Is a New FM grad qualified for Med Director of ALF?

[adamanteus]

Just wondering what folks here might think about a new FM grad taking on the role of Medical Director of a 100 bed Assisted Living Facility. There is a potential opportunity for me after I graduate in 1.5 yrs, and While I do see a LOT of geriatrics in clinic, I can't help but wonder if this is a whole different ballgame. Anyone here have experience with it, and can you tell me a little about what the day to day grind is like? I can imagine there is a lot of admin work, which I think I would like. Is 100 beds too many to consider it for part time work, 2-3 days per week?

Thanks!

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[smq123]

Just wondering what folks here might think about a new FM grad taking on the role of Medical Director of a 100 bed Assisted Living Facility. There is a potential opportunity for me after I graduate in 1.5 yrs, and While I do see a LOT of geriatrics in clinic, I can't help but wonder if this is a whole different ballgame. Anyone here have experience with it, and can you tell me a little about what the day to day grind is like? I can imagine there is a lot of admin work, which I think I would like. Is 100 beds too many to consider it for part time work, 2-3 days per week?

Thanks!

And this is how I know you're crazy.

This doesn't sound like a great setup, for a number of reasons. Essentially, you'll be learning how to be both a new attending (which has a steep learning curve on its own), while trying to learn to be a midlevel administrator at the same time. How much do they plan on paying you for this? How much autonomy does being a "medical director" afford you? Will you be allowed to hire and fire staff, or will you be expected to be just a glorified shepherd? Will you be given a lot of administrative and financial support, or will they expect you to be some kind of magician, making things magically happen with no money or help whatsoever? Who else will be caring for all these patients besides you?

 

[DoubleBogey]

And this is how I know you're crazy.

This doesn't sound like a great setup, for a number of reasons. Essentially, you'll be learning how to be both a new attending (which has a steep learning curve on its own), while trying to learn to be a midlevel administrator at the same time. How much do they plan on paying you for this? How much autonomy does being a "medical director" afford you? Will you be allowed to hire and fire staff, or will you be expected to be just a glorified shepherd? Will you be given a lot of administrative and financial support, or will they expect you to be some kind of magician, making things magically happen with no money or help whatsoever? Who else will be caring for all these patients besides you?

Agree - steep learning curve when initially starting to practice.

Medical director, at least in my neck of the woods, pays usually 1k per month. I have a partner who is medical director at 3 local nursing homes and we have talked about the demands when I initially came out of residency. You deal with “putting out fires” disgruntled families, providers not appropriately following the bylaws/rules of the facility, you can typically take on patients with no provider/PCP (or whose PCP doesn’t go to nursing homes). The demands aren’t too great, but certainly who be a greater challenge if taking on the responsiblility early in your career (although if you were 1.5 years out practicing I think you would be fine). 100 bed facility is a decent amt as well, so maybe you would be able to bump the pay to 2k/month (the 3 nursing homes my partner is medical director all pay 1k each - he’s also board certified in geriatrics, which isn’t necessary but certainly helps).

Good luck


- edit
Looks like you’re graduating in 1.5 years
Also, I would still consider the 100 bed facility part time - you won’t make enough to support you/family/loans on the medical director pay alone

 

[adamanteus]

Thank you both for the informative replies. Very helpful for someone who literally knows nothing about this. I am very interested in this particular position due to the circumstance. My situation is a little unique in that the ALF is managed by a Property Management Group owned by my in-laws. They, along with the owners, are looking to expand their investments into other ALFs in the area and surrounding states. The "idea" I am floating around would be for me to take on the role of Med Director of this facility and then the others, and over time assume more roles in the management side of things besides medical as my in-laws phase themselves out of the management business into retirement, while I and my wife take over. We are both in medicine and don't see ourselves staying in it long-term. We are toying with the idea of this as a financially sound way out. This would occur over the course of many years.

That being said, I don't want to bite off more than I can chew, and if a new grad is not capable of handling this, I don't want to do it. On the other hand, I love management, planning, "brainstorming," and solving the types of problems I hear my father-in-law talking about, so I'm just trying to figure out the feasibility of it.

 

[deleted87716]

I'd wait until you have more experience. It will either make you better, or change your mind.

 

[fantasty]

Run away! (j/k - someone referred me here ^^^ )

I would be glad to give you a more complete opinion and I'll try not to be biased in anyway. But, today's not that day...

But, here's one place to start looking into details about this type of practice: AMDA

I'm sure there are a lot of reasons why my experiences are probably a lot different than what you may encounter. But, to start - an assisted-living facility is likely going to resemble a primary care panel than what I deal with in post-acute/long term care. But, there are similarities. The medical director duties are pretty much what the others have described. But, it's really important to understand the dynamics that the facility has - like if you will be the attending of record for everyone, or if other practices will continue to take care of their own patients. And, I actually empathize with you in the sense that I *like* doing administrative work and the reason I thought this would be a good match for me is that it is essentially "population health management" (a buzzword in preventive medicine lately). But, like others said, this type of work is a time-suck, and certainly hobbles your ability to be "productive" by any standard measure (if that's something important in your contract).

I don't think ALF are as tightly regulated as SNF. But, there is a learning curve for sure. That's part of the reason for providing the above link. If you are interested in a "formalized" education and certification in being a medical director (or a CMD), you can take the AMDA organization's course (online or in person). I was dumb enough to jump in as both attending and medical director without experience, and it's been a nightmare. But, I also work in... less than desirable facilities and for people who... need better management skills. And, the PA/LTC world is a bit higher acuity since you're dealing with really sick folks dumped (I mean discharged) to rehab, as well as the chronic LTC folks who you'd expect in a nursing facility. But, demographics are shifting (here) so that it's not necessarily a geriatrician's population anymore. We have a lot of young residents who have early disability or degenerative diseases, and a fairly large percentage with significant psychiatric comorbidity.

Ultimately, you will know if it's a good fit. But, it might be best to start as an attending for your own patients who reside in the facility and see how things operate before taking on medical director.

 

[adamanteus]

Delayed response, but it's been a little crazy. Thank you for taking the time for that reply. I have a lot to think about and research. These folks seem to be in pretty good health overall. If they become complicated they are moved to a higher level of care.