1. The Evolution of Palliative Medicine as a Medical Subspecialty James Hallenbeck, MD Director, Palliative Care Services Hub-site Director, VA Interprofessional Palliative Care Fellowship Program

2. Definitions Hospice care – Dedicated to alleviating suffering and promoting quality of life for terminally ill patients Palliative care- Interdisciplinary approach to alleviating suffering and promoting quality of life for ALL patients Palliative medicine- the evolving medical subspecialty that does hospice and palliative care

3. Key Theme: Hospice initially a form of alternative medicine Only later was there an attempt to incorporate hospice principles into mainstream medicine through palliative care

4. History 1967 St. Christophers, First modern hospice established in London 1975 Three inpatient hospices established in North America 1979 VA Hospice established in VA Menlo Park nursing home

5. History continued… 1983 Medicare Hospice Benefit 1993 Oxford Textbook of Palliative Medicine first published 1995 American Academy of Hospice Physicians -  American Academy of Hospice and Palliative Medicine 1996 Boards American Board of Hospice and Palliative Medicine

6. History continued… 2000 Consortium of physicians agreed to push for formal subspecialty status – 20 fellowship programs nationally 2002 VA Interprofessional Palliative Care Fellowship started at 6 VA sites 2004 Palliative Care standards issued – www.nationalconsensusproject.org 2004 Voluntary accreditation of ~ 10/45 palliative medicine fellowship programs

7. The Future ABIM and Family Medicine will promote palliative medicine as a subspecialty to the American Board of Medical Specialties (ABMS) and American College of Graduate Medical Education (ACGME), showcasing programs with voluntary accreditation Anticipated subspecialty status ~ 2 years

8. Questions Do we need this new subspecialty? Relationship of palliative medicine to existing disciplines: – General Medicine Hospitalists – Oncology – Geriatrics

10. Palliative Medicine at Stanford Does Stanford need palliative medicine? – If so, in what form – consult team, clinic, beds etc. What should be the “home” for palliative medicine at Stanford? How to integrate clinical, educational, and research missions with ongoing activities? – Balance between school, hospital and clinic