The situation in postgraduate training is little better. Although many postgraduate programs in family medicine include some exposure to palliative care, it is neither mandatory nor extensive, and exposure to such training is rare in any of the postgraduate programs of the Royal College of Physicians and Surgeons of Canada. Accreditation standards for undergraduate and postgraduate training generally fail to consider palliative medicine. There are few full-time palliative care physicians on university faculties in this country. At the same time, the burden of illness is growing because of both the increasing proportion of elderly patients in society and the rise in the prevalence of cancer.
Various studies suggest that the care of patients in advanced stages of illness is far from optimal.
To address these needs there must be increased professional acceptance, priority, funding, recruitment, and development of research and education in palliative medicine in Canada. We recognize that most palliative care will and should be delivered by family physicians and, to a lesser extent, by oncologists and other specialists. However, the enormity of the task of providing educational programs and performing research on which to base clinical practice demands that there be a small number of training centres and physicians with specialized training in the discipline of palliative medicine. A more direct answer to the question of whether palliative medicine constitutes a specialized body of knowledge, skills and attitudes is evident from the nature of the work itself. The physician providing palliative care is confronted by patients with multiple diseases, complex symptoms and syndromes, and multiorgan failure, so meticulous attention to treatment is required.