Professional Certification of Palliative Medicine Charles F. von Gunten, MD, PhD Past Chairman.
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Transcript of Professional Certification of Palliative Medicine Charles F. von Gunten, MD, PhD Past Chairman.
Professional Certification of Professional Certification of Palliative MedicinePalliative Medicine
Charles F. von Gunten, MD, PhDCharles F. von Gunten, MD, PhDPast ChairmanPast Chairman
Setting the Standard of Setting the Standard of Excellence in Hospice and Excellence in Hospice and
Palliative MedicinePalliative Medicine
Professional Professional certification is certification is
important for the fieldimportant for the field
Palliative Care Palliative Care Interdisciplinary care focused Interdisciplinary care focused
on relieving suffering and on relieving suffering and improving quality of life.improving quality of life.
May be May be combinedcombined with with therapies aimed at reducing therapies aimed at reducing or curing the illness, or it may or curing the illness, or it may be the total focus of care.be the total focus of care.
Standard Model of CareStandard Model of Care
PresentationPresentation DeathDeath
Therapy with Curative IntentTherapy with Curative IntentBereavementBereavement
CareCare
6m6m
Medicare Medicare Hospice Hospice BenefitBenefit
Field & Cassel (eds) IOM Report, 1997
Palliative Care ModelPalliative Care Model
PresentationPresentation DeathDeath
Therapy with Curative IntentTherapy with Curative IntentBereavementBereavement
CareCare
Symptom Rx Symptom Rx Relieve Relieve
SufferingSuffering
Palliative Care
6m6m
Medicare Medicare Hospice Hospice BenefitBenefit
Who does palliative care?Who does palliative care?
PrimaryPrimarySecondarySecondaryTertiaryTertiary
JAMA 2002;287:875-881
Example: Interface of Palliative Example: Interface of Palliative Care and NephrologyCare and Nephrology
Primary Primary Palliative CarePalliative Care
Secondary Secondary Palliative CarePalliative Care
Tertiary Tertiary Palliative CarePalliative Care
Pt with Pt with ESRD, ESRD, nausea & nausea & abdominal abdominal painpain
Nephrologist Nephrologist successfully successfully uses uses antiemetics, antiemetics, analgesics & analgesics & coanalgesicscoanalgesics
Asks for Asks for consult for consult for refractory sx refractory sx and for time-and for time-consuming consuming family family dynamicsdynamics
Admitted to Admitted to pc unit for pc unit for refractory refractory Sx. Rx. PM Sx. Rx. PM fellowfellow
Palliative MedicinePalliative Medicine
The term palliative medicine The term palliative medicine refers to the physician refers to the physician discipline as part of discipline as part of interdisciplinary palliative interdisciplinary palliative care at secondary and care at secondary and tertiary levelstertiary levels
Why a Palliative Medicine Why a Palliative Medicine Subspecialty?Subspecialty?
Improve patient careImprove patient careCreate and disseminate new Create and disseminate new
knowledge knowledge Credibility and recognitionCredibility and recognitionRecognized in UK, Ireland, Recognized in UK, Ireland,
Canada, Australia, New Canada, Australia, New ZealandZealand
Field & Cassel (eds) IOM Report, 1997
The case for palliative The case for palliative medicine subspecialtymedicine subspecialty
Board certificationBoard certificationScholarly researchScholarly researchFellowship trainingFellowship trainingProfessional AssociationProfessional AssociationProfessional RoleProfessional Role
Board CertificationBoard Certification Founded 1995Founded 1995 First examination 1996First examination 1996 1800 diplomates1800 diplomates Exam by NBMEExam by NBME
– 230 items in 4 hour exam230 items in 4 hour exam– 688 items in bank688 items in bank
> 500 applicants for 2005> 500 applicants for 2005 20% growth per year20% growth per year MOC initiated in 2004MOC initiated in 2004
J Palliat Med 2000; 3:441-447
0 10 20 30 40 50 60
Anesthesia
Family Practice
Internal Medicine
Pediatrics
Radiation Oncology
Surgery
Other
No Response
percent
ABMS BoardsABMS Boards
J Palliat Med 2000; 3:441-447
n = 1535
Scholarly ResearchScholarly Research > 7 Medline-listed peer-> 7 Medline-listed peer-
reviewed specialty journalsreviewed specialty journals– Listed on Fact SheetListed on Fact Sheet
Also published in major Also published in major journals (NEJM, JAMA)journals (NEJM, JAMA)
Many TextbooksMany Textbooks
Fellowship TrainingFellowship Training
47 programs in 200447 programs in 2004– 3 NCI-funded3 NCI-funded
– 6 VA programs6 VA programs
– 97 slots total annually97 slots total annually
www.aahpm.org Accessed May 4, 2004
Fellowship TrainingFellowship Training
1.9 slots per program 1.9 slots per program (median 2, range 1 – 8)(median 2, range 1 – 8)
8.5 applicants per program 8.5 applicants per program (median 6, range 0 – 40)(median 6, range 0 – 40)
4.5 applicants per slot4.5 applicants per slot
February 2004 E-mail surveyFebruary 2004 E-mail survey 86% response rate86% response rate
Fellowship TrainingFellowship Training Voluntary Guidelines Voluntary Guidelines
modeled after ACGME modeled after ACGME modelmodel
Palliative Medicine Review Palliative Medicine Review Committee accredits after Committee accredits after ACGME RRC modelACGME RRC model
ACGME application initiatedACGME application initiated
J Palliat Med 2002; 5:23-33
Professional AssociationProfessional Association
American Academy of American Academy of Hospice and Palliative Hospice and Palliative MedicineMedicine
1900 members1900 members
Professional RoleProfessional Role
Hospital-based consultantsHospital-based consultants– Ambulatory outpatient Ambulatory outpatient
componentcomponent
Hospice medical directorsHospice medical directors
Cohen B, Salsberg, E. SUNY Albany, 2002. http://chws.albany.edu
Professional RoleProfessional Role
30% US hospitals (26% of 30% US hospitals (26% of teaching hospitals) have teaching hospitals) have palliative care consult palliative care consult teamsteams
20% increase annually20% increase annually 6,021 hospitals listed by 6,021 hospitals listed by
AHAAHA
J Palliat Med 2001;4:315-24 J Palliat Med 2001;4:309-14
Professional RoleProfessional Role
3,200 hospice programs3,200 hospice programs care for 25% of US deathscare for 25% of US deaths Each must have at least Each must have at least
one physician medical one physician medical directordirector
Volume of NeedVolume of Need Rapid growth in serious, Rapid growth in serious,
chronic illnesschronic illness Consequence of effective Consequence of effective
technologiestechnologies 2.3 million deaths2.3 million deaths
– 10% sudden10% sudden– Of remaining 90%Of remaining 90%
• 40-60% with unrelieved suffering40-60% with unrelieved suffering
The case for palliative The case for palliative medicine subspecialtymedicine subspecialty
Board certificationBoard certificationScholarly researchScholarly researchFellowship trainingFellowship trainingProfessional AssociationProfessional AssociationProfessional RoleProfessional Role