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Despite the fact that palliative medicine postgraduate fellowship training programs have grown substantially over the last few years, the number of hospitals looking to fill positions for new palliative medicine programs is outpacing the number of trained fellows. More than 70 percent of hospitals with 250 or more beds and 55 percent of hospitals with more than 100 beds now have hospital-based palliative programs, according to the Center for the Advancement of Palliative Care Medicine (CAPC). Current fellowship programs now number 61, according to the American Academy of Hospital and Palliative Medicine (AAHPM). Many of these hospitals also offer short-term preceptorship programs. “Seventy-five percent of teaching hospitals have a clinical palliative program and it is increasingly becoming a part of residency training,” says Diane Meier, MD, the director of the CAPC and the Hertzberg Palliative Care Institute at Mount Sinai School of Medicine in New York City. Hospice and palliative medicine is a relatively new and growing specialty that is attracting the attention of both physician fellows and practicing doctors because of its more humanistic, patient-focused style of care. The specialty received additional validation when it was recognized as an official subspecialty in September 2006 by the American Board of Medical Specialties.

“Many practicing physicians are turning to palliative medicine because they see it as an opportunity to practice medicine as most of us would like to practice medicine,” says Thomas Smith, MD, an oncologist and a palliative care medicine specialist and professor and chair at Massey Cancer Center—Virginia Commonwealth University’s (VCU) division of hematology/oncology in Richmond.  “It provides doctors the opportunity to wrap their arms around the whole patient. It involves medical solving for the condition as well as for the whole person.” Smith says the the nature of the specialty is challenging. “The environment can be emotionally draining,” he says.“Up to one-third of our admissions result in death.” Many fellows, says Smith, are combining palliative medicine fellowships with oncology to allow themselves to become better trained at managing pain, treating chronic and complex illnesses, as well as dealing with communication and family dynamics. Starting salaries for palliative medicine physicians average in the $140,000 to $180,000 range. Board certification in hospice and palliative medicine is available via two career paths. Physicians may complete a one-year fellowship program and complete the certification exam. A grandfather clause is being offered to practicing physicians until 2012 to become certified without additional fellowship

training. Froedtert Hospital at the Medical College of Wisconsin has been primary player in training health professionals in pain management and palliative care. Weissman, MD, the program director at Froedtert, who is internationally recognized for his work in this field, has been funded by the Robert Wood Johnson Foundation to improve medical residency training through the National Residency End of Life Education Project. Since 1998, nearly 400 residency programs have participated in a one-year curriculum reform project to develop new educational programs in palliative medicine. For physicians thinking about starting or strengthening a palliative care program at their hospitals, participation in the CAPC’s Palliative Care Leadership program may be the extra boost their programs need. The CAPC has designated six

hospitals as Palliative Care Leadership Centers to help hospitals develop or improve current programs. These facilities include: Froedtert and the Medical College of Wisconsin; Fairview Health Services, Minneapolis, Minnesota; Mount Carmel Health System, Columbus, Ohio; Palliative Care Center of the Bluegrass, Lexington, Kentucky, University of California, San Franciso; and VCU’s Massey Cancer Center, Richmond, Virginia. Hospital teams can apply for a two-day training session and an ongoing mentorship. The two-day training session walks each team through the development and implementation of a strategic plan, an organizational model that fits its organization’s needs, staffing plans, how to collect and interpret financial data, and the implementation

of marketing strategies to promote and grow its program. After the on-site training, the staff continues to provide one-on-one mentoring for a full year to assess progress, trouble-shoot, and provide resources. “Palliative care is a very satisfying aspect of medicine,” says Meier. “You are caring for patients and their families who are going through very challenging and profound transitions. You are witness to incredible love and courage on the part of the patients and families, and with training, you are able to relieve what otherwise would have been previously intractable suffering, not only physical, but also emotional, spiritual, and existential suffering. There is no more gratifying feeling than to know as a physician that we met the patient and family where they are, found out what they needed, and mobilized resources to meet their needs.”