Professional Certification of Palliative Medicine Charles F. von Gunten, MD, PhD Past Chairman
Setting the Standard of Excellence in Hospice and Palliative Medicine Professional certification is important for the field
Palliative Care IIIInterdisciplinary care focused on relieving suffering and improving quality of life. MMMMay be combined with therapies aimed at reducing or curing the illness, or it may be the total focus of care.
Standard Model of Care PresentationDeath Therapy with Curative Intent Bereavement Care 6m Medicare Hospice Benefit Field & Cassel (eds) IOM Report, 1997
Palliative Care Model PresentationDeath Therapy with Curative Intent Bereavement Care Symptom Rx Relieve Suffering Palliative Care 6m Medicare Hospice Benefit
Who does palliative care? Primary Secondary Tertiary JAMA 2002;287:
Example: Interface of Palliative Care and Nephrology Primary Palliative Care Secondary Palliative Care Tertiary Palliative Care Pt with ESRD, nausea & abdominal pain Nephrologist successfully uses antiemetics, analgesics & coanalgesics Asks for consult for refractory sx and for time- consuming family dynamics Admitted to pc unit for refractory Sx. Rx. PM fellow
Palliative Medicine The term palliative medicine refers to the physician discipline as part of interdisciplinary palliative care at secondary and tertiary levels
Why a Palliative Medicine Subspecialty? Improve patient care Create and disseminate new knowledge Credibility and recognition Recognized in UK, Ireland, Canada, Australia, New Zealand Field & Cassel (eds) IOM Report, 1997
The case for palliative medicine subspecialty Board certification Scholarly research Fellowship training Professional Association Professional Role
Board Certification Founded 1995 First examination 1996 1800 diplomates Exam by NBME –230 items in 4 hour exam –688 items in bank > 500 applicants for 2005 20% growth per year MOC initiated in 2004 J Palliat Med 2000; 3:
New ABHPM Diplomates
ABMS Boards J Palliat Med 2000; 3: n = 1535
Scholarly Research > 7 Medline-listed peer- reviewed specialty journals –Listed on Fact Sheet Also published in major journals (NEJM, JAMA) Many Textbooks
Fellowship Training 47 programs in 2004 –3 NCI-funded –6 VA programs –97 slots total annually Accessed May 4, 2004
Fellowship Training 1.9 slots per program (median 2, range 1 – 8) 8.5 applicants per program (median 6, range 0 – 40) 4.5 applicants per slot February survey 86% response rate 86% response rate
Fellowship Training Voluntary Guidelines modeled after ACGME model Palliative Medicine Review Committee accredits after ACGME RRC model ACGME application initiated J Palliat Med 2002; 5:23-33
Professional Association American Academy of Hospice and Palliative Medicine 1900 members
Professional Role Hospital-based consultants –Ambulatory outpatient component Hospice medical directors Cohen B, Salsberg, E. SUNY Albany,
Professional Role 30% US hospitals (26% of teaching hospitals) have palliative care consult teams 20% increase annually 6,021 hospitals listed by AHA J Palliat Med 2001;4: J Palliat Med 2001;4:309-14
Professional Role 3,200 hospice programs care for 25% of US deaths Each must have at least one physician medical director
Volume of Need Rapid growth in serious, chronic illness Consequence of effective technologies 2.3 million deaths –10% sudden –Of remaining 90% 40-60% with unrelieved suffering40-60% with unrelieved suffering
The case for palliative medicine subspecialty Board certification Scholarly research Fellowship training Professional Association Professional Role
Setting the Standard of Excellence in Hospice and Palliative Medicine Professional certification is important for the field