Please provide a brief background of your training and practice setting and years in practice.

I received my medical degree at University of Missouri-Kansas City and trained in internal medicine at Washington University-Barnes Jewish Hospital. I completed my clinical geriatric fellowship at Stanford-VA Palo Alto and then a geriatric clinical-educator fellowship at University of California-San Francisco. I previously worked as a geriatrician and palliative care physician at Santa Clara Valley Medical Center for 6 years and served as Chief of Geriatrics. I care for frail, older adults in a variety of settings including skilled nursing facility, hospital, and clinic. I recently joined the Palo Alto Division of Palo Alto Medical Foundation this year and will be lead physician in developing a community palliative care program.

What are you passionate about in long term care? How are you pursuing your passion?

I believe there is a great clinical need for more well-trained, excellent physicians to meet the growing needs and complexity of long-term care patients. I am most interested in 2 areas of quality improvement in the skilled nursing facility setting. First, patients are being discharged "quicker and sicker" from the hospital and the skilled nursing facility has evolved into a subacute hospital setting. I'd like to see more education and training of nursing staff on early recognition and identification of acute change in status of patients and better communication between nursing and physicians. This is the key to potentially avoiding a crisis and rehospitalizations. I am working with local facilities affiliated with Palo Alto Medical Foundation to help implement INTERACT (Interventions to Reduce Acute Care Transfer). Second, I believe advance care planning should be a top priority for patient-centered care in the long-term care setting. The POLST (Physician Orders for Life-Sustaining Treatment) has highlighted the need to have earlier, meaningful conversations with our patients and families to ensure that their treatment preferences match their values and goals. I am leading the Santa Clara County POLST coalition with support from the California HealthCare Foundation grant to improve the quality of conversations regarding goals of care and end-of-life discussions in the long-term care setting.

What advice would you give to a new graduate contemplating a career in long term care?

I believe a career in long-term care is challenging work, but ultimately rewarding and meaningful work that meets a real need in our fragmented healthcare system. It is a nice balance of clinical practice ranging from postacute rehabilitation patients with complex medical issues to getting to know patients and families age over time with their chronic conditions. There is a great opportunity to work closely with an interdisciplinary team at the SNF to provide the best care for your patients. A long-term care practice also offers more flexible hours which is important in balancing family life and work. I recommend talking to other long-term care physicians in the local area to get a better idea of the scope of practice and opportunities to improve the quality of care.

What additional training do you wish you had that may help with your current practice?

There are many patients with wound care issues and it would be advantageous to get more formal training in wound care. I think more experience working in interdisciplinary teams during training would be valuable in working closely with other disciplines. I think that training in developing quality improvement projects with staff members at the facility would be helpful to impact positive change.

How has CALTCM impacted your practice

CALTCM is a wonderful organization that has provided great guidance, mentorship, and inspiration for a young physician starting his career. The networking with experienced medical directors across the state has been very helpful to translate ideas into action. The annual CALTCM conferences have also been very educational and a great venue to share best practices.