On-the-Job Training Opens Palliative Care Doors
Dr. Smusz paid for her initial training herself, but made the money she needed by starting hospice work while in her retraining period.
“Dr. Pile and Dr. Smusz have demonstrated an innovative approach to delivery of palliative care by combining the roles of the practice of palliative medicine with medical directorships of hospices and nursing homes,” said Dr. Vandenberg. “For the nursing home, this approach would provide skills and knowledge along with leadership in an area that critically needs improved end-of-life care. Through the medical directorship position, these physicians will not only have the ability to provide expertise in palliative care but also make system changes through quality improvement activities in end-of-life care in the nursing home. Finally, to provide this expertise in a rural environment addresses the areas that need it most.”
For those interested in making the transition to palliative care, Dr. Smusz recommended starting at a hospice. “You need to learn frontline … care of dying people before you ever pretend that you know how to do palliative medicine,” she said. Her compensation and training have been supported by all the facilities with which she works.
“The thing that makes this work is the teams,” said Dr. Pile. At every facility, a palliative care specialist should assemble a team made up of interested people from various disciplines—respiratory therapists, social workers, administrators, physicians, and nurses. It's the support of these teams that has allowed Dr. Pile to cover a broad geographic area, he said.
Dr. Pile said it is important for a palliative care specialist to regularly reinforce his or her value to rural facilities. He recommended keeping records of the annual number of patient-days spent in hospice and the average number of referrals made to hospice per month for each facility. Data such as these can demonstrate to administrators that having a palliative care specialist available can generate income from hospice services.
Physicians interested in entering palliative medicine have a 5-year window in which they can become certified without the requirement for a formal fellowship. Beginning this year, cooperating boards within the American Board of Medical Specialties will offer a subspecialty certificate in hospice and palliative medicine. Through 2012, candidates without formal training may sit for examination if they have prior certification by the American Board of Hospice and Palliative Medicine or have had at least 800 hours of subspecialty-level practice in hospice and palliative medicine during the past 5 years.
Dr. Pile and Dr. Smusz said they have no financial relationships to disclose.
Places to Turn For Guidance
▸ American Academy of Hospice and Palliative Medicine (
▸ Center to Advance Palliative Care (
▸ Educating Physicians in End-of-Life Care (
www.epec.net/EPEC/webpages/index.cfm
▸ Program in Palliative Care Education and Practice, Harvard Medical School (
