Medical Directors are in Short Supply When Their Expertise is Needed Most

A continued shortage of medical directors opting to enter the aging space has had unforeseen ramifications in skilled nursing facilities, with this position being key to convincing staff to receive the COVID-19 vaccine.

Certified nursing assistants (CNAs) in particular, according to the National Association of Health Care Assistants CEO Lori Porter, put a lot of trust in what their medical director advises.

A Secure Relationship


“[CNAs] have a great deal of trust and faith in those positions,” explained Porter. “Medical directors should have been really the only trusted source for the nursing homes themselves because that’s their role in being the medical director, to ensure the staff is educated, informed, empowered to make these important health care decisions.”

The top clinical professional in a nursing home is the medical director, Porter said, adding that their importance was heightened for the last several years with what she calls an undermining of the Centers for Disease Control & Prevention (CDC).

“They were not the trusted source for nursing homes,” Porter said of the CDC.


Reports last year document efforts by the Trump administration to alter or withhold reports damaging to the administration’s response during the pandemic.

On the opposite side of that conversation, medical directors need to be doing more to engage with SNF staff, Porter noted.

“I know the medical directors have all held town halls, but … we weren’t addressing it in the way it needed to be addressed,” said Porter. “We needed to answer the questions we knew they had without asking them to try to articulate them; a lot of people didn’t raise their hands and still had questions. My feelings are we should leverage the relationship of the medical director.”

About 45% of the country’s 1.5 million nursing home staff are unvaccinated against COVID-19 as of June, NAHCA reported. CNAs make up 34.4% of nursing home staff, according to a May 2020 report released by the U.S. Bureau of Labor Statistics.

Medical directors account for 1.65% of nursing home staff, the report stated.

Filling the Role

Operators have had to get creative to fill the role, partnering with medical groups instead of hiring directly due to costly wages, inconsistent hours and duties, and a general perception that the role isn’t as exciting as what a physician would encounter at a hospital.

The median annual wage for the role was $104,280 as of May 2020, according to the U.S. Bureau of Labor Statistics.

Southfield, Mich.-based Ciena Group contracts with Theoria Medical to supply its medical directors, and corporate medical director, across 28 of its facilities.

“There are some organizations out there that hire their own staff, it’s just more costly to do it that way,” said Lisa Anetrini, vice president of clinical operations for Ciena, of its partnership with Theoria. “Most of the medical directors are [brought on] through a contract basis so they can cover more facilities. I don’t anticipate that changing in the near future.”

Theoria, founded just two years ago and headquartered in Novi, Mich., brands itself as an all-inclusive medical group, providing physicians, physician services, and a telemedicine team, in addition to medical directors to upwards of 500 facilities in more than 25 states.

Dr. Justin Di Rezze, CEO of Theoria Medical told SNN the shortage of medical directors stems from physicians not choosing this career path, rather than there not being enough individuals to choose from. Most physicians choose the “hospitalist path,” Di Rezze said, having chosen this path himself when first practicing medicine.

“Post-acute care is not an attractive area … it’s not an exciting area of medicine, like it is like working in the hospital; that’s the perception,” said Di Rezze. “Do I agree with that? No, I don’t agree with that, I think that post-acute care is incredibly exciting. I think it’s exciting because if you are innovative, and you want to truly make an impact it’s a blank slate to do so.”

Changing Perceptions

About 85% of Theoria’s physicians were hospitalists or had hospital experience before transitioning to aging care.

“As a medical director, as an attending physician, as a [nursing director] or [physician assistant], you can implement processes, right in the moment … that’s just extremely fulfilling. As a physician, personally I was tired of corporate medicine.”

Di Rezze said there hasn’t been concrete standardization in the way medical directorship is done, or the way physician services are rendered in post-acute care, leaving a lot of variance in what is expected of the position. At that point physicians opt for a reliable shift and hospital duties instead of a role that shifts depending on what facility you’re overseeing.

Theoria has had 100% success finding medical directors for its locations, that includes both urban and rural — and rural positions are notoriously difficult to fill, Di Rezze said.

“We have facilities in the Upper Peninsula of Michigan, we have facilities in rural North Carolina, rural Texas, areas that, even the building admins were telling us you will never find staff at this facility,” added Di Rezze. “There’s a shortage of commitment to finding medical directors and I think there’s a shortage of investment from the physician side.”

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