Resident’s Right to Choose Attending Physician

Nursing home residents have the right to choose his or her attending physician. The physician must be licensed to practice, and if the physician chosen by the resident refuses to or does not meet requirements specified in this part, the facility may seek alternate physician participation as specified in paragraphs (d)(4) and (5) of this section to assure provision of appropriate and adequate care and treatment. The facility must ensure that each resident remains informed of the name, specialty, and way of contacting the physician and other primary care professionals responsible for his or her care. The facility must inform the resident if the facility determines that the physician chosen by the resident is unable or unwilling to meet requirements specified in this part and the facility seeks alternate physician participation to assure provision of appropriate and adequate care and treatment. The facility must discuss the alternative physician participation with the resident and honor the resident’s preferences, if any, among options. If the resident subsequently selects another attending physician who meets the requirements specified in this part, the facility must honor that choice. See 42 C.F.R. § 483.10(d). See also O.C.G.A. § 31-8-108(b)(1). Each resident is entitled to receive the name, address, and telephone number of the resident’s physician. O.C.G.A. § 31-8-108(b)(4).

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Defintions

“Attending physician” refers to the primary physician who is responsible for managing the resident’s medical care. This does not include other physicians whom the resident may see periodically, such as specialists.

Guidance

The right to choose a personal physician does not mean that a resident is required to do so. It also does not mean that the physician the resident chose is obligated to provide service to the resident. If a resident or his or her representative declines to designate a personal physician or if a physician of the resident’s choosing fails to fulfill their responsibilities, as specified in §483.30, F710, Physician Services, or elsewhere as required in these regulations, facility staff may choose another physician after informing the resident or the resident’s representative. Before consulting an alternate physician, the medical director must have a discussion with the attending physician. Only after a failed attempt to work with the attending physician or mediate differences may facility staff request an alternate physician.

Facility staff may not interfere in the process by which a resident chooses his or her physician. If a resident does not have a physician, or if the resident’s physician becomes unable or unwilling to continue providing care to the resident, facility staff must assist the resident or the resident’s representative in finding a replacement.

If it is a condition for admission to a nursing home contained within a Continuing Care Retirement Community (CCRC), the requirement for free choice is met if a resident chooses a personal physician from among those who have practice privileges at the CCRC.

A resident in a distinct part of a general acute care hospital may choose his or her own physician. If the hospital requires that physicians who supervise residents in the distinct part have privileges, then the resident cannot choose a physician who lacks them.

Probes

• • Through interviews with facility staff and residents and/or their representatives, determine how residents or their representative are informed of and are supported in:
    • His or her right to choose a physician;
    • How to contact their physician and other primary care professionals responsible for their care;
    • His or her options to choose an alternate physician or other primary care professional.
  • If his or her physician is unable or not willing to provide necessary care and services, determine if facility staff worked with the resident to choose another physician