A medical director oversees the medical aspects of a healthcare facility, like a skilled nursing facility (SNF). For example, they’re responsible for developing medical policies and ensuring staff comply. An attending physician focuses on providing direct patient care. Both roles involve leadership and clinical decision-making.
SNFs rely on qualified medical directors and attending physicians to comply with regulations and deliver high-quality care. As SNFs face rising occupancy rates, persistent workforce shortages, and evolving regulations, strong leadership becomes even more vital.
By understanding the differences between medical directorship and attending physician responsibilities, you can clearly define their roles and how they can contribute to your organization’s vision.
A medical director is a licensed physician who leads medical teams, develops clinical care policies, and monitors patient and resident outcomes to ensure regulatory compliance. Under Title 42 Part 483 of the Code of Federal Regulations (CFR), the Centers for Medicare and Medicaid Services (CMS) requires SNFs to designate a qualified medical director if they accept Medicare or Medicaid.
Beyond fulfilling CMS requirements, medical directors are essential in SNFs. A medical director who is engaged and focused on their site functions as a compass, guiding clinical care teams toward improved patient care and advocating for patient and resident needs.
A medical director’s responsibilities vary depending on the type of healthcare facility and its preferences. For instance, under Section 483.75 of the CMS regulations, a medical director — or their designee — is required to be a part of the quality assessment and assurance committee in a long-term care facility. In other words, medical directors are an essential voice in quality assurance and performance improvement (QAPI) programs.
CMS provides further guidance under Section 483.5, saying that medical directors in SNFs must be responsible for:
The Post-Acute and Long-Term Care Medical Association (PALTMed) recommends medical directors handle the following responsibilities:
Overall, medical directors are physician-trained decision-makers equipped to strategically align a SNF’s goals with patient care. Depending on a center’s needs and vision, they may offer more than the above.
In 42 CFR section 483.70, it states that long-term care facilities, including SNFs, “must designate a physician to serve as medical director.” Therefore, to be a medical director in a SNF, one must hold a current and valid license to practice medicine or osteopathy in their state, at a minimum.
Some states have additional requirements to supplement federal regulations. For example, in Maryland, physicians must have two years of experience providing medical care to geriatric or chronically ill residents or specialized training and completion of an approved curriculum before qualifying to become a long-term care facility medical director.
In California, nursing home medical directors must obtain a Certified Medical Director (CMD) credential in addition to a medical license. Other states may eventually follow suit.
Outside of the required qualifications, the following helps SNF medical directors succeed in their roles:
At First Docs, our physicians are trained in both internal medicine and medical directorship. They’re experienced in QAPI processes, ensuring CMS compliance, managing regulatory updates, and lowering readmission rates.
Our medical directors aren’t just specialized physicians who believe in high-quality, patient-centric care — they are collaborative leaders who are passionate about helping SNFs achieve their quality improvement goals. They are committed to ongoing education and training, enabling them to guide healthcare teams with up-to-date skills and knowledge.
An attending physician is a licensed physician who has completed residency training and is qualified to practice without supervision. They are expected to be experts in their field, capable of delivering the best possible care.
Attending physicians may also fulfill supervisory roles, overseeing resident and fellow physicians. They are responsible for all patient care they or their medical team provide.
Attending physicians primarily focus on providing direct patient care and ensuring continuity of care after discharge. Those who specialize in SNF care and take a patient-centric approach are also informally referred to as SNFists. According to a study published in the Journal of the American Medical Directors Association, SNF experts agree that SNFists provide higher quality care than other physicians.
Regardless of whether an attending physician is a SNFist, their core responsibilities generally include:
Attending physicians must have a current license as a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) in their state. It is also becoming increasingly common for attending physicians to have a board certification in their specialty. According to the most recent American Board of Medical Specialties (ABMS) Board Certification Report, there were over 997,000 diplomates with an active ABMS certification in 2024 — an increase of around 12,800 from the previous year.
