SNFists Provide High-Quality Care, Deserve a Standard Definition and Formal Specialty Designation

June 9, 2022

June 9, 2022
Contact: Ellen Mullally

There is a strong consensus among physicians with expertise in nursing home care that “SNFists”—those doctors who practice primarily in nursing homes—provide higher quality care for residents than other physicians, according to the authors of an article in the June issue of JAMDA. However, they noted that a standard definition of this role—based on competencies as well as uniform performance measures—are needed.

In Defining The Role and Value of Physicians Who Primarily Practice in Nursing Homes: Perspectives of Nursing Home Physicians, the authors conducted interviews with 35 physicians across the United States who currently serve or previously served as medical directors and/or attending physicians in nursing homes. They identified six themes emphasized by participants: (1) an unclear definition of and loose qualifications for SNFists may affect quality of care; (2) specific skills and medical knowledge are needed for competent SNFist practice; (3) SNFists are distinguished by their unique practice approach and often provide services that are unbillable or under-reimbursed; (4) SNFists achieve better outcomes (but opinions varied on performance measures); (5) SNFists may contribute to discontinuity of care; and (6) SNFists remained in nursing homes during the COVID pandemic.

The authors observed that the ranks of SNFists have grown in recent years. In fact, the number of these practitioners increased 48% between 2007 and 2014. As of 2017, there were more than 6,000 physician SNFists practicing in nursing homes in the United States. While there is no formal medical specialization in nursing home medicine, the term “SNFist” has been found in the medical literature and is used by the Centers for Medicare & Medicaid Services (CMS).

The authors suggested, “Despite not being a formal medical specialty, SNFists ‘specialization’ in NH care may increase their effectiveness through extensive knowledge of NH regulations and guidelines in addition to in-depth knowledge of care provided to clinically complex residents. NH specialization may also enhance communication with direct care staff and administration and could help build relationships with residents and families.” They noted the benefits of SNFists may warrant a formal specialty based on care for nursing home patients.

The need to link physician care and NH quality has long been recognized by AMDA, whose affiliate, the American Board of Post-Acute and Long-Term Care Medicine, has developed a set of competencies specifically for attending physicians in nursing homes, in addition to quality indicators. “Similarly defined competencies and performance measures are needed as a first step to more clearly define the link between SNFist care and outcomes,” the authors said.

The study was conducted by researchers at the Department of Population Health Sciences, Weill Cornell Medical College, New York, NY.

Get more information on the findings above and more details about the study. To contact the researchers or JAMDA editor for an interview, please email





JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit for more information.


About AMDA – The Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit for more information.