Palliative Care to Be Recognized as Subspecialty: Physicians in Psychiatry and Other Specialties May Be Able to Take Certification Examination by 2008

Article excerpt

The field of palliative care took a major step forward last year, when members of the American Board of Medical Specialties voted to approve hospice and palliative medicine as a recognized subspecialty.

The application to recognize the subspecialty had broad support and was cosponsored by 10 medical specialty boards.

As a result, physicians in several specialties--including psychiatry, neurology, internal medicine, family medicine, pediatrics, surgery, emergency medicine, and obstetrics and gynecology--will be able to seek the certification.

The first certification examination is expected to be administered in 2008, according to Dr. F. Daniel Duffy, senior adviser to the president of the American Board of Internal Medicine.

"It's going to be a real boost to patient care," Dr. Duffy said.

The milestone is just the latest in a series of developments in the size and status of the field of palliative care. Between 2000 and 2004, the number of hospital-owned palliative care programs in the United States increased by nearly 75%, jumping from 632 in 2000 to 1,102 in 2004.

As of 2004, 63% of large hospitals--those with at least 200 general adult beds--reported that they had some type of palliative care program in operation, according to the Center to Advance Palliative Care.

Last summer, palliative medicine received a nod from the Accreditation Council for Graduate Medical Education (ACGME) when the organization voted to approve an accreditation process for hospice and palliative medicine fellowship training programs.

ACGME is expected to begin accepting applications this summer.

"We're well beyond the tipping point," said Dr. Diane Meier, director of the Center to Advance Palliative Care and director of the Hertzberg Palliative Care Institute at Mount Sinai School of Medicine in New York.

At Dr. Meier's institution, palliative care has become so well accepted that asking for a palliative care consult is as routine as calling for an infectious disease consult.

Physicians no longer see it as a personal failure in their treatment of the patient to get assistance from palliative care, she said.

Now the focus has shifted from selling the concept of palliative medicine to ensuring that programs across the country have consistently high standards, Dr. Meier said.

Work is already underway in this area. The National Consensus Project for Quality Palliative Care, which is sponsored by three national palliative medicine organizations, has released quality guidelines.

These guidelines include having interdisciplinary teams, making grief and bereavement services available to patients and families, and providing evidence-based pain and symptom relief, among others.

The standards are a guidepost but will be challenging for smaller programs, Dr. Meier said, and should be filtered by the size of the facility, the staff available, and the needs of the institution.

The National Quality Forum approved its own framework for palliative and hospice care in 2006. "That's real legitimacy," Dr. Meier said.

In an effort to ensure that new programs have high-quality processes in place, the Center to Advance Palliative Care launched the Palliative Care Leadership Centers--six centers of excellence in palliative care across the country charged with the taks of training teams of health care providers. …