Evolving the Palliative Care Workforce to Provide Responsive, Serious Illness Care
Authors: Arif H. Kamal, Jennifer M. Maguire, Diane E. Meier
Journal: Annals of Internal Medicine (2015)

Ideas and Opinions20 October 2015Evolving the Palliative Care Workforce to Provide Responsive, Serious Illness CareArif H. Kamal, MD, MHS, Jennifer M. Maguire, MD, and Diane E. Meier, MDArif H. Kamal, MD, MHSFrom Duke Cancer Institute, Durham, North Carolina; University of North Carolina School of Medicine, Chapel Hill, North Carolina; and Icahn School of Medicine at Mount Sinai, New York, New York., Jennifer M. Maguire, MDFrom Duke Cancer Institute, Durham, North Carolina; University of North Carolina School of Medicine, Chapel Hill, North Carolina; and Icahn School of Medicine at Mount Sinai, New York, New York., and Diane E. Meier, MDFrom Duke Cancer Institute, Durham, North Carolina; University of North Carolina School of Medicine, Chapel Hill, North Carolina; and Icahn School of Medicine at Mount Sinai, New York, New York.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M15-0071 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Two hospitalists recently discussed a patient admitted for advanced emphysema. The patient had full code status, showed limited understanding of his condition, and was readmitted frequently. The hospitalists previously attempted to discuss goals of care, but they felt unsuccessful and cited time constraints and hesitancy with facilitating the complex goals of care discussions. One physician said to her colleague, "Where I trained, we could consult palliative care to help with complex patients. Our position for a palliative care specialist remains unfilled after 2 years. When will we get some help?"This situation is 1 example of a national crisis in ...References1. Quill TE, Abernethy AP. Generalist plus specialist palliative care—creating a more sustainable model. N Engl J Med. 2013;368:1173-5. [PMID: 23465068] doi:10.1056/NEJMp1215620 CrossrefMedlineGoogle Scholar2. Center to Advance Palliative Care. National palliative care registry annual survey summary: results of the 2012 national palliative care registry survey, as of July 2014. Accessed at https://registry.capc.org/cms/portals/1/Reports/National_Palliative_Care%20Registry_Annual_Survey_Summary_9.2.2014.pdf on 24 July 2015. Google Scholar3. Lupu D; American Academy of Hospice and Palliative Medicine Workforce Task Force. Estimate of current hospice and palliative medicine physician workforce shortage. J Pain Symptom Manage. 2010;40:899-911. [PMID: 21145468] doi:10.1016/j.jpainsymman.2010.07.004 CrossrefMedlineGoogle Scholar4. American Academy of Hospice and Palliative Medicine. Number of certified hospice and palliative medicine physicians by cosponsoring specialty board. Accessed at http://aahpm.org/hpm/number-certified on 27 March 2015. Google Scholar5. Wu SY, Green A. Projection of Chronic Illness Prevalence and Cost Inflation. Santa Monica, CA: RAND Corporation; 2000. Google Scholar6. Accreditation Council for Graduate Medical Education. ACGME public program search. Accessed at www.acgme.org/ads/Public/Programs/Search on 27 March 2015. Google Scholar7. Kamal AH, Bull J, Wolf S, Samsa G, Ast K, Swetz KM, et al. Prevalence and predictors of burnout among specialty palliative care clinicians in the United States: results of a national survey. J Clin Oncol. 2014;32(suppl 31; abstr 87). Google Scholar8. Feely MA, Havyer RD, Carey EC, Swetz KM. A novel program to promote competency and hospice and palliative medicine board certification [Letter]. J Palliat Med. 2011;14:272-3. [PMID: 21361834] doi:10.1089/jpm.2010.0455 CrossrefMedlineGoogle Scholar9. Kamal AH, Bull J, Rogers UA, Swetz KM, Kavalieratos D, Abernethy AP, et al. Characterizing the specialty palliative care workforce in the United States: results of a national survey. J Clin Oncol. 2014;32 (suppl 31; abstr 90). Google Scholar10. National Hospice and Palliative Care Organization. NHPCO's facts and figures: hospice care in America: 2014 edition. Accessed at www.nhpco.org/sites/default/files/public/Statistics_Research/2014_Facts_Figures.pdf on 24 July 2015. Google Scholar Author, Article, and Disclosure InformationAffiliations: From Duke Cancer Institute, Durham, North Carolina; University of North Carolina School of Medicine, Chapel Hill, North Carolina; and Icahn School of Medicine at Mount Sinai, New York, New York.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-0071.Corresponding Author: Arif H. Kamal, MD, MHS, Duke Clinical Research Institute, 2400 Pratt Street, Room 8043, Durham, NC 27710; e-mail, arif.[email protected]edu.Current Author Addresses: Dr. Kamal: Duke Clinical Research Institute, 2400 Pratt Street, Room 8043, Durham, NC 27710.Dr. Maguire: Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina School of Medicine, CB 7020, 130 Mason Farm Road, 4th Floor Bioinformatics Building, Chapel Hill, NC 27599.Dr. Meier: Center to Advance Palliative Care, Icahn School of Medicine at Mount Sinai, Annenberg Building, 1468 Madison Avenue, New York, NY 10029.Author Contributions: Conception and design: A.H. Kamal, J.M. Maguire, D.E. Meier.Drafting of the article: A.H. Kamal, J.M. Maguire, D.E. Meier.Critical revision of the article for important intellectual content: A.H. Kamal, J.M. Maguire, D.E. Meier.Final approval of the article: A.H. Kamal, J.M. Maguire, D.E. Meier.Collection and assembly of data: A.H. Kamal.This article was published online first at www.annals.org on 11 August 2015. 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