So, I'm starting a palliative care fellowship in July and I want to hear from other palliative care folks. This career is in its infancy and it feels a bit isolated out here. I want to hear from current or former palliative care fellows; what are you doing, how do you like it, what kind of practice do you have, are you full time, what kind of income should a new grad expect, etc? Facebook has some discussions, but I think there should be more. I'd love to hear from all of you out there and your unique/common experiences....
Anybody out there?
- Thread starter bunnymd
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I've posted most of the above info in various threads. When I was interviewing I was seeing $120,000-$200,000 (and the group offering $120,000 couldn't figure out why it was unfilled for years now given the high COL in that area!). Average offer was $140,000-$150,000. I make a bit more than that as a Hospice Medical Director somewhere in Middle America. I work FT.
I completed a fellowship in H&PM.
Any specific concerns?
I completed a fellowship in H&PM.
Any specific concerns?
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I've noticed the scarcity of posts on this board. I think it's due to a number of reasons.
One, many hospice folk tend to be the older generation who sort of just walked into hospice. Unfortunately, they haven't quite learned to be computer or forum savy yet.
Second, the young residency grad starting a hospice fellowship is a novel and new concept. There are just a handful of us out there and even less on this forum.
I believe this will change. Palliative and Hospice care will grow and become a big facet of medical care in the US. The forum should grow in the years to come. When it does, watch out, this specialty seems to attract docs who like to talk and express their opinions.
One, many hospice folk tend to be the older generation who sort of just walked into hospice. Unfortunately, they haven't quite learned to be computer or forum savy yet.
Second, the young residency grad starting a hospice fellowship is a novel and new concept. There are just a handful of us out there and even less on this forum.
I believe this will change. Palliative and Hospice care will grow and become a big facet of medical care in the US. The forum should grow in the years to come. When it does, watch out, this specialty seems to attract docs who like to talk and express their opinions.
I'm glad to see the responses. Thanks for the specific info Signomi. I have read your posts before and appreciate your contributions. I guess I have more questions than concerns. It seems that palliative medicine is appreciated more in systems with capitated costs (see Kaiser and VA). These systems have developed an appreciation for palliative care because of the money it saves the system. In fee-for-service medicine this concept can't catch on so well when procedures and acute care pay the bills.
I'm interested in inpatient palliative care consultative services as well as hospice. I would like to hear about practice opportunities that reward fellowship training and provide a balance of inpatient and outpatient services. Does this even exist?
How do hospice/palliative care opportunities vary across the states? Are there states that are more "progressive" than others? How difficult is it to uproot and find a job in another state where one has not done a fellowship?
Given the small number of folks in this field (not to mention, the forum), I doubt there is much info out there. I just want to encourage as many responses possible...
I'm interested in inpatient palliative care consultative services as well as hospice. I would like to hear about practice opportunities that reward fellowship training and provide a balance of inpatient and outpatient services. Does this even exist?
How do hospice/palliative care opportunities vary across the states? Are there states that are more "progressive" than others? How difficult is it to uproot and find a job in another state where one has not done a fellowship?
Given the small number of folks in this field (not to mention, the forum), I doubt there is much info out there. I just want to encourage as many responses possible...
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I've notice a trend with palliative/hospice care. Most residencies are now trying to drudge up training regarding the area. Furthermore this field is open to just about everyone. Surely we will still need our full time palliative care/hospice docs, but more importantly in order to succeed on a global scale, we will need every residency trained physician to have some skill, knowledge, and certain amount of buy in to the palliative care and hospice approach.
This brings up the idea that becoming fellowship trained in palliative care/hospice doesn't necessarily mean you are going to practice full time in this arena. One can still maintain their original specialty while also being advocates, educators, and even part-time participants in the global cause.
This brings up the idea that becoming fellowship trained in palliative care/hospice doesn't necessarily mean you are going to practice full time in this arena. One can still maintain their original specialty while also being advocates, educators, and even part-time participants in the global cause.
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Ouch! Careful there!
I'm 48 this month
and consider myself computer- and board-savvy
.
I think an important aspect of the establishment and subsequent growth process for HP&M will be good, old-fashioned teaching
prof: Remember - Doctor from L. doctor "teacher," from doct- stem of docere "to show, teach").
Med schools want fellowship-trained H&PM sub-specialists to didactically teach med students. Residency programs in H&PM-sponsoring specialities want fellowship-trained H&PM sub-specialists to didactically teach residents. Med schools and residency will also want bedside teaching opportunities, with mini-rotations, and rotations available.
I'm a non-traditional resident in PM&R (one of the H&PM-sponsoring specialities) aiming for a H&PM fellowship. I just did a month-long rotation in April and saw inpatient, outpatient, adults and peds, with on-going didactic and bedside teaching as part of the monthly schedule for the attendings.
What I have seen at 3 different academic institutions is attendings (from full-time tenured faculty to part-time volunteer faculty) most often having an inpatient-outpatient mixed practice, with varying amounts of teaching, often with being a hospice medical director. Seems like an advantageous and interesting practice to me.
