The facility medical director role is changing. The days of signing forms, attending a meeting, and receiving monthly stipends are over. Welcome to active oversight, interventions for improving patient care, combating polypharmacy, evaluating and enforcing antibiotic stewardship, reducing inappropriate psychotropics, understanding the letter and intent of the regulations from the Centers for Medicare & Medicaid Services … and hourly rates for work actually done.
As an aging group of “old-time” medical directors prepares to retire, finding younger replacements has been challenging. Finding physicians who want to assume this role — which requires staying educated (academically and administratively) as well as being involved in patient care decisions and frequently being the “bad guy” to patients, families, and peers — isn’t easy. As the president of CMDA — The Colorado Society for PALTC Medicine from 2012–2016 and chief medical officer for a long-term care chain, I was always scoping out new prospects.
Let’s rewind to 2014: Enter a young provider, whom I had come to know and respect for his clinical acumen, intellectual curiosity, participation in psychopharmacology meetings, and, luckily, his willingness to thoughtfully challenge recommendations. I relish finding this kind of provider, but unfortunately my successes have been few and far between. Most either blindly follow recommendations without thinking or questioning, or they simply ignore them. I have little respect for either.
Now let’s jump to 2016: The young provider has asked me what it would take to be a medical director. My reluctant response was simply, “Different initials after your name” — MD or DO rather than PA-C. Nonetheless, I tucked the information away, knowing he actively attended CMDA meetings, displayed the previously described attributes, and was actively seeking to attain skills and knowledge he didn’t yet possess.
In short, he was exactly what I’d been looking for. It would take two years and many meetings with leadership, but eventually they allowed me to hire him as a corporate “assistant to the medical director” to fill some glaringly obvious responsibility gaps among some of our medical directors. When this role worked out beyond expectations, it was only a minor tweak to add him to the team in a facility where most patients were followed by the medical director of record. Six months later, I received this feedback from the director of nursing/nursing home administrator:
“Travis is an awesome addition to our team! He is collaborative and recommendations are very compatible for our vision. Psychpharm used to be a meeting everyone dreaded, and now it feels like everyone has a voice — no idea is shot down. [Travis] is a huge part of the positive transition for us. So much better than anything we had last year!”
The rest is history — a very positive one.
Dr. Gahm is a geriatrician serving as chief medical officer for Vivage Senior Living and medical director for a number of Denver-area nursing homes. He served as president of CMDA — The Colorado Society for PALTC Medicine. Dr. Gahm serves on several task forces, including antibiotic stewardship, inappropriate use of antipsychotics and psychoactive agents, prevention of Clostridium difficile infections, and strategies for discharging very difficult long-term care patients. For the past five years, he has led a monthly Geriatric Journal Club for LTC providers in Colorado.
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- Supporting the Medical Director: An Opportunity for Physicians, NPs, and PAsCaring for the AgesVol. 21Issue 2
- PreviewI remember a key turning point in my career in post-acute and long-term care. The new medical director at the facility where I had been working for several years began to give me recommendations on the impact of my care. Before that, I had barely known there was a medical director. And even as others complained about the new medical director “telling them what to do” or “not understanding how difficult this patient is to manage,” I welcomed the oversight as a learning opportunity.
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