The american academy of nurse practitioners survey in 2004 estimates there are over 100000 nps in the us with 13 having privileges in long term care in practice as little as 2 may actually be in nursing home settings 56 findings from the us department of health and human services national sample survey of registered nurses places the estimate at about 68000 nps in all practice . Patients entering nursing homes that serve those who need medical and skilled nursing care after treatment for acute conditions high medicare nursing homes now have even greater clinical needs . The american medical directors association amda was founded on the premise that physician involvement in long term care is essential to the delivery of quality long term care attending physicians should lead the clinical decision making for patients under their care they can provide a high level of knowledge skill and experience needed in caring for a medically complex population in a . The authors propose that creating a nursing home medicine specialty which recognizes the nursing home as a unique practice site would go a long way toward remedying existing problems with care in skilled nursing facilities and would best serve the needs of the 16 million nursing home residents in the united states reviewing what is known about physician practice in nursing homes and
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