Country Medical Directors: Leadership in Nephrology


Country Medical Directors: Leadership in Nephrology

September 21, 2020 • 4 min read


Country medical directors (CMDs) are key members of the Global Medical Office leadership team. Their role is multifaceted and includes managing clinical service delivery and the complexities of local regulations, coordinating and implementing global healthcare strategies on a country-wide level, and recognizing new opportunities to improve patient care. CMDs also play a vital role in representing the patient-focused values of Fresenius Medical Care and serving as the company’s interface with local medical communities.

Healthcare systems worldwide are rapidly changing enterprises facing many challenges. The demand for cost management, greater care coordination, and efficiency is balanced against delivering high-quality value-based care for chronically ill patients across societies and healthcare systems of varying maturity. With a care footprint spanning 150 countries—each with its own unique challenges and regulatory and governmental frameworks— Fresenius Medical Care’s Global Medical Office delivers agile, impactful medical leadership that drives success across this highly variable healthcare landscape.

As experts in the structure, nuances, and dynamics of the myriad healthcare systems in which it operates, the company’s country medical directors (CMDs) play a vital leadership role in managing the medical complexities of patient care at the local and regional levels. In Fresenius Medical Care’s Europe, Middle East, and Africa (FMC-EMEA) region, the CMDs are responsible for the countrybased clinical strategy, decisions, and new medical opportunities.

The NephroCare network is the clinical footprint in FMC-EMEA including more than 790 clinics and is coordinated by 28 dedicated physicians across 29 countries that make up the EMEA region (Figure 1).


FIGURE 1 |Fresenius Medical Care's EMEA region includes 29 countries with 28 physicians appointed as country medical directors

The leadership structure of the Global Medical Office provides optimal global medical and clinical oversight by addressing universal issues in chronic disease care at the global level, while managing the complexities and diverse regulatory requirements of markets at the country and local levels (Figure 2). This fosters both local and global progress. With the evolution of precision medicine, integrated patient data collection, precise dialysis treatment prescription through diagnostic tailoring, genomics, integrated artificial intelligence, machine learning, and care delivery standardization, CMDs lead the country-level opportunities to improve patient care while playing an important role in enabling care coordination across the Fresenius Medical Care network at a global level.

FIGURE 2 |The Global Medical Office leadership structure

The functional community of CMDs in FMC-EMEA is supervised by the EMEA chief clinical officer, improving the effectiveness and efficiency of the company’s NephroCare dialysis clinics throughout the region while reducing variations in clinical practice.

The CMDs provide scientific-medical support and guidance in nephrology and dialysis to all areas of the company. In their respective countries, they organize medical meetings, medical training, and education to healthcare professionals within and outside the NephroCare clinic network, in cooperation with the corresponding departments at the EMEA head office. By providing scientific-medical support, CMDs are the key interface to the local medical community. The role of the EMEA CMDs has expanded over time to include clinical service leadership, management and mentorship, coordination and communication, and reporting and documentation (Figure 3). Their responsibilities include:

FIGURE 3 | Role of the CMDs in EMEA

  • Managing the local dissemination and implementation of corporate strategic medical projects and outcomes-based standards of safety and patient care
  • Overseeing and leading the medical processes and clinical governance of NephroCare dialysis clinics
  • Supervising population management and the implementation of patient care standards, addressing treatment incidents, and complying with legal and regulatory guidelines
  • Supervising and monitoring patient care quality performance delivered by all NephroCare dialysis centers, and setting medical quality targets (including targets for cost elements related to medical objectives) in agreement with the EMEA chief clinical officer
  • Pursuing new medical opportunities of value to the region in coordination with the company’s Global Medical Office

CMDs also play an important role in managing the local medical directors within a specific country, supporting the recruitment processes for medical directors and physicians, and collaborating with human resources and NephroCare operations managers to define medical director and clinic staff responsibilities. This part of the CMD role requires leadership and engagement skills to foster and reinforce Fresenius Medical Care’s values of continuous quality improvement and clinical effectiveness and a culture of excellence.

In each country in the EMEA region, the clinic staff is continuously challenged to implement both evolving and new treatment prescriptions, complex medication regimens, and new dialysis techniques, as well as individualized fluid status to reduce the intradialytic hypotensive episodes and long-term uremic cardiovascular complications. CMDs help determine how these innovations can be implemented at the local level while maintaining focus on key global objectives.

Physician leadership across the Global Medical Office has played a vital role in advancing Fresenius Medical Care’s global credibility while fostering a culture of compliance. Physicians are increasingly taking management positions in healthcare organizations where they are expected to be skilled in leading staff, care teams, and community initiatives. A paper published in Social Science & Medicine examined strategic governance in the United Kingdom’s National Health Service (NHS) hospital trusts and found a significant and positive association between a higher percentage of clinicians on boards and the quality ratings of service providers.1 Physicians have the highest influence when it comes to implementing operational changes that can lead to improved performance.2,3 A study published in Health Care Management Review reported that large hospital systems led by physicians in 2015 received higher U.S. News and World Report quality ratings, performed better financially, and operated more efficiently than those led by non-physician managers.4

Ongoing listening and learning are key to the company’s success in meeting the needs of chronically ill patients around the world. By investing in its medical directors, Fresenius Medical Care applies their collective ingenuity and sophisticated understandings of regional and country health dynamics to lead the way in developing value-based care models that are responsive to global complexities.

The Global Medical Office at Fresenius Medical Care has identified five focus areas of social determinants of health that directly relate to the functional status of with ESKD


Veteran nephrologist Stefano Stuard, MD, PhD, is chief clinical officer of Fresenius Medical Care’s Europe, Middle East, and Africa NephroCare network of dialysis clinics. As part of the region’s commitment to lifelong learning and development for medical directors and physicians, a country medical directors symposium is held annually to review the latest developments in chronic kidney disease care. Although it is a company event, the scientific merits of the symposium have earned the meeting accreditation by the Union Européenne des Médecins Spécialistes, which awards continuing medical education credits to attendees. The meeting is also endorsed by the European Renal Association-European Dialysis and Transplant Association as a scientific meeting.

Stefano Stuard, MD, PhD, Chief Clinical Officer for Europe, Middle East, and Africa region, welcomes participants to the annual Fresenius Medical Care EMEA symposium.

Meet The Experts

Chief Clinical Officer, Fresenius Medical Care, Europe, Middle East, and Africa


  1. Veronesi G, Kirkpatrick I, Vallascas F. Clinicians on the board: what difference does it make? Soc Sci Med 2013;77:147-55.
  2. Hamilton P, Spurgeon P, Clark J, et al. Engaging doctors: can doctors influence organisational performance? NHS Institute for Innovation and Improvement, July 2008.
    49794%20Engaging%20Doctors%20-%20Can%20doctors%20 influence%20organisational%20performance.pdf. Accessed June 30, 2020.
  3. Dickinson H, Ham C. Engaging doctors in leadership: review of the literature. NHS Institute for Innovation and Improvement, January 2008. Accessed June 30, 2020.
  4. Tasi MC, Keswani A, Bozic KJ. Does physician leadership affect hospital quality, operational efficiency, and financial performance? Health Care Manage Rev 2019;44(3):256-62.