American race-car driver Bobby Unser said, “Success is where preparation and opportunity meet,” and with that attitude he won the Indianapolis 500 a total of 3 times as part of his illustrious career.1 This sentiment rings true to Dr Brian Rowe, Professor in the Department of Emergency Medicine at the University of Alberta in Edmonton, whose hard work and collaboration with influential mentors resulted in a rewarding career in primary care research.
In a study published in the May 2024 issue of Canadian Family Physician, Aggarwal et al reported on the contributions of highly productive primary care researchers in Canada and identified individuals whose work has been cited widely in the medical literature.2 Dr Rowe was recognized as the primary care researcher with the highest h index score, a metric that reflects an individual’s academic publishing productivity and the citation impact of their research articles. Additional statistics from Dr Rowe’s career are highlighted in Box 1 and his most-cited peer-reviewed articles as first author are listed in Box 2.
Dr Brian Rowe, by the numbers: Data as of January 2023.
Number of publications: 651
Number of publications as first author: 88
Number of citations as first author: 2508
Total number of citations: 27,155
Author h index score,* 2007 to 2022: 87
*The h index score is calculated as the highest number of manuscripts (h) from an author that all have at least the same number of citations (h).
Most-cited publications as first author
Rowe BH, Spooner C, Ducharme FM, Bretzlaff JA, Bota GW. Early emergency department treatment of acute asthma with systemic corticosteroids. Cochrane Database Syst Rev 2001;(1):CD002178. Update of: Cochrane Database Syst Rev 2000;2001(2):CD002178.
Rowe BH, Bretzlaff JA, Bourdon C, Bota GW, Camargo CA Jr. Magnesium sulfate for treating exacerbations of acute asthma in the emergency department. Cochrane Database Syst Rev 2000;(2):CD001490.
Rowe BH, Keller JL, Oxman AD. Effectiveness of steroid therapy in acute exacerbations of asthma: a meta-analysis. Am J Emerg Med 1992;10(4):301-10.
Rowe BH, Spooner CH, Ducharme FM, Bretzlaff JA, Bota GW. Corticosteroids for preventing relapse following acute exacerbations of asthma. Cochrane Database Syst Rev 2001;(1):CD000195. Update in: Cochrane Database Syst Rev 2007;(3):CD000195.
Rowe BH, Channan P, Bullard M, Blitz S, Saunders LD, Rosychuk RJ, et al. Characteristics of patients who leave emergency departments without being seen. Acad Emerg Med 2006;13(8):848-52. Epub 2006 May 2.
This interview with Dr Rowe is the fourth installation in our 5-part series profiling highly cited primary care researchers in Canada.
You have been a powerhouse in emergency medicine research for more than 30 years. What led you down that path?
Thank you for the kind compliment. During medical school and residency I had a general interest in many different topics and enjoyed almost all clinical rotations. Consequently, I felt I was most suited to [being a] medical generalist: pediatrician, general internist, family physician, or emergency physician. In 1983 I was fortunate to venture to Little Current on Manitoulin Island [in Ontario] for a rotation in family medicine. While there I was introduced to [a combined career in] family medicine and emergency medicine, and it instantly appealed to me. In addition, I was exposed to Indigenous health disparities and solutions, especially the approach of 2-eyed seeing. That experience left a lasting impression on my career. I was also encouraged to seek rotations in Sudbury, Ontario, and later started my career there following graduation. Throughout my training, evidence-based medicine was just emerging in Canada, and I was encouraged to seek additional training in this field. As they say, the rest is history.
Who and what experiences have contributed most to your development as a researcher?
Like many successful clinician scientists, I was fortunate to have mentors who impacted my career. My father, Dr Richard D. Rowe, a world-renowned pediatric cardiologist, was my first mentor. He was followed closely by my brother Dr Peter C. Rowe, a general pediatrician who has been instrumental in our understanding of myalgic encephalomyelitis (or chronic fatigue syndrome) and its related entity, the long COVID condition. They both showed me the value of hard work, commitment to scientific integrity, and the important role of a clinician scientist. While doing my undergraduate science degree at Queen’s University [in Kingston, Ontario] I was an intercollegiate soccer player, coached by Dr John Walker. Dr Walker was a Latin and Spanish professor, and in his unique way he guided us as young scholar athletes. Throughout medical training, I was inspired by mentors who challenged me to seek the truth, most importantly Drs Jane Hadley and William (“Bill”) Feldman. Finally, when I resumed my training in clinical epidemiology at McMaster University [in Hamilton, Ontario], I worked with generous and accomplished mentors (Drs Ruth Milner, Brian Haynes, Andrew Oxman, Charles Goldsmith, and Paul O’Byrne) who helped guide my further research development. I continue to be motivated by my patients, colleagues, mentees, and needs in the health care system.
How have luck or good planning factored into your research success?
I don’t really have a strong belief in the role of luck; however, I do believe in the thought that success is where preparation meets opportunity. [For me,] as a clinician scientist, preparation means becoming a qualified clinician and then securing the skills to contribute to health science. The opportunity represents a setting where your academic contributions are valued and rewarded, you have secured dedicated time to conduct research, and where support exists to assist you with the generation and dissemination of knowledge. Both are needed for success, and one without the other generally leads to failure. In academia, this clinician-scientist preparation led me to other opportunities as a research director, graduate supervisor, reviewer, editor, grant recipient, and eventually my most recent leadership position as Scientific Director of the Institute of Circulatory and Respiratory Health at the Canadian Institutes of Health Research, [an appointment that ended in January 2024].
What is your most important research accomplishment?
