A recent article in JAMDA details a job analysis of attending physicians in long term/post-acute care that documents the unique and specific role they play in this setting.

“The pandemic highlighted the importance of engaged physicians to care for our residents, provide comfort measures, and prevent avoidable hospitalizations. This analysis bears out the importance of this involvement,” says Laura Morton, MD, CMD, one of the article’s authors.

The survey of attending physicians addressed a list of tasks, experience, and medical knowledge needed in their role in long term care. These items, developed and refined by a task force of subject matter experts, were written as statements that described distinct, identifiable, and specific practice-related activities. In all the survey consisted of 260 items.

The results showed that attending physicians supported statements related to ethical and culturally sensitive conduct, including applying principles of shared decision making, to achieve a patient- and resident-centered approach to care.

They also ranked highly knowledge relating to maintaining good facility coverage. Top medical care delivery statements related to recognizing, assessing, and treating patients and residents in a timely and nondisruptive manner, and ensuring continuous medical coverage.

Top-rated medical knowledge tasks centered on utilizing individualized information about comorbidities and risk factors to evaluate symptoms, as well as developing and following plans for additional and regular evaluation and re-evaluation. This includes deprescribing medications whenever possible. In support of these tasks, knowledge of differential diagnosis, deprescribing, pain management, multiple morbidity, and the use of decision-making tools were all highly rated.

“We hope that facility leaders will use this information to start a dialogue with attending physicians,” says Morton. “Talk about how you can work together to ensure the best possible care for residents.” Some physicians are more experienced than others, she notes, but there are numerous training and educational opportunities for all of them. “It is important to give physicians the tools and resources to succeed in this environment,” she says.

As new attendings come into facilities with little experience in this setting, it is important to ensure they understand the many unique aspects of long term/post-acute care, Morton says. “This requires training and education, and it will be useful to connect them with experienced practitioners who understand the specific regulatory environment, clinical evidence, and best practices for this space.”

More than ever, she says, “We understand the need for collaboration with all team members. These relationships will help us moving forward and prepare for future outbreaks. Our attendings are a key part of this.”

The job analysis was conducted for the American Board of Post-Acute and Long-Term Care Medicine. It is available online here.