"I get to spend time with my patients": nursing home physicians discuss their role.

Objectives: The purpose of this study was to learn about the role of the nursing home physician, and to begin to identify and articulate key concepts related to the role.

Design: A qualitative exploratory methodology was selected. Two medical students interviewed nursing home physicians in person, using open-ended questions.

Setting: The data reflect the nursing home setting.

Participants: Twelve physicians who practice full-time or part-time in a nursing home setting were interviewed. Six physicians were fellowship trained and seven were affiliated with an academic medical center. Eight physicians were from an urban area, and four were from a rural area in a Midwestern state.

Measurement: Qualitative data were grouped and coded to develop conceptual categories.

Results: Physicians were categorized as "pursuers, inheritors, or practice builders," based on their path to coming to care for nursing home residents. The medical directors among the physicians reported that their role was heavily dependent upon the desires of the nursing home administrator. Students were encouraged to visit many nursing homes to learn about the different ways in which the medical director role can be played out. Physicians reported positive aspects of their role including relationships with residents, families,staff; interesting and meaningful patient care; and autonomy. Less desirable aspects included: staff turnover, difficult expectations, and administrative issues. Although physicians indicated that social and indeed professional stigma are troublesome to people who work in nursing homes, they assured the medical student interviewer that caring for nursing home residents was gratifying and meaningful work.

Conclusion: The need for physicians to care for the growing number of nursing home residents will continue for decades. Learning more about how physicians come to care for nursing home residents can be used to develop better ways to recruit, train, and retain physicians. Information about what nursing home physicians value about their role can be used to structure more desirable roles.