We’re
in trouble. There just aren’t enough
specialists in palliative care to palliate all the suffering out there. One estimate of provider need is over 5,000
full time employees, which could require up to 18,000 trained providers depending
on the proportion of time providers devote to the practice of palliative
medicine.
One
important strategy to address this problem, as highlighted by the recent IOM report Dying in America, is
to improve the skills of all providers in the practice of “primary” palliative
care.
Historically,
some physicians have turned towards palliative medicine and hospice later in
their careers – perhaps out of a desire to broaden the meaning they find in their
work. However, board eligibility in Hospice and Palliative Medicine now
requires fellowship training. While this
is a wonderful thing for establishing the legitimacy of the field, a potential
externality is further threatening the workforce supply. Not only are there a limited number of
Palliative Medicine fellowships, it is very difficult for many mid-career
clinicians to obtain training without a major disruption of their lives, such
as leaving their practice and/or moving. Currently there are 300-350 palliative
medicine fellows in training each year; there are a limited number of
opportunities for specialty training for nurse practitioners and no programs we
are aware of for physician assistants.
Amos
Bailey, MD, a well-known leader in the field of Palliative Medicine and a new
colleague of mine at the University of Colorado has a pretty innovative
idea. He has set up a task force to
prepare an application to the Board of Regents to offer a new degree program:
Master of Science in Palliative Care. This would be an inter-professional executive Masters that would be provided predominantly online (with three separate
one-week on-campus intensives). This
program will be designed for the clinicians (physicians and advance practice
providers) who are already working and need or desire more training in
Palliative Care.
As
part of this effort, we need to gauge potential interest in such a Masters
Program. Dr. Bailey has prepared a brief
(2-3 minute) survey to explore potential demand among physicians and advanced
practice providers who might be interested in such a program. [Click here for a link to the survey]
What do you think of this
idea? Personally, I’m pretty sold on the idea.
Currently, the need is so great that I have no worry that such a program
would undermine my board certification in Hospice and Palliative Medicine
although I can see that being a concern.
We would love to hear thoughts.
Also, any help you can provide in identifying potential participants in
the program to respond to our survey would be greatly appreciated.
by: Dan Matlock, MD, MPH
14 comments:
Please note for social workers on the team: The California State University Institute for Palliative Care’s Post-MSW Palliative Care Social Work Certificate and the similar preparation and credential offered by the Smith College of Social Work.
I would love to see the day when there is a designated Hospice and Palliative Care Nurse Practitioner program track. I would apply and enroll on the spot.
Brilliant!
Having Palliative Training is a great idea. Not sure the Master's program is the way to go.
As a practicing physician in the Denver area working as a Medical Director for a small hospice, I obtained my MBA 20 years ago with a considerable time commitment...2 courses a semester for nearly 5 years. That's huge, and one difficult to repeat. We ARE short on good Docs/NP's practicing hospice and pal medicine, and putting a program (barrier?) like a Master's program would be daunting, taking time away from practice (and family). Finding good teachers would be a challenge, as the "better ones" would pr practicing clinicians. Plus the cost of the program would be large (its a university, and needs to charge well for its overhead).
Perhaps a "certificate program" would be better, easier to administer, and more likely to bring forward the people who need/desire the training. Spending a couple of weekend days in a quarter on larger subjects like pain meds, adjuvant meds for pain, prognostication, symptom management, wound care, management of the IDT team meeting, etc would be easier. Not all Hospice docs come from primary care, and don't have a firm grounding in routine care of the Geriatric patient, and sharing experience from those of us that do would be helpful.
Perhaps there would even be $$ out there from a grant to pilot this kind of program, and then take it to the other more than 450 large metropolitan markets in the country.
I'd be happy to help.
Patrick Roney MD MBA
Could application also be open it to registered nurses with bachelor of science in nursing, maybe also require certification in hospice and palliative nursing - so credentials RN, BSN,CHPN.
Or does the need to prescribe prevent it?
I would enroll on the spot too for a nurse practioner in palliative/hospice track. As a current RN, BSN, CHPN, I am getting my MSN right now, but focusing on management and leadership rather than the NP track as I have no desire to work as a gerentological or family NP. But of I could get specific training to be a palliative NP, I would start immediately.
Alyssa, I hope you identify a path. We need clinicians more than we do administrators ;^)
Great idea. Perhaps that certificate option could be one rung on a clinical ladder, with the MSc, fellowship, etc as others.
Great idea. Perhaps that certificate option could be one rung on a clinical ladder, with the MSc, fellowship, etc as others.
As a practicing hospitalist in an academic medical center, I would love to see this option as long as it qualified me to sit for Board certification.
This is a fantastic idea. I would appreciate the opportunity to earn an official certification or masters in palliative care, especially if it lends credibility in the eyes of those hiring providers.
I work in emergency medicine - please don't forget about us as we see a lot of patients with pain crises and/or at the end of life.
Ditto! The closest program I have found is to get NP in Gerontology with a Focus on end of life. Self made program!
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