Demand for palliative care has grown (.pdf) tremendously over the past decade. VJ Periyakoil, MD, director of Stanford's hospice and palliative medicine fellowship program, has experienced firsthand how the burgeoning specialty has exploded, and how the nation's physician workforce has struggled to keep pace.
"We are at a point in time where the demand for quality palliative care far exceeds the supply of clinicians with required expertise," Periyakoil told me. "It takes a long time to train doctors and currently we are churning out about 300 fellows annually. Each year, the fellows who graduate from our palliative care fellowship get multiple job offers and most are often recruited to leadership positions."
A recent American Medical News story offered a detailed look at the rapidly growing need for palliative care services, as well as physicians trained in hospice care:
From 8,000 to 10,000 physician specialists are needed to meet demands in hospice and palliative care programs nationwide, according to the [American Academy of Hospice and Palliative Medicine], a professional organization for hospice and palliative medicine physicians. But only 4,500 doctors specialize in the field, and training programs are expected to produce only an additional 4,600 specialists in the next 20 years, the academy said.
The demand for palliative medicine is driven in large part by advancements in biomedicine and the United States' graying population. Additionally, a growing body of scientific evidence on the speciality is beginning to show it can improve quality of life for patients diagnosed with serious chronic illnesses and can reduce health costs. As a result, an increasing number of hospitals are adding or expanding their palliative care programs and more patients seeking services.
In an effort to increase interdisciplinary training in hospice and palliative care, Congress is considering legislation that would allocate nearly $50 million for a range of programs, including training for doctors and fellowships to encourage mid-career physicians to transition to the specialty. The Palliative Care and Hospice Education and Training Act was introduced in July and would also provide awards to support educators in the field.
When I asked Periyakoil how the bill, in enacted into law, would help meet future hospice and palliative care demands, she responded:
If we look at the field of geriatrics, the federal Health Resources and Services Administration funds the Geriatric Academic Career Award (GACA) to increase the number of junior faculty at accredited schools of allopathic and osteopathic medicine. It also promotes the development of their careers as academic geriatricians who emphasize training in clinical geriatrics, including the training of interdisciplinary teams of health professionals. The proposed legislation is a similar effort to promote interdisciplinary palliative care.
The bill could also have important implications for Stanford's fellowship program. Our fellowship is the oldest interprofessional palliative care fellowships in the country. Funded by the Office of Academic Affiliations, the program trains fellows from the field of medicine, psychology, social work and chaplaincy in palliative care. The fellows learn to train together and work together. Currently, this model is restricted to the fellows serving Veterans Affairs hospitals due to funding reasons. In the future, if the legislature passes, I hope that we will have funding to expand these interprofessional fellowships in academic medical centers.