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Discussing family medicine: Q&A with Jeffrey Scherrer

Family medicine plays a large role in day-to-day healthcare. To further our knowledge of the primary care landscape, we’re thrilled to welcome Jeffrey Scherrer, PhD, as the new Editor-in-Chief of Family Practice, a journal that takes an international approach of the problems and preoccupations in the field. Jeffrey sat down with us recently to discuss his vision for the journal’s future and his work in research and mentorship.

How did you get involved with Family Practice?
My Department Chair advised me to attend NAPCRG. While attending my first NAPCRG meeting in 2013, I made a visit to the Family Practice booth and asked if they were looking for reviewers. I was then invited to join the editorial board.

What led you to the field of family medicine?
I started my career in 1990 as a research assistant in animal models of memory. After developing really bad allergies to rodents, I sought out a research coordinator position in epidemiology during which time I also completed my doctoral degree in Health Services Research. In 2004 I received an appointment to Washington University Department of Psychiatry as an assistant professor. My research was in psychiatric epidemiology and I enjoyed the field but also realized that my interests were much broader than psychiatry. I thus sought out a new academic appointment in 2013 and joined the Department of Family and Community Medicine at Saint Louis University School of Medicine. Family medicine turned out to be a perfect home to pursue my over-arching research interest in the interplay of mental and physical health. I enjoy methods almost as much as the research question. Here, I can pursue my interests ranging from diabetes quality indicators to military veteran issues, to metformin and its association with dementia, while maintaining my funded research focus on risk factors for, and consequences of, mood disorders. Family medicine is a perfect home for me because I can pursue my eclectic interests while still focusing on mind-body relationships.

How do you see the journal developing in the future?

Without being too political, we need to educate our elected representatives so they understand the individual and societal costs of being uninsured. We have long ago accepted clean water as a standard, when will we see healthcare of equal importance?

First, I commend Dr. Neale’s successful term as Editor-in-Chief during which the journal’s impact factor continuously increased. To continue to grow our impact, we must increase reach into the United States. Many of my family medicine colleagues are unaware of Family Practice. I hope engaging family medicine and primary care professional organizations will encourage submissions and serve to disseminate the high quality research we publish. To encourage scientific discourse I would like to see the journal establish a stable volume of high quality editorials on published manuscripts. A recurring educational section on statistics and or methods would make the journal a unique resource for primary care researchers. I will also encourage authors to work with their institutions and the journal in developing press releases for their accepted papers. This can greatly increase our name recognition. I have several theme issues in mind that are related to many of the challenges faced by family medicine and general practice and I look forward to engaging the AEs in selecting these themes.

What do you think are the biggest challenges facing family medicine, general practice, and primary care today?
It might be easier to list the topics that are not big challenges! While I expect my opinions are biased by being a research professor in the United States, many of the major challenges in the US are also key problems in other countries. The prescription opioid epidemic, obesity, and diabetes rank in the top.

Although opioid prescriptions have levelled off in the United States, we are still witnessing an epidemic of overdose, misuse, and chronic prescription opioid use that no longer provides pain relief. We must find ways to manage pain with safer medications and therapies and provide patients realistic goals for analgesia and functioning.

Obesity is now a world-wide problem for adults and children. We know eating less, eating healthy, and exercise leads to weight loss but motivating patients to make lifestyle changes is a major challenge. I think primary care should be a leader in developing new interventions that increase patient engagement with weight loss and most importantly develop interventions that maintain weight loss efforts. Clever diets are not the answer. This is an area where integrated behavioural health professionals can have a significant impact. The increasing prevalence of type 2 diabetes is one of many consequences of obesity. Early detection and novel interventions for lifestyle change in patients with pre-diabetes could mitigate this problem.

Using the full potential of electronic health records (EHRs) is also a challenge for many private practices. Without strong technical support, this tool becomes an electronic version of paper records. I would hope to see increasing integration of EHRs across regions and then across countries. One day the World Health Organization may have access to multi-national historical medical records to inform disease prevention and best clinical practices for unique subgroups of the patient population. Thus how to deliver precision medicine in primary care is among our research priorities. Patient portals linked to EHRs can help reach rural locations and coupled with telemedicine, rural health disparities could be reduced.

Even when guideline concordant care is provided and patients have insurance and no access barriers, there are many social determinants of health that may prevent some persons from regaining or maintaining health. If a patient intends to eat healthy and exercise but they have no access to safe neighborhoods and healthy foods, they are less likely to succeed. I would like to see more research on environmental factors that contribute to health services utilization, adherence, risk of disease, response to treatment, and disease. This field is advancing with the ability to merge geo-spatial data with EHRs and wearable health monitoring devices. I think this area is a good intersection for primary care and public health collaboration.

Professor Jeffrey F. Scherrer. Image used with permission.

Health insurance is a key challenge in the United States. At this time we are looking at efforts by Congress to repeal the Affordable Healthcare Act. All nations must recognize that healthcare is a means of maintaining a robust and productive society. Unfortunately, the right to healthcare is under threat in the United States. Without being too political, we need to educate our elected representatives so they understand the individual and societal costs of being uninsured. We have long ago accepted clean water as a standard, when will we see healthcare of equal importance?

Last, recruiting more medical students to family medicine and general practice is a priority, as is preventing physician burnout and promoting physician wellness.

Tell us about your work outside the journal.
I am currently the Principal Investigator on two NIH grants. One is focused on determining if treatment of PTSD and reduction in symptoms leads to better health behaviors, such as weight loss, and subsequently reduced risk of cardiometabolic disease. The other is designed to determine if metformin is associated with reduced risk of dementia. In addition to developing my own research, I mentor many junior faculty and clinicians to increase our peer reviewed, original research publications. I serve on several dissertation committees, conduct ad hoc grant reviews for NIH and the Veterans Administration, and participate in university committees to grow our research infrastructure. I love mentoring relationships because I often learn about a new topic and mentees bring new ideas and greatly appreciate the support I can offer them. Everyone needs mentors in research and as your career advances, we should all be mentoring junior faculty. The process of developing a research career is not taught in graduate school and is learned over many years by working with an array of more experienced investigators.

What are you most looking forward to about being editor?
I am excited about expanding the journal’s reach. There is no reason the journal should not be among the top two journals in Family Medicine. I am confident that increasing our impact is possible by engaging investigators who have yet to submit their work to Family Practice. I look forward to regular communications with our AEs to solicit ideas for improvement, selecting theme issues, increasing editorials and discourse about research priorities for primary care. Given the generous nature of family medicine investigators, I believe we can rapidly increase our reviewer pool which will be critical to providing the rapid peer review promised to authors. Last, I know this will be a valuable learning and professional development experience. This rare opportunity should help me stay current in this broad research field and make me a better investigator, mentor, and colleague.

Featured image created by Freepik.

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