General qualifications include:
Medical directors and attending physicians are interdependent. They share the same goals — improving care quality, boosting health outcomes, and ensuring regulatory compliance. Working together empowers them to achieve these goals as each role complements the other. Both roles involve responsibility for patient oversight, though understanding the difference between medical directors and attending physicians demonstrates how this collaboration functions operationally
For example, a medical director might optimize a center’s transitional care program to reduce hospital readmissions, which the attending physician will help implement. Meanwhile, an attending physician will ensure care teams follow documentation protocols to gather valuable quality metrics, which they’ll share with the medical director to support their involvement in QAPI processes.
Regular communication, meetings between the medical director and attending physicians, and clinical feedback loops are crucial to creating a culture of high-quality, patient-centric care.
Strong leadership has always been important in SNFs. However, as CMS regulations frequently evolve and care needs grow more complex with a rapidly aging population, SNFs increasingly rely on skilled leaders to drive compliance and develop robust care policies.
The following factors, in particular, have led to an increased demand for experienced, qualified medical directors in SNFs:
If you have more questions about attending physicians and medical directors in a skilled nursing facility, review our FAQs below.
Yes. While they serve distinct roles, it’s common for medical directors to also serve as attending physicians in SNFs.
Requirements vary by the organization, but attending physicians generally gain several years of experience before becoming a medical director. Attending physicians should also be able to demonstrate leadership and administrative skills before taking a directorship position. Earning a CMD credential through PALTmed can give attending physicians a competitive edge when applying to be a medical director.
Yes, medical directors play pivotal roles in staff training. While they may not provide the hands-on training that attending physicians offer, they will ensure medical staff are adequately trained and meet performance needs. Medical directors may also be responsible for developing and overseeing training programs.
Collaborating physicians balance the individual preferences and needs of each patient and resident with financial, clinical, and strategic pressures while considering family and skilled nursing facility (SNF) leadership inputs. These physicians also coordinate hospital systems, accountable care organizations (ACOs), and insurance companies. The dynamic coordination builds trusting relationships and delivers personalized, consistent quality care, resulting in greater patient and resident engagement, satisfaction, and well-being.
A collaborative approach allows diverse perspectives and decision-making. In addition, the multidisciplinary inputs provide comprehensive and balanced outcomes for patients and residents.
First Docs is the medical director of several SNFs in Bucks County, Pennsylvania, and participates with a local hospital accountable care organization/Medicare Shared Savings Program (MSSP). An annual comparison between three centers where First Docs is the medical director and primary attending versus three centers without First Docs’ collaborative involvement showcases the tangible differences. First Docs’ involvement resulted in:
The three centers without First Docs involvement had:
First Docs’ collaborative physicians reduced the readmittance rate, kept the average length of stay on par with ACO goals, and decreased cost per claim.
While attending physicians and medical directors have separate responsibilities, their roles are complementary. It is through their intertwined relationship that SNFs are equipped to deliver high-quality care while meeting administrative and regulatory requirements. In today’s complex healthcare landscape, investing in strong, visionary leadership is key to achieving the desired outcomes.
Ready to elevate your SNF? Partner with First Docs. We are the trusted internal medicine physician group for SNFs nationwide, providing experienced medical directors and attending physicians trained in PDPM, quality assurance, CMS regulations, and proactive care.
Unlike traditional models that emphasize passive leadership or limited on-site presence — which can diminish care quality and hinder progress — we prioritize proactive, patient-centered care and collaborative, engaged leadership. Our medical directors are dedicated to consistent and regular on-site presence, enabling them to provide proactive leadership that improves residents’ and patients’ health and well-being.
Request a proposal today to strengthen your medical leadership team with First Docs.
Our medical directors are also committed to actively participating in QAPI meetings and fully engaging with a center’s quality improvement strategies, often taking the lead in implementing evidence-based protocols to move initiatives forward.