It’s Time to Expect More From Your Medical Director!

A common complaint I hear revolves around the medical director and his or her unwillingness to perform the most basic duties of their role or that they are standing in the way of a facility’s progress.

I’ve seen medical directors who wouldn’t come to see their patients regularly.  I’ve seen them fail to keep their progress notes up.  I’ve seen medical directors dictate what home health  or hospice company a nursing home would utilize.  I’ve seen medical directors who wouldn’t “let” their facility use any other type of negative pressure pump other than KCI, even when KCI was overcharging.  I’ve seen medical directors who would not culture wounds because they didn’t want to know if MRSA was present, and then, obviously, failed to order the appropriate antibiotic treatment.  Some failed to attend the QA Committee meetings as they are required to.  I have even seen medical directors who hindered the admissions process at facilities demanding that all referrals be run through them before the facility accepts or they wouldn’t take the patient.

All of this is unacceptable.

The way I look at it is this – I pay the medical director.  He is a contract employee independent contractor of mine.  He works for me, not the other way around.  He is certainly not going to stand in my way or hinder my progress.  When I take a facility, I usually ensure the medical director knows what direction I will take the facility right from the start and I make sure he understands that we need to be on the same team to accomplish this.  I’m not confrontational, but I make sure he understands that I’m a professional and that I am the leader of my facility; I’m not the complacent, stay-in-the-office, never-say-anything administrator that he may be used to from the past .  If he is unwilling to get on board, then he probably should have never been hired in the first place.  Many times, a physician is hired as the medical director without giving much thought of how they will impact the facility.  I have hired and fired medical directors and have had to have many conversations to ensure they were taking care of what I expected them to.  If you have hired or inherited a medical director who is failing to live up to your expectations after you’ve had the necessary conversations with him, cut your losses.  Can him!  Don’t worry about how it’s going to affect you in the community.  You can’t be held hostage by a physician who isn’t vested in your success.

I always have the cell phone number to the medical director and they are accessible to me 24/7.  I have no qualms about calling them on a Saturday to deal with a problem they failed to address Friday.  On the same note, it is an unwritten rule that if you are the medical director, you will accept any new patients that we don’t have another physician for.  If you can’t handle that, I doubt you can handle the other expectations I have of you.

Administrators, it’s time to toughen up.  Don’t let your contract employee independent contractor (aka medical director) run over you.  Set your team up for success by hiring the right physician and ensuring excellent communication with them.  Take control of your facilities, set the example, and be a leader.  Physicians have to be managed, too. You’re the person responsible for doing it.

Good luck!

EDIT: Please see Dr. Clark’s comments below.  For clarification, the terminology “contracted employee” is not in line with IRS regulatory language and, as such, the hypothetical individual used in our example in this post would in fact be a “independent contractor.”  Thanks to Dr. Clark for shedding some light on this.

Administrators, this doesn’t relieve you of your responsibilities to ensure your employees and indivividuals independently contracted to your facility are keeping you in compliance.  While there are certainly many great medical directors that should be recognized, this particular post focuses on those that need a push.

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5 Responses to “It’s Time to Expect More From Your Medical Director!”

  • Nursing Online on

    Great post!

  • Peter Clark, MD, CMD on

    You have a model. It is not the standard model or even most common one. Not all medical directors serve as attending physicians. Not all medical directors report to the administrator; many report top the board. Most are not “employees”. “Contract employees” reflects confusion about this. Many medical directors are passionate about care of our elders. Many medical directors have watched administrators come and go while the medical directors steadfastly and reliably cared for the residents and the facility.

  • Mark on

    Hello, Dr. Clark. Thank you for your contribution. I knew my post may ruffle a few feathers, but hey, it gets people talking. You are accurate in your comments for the most part; however, if the physician has signed a contract to provide duties as a medical director to the facility, he’s a contracted employee. It’s not a partnership. If he or she doesn’t feel they are a contracted employee to the facility, then the contracted obligations were not clearly defined or something is lacking. If the Medical Director isn’t accountable to the administrator, I would hate to work in that home as it’s structure of mangement organization is truly questionable. And, yes, it’s true that while many medical directors are passionate about the care of our elders, there’s quite a growing number who are giving your group a bad name. I know how that feels because there’s a growing number of less-than-stellar administrators and operators that are giving my group a bad name as well. Obviously, my post isn’t to slam all medical directors – I’ve had some great ones – just those who aren’t getting the job done. I do appreciate your insight and opinion and would like to invite you to share your experience with our readers again.

  • Peter Clark, MD, CMD on

    Kindly see http://www.irs.gov/businesses/small/article/0,,id=99921,00.html
    At my nursing facilities I function as an independent contractor.

    -Peter Clark, MD, CMD

  • Mark on

    🙂 I stand corrected.

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