Let’s Make Placing Doctors in Nursing Homes a Full-Time Pursuit

July 29, 2022
There’s a dogma that pervades most large companies, including every large hospital institution that I have ever worked for. In essence, this overriding belief is manifest in an arrogance that flatly maintains, “We do things the way we do things because we have always done it that way.” At SilverSage, where we are marking our […]

There’s a dogma that pervades most large companies, including every large hospital institution that I have ever worked for. In essence, this overriding belief is manifest in an arrogance that flatly maintains, “We do things the way we do things because we have always done it that way.”

At SilverSage, where we are marking our sixth anniversary on a continuing journey to positively revamp the doctor–patient relationship in nursing facilities, we embrace a completely opposite approach. Our big picture mission is unabashedly to provide better care for patients in the post-acute and long-term care setting.

In a nutshell, SilverSage was formed to provide a way to have a full-time doctor providing care at each affiliated facility. Much like his or her office, if stationed at one facility, the doctor observes and cares deeply about the level of quality delivered under their watch. They know that since they are working there as the main doctor (and usually as the medical director), the quality delivered at their facility reflects directly on them.

It’s no mystery that nursing homes derived their name from the fact that they are generally run by nurses, not doctors. One of the biggest issues with nursing homes is the lack of regular and consistent physician input. There’s the idea that nursing homes are where old, frail people go and that there’s little else for them to do until they die.

We need to recalibrate our expectations and recognize that nursing homes are also a place to practice medicine. I learned that lesson time and again through an array of personal experiences throughout my career and they have certainly informed our business model at SilverSage. Let me share a few of those experiences with you.

A New Way of Doing Things

Early in my career, I was working at a large hospital in Tennessee. It was a 500-bed facility, a teaching hospital, and a level II trauma center with a full range of subspecialties. The only thing we didn’t do was major organ transplants. Like every hospital in the country, this one had good and bad years, and I worked there through times of plenty as well as times of scarcity. 

One year, during a financially trying time, community complaints began to pour in regarding the level of service the hospital was providing. Complaints were far-reaching, ranging from a lack of hospitality and poor communication between medical staff and patients’ families to dirty hallways and unkempt rooms. These complaints contributed to a lack of faith from the community in the level of care they would receive at the hospital.

To help address these concerns, the administration and medical staff decided to appoint a specific doctor to be the physician liaison to each floor or unit of the hospital. I was appointed to be the lead doctor for the sixth floor, which was a heavy med-surge unit. My duties were somewhat nebulous since this position had never been created before, but my responsibility was clear: figure out how to make the sixth floor better.

As the year progressed, I met regularly with the charge nurse to discuss any problematic outcomes on the floor and troubleshoot how we could avoid similar situations reoccurring. Conversations with the nursing staff revealed terribly low morale due to a heavy workload combined with frontline complaints about their work from patients, family members, and subspecialists. I made it a point to meet with unhappy family members and patients—none of which were mine—to discuss their concerns. If they were particularly upset, I would be assigned to take over their care. I also met with the subspecialists to see what they were critical about and learn how to make things run smoother on the floor.

The program worked to a large degree over the next few years—not just on my floor but on the others as well. Not surprisingly, the hospital’s reputation improved as the feeling in the community gradually began to change. 

The Origins of SilverSage

Around that same time, I was recommended by a partner to assume the medical directorship of my first nursing home. I asked my partner why, on top of everything else I was already doing at the hospital, I should consider taking on the demands and responsibility of this additional position. He told me that I was a young doctor with a lot of energy, and it would be the easiest money I would ever make. “All you have to do is show up once a month for a couple of meetings, sign some papers, and pick up $2,000.”

Well, there was one thing he was right about: I was young—and apparently just naive enough to believe it would offer some easy money. So I went to visit the nursing home. 

What I found was not at all pleasing. As soon as I opened the front door, terrible smells hit my nostrils. As I walked the halls and visited dirty, disorderly rooms, I began to feel worse and worse for the patients. It was a real eye-opener.

Despite the challenges this visit displayed, I did take the job, as I felt the patients needed me, and I was compelled to get involved.

Three months later, however, I found myself lying in bed in the middle of the night, staring at the ceiling in a cold sweat, unable to sleep. The enormity of the situation finally weighed on me, and I realized I knew very little about not only nursing homes and how they should be run but also how to better serve these patients. Not only that, but I also knew this nursing home was likely to be shut down, and as medical director, I was going down with it.

That very night, I recognized I had an important choice to make: Either I could flee to the hills, the way the previous medical director did, or I could lean in even more and really try to understand the business of nursing homes and figure out how to better address the needs of these patients. 

I decided I would lean in. In a very real way, SilverSage was born in that moment. 

“You’re Over There Way Too Much”

Shortly thereafter, I attached myself to an older doctor who had years of experience as a medical director. Similar to my position as the liaison to the hospital’s sixth floor, I determined that I couldn’t truly help solve the problems at the nursing home if I wasn’t there interacting with staff and patients and witnessing the issues in real-time. So even though I still had a full-time job at the hospital, I committed to finding the time to show up every day, whether I had a patient to see or not, until I understood the pulse of the building and could offer viable solutions to problems as they arose.

It was a slow process, but five years later, we had the best state survey in our region. Our facility—which had been on the brink of bankruptcy and less than half full when I started—was now completely filled and even boasted a robust waiting list. The state ombudsman, who previously had been pushing to close the building down, was now applauding our accomplishments.

At one point during those first five years, my senior partner at the hospital came back to me and said, “Ken, I should never have recommended you for that medical director position.”

A bit confused, I asked why he would say that.

“You aren’t doing it like everyone else,” he said. “You’re over there way too much.”

But it was too late. I’d seen the difference in overall care this model had produced, and there was no going back.

Doctors at the hospital, where I remained working full-time, started teasing me in the lounge, referring to me as Dr. Death. When I asked why, they said, “No doctor shows up more in the obituary column than you do.” This was news to me as I didn’t have much time to read the paper, and I certainly didn’t read the obituaries. But armed with that knowledge, I began to pay attention and soon realized that as my patients at the nursing home passed away, I was frequently listed as an honorary pallbearer.

The patients of those other doctors didn’t leave the planet any differently than mine did, except for how supported they and their families felt while making their final journey.

Our Three Overriding Goals

When I started SilverSage in 2016, we identified three overriding goals. Those three goals formed the reason why SilverSage exists and why it is needed:

  1. To provide better care for patients in the post-acute and long-term care setting
  2. To help improve the overall care the facility provides to all its patients—oversight of policies and quality oversight (the medical director role)
  3. To restore the joy of practicing medicine in doctors

In the weeks ahead, I’ll delve into each of these goals in more detail.

While the dogma at many places remains to do things as they’ve always been done, rest assured that at SilverSage, we will continue to innovate and push for change. If you’re a physician, NP, or PA looking for a job, a nursing home looking for a physician, or a concerned family member searching for quality care for a loved one, SilverSage may be exactly what you’re looking for. Contact us today to learn more.

Kenneth L. Scott Jr., DO, CMD

Kenneth L. Scott Jr., DO, CMD

CEO of SilverSage Management Services

Dr. Kenneth L. Scott Jr., DO, CMD, is a proud father, husband, and experienced medical professional with over 30 years of experience. From serving in management as a certified medical director, to belonging to numerous medical societies, he leads with a vision to change medicine for the better.


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