2. Professional Certification of Palliative Medicine Charles F. von Gunten, MD, PhD Past Chairman

3. Setting the Standard of Excellence in Hospice and Palliative Medicine Professional certification is important for the field

4. Palliative Care IIIInterdisciplinary care focused on relieving suffering and improving quality of life. MMMMay be combined with therapies aimed at reducing or curing the illness, or it may be the total focus of care.

5. Standard Model of Care PresentationDeath Therapy with Curative Intent Bereavement Care 6m Medicare Hospice Benefit Field & Cassel (eds) IOM Report, 1997

6. Palliative Care Model PresentationDeath Therapy with Curative Intent Bereavement Care Symptom Rx Relieve Suffering Palliative Care 6m Medicare Hospice Benefit

7. Who does palliative care?  Primary  Secondary  Tertiary JAMA 2002;287:875-881

8. 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

9. Palliative Medicine  The term palliative medicine refers to the physician discipline as part of interdisciplinary palliative care at secondary and tertiary levels

10. 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

11. The case for palliative medicine subspecialty  Board certification  Scholarly research  Fellowship training  Professional Association  Professional Role

12. 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; 3:441-447

13. New ABHPM Diplomates

14. ABMS Boards J Palliat Med 2000; 3:441-447 n = 1535

15. Scholarly Research  > 7 Medline-listed peer- reviewed specialty journals –Listed on Fact Sheet  Also published in major journals (NEJM, JAMA)  Many Textbooks

16. Fellowship Training  47 programs in 2004 –3 NCI-funded –6 VA programs –97 slots total annually www.aahpm.org Accessed May 4, 2004

17. 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 2004 E-mail survey 86% response rate 86% response rate

18. 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

20. Professional Association  American Academy of Hospice and Palliative Medicine  1900 members

21. Professional Role  Hospital-based consultants –Ambulatory outpatient component  Hospice medical directors Cohen B, Salsberg, E. SUNY Albany, 2002. http://chws.albany.edu

22. 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;4:315-24 J Palliat Med 2001;4:309-14

23. Professional Role  3,200 hospice programs  care for 25% of US deaths  Each must have at least one physician medical director

24. 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

25. The case for palliative medicine subspecialty  Board certification  Scholarly research  Fellowship training  Professional Association  Professional Role

26. Setting the Standard of Excellence in Hospice and Palliative Medicine Professional certification is important for the field