Concrete Steps Toward Academic Medicine in Long Term Care

Abstract

Over the past 5 years, many articles have been published about the role of nursing home (NH) physician specialists in the quality of medical care in long term care settings.1e12 Recently, Katz and Pfeil7 argued in the Journal that there is a necessity to increase the credibility of NH physicians. One of the initiatives of the board of directors of the American Medical Directors Association (AMDA) was to develop a core set of competencies for physicians working in NHs. Katz and Pfeil7 state that there is also a need for NH leadership and that physicians who are embedded in the organizational culture of the homes are more likely to find success in leadership and therefore can have great impact on quality of care. Finally, Katz and Pfeil7 call for more research to demonstrate the link between physician competency and quality of care. That research can improve quality of care is also argued by Rolland and de Souto Barreto.13 They state that research can improve ongoing training of NH staff, encourage new strategies of care, including medication and nonpharmacological interventions, enhance daily practice, and can help to change negative cultural and societal representations of NHs and their workers.13 However, improving research in NHs poses many challenges for academics, as there is neither a research culture nor an adequate infrastructure to perform highquality research. Although some of the articles have pointed at the Dutch situation, most of the authors insufficiently recognize the achievements and the developments of the Dutch long term care sector and that the Netherlands already has provided some answers to the challenges raised before. We point at 2 concrete initiatives: (1) the establishment of a NH physician specialty with a 3-year training program, and (2) the establishment of academic networks of NHs providing an infrastructure for teaching, research, and best practices.