The View from the Lou - SNF Physician Workforce Challenges

By Marc Rothman, MD


 Dr. Marc Rothman, Chief Medical Officer and Senior Vice President, Nursing Center Division Dr. Marc Rothman, Chief Medical Officer and Senior Vice President, Nursing Center Division


It doesn’t take a Ph.D. to know that changes are afoot in the SNF physician workforce. On some days it seems like our way of life is nearly extinct. I’ve had a dozen phone conversations over the past eighteen months with colleagues in Arizona, Colorado, Wisconsin, Kentucky, Georgia, North Carolina, Pennsylvania, and Vermont – to name a few – who all relate a similar tale: there used to be 8-10 physicians who cared for SNF patients in our community, now there are only two or three, sometimes only one, and in a few instances none at all! In several instances, the struggle to find physician coverage for our residents and medical directors for our centers has been painstaking and nerve-racking. And it is the rare physician who arranges his or her own succession plan, as you probably well know.

But on other days the story couldn’t be more different: competition for SNF patients and Medical Directorships has become intense in other parts of the country. The focus on improving transitions between healthcare settings, and the high price patients – and Medicare – pay for discontinuity, has inspired physicians across the country to develop new models and new relationships for post-acute and long-term care. In some areas everyone wants to practice in the SNF’s now. Large SNF’ist groups are looking to expand, local hospitalists are trying to stabilize patients after hospital or ER discharge, small home-based physicians see the SNF as a natural extension of their practice environment and a means to avoid unnecessary hospitalizations, and national hospitalist chains look at sixteen thousand nursing centers as an opportunity for growth.

These changing times are a perfect opportunity for us to take a good hard look in the mirror – and at the new cohort of SNF physicians entering our ranks – and ask some tough questions. Are patients being seen quickly enough upon admission or when there is a change of condition? Are our Medical Directors involved enough in the performance assessment and improvement process? Are we managing our formulary – our antibiotics and antipsychotics, for example – in a responsible way? Do we really provide adequate discharge documentation for the next level of care when patients move to home health or hospice? Do we assess our own rehospitalization rates and look for system issues that could be improved, or others that are great examples of best practice? Do we share those practices with our peers?

As these issues move from the shadows to the forefront, our expectations, our resources, and the data needed to monitor our progress all need to be recalibrated. This is the challenge and also the pleasure of being in the Nursing Center Division here at Kindred.