Northern Ontario rotation inspires new perspective on pharmacy practice

Alina Montgomery’s rotation on Manitoulin Island demonstrated the importance of pharmacists in northern communities

Tucked in a bay on the northeastern shore of Manitoulin Island is the town of Manitowaning. This small town, which is home to about 1000 people, has one of the island’s few community pharmacies – and was the site of one of Alina Montgomery’s fourth-year advanced pharmacy practice experience (APPE) courses. The rotation gave her hands-on experience with pharmacy practice in northern communities.

“Northern Ontario needs health care workers and pharmacists are among those people,” says Montgomery, a fourth-year Doctor of Pharmacy (PharmD) student at U of T’s Leslie Dan Faculty of Pharmacy. “We are always taught that pharmacists are the most accessible health care providers, and in rural areas, you see that so clearly and have the opportunity to demonstrate our full scope of practice.”

Montgomery grew up in Sudbury, about 120 km northeast of the bridge to Manitoulin Island. Throughout her studies, she knew she wanted to return to practise in Northern Ontario following her PharmD degree. She sought out APPE rotations in Sudbury and other parts of Northern Ontario where she could gain practical experience with the unique needs of northern communities and connect with pharmacists in the area.

Manitoulin Island was one of her top choices. She had visited the island regularly while growing up and enjoyed its peaceful environment and friendly communities. She secured a rotation at the Guardian Pharmacy in Manitowaning, with preceptor Mena Geurguis, for the summer of 2024.

With the rotation being early in her APPE year, she gained more experience with dispensing and verifying medications. But she also saw the pharmacist’s role in minor ailment prescribing; she was in Manitowaning at the height of tourist season, and pharmacists were providing care for visitors with ailments not severe enough to warrant a trip to the emergency department. She also learned about the pharmacy’s opioid agonist program, which serves residents who often need to drive many kilometres every day to receive their treatment.

While Manitoulin Island has three family health teams and two small hospitals, patients may have to travel many kilometres over country roads to access the care they need. If they need more specialized care, they have to travel to Sudbury, which is a health care hub for northern Ontario. Montgomery saw firsthand how pharmacists could help fill those gaps and serve as trusted health care professionals.

“It can be hard for people to see their doctor or go to the emergency room, which functions almost as a walk-in clinic on the island, but a pharmacy might be a little bit closer and often serves as a kind of information hub,” she says.

“People really value the pharmacists’ advice, and I could see that they really trusted them and had good relationships with them.”

Faculty offers patient care rotations in northern communities

With pharmacists being such an integral and trusted part of health care in Northern Ontario communities, the Leslie Dan Faculty of Pharmacy offers opportunities for students to gain experience in northern pharmacy practices—whether they are originally from those communities and planning to return to practice or they want to see a practice different from what they may be used to in more urban settings.

“Pharmacy practice in northern areas is different from the Greater Toronto Area because the communities are different, patients have unique needs, and access to resources may require different solutions to navigating the local health care system,” says Marcia McLean, assistant professor (teaching stream) and academic lead experiential education and professional programs at the Leslie Dan Faculty of Pharmacy. “Pharmacists often have deep ties to the community, and their practice may vary according to the availability of other health professionals nearby.”

The Leslie Dan Faculty of Pharmacy offers several community and hospital pharmacy rotations in northern Ontario. To support these experiences, students who may face extra costs for these rotations may apply to the Faculty for financial support through the Shaping Student Life and Learning (SSLL) Awards.

McLean says that gaining experience in northern or remote communities can be a valuable experience for a pharmacy student to see how practices differ, even within the same province.

“It’s valuable for students to gain an understanding of how that practice is different and how pharmacists operate given different resource intensities. For example, access to specialist care may be different for patients in remote communities, so pharmacists in these communities may have different systems in place to support patients,” says McLean.

Patients in small communities benefit from familiar faces

All of Montgomery’s APPE rotations have been in Northern Ontario, and she plans to return to her hometown of Sudbury to practise after she graduates.

She says the rotation in a rural community on Manitoulin Island provided her with a valuable experience.

“The people in the community were always kind and patient, and they valued having a pharmacy in their community and seeing familiar faces there,” she says. “Health care providers in small communities like this tend to know their patients really well, and patients benefit from seeing familiar faces because and it helps them build trust in their provider.”