first grant application I had ever completed, and it took me far (far) longer than I expected. I complained to my supervisor Dr Chris Barton repeatedly during the grant writing process that it would be more effective if I worked a few extra shifts at the clinic to fund the research myself. It was the same patient response he gave me each time: “This will help you build up a track record!!”

The application was all online, but I did that classic 1990s thing where I wrote it all on down on Microsoft word first (please remember I am from the time of unreliable dial-up modem). I tried to convince the selection committee that my research was important and would benefit Australian health and GPs, I needed the money to undertake my PhD, I had great supervisors and I had lots of research experience so far (for someone at my stage of career). Four months later, I was at a primary care conference when I received an email congratulating me on my application and notifying me of its success. Life was great. Like someone in labour, I completely forgot about all the hours of work I had put into the application when I received this small child (I mean, grant).

It was very motivating after that. I needed funding for remaining studies, and I understood the grant game now. I applied for a philanthropic grant to the value of 40 times what I had received in the RACGP Foundation Grant. If you work in research or business, you probably won’t be too intimidated by this process, but I sure was. It takes confidence to write to a panel or speak to an interview committee and ask for thousands (or hundreds of thousands) of dollars for something you haven’t done yet. That’s where track record helps; I think I got the philanthropic grant because I could show the importance of my work, and previous successful funding applications.

After these two grants, I got a PhD top-up scholarship. By this time, I had collected enough of a track record that I felt confident enough to apply for something really big. I got a Fulbright scholarship to Stanford University. Chris was right (he always is); the track record can be really important. It builds trust in researchers, facilitates collaborations and improves resilience for the world of academia.

Although this article is pretty light-hearted, let me make two things clear. Firstly, the track record only shows successes, not failures. For every one grant I have received, I have unsuccessfully applied for another two or three. My publications have all been rejected at least once before they were accepted. I have had several conference abstracts declined. I don’t mind. I learn from each experience and try to read through the synopses of the successful applicants and projects to understand why their applications were successful and mine was not.

Secondly, we win some and we lose some. The year I was awarded the RACGP Foundation Charles Bridges-Webb Memorial Award, several people would have missed out because there’s only one grant available. The next year I applied for two different RACGP foundation grants, and both were unsuccessful. That’s absolutely fine! I’m sad for a day and then as Prof Mazza once consoled me; “Onwards and upwards!”. It means other researchers now have a better track record and more opportunity for their research. No one has been injured. No one has received a life-threatening diagnosis. We see the bad stuff in medicine, and I hope this gives us an advantage to cope better when we (inevitably) get rejections.

So- these RACGP Foundation grants. What’s the worst that could happen if we apply? We’re unsuccessful. What’s the best thing that could happen? It could be the start of a great track record and a whole lot of opportunities.

Dr Pallavi Prathivadi