by Sharon Beder
Pressures and Constraints
earch programme. But the first obstacle to achieving this is a lack of sufficient funding. "Funding for this kind of work is very competitive and there are a lot of other people with good projects too," says McCarthy. "The supply of funding money is finite and even when a research team has a particularly good idea they can't always get it started immediately. Sometimes it may two years or more to find the funds and again that time delay is frustrating." One solution they have found at the Melanoma Unit is to fund quite a lot of it themselves through donations.
Another problem with any research work anywhere in the world and particularly in Australia is simply the lack of space. "It is very hard in the University of Sydney to find a bench to work on because space at the University is also finite. A lot of people want to do research. There are enough people around already doing research to completely fill the available research spaces. The situation is so acute that sometimes researchers are glad not to get a research grant because they might have had trouble finding the physical space to actually put another person to work. Sometimes they more or less have to take that into consideration before they can agree to expand their basic research programmes. The availability of space is a constant problem in most research."
Bill McCarthy finds that being a surgical academic, or a medical academic in general, he is also expected to be a leader in his profession. "To be a leader in your profession you have to practice your profession. So we have in this unit a big treatment centre. Some people say we are too big, being academics. But because we are academics and because we are pretty good at looking after patients, we get asked to treat a lot of patients and so we treat them," he says.
The patients provide a number of important things for research. One is the provision of biological specimens. All the human melanomas, for instance, have to come from patients. All the blood specimens and all the tissue experiments are only possible if patients are being treated. So it is necessary to have a flow through of people with the disease. But in order to maintain the flow through of people the patients have to be well managed. To manage them well there has to be an elaborate structure; lots of secretaries and nurses and interns, registrars and all the rest. So then this medical structure in turn also has to be managed. As head of the unit McCarthy has to manage the administration of the unit.
"If you are the head of the unit you have to go into the business of hospital administration and then you are responsible for a hospital budget. So you find you have to spend a lot of time doing things other than research and teaching in order to maintain the basis for your research and teaching," he says.
Patients also have to be available for undergraduate teaching. If all the patients are in private hospitals because that's where the best surgeons are then students don't get to see them. McCarthy finds there are frustrations in simply having time to do all the things that he needs to do.
"The higher you go up the ladder the more you are expected to manage and administer. You find yourself doing less of the actual research, less of the actual teaching and even to some extent less patient care. You have to manage what becomes a bigger and more elaborate structure as time goes by," he says.
The problems of a medical academic are very different from those of a non-medical academic. It is very rewarding, of course, to work with people and to be able to deal with their medical problems but it can become time consuming in the extreme to manage all three facets; research, teaching and administration. When you add on to that a substantial component of patient care you tend to run out of time.
Currently McCarthy's working week averages 60 hours. He says there is no way he could work anything less and still keep up. He is now at the stage where he has to work most Saturdays, just to keep on top of things. "That is what people must accept to become academic researchers in the medical field. They are constrained by time and they can't always find the money to employ someone else to come in and do the kind of work that they would like to have done."
Despite these problems McCarthy says of his life that it is constantly interesting and exciting. "I have a more interesting life than anyone I know," he says. "I can honestly say that I have never been bored. I don't even know the meaning of the word bored. I wish I could get bored sometimes. As soon as I get any free time someone comes to the door and offers me another little problem. I am involved in all sorts of issues. I wouldn't like to give the impression that the frustrations of this type of work are not to a large extent counterbalanced by having an interesting and exciting life with always something new happening."
"The patients themselves provide a constantly variable challenge. They're never the same and are always different people who respond differently to illness. All these responses have to be followed and dealt with. That is another facet of being a medical academic which is very interesting although it is also time consuming. It is also very rewarding to be able to offer help to people when their illness is first diagnosed."
"We can cure most of them, about 80%, which isn't bad," says McCarthy. "But of course the other 20%, which amount to about 200 or 300 a year, require a lot of difficult work in terms of managing them. It is a fact in medical practice that a large part of the time, effort and money that is spent ends up only helping people to die. It can be very costly. We make these people more comfortable and help them to get over immediate psychological problems but they finish up dying. I suppose this is all part of a civilised community. We have to look after our very sick and it is costly." McCarthy is particularly interested in the problems of cost effectiveness in medical care and the need to ration scarce medical resources.
"At least the majority of people that come through here now, come and go quickly and they are cured. I think that surgeons have an advantage because quite a bit of what they do, although it may be traumatic for the patient in the short term, is ultimately beneficial in the long term. Once they are over the worst of it the patients get well and that is the finish of their problem."
"People who deal only with the advanced cancers or with advanced stages of degenerative diseases of one sort or another have a harder road to hoe than the rest of us. At best they can stop the patient from suffering too much but they can't influence the outcome of the disease very much in many cases. But that doesn't mean that it isn't satisfying, rewarding and worthwhile to help people to get through crises of this nature. Even if they die, if they can die without pain and suffering and in reasonably good psychological order, that is rewarding in its own right. But I guess because we are seeing patients with all different types of melanoma we have the opportunity to give a reasonable number of people cures as well," he says.