We read with great interest the article by Johnson1 on the physician's role in changing the culture of nursing homes. However, we were surprised that the author did not point at the Dutch situation, where specialty training for nursing home physicians has existed since 1990.2 Over the past 20 years, the Netherlands has developed unique working methods, based on the Chronic Care Model (http://www.improvingchroniccare.org). Dutch nursing home physicians are employed by the nursing home. One full-time physician has the treatment responsibility for 100 residents and applies all aspects of medical care that Johnson1 describes.
Koopmans RTCM, Lavrijsen JCM, Zuidema SU. The Physician’s Role in Nursing Homes: The Dutch Solution. Arch Intern Med. 2010;170(15):1406-1407. doi:10.1001/archinternmed.2010.278