History and evolution of the role of the medical director.

Federal regulations that were published in 1974 required a physician to be employed full or part time as the medical directory by a skilled nursing facilities. Negotiation was needed in each facility to reconcile the traditional role of the physician who care for individual patients with the new role of the physician who would be involved in decisions regarding the care of groups of residents. Professional and provider organizations attempted to define the new role, which developed through experience, networking, and educational opportunities. A consensus conference held in January 1988 identified the functions and tasks associated with medical direction, and, subsequently, educational opportunities focusing on the competencies associated with performing these tasks and functions were developed. This article traces the history and evolution of the formalization of the medical director's role.