Skills for Long-Term Residential Care: Doctors Bob James Joel Lexchin Margaret McGregor

Which Categories Should Be Present & Why Doctors – Legislation in at least three Canadian provinces requires a medical director Not necessarily the case in other countries – Doctors needed for medical decision-making Some could be done remotely by RNs but doctors would be uncomfortable if they were not physically present some of the time In some provinces NPs can fulfill doctor role – Can sometimes help avoid hospitalizations and complications

Question – Level of Training & Full vs Part-time Type of doctor General PractitionerGeriatrician Full timeGeriatric trainingNo geriatric training Yes??? No???

How Should Work Be Divided & Coordinated Doctors typically do things such as admission physicals, annual reviews and medication reviews Ideally provide pro-active longitudinal care & develop relationships with residents & families Provide care for acute events on a 24/7 basis Medical directors, where present, in Canada coordinate work of all doctors – In other countries may be done by administrators In some LTC homes Medical Advisory Committee generates medical policy Doctors & other care staff – Communication with senior nursing staff usually face-to-face – Communication with other staff through “communication book”

Questions Should doctors just be involved with narrow medical issues or wider social issues? How do doctors organize their time in the nursing home versus what nurses need in terms of doctor time? Who should doctors be accountable to?

Gender and Racialization Primarily older white male doctors versus primarily female staff often from developing world countries Administrative and leadership staff tend not to come from visible minorities

Questions Are these differences expressed in power relationships? Do female doctors interact differently with other staff & patients compared to male doctors?