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What is a Medical Director?

A long term care facility medical director is the organization's clinical leader. He or she oversee clinical care in the facility, works with the interdisciplinary team to ensure quality care and implement appropriate clinical policies, procedures, and programs, and works with the facility administration regarding staff management and survey issues, quality assurance activities, and education and training for physicians, nurses, and caregivers. Briefly, in fact, the roles and responsibilities of the medical director in the nursing home can be divided into four areas: physician leadership, patient care-clinical leadership, quality of care, and education.

Why is a medical director important?
AMDA believes that physician involvement in long term care is necessary to the delivery of quality long term care. More and more, medical directors are held accountable by state legislators, regulators, and the judicial system for their clinical and administrative roles in facilities of all kinds. At least one state has passed a law outlining specific regulatory responsibilities and educational requirements for medical directors, and other states may follow its lead.

The 2001 Institute of Medicine report Improving the Quality of Long Term Care urges facilities to give medical directors greater authority and hold them more accountable for medical services. The report further states, "Nursing homes should develop structures and processes that enable and require a more focused and dedicated medical staff responsible for patient care. These organizational structures should include credentialing, peer review, and accountability to the medical director (Institute of Medicine 2001, 140)."

What is the value of a medical director?
Physician medical directors are responsible for implementing federal standards requiring that medical services, as well as psychosocial services, be provided to help each resident meet his or her highest level of well-being. This has contributed to improvements in patient care including:

  • Increased ability to maintain physical functioning in activities of daily living (i.e., eating, dressing, bathing) for longer periods of time;
  • Reduced use of physical restraints by 50%;
  • Reduced dehydration by 50%;
  • Reduced rate of use of indwelling catheters by 29%;
  • Increased treatment of depression by 12%;
  • Increased residents with advance directives by 64%;
  • Increased use of hearing aids for persons with hearing difficulty by 30%; and
  • Reduced use of hospital services by 25%.

Why is it important for medical directors to be members of the American Medical Directors Association?
AMDA provides cutting-edge education, information, and tools on clinical, management, and technology topics that are specific to the long term care setting. The organization also offers opportunities for members to learn from their fellow physicians and other long term care leaders about best practices and other ideas and activities that can maximize the quality of care and quality of life for patients.

Medical directors who are AMDA members understand benefits of the team approach to quality care, have leadership skills, and know about the latest trends, developments, treatments, and research that impact patient care.

What is the difference between a medical director and an attending physician?
Many AMDA members often take on the role of the medical director as well as the role of the attending physician. It is the responsibility of the attending physician in the long term care setting to lead the clinical decision-making for patients under their care. They can provide a high level of knowledge, skill, and experience needed in caring for a medically complicated population.

Why is it important for a medical director to be a Certified Medical Director?
The Certified Medical Director in Long Term Care (AMDA CMD) Program was created to professionalize the field of medical direction. The AMDA CMD Program was developed by AMDA in 1991, after three years of research and development using surveys, consensus conferences and experts to define the core skills and knowledge necessary for effective medical direction.

The CMD program recognizes the dual clinical and managerial roles of the medical director. Certification requires demonstrated competence in clinical medicine and medical management in long term care. Physicians who become CMDs have proven that that they have a high level of management and leadership skills and abilities, as well as cutting-edge, specialized knowledge about common geriatric syndromes such as Alzheimer's disease and dementia, Parkinson's disease, congestive heart failure, COPD and other respiratory illnesses, infectious diseases such as pneumonia, and chronic pain. They not only know how to best manage these conditions when they occur in elderly patients, they also understanding how to best address them in the unique setting of the long term care facility.

Is the medical director a full-time employee of the facility?
Most medical directors actually are part-time employees of the facility. In fact, 84% of medical directors work part-time. At the same time, 87% also serve as attending physicians. Nearly 60% have a private practice outside of their long term care responsibilities.

According to an AMDA survey, the majority of medical directors are experienced. In fact, the survey showed that physician leaders have an average 10.5 years of experience in this role.

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