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The Medical Administrative Role of Medical Directors and Advisory Physicians in Ontario Nursing Homes and Homes for the Aged*

Published online by Cambridge University Press:  29 November 2010

Cathy Charles ,
E. Ann Mohide  and
Marguerite Neimanis
Cathy Charles
Affiliation:
McMaster University
E. Ann Mohide
Affiliation:
McMaster University
Marguerite Neimanis
Affiliation:
McMaster University
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Abstract

A self-administered mailed questionnaire was sent to a stratified random sample of medical administrators in Ontario homes for the aged (HFAs) and nursing homes (NHs) in 1991 in order to explore the types and extent of medical-administrative activities undertaken by these physicians, and their perceptions of skills, attitudes and knowledge that were important in carrying out their roles. Three key findings emerged from the survey. First, considerable variation exists in the extent of medical administrative activities undertaken within each of the two facility types and, in some cases, across the two facility types. Second, there were few activities which ≥75 per cent of medical administrators reported undertaking on all occasions and many activities which ≥25 per cent of physicians reported not undertaking on any occasion. Third, in general, medical administrators did not express values congruent with adoption of a broader management role in facility administration, financing, and planning activities. Research and policy implications for the evolving role of medical administrators in NHs and HFAs are discussed.

Résumé

En 1991, un questionnaire a été posté à un échantillon aléatoire stratifié de médecins administrateurs de résidences pour aînés et de centres d'hébergement de l'Ontario, afin d'étudier les types et l'ampleur des activités médico-administratives que ces derniers doivent effectuer. De plus, le sondage visait à déterminer leurs perceptions des aptitudes, des attitudes et des connaissances dont ils doivent faire preuve afin de mener ces tâches à bien. Cette étude a révélé trois principaux aspects. Premièrement, il existe une importante différence entre l'ampleur des activités médico-administratives devant être effectuées au sein de chacun de ces deux types d'établissement et, dans certains cas, par les deux. Deuxièmement, peu d'activités sont rapportées par plus de 75 pour cent des edministrateurs et un grand nombre d'activités ne sont jamais effectuées par plus de 25 pour cent d'entre eux. Troisièmement, en général, les médecins administrateurs n'ont pas exprimé d'intérêt envers l'adoption d'un rôle de gestion élargi en matière d'administration d'établissements, de financement et de planification d'activités. Les auteurs traitent des conséquences au plan de la recherche et des politiques de l'évolution du rôle des médecins administrateurs au sein des résidences pour aînés et centres d'hébergement.

Keywords

Medical AdministratorsDirectorsAdvisory PhysiciansLong-Term Care FacilitiesNursing HomesHomes for the AgedCadres médicauxdirecteursmédecins consultantsétablissements de longue duréecentre d'hébergementrésidences pour les aînés.
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 14 , Issue 4 , Winter/hiver 1995 , pp. 657 - 685
Copyright
Copyright © Canadian Association on Gerontology 1995