I'm 48 this month
and consider myself computer- and board-savvy .I think an important aspect of the establishment and subsequent growth process for HP&M will be good, old-fashioned teaching
prof: Remember - Doctor from L. doctor "teacher," from doct- stem of docere "to show, teach"). Med schools want fellowship-trained H&PM sub-specialists to didactically teach med students. Residency programs in H&PM-sponsoring specialities want fellowship-trained H&PM sub-specialists to didactically teach residents. Med schools and residency will also want bedside teaching opportunities, with mini-rotations, and rotations available.
I'm a non-traditional resident in PM&R (one of the H&PM-sponsoring specialities) aiming for a H&PM fellowship. I just did a month-long rotation in April and saw inpatient, outpatient, adults and peds, with on-going didactic and bedside teaching as part of the monthly schedule for the attendings.
What I have seen at 3 different academic institutions is attendings (from full-time tenured faculty to part-time volunteer faculty) most often having an inpatient-outpatient mixed practice, with varying amounts of teaching, often with being a hospice medical director. Seems like an advantageous and interesting practice to me.
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I just started my hospice and palliative medicine fellowship last month. This is a growing field, and I think many hospital systems are only beginning to appreciate the benefits of fellowship trained physicians and palliative medicine in general. My attending physician told me not to accept a full-time position that offers under $150,000. I am leaning more toward doing full time hospice or hospice with palliative medicine, but when recruiters call me about family medicine opportunities (my residency field), they are very interested in dual FM/pall med employment when I mention my fellowship. I think that you can customize your job to your interests and as the population ages and resources don't become any more plentiful, this will continue to be a growing field.
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I recognize it as a growing field however, despite Obama's paying lip service to more and better EOL care, in actuality we are constantly threatened with cuts. Where I am we just got nailed with a big one that may see our rural non-profit hospice going out of business in the next 6-9 months. The money picture of running hospices is not something you get a lot of exposure to in fellowships, especially since they tend to be run out of academic centers that can eat any costs or large city hospices. The struggle of the rural hospice is under-appreciated.
I advise you strongly to understand the COPs and the ins and outs of being a hospice medical director on the BUSINESS side, not just the medical side.
I advise you strongly to understand the COPs and the ins and outs of being a hospice medical director on the BUSINESS side, not just the medical side.
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AAHPM has a section for rural hospices and they had a meeting at the last annual conference. The plight of the rural hospice is under-appreciated and they talked about that. It does appear that it is not a sustainable model without very significant private donations which are hard to come by in such areas.
For instance in our hospice:
To survive we need an ADC of 130 minimum. We have 110 right now and are losing money due to short high acuity stays (patients come home from our regional Man's Greatest Hospital to die with one foot and two hands in the grave). Why are we down? Because we have been following the LCDs by the book which means those dementia patients that were in program for 1-2 years have all been discharged - we were averaging around 18-24 months stays for dementia patients. Did we save Medicare money? Oh yes we did! But if you cannot document an objective decline in each cert period, they have to be d/c. And they are cracking down right now. Palmetto GBA is doing ADRs on hundreds of hospices right now due to too high average LOS. For small rural hospices those longer LOSs funded those high cost short stays and the overhead it takes to run a four county hospice. It can take one nurse 2 hours to cross our service area in one direction!
I think it is a good idea to start as a staff hospice doc to get a feel for how things work before diving into medical directorship. It also affords you the opportunity to truly understand the viability of your organization. That said, there are a lot of large, safe, well funded hospices where you can start your career.
Compliance with COPs, caps, etc was abstract for me as a fellow...a couple paragraphs in the UNIPAC. LCDs are simple but what about documentation that supports each recert? When you are out there in the real world you will need to understand exactly how they will effect the hospice you may join and what your role may be in maintaining compliance. This is critical in small hospices. What will your role be in PR? Doc to doc education? Patient "recruitment"?
For instance in our hospice:
To survive we need an ADC of 130 minimum. We have 110 right now and are losing money due to short high acuity stays (patients come home from our regional Man's Greatest Hospital to die with one foot and two hands in the grave). Why are we down? Because we have been following the LCDs by the book which means those dementia patients that were in program for 1-2 years have all been discharged - we were averaging around 18-24 months stays for dementia patients. Did we save Medicare money? Oh yes we did! But if you cannot document an objective decline in each cert period, they have to be d/c. And they are cracking down right now. Palmetto GBA is doing ADRs on hundreds of hospices right now due to too high average LOS. For small rural hospices those longer LOSs funded those high cost short stays and the overhead it takes to run a four county hospice. It can take one nurse 2 hours to cross our service area in one direction!
I think it is a good idea to start as a staff hospice doc to get a feel for how things work before diving into medical directorship. It also affords you the opportunity to truly understand the viability of your organization. That said, there are a lot of large, safe, well funded hospices where you can start your career.
Compliance with COPs, caps, etc was abstract for me as a fellow...a couple paragraphs in the UNIPAC. LCDs are simple but what about documentation that supports each recert? When you are out there in the real world you will need to understand exactly how they will effect the hospice you may join and what your role may be in maintaining compliance. This is critical in small hospices. What will your role be in PR? Doc to doc education? Patient "recruitment"?
