Appendix G: Medical Director's Role and Responsibilities

This document is a recommended job description for a hospice medical director. It can be used as a guideline for administrator and physician, provided the terms and provisions of the document are modified to apply to the specific scope and resources of each individual situation.

The physician medical director should establish a job description, after consulting with a facility's administrator and director of nursing.

1. In collaboration with the nursing director, the administrator, and other health professionals should develop formal patient care policies for the facility that:

   • provide for the total medical and psychosocial needs of the resident, including admissions, transfer, discharge planning, range of services available to resident, emergency procedures, and frequency of physician visits, in accordance with resident needs, and;

   • help enhance residents rights as identified by the federally-mandated Patient Bill of Rights.

   The medical director should help the facility ensure that these patient care policies are carried out, as reflected and documented in a facility's drug regimen review and quality assurance committee activities.

2. Act as liaison between the attending physicians and other health professionals caring for residents.

3. In an emergency, be prepared to assume temporary responsibility for the care of a resident if the resident's own attending physician or the designated alternate physician is not available.

4. Develop, amend, recommend, and implement appropriate clinical practices and medical care policies that help ensure that each patient's medical regime is incorporated appropriately into the plan of care.

5. Exercise medical and clinical leadership in a multi-disciplinary approach to resident care and care planning within the long term care setting, and interact with the attending staff as a colleague and a peer.

6. Monitor the clinical practices of attending physicians and intervene as needed on behalf of patients or the facility's administration.

7. In cooperation with the administration and with the approval of the governing body, represent the medical staff in developing rules, regulations and policies for the attending physicians who admit their patients to the facility.

8. Review recommendations and reports of drug regimen review and quality assurance activities, and take appropriate and timely action as needed to implement recommendations.

9. Meet periodically with nursing and other professional staff to discuss clinical and administrative issues, specific patient care problems and professional staff needs for education or consultants, offering solutions to problems and identifying areas where policy should be developed.

10. Help obtain the services of qualified professionals to serve as consultants to help meet residents' special needs, such as dentistry, podiatry, dermatology, or orthopedics.

11. Help the facility administrator and professional staff ensure a safe and sanitary environment for residents and personnel, by reviewing incidents and accidents, identifying hazards to health and safety, and advising about possible correction or improvement of the environment.

The Medical Director may also:

1. Attain and provide information about federal, state and local regulations and codes applicable to long term care facilities, applicable to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and the professional service and administrative requirements and expectation of third party payers.

2. Help develop in-service and other education programs and materials for attending physicians and professional staff within the institution, in cooperation with the director of nursing and the administrator.

3. Provide current information and advice about patient care, new treatment modalities, and the pathophysiology of illness.

4. Prepare a periodic report for administration summarizing his/her actions, concerns and recommendations as medical director.

5. Represent the facility in discussions and meetings with other institutions or agencies on issues relevant to medical care.

6. Help the facility develop an ongoing program to evaluate and manage the health of the facility's employees, by 1) establishing policy and procedures, and 2) direct physical examination of employees, emphasizing freedom from significant infection, pre-employment physical examinations and reexaminations, and compliance with local and state health regulations.

7. Help manage review and respond to federal, state or local surveys and inspections.