Professional Certification of Palliative Medicine

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

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

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

4. Standard Model of Care Medicare Hospice Benefit Therapy with Curative Intent BereavementCare Presentation 6m Death Field & Cassel (eds) IOM Report, 1997

5. Palliative Care Model Medicare Hospice Benefit BereavementCare Therapy with Curative Intent Palliative Care Presentation 6m Death Symptom Rx Relieve Suffering

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

7. Example: Interface of Palliative Care and Nephrology

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

9. 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

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

11. 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

12. New ABHPM Diplomates

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

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

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

16. 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

17. 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

19. Professional Association • American Academy of Hospice and Palliative Medicine • 1900 members

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

21. 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

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

23. 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 suffering

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

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