Community based care is a practical solution to save health care cost.¹ The World Health Organization's (WHO) Global Strategy of Health For All by the Year 2000 (HFA 2000) was accepted as WHO policy in 1981, and the development of primary health care is central to the attainment of the goal.² In 1994, the World Organization of Family Doctors (WONCA) and WHO convened a meeting to identify specific actions to make health care, medical practice and medical education more relevant to people's needs so the goals of HFA would be achieved.³ It was recommended that family physicians (FPs) should have a central role in the achievement of quality, cost effectiveness, and equity in health care systems.

The development of any discipline needs to have a strong academic development to foster scholarly activities such as education, research, publications, and development of innovative projects. Successful academics must possess high skills in initiating all those activities. There has been a long heated debate on whether academic achievement should be weighted by being a successful educator or researcher. The answer should be both with no exception to family medicine (FM).

I had the privilege to teach medical students for both medical schools before I became a full time academic. I was deeply impressed with the development of the undergraduate FM curriculum of both medical schools. FM units of both medical schools have also developed strong postgraduate programmes meeting the needs of practising FPs. The Hong Kong College of Family Physicians (HKCFP) was the first local academic College to establish the continuing medical education programme and fellowship examination. However, not all FPs understand the great importance of developing research in primary care. For advancement of any discipline, development of new initiatives and innovative projects are very much needed. During the process of development, research is needed for prioritisation, assessment of needs, evaluation of effectiveness, and measurement of outcomes. One cannot develop and implement new initiatives without the support of research evidence.

Local academics in FM have been working very hard in developing more and more research projects despite the small numbers of academic staff. It is also encouraging to observe more research projects undertaken by practising FPs, young academics and also FM trainees including topics on SARS,^4-6 functional disorders,⁷ prescribing,^8-9 clinical management,^10-11 and epidemiology.¹² They should be supported and encouraged.

Topics for FM research are very broad and any problems related to the community would generate research questions.¹³ There have been many new community based initiatives in promoting better health of the community.¹⁴ Evaluation and outcome measurement of those programmes are potential research projects. FM research would start in the clinics, and extend to the community. Practising FPs can be engaged in various research studies in collaboration with academic units.

One cost effective way to develop academic FM is to create more career pathways for young trainees to enroll into academic work after completion of their four years basic training. One would develop academic fellowship programmes for potential candidates. They would then spend two years in academic units developing skills in research, and acquire the practical experience in protocol development, research grant application, conducting large scale studies and publication of research findings under the guidance of senior academic staff. Even when they pursue their careers as practising FPs later on, they would maintain the link with academic units and facilitate the community based research projects by establishing a strong research network with local FPs. By working closely with the academic units, they can become the resource persons and co-ordinators in the community for research.

A young generation of academics in FM is very much needed as it is time consuming to train a young assistant professor to associate professor, professor and eventually chair professor. If we do not start now, we will have a vacuum in one or two decades. If we have more young trainees starting their academic careers after completion of training, they would work their way up if they can demonstrate their strengths and potentials in academic activities.

We are unfortunate to face the hardship of economic downturn. We need to explore cost effective ways to advance the academic discipline. Exploring more opportunities for young trainees to pursue academic work either as advanced training and/or long term career development should be a priority issue. By developing more new initiatives in community based care meeting the needs of our population, more FM research projects would be generated, and the balance of primary and secondary care can then be restored.