My research team and I have used high-quality methods to address several important emergency department–related topics and issues, such as gaps in care and sex and gender differences. Early on, we contributed to prevention research in recreational injuries (sledding, bicycling, snowmobiles, et cetera). Later, we conducted systematic reviews and randomized controlled trials involving acute respiratory presentations (such as asthma and chronic obstructive pulmonary disease) and operational issues (such as emergency department overcrowding). More recently we have used advanced statistical methods to assess the management of migraine headache. Our commitment to improving patients’ experiences and health outcomes was the foundation of my main contributions to the Canadian Institutes of Health Research: the promotion of and advocacy for clinical trials and health outcomes research strategies engaging people with lived and living experience.
Have there been low points in your research career, or has it been smooth sailing?
Almost all research careers are filled with ups and downs. Sadly, we tend to ruminate on our failures and rarely celebrate our successes. My failures started early: I submitted my first major grant application multiple times to an Ontario granting agency that I was convinced should be interested. After 5 rejections, my elderly mother carted my grant up to the Physicians’ Services Incorporated Foundation in Toronto, [Ontario,] while my wife and I headed off on a long-anticipated holiday. The funding of the grant by the Physicians’ Services Incorporated Foundation led to a first-author paper in JAMA [(Journal of the American Medical Association)] and the launch of my academic career (and more credit to my mother!). Grant, manuscript, and promotion rejections are common in this career; resiliency and recovery after rejection have been pivotal factors during my academic career.
How has your work influenced primary health care policy and practice?
Our program of research has always focused on high-quality methods in the form of systematic reviews, randomized controlled trials, and prospective cohort studies that have contributed to practice through evidence-based guidance. Our research has benefited patients involved in the studies and clinicians practising in emergency medicine, and it has had an international impact through inclusion in clinical practice guidelines. In addition, particularly in the area of health promotion, our research has impacted injury prevention and recreational safety while our advocacy has had an impact on air quality and lung health.
How have you handled work-life balance challenges?
I have been married for 33 years to Katharyn Webb, and that was perhaps my best life decision (she confirms that!). We have 2 adult sons, and throughout my academic career I have been able to coach them in youth soccer, attend most major life events, holiday frequently as a family, and remain active through skiing, biking, swimming, and, more recently, hiking. My work and travel schedules haven’t been easy on my family, especially when they were growing up; however, Katharyn made it work and we remain a close-knit family. We are very proud of our sons, Bradley and Stewart. They are both married, employed, and “launched.”
Looking back, is there anything you would do differently?
Yes, there are some things I wish I had done differently. First, when I witnessed or experienced unfair, sexist, racist, or unethical behaviour earlier in my academic career, I wish I had done more and been a better ally. Second, I would have negotiated harder and more effectively before taking on administrative and academic roles. These jobs are almost always more onerous than they appear, and I didn’t recognize my own value to the organizations I joined. On several occasions I realized after the fact that I hadn’t negotiated hard enough for what I needed. I learned that your greatest negotiating position exists before starting the position; afterward, your bargaining position is much weaker. Finally, I would have been less trusting of the academic ecosystem and, most importantly, asked for formal written offers or contracts that ensured I was protected. In general, I think academics overestimate the verbal reassurances provided to them by their leaders, and signed documentation of contracts and agreements [should be] mandatory. I now advise my mentees on how to prepare for these jobs by negotiating hard, asking up front, and signing a formal contract.
What lessons would you like to pass on to anyone contemplating a career in primary health care research?
My first thought is to encourage them; combining clinical medicine and research results in a diverse, interesting, and rewarding career, and the main lesson I learned was: It’s worth it! Second, training in research methods is critically important to obtaining funding and academic recognition, and success without it is much more difficult. Third, be resilient. Rejection and failure are common in this career, and successful researchers develop strategies to overcome them. Take the positives and criticisms from rejection and then work harder to succeed the next time. Fourth, aim high methodologically and in knowledge mobilization. While your ideas may be too new or too novel for the relatively conservative research ecosystem, trust the results and stick with them. I am reminded of a famous saying along the lines of: When you don’t have the evidence, pound the table; when you have the evidence, pound the evidence. Fifth, collaborate, collaborate, collaborate. While I have enjoyed my collaborations in emergency medicine, I have also benefited from interactions with colleagues in public health, medicine (for example, respirology, cardiology, general internal medicine, neurology), nursing, and many other fields, including people with lived and living experience. My career has been enriched by these collaborations and they continue today. Sixth, surround yourself with a creative, knowledgeable, and enjoyable team. Finally, always contribute to training the next generation of scientists. I have thoroughly enjoyed mentoring summer students, graduate students, and residents. Their contributions continue to bring energy, enthusiasm, and new horizons to the research led by our team and to the organizations we represent.
Notes
Impact Interviews is a limited series in Canadian Family Physician coordinated by the Section of Researchers (SOR) of the College of Family Physicians of Canada. In highlighting the 5 most widely cited Canadian primary care researchers, the SOR’s goal is to celebrate their contributions and to inspire others to engage in this field. Find out more about the SOR at https://www.cfpc.ca/en/member-services/committees/section-of-researchers.
Footnotes
Competing interests
None declared
La traduction en français de cet article se trouve à https://www.cfp.ca dans la table des matières du numéro d’octobre 2024 à la page e176.
- Copyright © 2024 the College of Family Physicians of Canada
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- Article
- You have been a powerhouse in emergency medicine research for more than 30 years. What led you down that path?
- Who and what experiences have contributed most to your development as a researcher?
- How have luck or good planning factored into your research success?
- What is your most important research accomplishment?
- Have there been low points in your research career, or has it been smooth sailing?
- How has your work influenced primary health care policy and practice?
- How have you handled work-life balance challenges?
- Looking back, is there anything you would do differently?
- What lessons would you like to pass on to anyone contemplating a career in primary health care research?
- Notes
- Footnotes
- References
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