(From Connexion Newsletter Fall/Winter 2024)
Long-term care offers physicians a unique and rewarding opportunity to diversify their practices while making a significant impact on the lives of their patients. For some, long-term care (LTC) is integrated into their longitudinal family practices, with care provided to residents across one or two facilities. For others, LTC becomes the primary focus, with physicians taking on roles like Medical Director in one or more facilities.
We asked four LTC providers to share their personal experiences, and to describe the motivations that drive their practices, and the professional fulfillment that they find in this field.
Dr. Kraig Montalbetti:
“I have followed my own patients from my longitudinal community practice into long-term care since assuming the practice of my own family physician upon his retirement in 2011. I have found it easy and rewarding to continue to care for these patients in long-term care facilities as I knew them when they were younger and healthier (both mentally and physically) and continue to look after their family members. I have found my connection with them as they have transitioned from community/acute to subacute/short-stay to long-term care helpful in knowing when and how to assist with adjusting their focus/goals of care as they progress through these settings.
“Logistically, I find attending long-term care facilities to be a nice way to add variety to my practice. You can drop in whenever there is a gap in your schedule, making rounding quite convenient. With the institution of the LFP payment model, we are now paid very well to do this work, including travel time when driving between facilities!”
Dr. Jim Howie:
“I have been a family physician in Kamloops since 1983. During my career, I was a full-service family physician, doing a combination of Emergency work, hospital rounds, office practice, delivering babies, and long-term care on my practice patients who went into long-term care.
“Following my retirement from my office-based practice four years ago, I work exclusively in long-term care. I have found long-term care an important part of my practice. Working with nurses and care aides and other allied health workers has been a challenging and rewarding aspect of medicine for me as I have been a medical director of two Kamloops’ facilities over the past 20 years. I still have the drive to continue working in long-term care.”
Dr. Phillip Sigalet:
“Caring for people in long-term care tends to go under the radar. It is a place where you practice narrative medicine in its purest form — with limited access to labs and no imaging, we rely on history and physical exams. It is team-based care: We rely on care aids, LPNs, dietitians, physiotherapists, recreation therapists, pharmacists, and families to develop plans and deliver care. We care for some of the most vulnerable people in our society who happen to be the builders of that very society.”
Dr. Alina Cribb:
“I was drawn into significantly expanding my long-term care practice by a phone call from a retiring colleague. Basically, he suggested I consolidate my practice into one long-term care facility and suggested a regular day for visiting. I had recently moved to Kamloops, and in my previous family practices, we had shared our long-term care practice. When it was your weekend on call, you zoomed around to all the long-term care facilities to put out fires.
“Currently, the practice standards for long-term care that have been developed over the last 10 years encourage a more proactive type of care, with regular preventative visits to clients living in facilities.
“In any case, I was wooed to take on his 10 patients, and so my journey to markedly increased involvement in long-term care began. Those 10 patients in The Hamlets bloomed to between 80-85 patients over the years. Naturally, with that many people, a regular day of rounding is useful. If you are interested in teamwork, long-term care offers the opportunity to work with nurses, care aides, recreation directors, physiotherapists, or occupational therapists, social workers, dieticians, and families.
“I enjoy the time I spend in LTC. The skills needed are both different, and the same, than what are needed in office-based practice. There are plenty of opportunities to practice your clinical exam skills and truly explore conversations with patients and families about what matters to them in their care. You may end up looking after a multitude of different debilitating diseases, in all age groups, from young adults to frail 100-year-olds. You will definitely be expanding your scope of practice if you’ve found yourself stagnating in the office.
“I would recommend joining a call group so you can keep some balance in life. Overall, I would say I’m glad a colleague called me and lured me into taking on a Long-Term Care practice. There was a learning curve, and some growing pains, but I enjoy the outing from the clinic, the teamwork, the variety, the challenges of some creative problem solving, and the wide range of clients.”
Learn more about working in Long-term Care.
Contact Ania Zubrowska, Long-term Care Initiative Project Manager.
Email: azubrowska@thompsondivision.ca