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References

Adams, O. (1986). Getting Physicians Involved in Hospital Management. Canadian Medical Association Journal, 134, 157–159.Google ScholarPubMed
American Medical Association. (1977). The Medical Director in the Long Term Care Facility. Chicago: American Medical Association.Google Scholar
Anderson, T., & Mooney, G. (1990). The Challenges of Medical Practice Variations. London: Macmillan Press.CrossRefGoogle Scholar
Berwick, D.M. (1991). Controlling Variation in Health Care. Medical Care, 29(12), 1212–1225.CrossRefGoogle ScholarPubMed
Biddle, B.J., & Thomas, E.J. (1966). Role Theory: Concepts & Research. New York: John Wiley & Sons.Google Scholar
Bill 101, An Act to Amend Certain Acts Concerning Long Term Care. (1993). Ontario: Queen's Printer.Google Scholar
Bladek, R. (1989). The Role of the Medical Director in a Home for the Aged. Unpublished Document. Ontario Ministry of Community and Social Services.Google Scholar
Brimigion, J., & Feldman, A.C. (1977). Shifting Arenas of Responsibility in Long- Term Care. Journal of Nursing Administration, September, 37–40.CrossRefGoogle Scholar
Cassel, C. (1985). Doctors and Allocation Decisions: A New Role in the New Medicine. Journal of Health Politics, Policy and Law, 10(3): 549–565.CrossRefGoogle Scholar
Chassin, M.R., Brook, R.H., Park, R.E., Keesey, J., Fink, A., Kosecoff, J., Kahn, K., Merrick, N., & Solomon, D.H. (1986). Variations in the Use of Medical and Surgical Services by the Medicare Population. New England Journal of Medicine, 314, 285–290.CrossRefGoogle Scholar
Chronic Care Role Study Steering Committee. (1993). Executive Summary of the Project Report for the Chronic Care Role Study. Toronto: Hundert & Associates.Google Scholar
Collins, R.J. (1982). Medical Director and Administrator. New York State Journal of Medicine, March, 377–378.Google Scholar
Dillman, P.A. (1978). Mail and Telephone Surveys: The Total Design Method. New York: Wiley.Google Scholar
Durán-Arenas, L., Asfura, M.B., & Mora, J.F. (1992). The Role of Doctors as Health Care Managers: An International Perspective. Social Science and Medicine, 35(4), 549–555.CrossRefGoogle ScholarPubMed
Eisenberg, J.M. (1986). Doctors' Decisions and the Cost of Medical Care. Ann Arbor, MI: Health Administration Press Perspectives.Google Scholar
Elon, R. (1993). The Nursing Home Medical Director Role in Transition. Journal of the American Geriatrics Society, 41, 131–135.CrossRefGoogle ScholarPubMed
Fanale, J.E. (1989). The Nursing Home Director. Journal of the American Geriatrics Society, 37, 369–375.CrossRefGoogle Scholar
Freidson, E. (1970a). The Profession of Medicine. New York: Harper & Row Publishers.Google Scholar
Freidson, E. (1970b). Professional Dominance. New York: Atherton Press.Google Scholar
Freidson, E. (1980). Doctoring Together: A Study of Professional Social Control. Chicago: University of Chicago Press.Google Scholar
Freidson, E. (1986). Professional Powers. Chicago: University of Chicago Press.Google Scholar
Health Services Research Group (1992). Small Area Variations: What Arc They and What Do They Mean? Canadian Medical Association Journal, 146(4), 467–470.Google Scholar
Iglehart, J.K. (1987). Physician and Society: Renegotiating the Contract. Michael M. Davis Lecture. Chicago: Center for Health Administration Studies, Graduate School of Business, Division of Biological Sciences: University of Chicago Press.Google ScholarPubMed
Isack, A. (1973). Federal Government Involvement in Training Medical Directors of Long-Term Care Facilities. Journal of American Geriatrics Society, July, 261–263.CrossRefGoogle Scholar
Joint Commission on Accreditation of Healthcare Organizations. Long Term Care Standards Manual. (1988). Chicago.Google Scholar
Lawson, I. (1976). The Nursing Home's Medical Director-A New Breed of Mentor. Geriatrics, December, 91–93.Google Scholar
Levenson, S.A. (1989). The Nursing Home Medical Director: A New Era. The Journal of Long Term Care Administration, Spring, 6–9.Google Scholar
Linton, A.L., & Peachey, D.K. (1989). Utilization Management: A Medical Responsibility. Canadian Medical Association Journal, 141, 283–286.Google ScholarPubMed
Lomas, J. (1989). Physician Partnership in Resource Allocation: Towards a New Medical Ethos. Unpublished paper. CHEPA, McMaster University.Google Scholar
