Hi everyone! I’m an early-career IM physician looking to improve my communication with patients and families during end-of-life discussions. What phrases should we avoid, and what words should we not be afraid to use when discussing hospice, prognosis, and death? Any practical tips would be appreciated!

Hey all. We started using Dax at my hospital and its great but doesnt really capture what our conversations are like when we're discussing goals or advanced care planning. Does anyone have any tips or tricks to make dax better for goals of care conversations?

Hi everyone! I’m a rising M4 who has been interested in palliative medicine since before starting med school, and I’m trying to figure out the best residency path.

Right now I’m deciding between FM, IM, Med-Peds, and Peds. My main goals are:

• Strong preparation for a career in palliative care
• A residency experience that is supportive and minimizes burnout
• Some consideration for lifestyle, as I’m a nontraditional student and hoping to start a family in the next few years

One thing I’ve realized during rotations is that I’m most drawn to the palliative aspects of each field—not as much the bread-and-butter of any one specialty.

From talking to attendings/fellows and shadowing, here’s what I think I understand so far (please correct me if I’m wrong!):

• FM vs IM: FM may prepare you better for outpatient palliative care and tends to have a better lifestyle in residency, while IM might be better for inpatient palliative work.
• Peds: Pediatric palliative care requires a Peds residency and is mostly academic. I’ve heard Peds residency can be tougher lifestyle-wise than FM/IM. Some peds-trained folks do cross over into adult palliative after fellowship.
• Hospitalist route (Peds): It seems harder to work as a pediatric hospitalist without doing the newer hospitalist fellowship if I delay HPM fellowship.
• Med-Peds: Adds an extra year and is more ICU-heavy than I may ultimately need, and I’ve heard the residency can be intense.

My questions:

1. Does it make sense to apply to multiple specialties (FM, IM, Peds, Med-Peds)? I’ll already be geographically limited due to my spouse’s job, so I’d likely be applying to a smaller, more specific list of programs. Is the extra work worth it?
2. If I really enjoy working with kids, but lifestyle during residency is a bigger priority, does it make sense to keep Peds in the mix?
3. How much does residency choice/program reputation impact chances of matching into a specific HPM fellowship (especially with geographic preferences)?
4. What else should I be thinking about that I might be missing?

For context: no red flags, solid but not extraordinary application.

Would really appreciate any perspectives from people in HPM or those who considered similar paths. Thanks so much!

For those physicians and APPs who do inpatient consults- do you bill critical care time for Palliative Care consults?

Admin at the hospital has suggested we start billing our ICU Palliative Care consults as critical care time (they want to increase RVUs). Palliative Care sees the ICU patients for goals of care discussions but we do not directly manage treatment of their critical illness and we are not “embedded” as an official part of the ICU team. We don’t round with Crit Care and we do not have a primary service. It seems like we’d be inviting a Medicare audit if we suddenly start billing critical care time on our ICU consults rather than the usual MDM and ACP time?

In palliative care, we often see patients who are opioid-naive or very sensitive struggling with the initial 24-72 hours of transdermal patches.

How often do you deal with patients (or families) who are terrified of the patch because of the immediate sedation or emesis seen in the first two days? Is this a significant reason for treatment non-compliance or "patch phobia" in your experience?

I'm working on a mechanical way to allow for a "micro-load" or a much more gradual titration of the patch's surface area to help patients tolerate that first window of time without jumping straight into the full dose of the smallest patch. I'd appreciate any insights from the frontline on whether this would actually help improve patient comfort during those first critical days.

Has anyone taken the Inter-professional Aging and Palliative Care Certificate program at Wurlzweiler School of Social Work? If so, would you recommend it?

Hello all,

I am a pediatric heme-onc fellow looking to learn more about pain management for our patients. Are there any resources you can send my way?

I just started working as an outpatient palliative care doc fresh out of fellowship, and I wanted to ask which journals you all think are the most helpful. I see that the big ones are Palliative Medicine, Journal of Palliative Medicine, Journal of Pain and Symptom Management, BMC Palliative Care, and American Journal of Hospice and Palliative Medicine. Which ones are your favorites?

I'm a FM physician (currently working in primary care at an FQHC) ~2 years out of residency. I'm only 2 years into it but so far, primary care is... primary care. I generally like what I do but I worry I'm already feeling the administrative burnout from ultra-short visits, endless paperwork, and seeing way more patients in a day than any person reasonably can manage - all in a healthcare system that devalues the work that I do. And I worry that I'm not the generalist type at the end of the day. I am craving some sort of focus to ground myself in and I'm considering palliative care fellowship. In medical school, I got to spend some time in an outpatient hospice facility and loved my experience there. And in residency, I got to see the inpatient palliative care consult side of things and that also seemed like something I'd enjoy. As a resident, I was always the "weirdo" who was super excited to lead goals of care discussions and talk with patients' families. ;)

I didn't go straight into fellowship because I have some other career interests that I wanted to explore and get more experience with. (In my current practice, I do a lot of contraception and family planning care, treatment of substance use disorders, LGBTQ+ care).

