Path(s) to palliative fellowship and beyond

[NY Musicologist]

Just thought I'd start a formal thread re. this common question (which has already popped up elsewhere on our embryonic H/P forum):

Which residencies (including sub-Is, transitional years, etc. if appropriate) are the most common and/or the most advisable entry points for careers in hospice and palliative medicine?

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[tedsadoc2002]

usually FP/IM/neurology

 

[maranatha]

Hello,

I'm a 4th-year medical student who is applying to psychiatry. I have been learning on the interview trail that psychiatrists are starting to do palliative care work as well as the ones mentioned above.

 

[DeanWormer]

shrinks are able to apply for pain fellowships and can handle the psychosocial and comorbid psychiatric symptoms too. Good intro into this specialty. Is it okay paying?

 

[CHMer]

Are anesthesiologists able to train in palliative care and be competitive for palliative care/hospice jobs?

 

[sunlioness]

I know one attending at the VA who got into it through IM and then a heme/onc fellowship.

At my old hospital we had a palliative care fellowship through IM, a palliative consult service, and an inpatient hospice service. My current hospital doesn't have this and the issues seem to be handled in a more fractured manner among social work, psychiatry, and the pain service (mostly anesthesiologists, I think). It works, but I have to say that my old hospital (UPMC Presbyterian/Montefiore) was AMAZING at this. They had docs, social workers, a music therapist, and a psychologist working together on one service. And they were all super nice. It really really rocked.

 

[psyjake]

I'm a 4th-year medical student who is applying to psychiatry. I have been learning on the interview trail that psychiatrists are starting to do palliative care work as well as the ones mentioned above.

I'm also currently in the match for a PGY-1 position in psychiatry. My main interests mostly fall along the lines of consult-liaison psychiatry and geriatric psychiatry. But hospice and palliative care psychiatry is a budding interest as well.

My top choice in the match (which I hope I get) is really pushing to expand its fellowship offerings. A new C-L / psychosomatic medicine fellowship should be up and running by the time I'm eligible to apply. Also they have some faculty that are double boarded in IM-Psych who are doing some great work in psychosocial aspects of oncology and there's a cancer center right next to the main university hospital.

So I'm hoping that I'll find the right kind of guidance for this career path in a setting like that. Although I don't think that the institution offers a formal hospice-palliative care fellowship, I hope that (if my interest is still there) I'll be well prepared to apply for one if I choose to go further than a general psych residency and a C-L fellowship.

 

[freelancewriter]

Haven't surfed around this forum in quite a while. I'm finding that I missed it!

There's a Palliative Fellowship in my hometown at Marshfield Clinic/St. Joseph's Hospital (Wisconsin). It looks like the attendings have IM and FP backgrounds, but I wonder if that will evolve over time as the formalized discipline gets more years under its belt.

According to Marshfield Clinic's Palliative Fellowship application page, their program is "open to applicants BC/BE in Internal Medicine, Family Practice, Neurology, or Physical Medicine & Rehabilitation."

I confess to not being a physician myself, but I'm fascinated by health care and the palliative field in particular, and am drawn to it in freelance writing.

Have people seen a changing trend in terms of background entry points for palliative medicine fellowships?

 

[radonc]

you can get to it through radonc. no fellowship needed at present, just care of a lot of palliative patients.

 

[marie337]

Is it possible to get to palliative medicine through psychiatry? It seems like there is so much psychiatric medicine involved that it would be possible.

 

[tedsadoc2002]

I have just completed my fellowship in Palliative Care medicine, primary specialty FM. The boards for certification in Hospice and Palliative Medicine are now given by ABMS. You can check to see if your specialty is one that can receive certification after fellowship. IM/FM/EM are 3 of the ones that I recall. Go to the website to check for psychiatry.

 

[tedsadoc2002]

I found this on the ABMS website (www.abms.org) these are the specialties that the organization has its candidates sit for and then the "certifications for special qualifications" note among them is Hospice and Palliative Medicine. (also noted it for anesthesia as well as Peds and OB/Gyn)

American Board of Psychiatry and Neurology
Psychiatry
Neurology
Neurology with Special Qualifications in :
[*]Child Neurology
[*]Addiction Psychiatry
[*]Child and Adolescent Psychiatry
[*]Clinical Neurophysiology
[*]Forensic Psychiatry
[*]Geriatric Psychiatry
[*]Hospice and Palliative Medicine
[*]Neurodevelopmental Disabilities
[*]Neuromuscular Medicine3
[*]Pain Medicine
[*]Psychosomatic Medicine
[*]Sleep Medicine
[*]Vascular Neurology

 

[brimcmike]

As of 2006, the specialties that are co-sponsoring subspeciality certification in Hospice and Palliative Medicine are :

Anesthesia, Emergency Medicine, Family Medicine, Internal Medicine, Obstetrics and Gynecology, Pediatrics, Physical Medicine and Rehabilitation, Psychiatry and Neurology, Radiology and Surgery http://www.abms.org/News_and_Events/downloads/NewSubcertPalliativeMed.pdf
http://www.abms.org/Who_We_Help/Physicians/specialties.aspx

My specialty is EM; I'm a PGY-2 resident. Here is ABEM's web info on subspecialization in HPM:
http://www.abem.org/PUBLIC/portal/alias__Rainbow/lang__en-US/tabID__3799/DesktopDefault.aspx
EM-based programs are just starting to get launched now.

Each specialty is finalizing their regulations - stay tuned.

 

[Sleepygator]

Although I do not do any hospice/palliative care now, I did some elective time on that service during my psychiatry residency. Where I felt that I contributed most was with comorbid anxiety and depression. I was also able to help with delirium and end-stage dementia.

However, I did not feel as comfortable with the more acute medical issues that came up. For example, we regularly were consulted in the ICU and it was difficult for me to see the big picture and converse with families, as I had been away from the ICU for too long.

If you were going to attempt to do hospice from a psychiatry residency, it might be helpful to do some extra rotations on a medicine service. I also did a rotation with the pain service, and I found this particularly valuable for palliative care.