Lomas, J. (1991). Negotiating Limits to Medicine: Towards Harmony in Public and Self-Regulation. CHEPA Health Policy Commentary Series C91–2. Hamilton, McMaster University.Google Scholar
Lomas, J., MacKinnon, B., & Marsh, L. (1988). Report For The Ontario Association of Medical Directors of Homes for Senior Citizens. Unpublished Document. McMaster University, Hamilton.Google Scholar
Mark, H. (1968). Organization of a Comprehensive Medical Care Program in a Chronic Disease Hospital. Journal of the American Geriatrics Society, 16(7), 772–778.CrossRefGoogle Scholar
McKibbin, R.C. (1978). The Medical Director in Long Term Care: Policies and Recent Experiences. The Journal of Long Term Care Administration, 6(2), 49–60.Google ScholarPubMed
Mico, P. (1974–1975). Some Dynamics of Change in the Organization and Management of Physician Services in Long Term Care Facilities. The Journal of Long Term Care Administration, Winter, 9–18.Google Scholar
Miller, D.B. (1976). The Interdisciplinary Role of the Nursing Home Medical Director. Wakefield, MA: Contemporary Publishing Inc.Google Scholar
Miller, D.B., Brimigion, J., & Keller, D. (1972). Nurse-Physician Communication in a Nursing Home Setting. Gerontologist, Autumn, 225–229.CrossRefGoogle Scholar
Miller, D.B., Keller, D., & Woodruff, S. (1974). Evaluation of an Open and Closed Medical Staff in a Nursing Home Setting. Gerontologist, April, 158–162.CrossRefGoogle Scholar
Miller, D.B., Lovenstein, R., & Winston, R. (1976). Physician's Attitudes Toward the Ill Aged and Nursing Homes. Journal of the American Geriatrics Society, 25(11), 498–504.CrossRefGoogle Scholar
Mitchell, J.B. (1982). Physician Visits to Nursing Homes. Gerontologist, 22(1), 45–47.CrossRefGoogle ScholarPubMed
Mitchell, J.B. & Hewes, H.T. (1986). Why Won't Physicians Make Nursing Home Visits? Gerontologist, 26(6), 650–654.CrossRefGoogle ScholarPubMed
Moss, B. (1975). Medical Direction in Long Term Care Facilities. Illinois Medical Journal, September, 235–239.Google Scholar
Ontario Ministry of Community and Social Services, Ministry of Health and Ministry of Citizenship. (1993a). Partnerships in Long Term Care: A Policy Framework. Ontario: Queen's Printer.Google Scholar
Ontario Ministry of Community and Social Services, Ministry of Health and Ministry of Citizenship. (1993b). Partnerships in Long Term Care: An Implementation Framework. Ontario: Queen's Printer.Google Scholar
Ontario Ministry of Health. (1993). Long Term Care Facility Program Manual Draft III: Implementation Copy. Toronto: Long Term Care Division.Google Scholar
Ontario Ministry of Health and Ministry of Community and Social Services, Long Term Care Division. (1993a). Long Term Care Facility Program Manual. Toronto: Policy Branch, Long Term Care Division.Google Scholar
Ontario Ministry of Health and Ministry of Community and Social Services. (1993b). 1992 Levels of Care Classification: Provincial Summary Data. Toronto: Long Term Care Division. Ontario Nursing Homes Act, RSO, 1990, Reg. 690, 50(3).Google Scholar
Ouslander, J.G. (1989). Medical Care in the Nursing Home. Journal of the American Medical Association, November 262(18), 2582–2590.CrossRefGoogle ScholarPubMed
Pattee, J. (1980). The Family Physician and Nursing Home Care. American Family Physician, November, 137–140.Google Scholar
Pattee, J. (1983). Update on the Medical Director Concept. American Family Physician, December, 129–133.Google Scholar
Roos, N.P., Wennberg, J.E., & McPherson, K. (1988). Using Diagnosis-Related Groups for Studying Variations in Hospital Admissions. Health Care Financing Review, 9(4), S53–62.Google ScholarPubMed
Snedecor, G.W., & Cochran, W.G. (1967). Statistical Methods (6th ed.). Iowa: The Iowa State University Press.Google Scholar
Solon, J.A. (1963). Medical Care: Its Social and Organizational Aspects. Medical Care, 269(20), 1067–1074.Google ScholarPubMed
Tessaro, E.A. (1974). The Medical Directorship. The Journal of Long Term Care Administration, Winter, 19–55.Google Scholar
Wennberg, J.E., Freeman, J.L., & Culp, W.J. (1987). Are Hospital Services Rationed in New Haven or Over-Utilized in Boston? Lancet, 1, 1185.CrossRefGoogle ScholarPubMed
Wickings, I. (1987). Combining Clinical Budgets and DRGs For Quality Management. Health Policy, 7, 215–226.CrossRefGoogle ScholarPubMed