In reply
Kapp has identified a lack of physician involvement in nursing home care as a major barrier to cultural change. He and others have cited fear of litigation, potential loss of income, complex regulations, insufficient nursing and administrative support, lack of respect for nursing home physicians, and the complexity of care as possible causes of physician unwillingness to engage in nursing home care.1,2 Although encouraging more physician involvement in nursing homes will require a multipronged approach, finding a way to engender professional respect for those who provide nursing home care is key.