residential care as a GP

[foozer93]

Is anyone doing residential care with regular family practice? anyone doing it with other fields like Hospitalist or emerge?

How do you split your time? whats the pay like? how do you get involved??

 

Thanks

[medisforme]

I do residential care in the Fraser Valley on top of regular family practice and addictions work

It is much more lucrative than many people think provided you have enough residential care patients.

Benefits

1) Very straightforward medicine, low pressure, team oriented work environment.  Most of the medicine is actually deprescribing and simplyfing care.

2) Still can bill chronic care fees on all residents with HTN, DM, COPD, CHF

3) Care conference fees pay decently well, when you book a bunch back/back

4) You can bill every single phone call/fax you respond to giving medical advice

5) I do "call" (if you can call it that) 0800-1700, one day a week and every 5th weekend for the community.  Get paid $125 for weekday and $250 for each weekend/holiday, then you can still bill anything you do on top of that.  It is extremely straightforward, can still work a regular clinic day and then head to care home after the day and still be home by 5:50-6.  I use my call day to follow up on any of my resident issues that need follow up.

6) Able to bill palliative care fees if appropriate

As a caveat, the money is a little better for me as I negotiated in my clinic contract the ability to use my clinics EMR while at the same time, not having any expectation of paying my nursing home billings into the overhead (this means you do all your own billings on separate billing platform) with the exception of office calls and fax responses during clinic hours (which is a very small percentage).

Cons

1) Dealing with family's who aren't ready to accept their loved one is in decline and who have unrealistic expectations of treatment (vs focus on QoL)- admittedly a large part of the job

2) There is a lot of allied health care staff turnover, many of whom do not have a good understanding of medication prescribing principles and approach to dementia and agitated behaviour for the elderly/residential care (you get numerous requests for anti-psychotics, zopiclone, ativan etc...).

Hope that helps

[Dodo]

On 8/31/2019 at 1:33 PM, medisforme said:

I do residential care in the Fraser Valley on top of regular family practice and addictions work

It is much more lucrative than many people think provided you have enough residential care patients.

Benefits

1) Very straightforward medicine, low pressure, team oriented work environment.  Most of the medicine is actually deprescribing and simplyfing care.

2) Still can bill chronic care fees on all residents with HTN, DM, COPD, CHF

3) Care conference fees pay decently well, when you book a bunch back/back

4) You can bill every single phone call/fax you respond to giving medical advice

5) I do "call" (if you can call it that) 0800-1700, one day a week and every 5th weekend for the community.  Get paid $125 for weekday and $250 for each weekend/holiday, then you can still bill anything you do on top of that.  It is extremely straightforward, can still work a regular clinic day and then head to care home after the day and still be home by 5:50-6.  I use my call day to follow up on any of my resident issues that need follow up.

6) Able to bill palliative care fees if appropriate

As a caveat, the money is a little better for me as I negotiated in my clinic contract the ability to use my clinics EMR while at the same time, not having any expectation of paying my nursing home billings into the overhead (this means you do all your own billings on separate billing platform) with the exception of office calls and fax responses during clinic hours (which is a very small percentage).

Cons

1) Dealing with family's who aren't ready to accept their loved one is in decline and who have unrealistic expectations of treatment (vs focus on QoL)- admittedly a large part of the job

2) There is a lot of allied health care staff turnover, many of whom do not have a good understanding of medication prescribing principles and approach to dementia and agitated behaviour for the elderly/residential care (you get numerous requests for anti-psychotics, zopiclone, ativan etc...).

Hope that helps

In your opinion, would it possible or common for someone with the +1 in Care of the Elderly to focus exclusively on elderly/residential care in Vancouver? what does the job market look like for IM geriatricians vs FM +1 in COE in the city?

[JohnGrisham]

52 minutes ago, Dodo said:

In your opinion, would it possible or common for someone with the +1 in Care of the Elderly to focus exclusively on elderly/residential care in Vancouver? what does the job market look like for IM geriatricians vs FM +1 in COE in the city?

You don't need a +1 to do residential care. Big cities though, residential care gigs can be hardish to get, as they are often scooped up due to the often lucrative call coverage pay and variably light work (depends widely of course).

IM Geri vs +1 COE is night and day in the city. IM Geri has a significantly broader scope, and billing availability for community consultations. Generally more complex patients go to IM geri.  

[medisforme]

On 4/25/2020 at 10:15 PM, Dodo said:

In your opinion, would it possible or common for someone with the +1 in Care of the Elderly to focus exclusively on elderly/residential care in Vancouver? what does the job market look like for IM geriatricians vs FM +1 in COE in the city?

I purposely did 90% of clerkship and residency outside of vancouver, and I never met an FM+1 COE anywhere.  I am not even clear what their role is compared to a "regular" GP with an interest in elderly care.  I am guessing jobs for them are confined to larger cities.

Outside of Vancouver, they are screaming for docs for residential care, it is very easy to find work.  In Vancouver, it is obviously more difficult to find work/jobs in niche areas of family medicine.

[guy30]

It differs city to city but from what I've seen, +1 COE docs work the same as IM geriatric docs ie they both work as geriatricians doing inpatient geri ward coverage, consults, and outpatient geri clinics.  I haven't seen a difference in scope of practice or community consultations but again, this might differ city to city.

 

Between CFPC and Royal College practice areas, I haven't seen much practical difference in day to day work between staff docs trained from either college in EM, COE, Palliative Care, Sports and Exercise Medicine, or Addiction Medicine. 

 

The areas that would have different scopes of practice (or are 'night and day') would obviously be GP Surgery, Primary Care Obstetrics, and GP Anesthesia.

[Dodo]

If both +1 COE docs and IM geriatricians do essentially the same job, I assume the IM geriatrician might have more opportunities in the city due to longer training? Can the IM geriatrician bill more for the same work?

[guy30]

This would be province specific but my understanding is that IM geriatricans have access to the IM billing codes which would pay better for consults etc. 

Some docs would also be on ARP's (especially given the nature of lengthy geri consults) which I imagine should pay the same for the same work done?  Don't know for sure though.