Hospice and Palliative Field's Certification Grows in Scope


SALT LAKE CITY — The new subspecialty of hospice and palliative medicine will be open to osteopathic as well as allopathic physicians, following a decision by the American Osteopathic Association's Bureau of Osteopathic Specialists to approve certification in the discipline.

The Feb. 16 action complements a decision by the American Board of Medical Specialties last September to move forward with plans to allow allopathic physicians to become certified in the new subspecialty.

ABMS-recognized certification will be offered to physicians in 10 specialties: obstetrics and gynecology, family medicine, internal medicine, anesthesiology, emergency medicine, pediatrics, physical medicine and rehabilitation, psychiatry and neurology, radiology, and surgery.

Osteopathic certification in the new field will be offered to osteopathic physicians in four specialties: family medicine, internal medicine, neurology and psychiatry, and physical medicine and rehabilitation.

Sponsorship of a subspecialty by such a large number of specialty boards is unprecedented, according to Dale E. Lupu, Ph.D., chief executive officer of the American Board of Hospice and Palliative Medicine (ABHPM), headquartered in Silver Spring, Md.

“Having 10 specialties working together is completely new,” she said at the annual meeting of the American Academy of Hospice and Palliative Medicine.

It took the ABHPM 10 years to persuade the ABMS to recognize hospice and palliative medicine as a medical subspecialty, Dr. Lupu said. From 1996 through 2006, the ABHPM certified more than 2,800 physicians in hospice and palliative medicine, she added.

The effort to achieve ABMS-recognized subspecialty status also involves accreditation of graduate medical education by the Accreditation Council of Graduate Medical Education (ACGME). “Successful completion of an accredited educational program usually is a prerequisite to admission to an ABMS board examination,” Dr. Lupu noted.

Starting in 2008, a new certification exam will be available, administered by the cosponsoring ABMS member boards.

During a 5-year grandfather period (2008–2012), physicians from the 10 ABMS specialties can sit for the board exam in hospice and palliative medicine without completing fellowship training, said Dr. Ronald S. Schonwetter, executive vice president and chief medical officer of LifePath Hospice and Palliative Care in Tampa.

During this period, applicants must qualify for the exam by having cared for at least 50 terminally ill patients and by meeting other criteria. (Eligibility requirements can be viewed at

After the initial 5-year period, “it will be necessary for [applicants] to take a year-long fellowship training before they can sit for the board and be certified in hospice and palliative medicine,” Dr. Schonwetter, a former chairman of the ABHPM, said in an interview.

There's much work to be done, he added. “We need to expand our services among hospitals, nursing homes, and assisted-living facilities, and to educate and understand the needs of physicians from the multiple disciplines” who wish to become palliative care specialists.

“Approval of hospice and palliative medicine by 10 ABMS specialties shows the desire for this type of care by our colleagues, who see on a first-hand basis what hospice and palliative medicine can do for their patients,” he said.

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