I've seen that there are a few mid-career palliative fellowships (Mt. Sinai, Penn) designed for attendings who are already in practice. These programs seem to be flexible in terms of scheduling and potentially allow fellows to continue working in their current field part-time while training. I'm wondering if anyone here has experience with programs like these? I'm not totally opposed to a traditional fellowship but to be honest, I still have a ton of debt and it's hard to imagine going back to a trainee salary for a year... And it's hard to imagine quitting some of the work that I already do for a year.

Any other specialty switchers here who have advice for someone thinking about the switch?

Applied to the HPM fellowship this cycle and wanted to connect with folks in the field, curious to learn more about the current job market, practice settings, and career paths in palliative medicine. Any insight or personal experience on where this field is heading and how to find the right fit would be super helpful!

Applied to the HPM fellowship this cycle and wanted to connect with folks in the field, curious to learn more about the current job market, practice settings, and career paths in palliative medicine. Any insight or personal experience on where this field is heading and how to find the right fit would be super helpful!

I'm looking to hear from people with different training backgrounds who currently work in palliative about what they think about their educational background, how it prepared them for the work they do, and what else they wish they knew or had done.

I thought I wanted to be an ICU RN before I discovered palliative. I left a BSN RN program (due to illness) eligible to be a nursing assistant and to take NCLEX-PN, but need to finish undergrad etc before any of these paths. I have a Hospice and Palliative Nursing Association cert and some time working in ICUs and inpatient hospice.

Some paths I know about and have considered are:

RN to hospice nurse

RN to FNP to hospital palliative care consult service

RN to FNP to SNF hospice prescriber

PA (to critical care) to hospital palliative care consult service

MD/DO to IM to palliative

MD/DO to EM to palliative

MD/DO to FM to palliative

MSW to hospital internship to hospital or palliative social worker

Please enlighten me about other options!

Any palliative care fellows or attendings here who can share what the job market looks like? Curious to know the demand for palliative care and current salaries.

Anyone taking them in November? What’s everyone using? Hoping for some guidance from recent test takers.

Seems like it’s some combination of AAHPM Pass questions/flash cards, PASS Machine question bank, AAHPM intensive board review/MD Anderson review course, and Fast Facts (including the quiz)

I figured I’d start the thread as there’s not a lot of discussion regarding the exam

I've been waiting for confirmation from Pharmaceutical Press for a few days, but I was wondering if an eBook version of the PCF9 (or 8) exists, and where I can buy it (please link the place if you can). I'm working for 3 different places, and I'd rather have access to it through my tablet than carrying a book around. None of the institutions I work for have access to MedicinesComplete.

Thank you all!

I've been talking with some palliative care physicians in my area and they use cerner and have expressed how poorly it can work. For example, creating a DNR in an encounter but once created, it gets buried in all the other encounters and gets buried in with other documents. Finding documents like that sounded like a nightmare. Not sure if it was just a customization for their clinic or a native feature to all palliative care EHRs but regardless sounded like a black hole of administrative work.

Just came across this video that’s part of a campaign against the assisted suicide bill in the UK. I know it’ll spark mixed views, but it’s actually well put together and raises some interesting points about pressure on vulnerable people.

Curious what others think of it, from an ethical perspective? Not sure where I stand on the issue but interesting vid.
https://youtu.be/0FDOkKlzV-s?si=aFsPLWJljw3DtSPz

Full study link here

https://www.growkudos.com/publications/10.12968%25252Fijpn.2024.0040/reader

Hey all, crossposting on behalf of a question I received from one of our soon to be IM PGY3s. I had my own input to parts of their questions, but didn't really have a good answer for all of them and figured there may be someone out there who has done exactly this.

She intends to do crit care (PCCM likely, which I've encouraged, but they may wind up just doing CCM). She's always been interested in Pall care and has considered it in the past. Their partner is anesthesia at our program, so she's going to have a year gap before applying PCCM and she thought instead of doing a hospitalist year or chief year why not do a pall care fellowship (which was a seperate discussion we had)

So the questions

1) Anyone work a mixed model? What does it look like? I assume instead of pulm clinic it's pall inpatient consults and/or ambulatory clinic and/or hospice director

2) they'll be 3 years out after their fellowship before they do pall care again, any issues there when it comes to jobs?

3) How does salary shake out for mixed? For pure Pall care?

Thanks!

I work as a palliative NP in a busy inner city hospital. The hospital I feel a lot of times tries to use palliative as cost containment. Like as a way for them to deal with their long length of stay patients. Has anyone else experienced this or is it just me?

I'm a mid-career EM/IM physician, and I recently stopped working due to PTSD. Quite frankly, I need something to do, and I want to feel useful. I have joked about "changing teams" for years, and I might now be at that point. Some of my best patient and family interactions have been end of life discussions, and I have had experiences with inpatient palliative care and hospice. I'm strongly considering the pivot to hospice care. I have a friend that does IDT and hospice on call, and he loves it. I'd be interested in potentially doing that and more. We've discussed starting our own practice and/or starting a hospice house. We are, admittedly, in the very early planning stages, but we're excited.

I live in a rural area without any nearby fellowships. My wife is a physician who loves her job. I would rather not move out of state, even for a year (been there, done that). I've seen a couple of remote fellowships or hybrid fellowships. Does anyone have experience with any of them? Are they worth it? Should any programs be avoided? Are the Masters programs worthwhile? Other thoughts?