More doctors sought to meet hospice and palliative care demands

Congress weighs legislation that would allocate funds for programs that train physicians in such care and encourage those in mid-career to transition to the specialty.

By — Posted Aug. 21, 2012

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The U.S. physician work force is failing to keep pace with increasing demands for hospice and palliative care services as more people live longer with chronic diseases, said the American Academy of Hospice and Palliative Medicine.

From 8,000 to 10,000 physician specialists are needed to meet demands in hospice and palliative care programs nationwide, according to the AAHPM, 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.

Physician shortages will worsen with the aging of the population, said AAHPM President Timothy Quill, MD, director of the palliative care program at the University of Rochester Medical Center in New York.

“Demand has grown faster than our ability to produce and train specialists,” Dr. Quill said.

The number of Americans 65 and older is projected to increase from 40.2 million in 2010 to 72.1 million in 2030 and 88.5 million in 2050, says the Dept. of Health and Human Services’ Administration on Aging.

Congress is considering legislation aimed at increasing interdisciplinary training in hospice and palliative care. The Palliative Care and Hospice Education and Training Act would provide nearly $50 million in funding to support a variety of programs, including training for doctors and fellowships to encourage mid-career physicians to transition to the specialty. It also would provide awards to support educators in the field.

The act was introduced July 19 in both the House and Senate by Sen. Ron Wyden (D, Ore.) and Rep. Eliot Engel (D, N.Y.). Several organizations support the legislation, including the American Cancer Society, the American Geriatrics Society, the Center to Advance Palliative Care and the National Hospice and Palliative Care Organization.

“Palliative care is a big change in health care delivery, and it works in favor of the patient,” said Chris Hansen, president of the American Cancer Society Cancer Action Network, the society’s advocacy affiliate. “That’s why palliative care is one the fastest-growing trends in health care and why we need more trained professionals in the field. With improved access to palliative care, patients will benefit from improved quality of life from the time of diagnosis and during treatment and follow-up care.”

Widespread demand for care

More than 1,600 hospitals nationwide have palliative care programs. About 1.6 million patients — 42% of all U.S. deaths — received hospice services in 2010, according to the legislation (link).

Palliative care emphasizes improving a patient’s quality of life by managing pain and other symptoms of serious illnesses, such as cancer, congestive heart failure, chronic obstructive pulmonary disease and Alzheimer’s disease. Hospice provides this care for patients in the last year of life.

Such care is associated with a higher quality of life for patients, improved patient satisfaction, reduced hospital stays and lower health care costs, Dr. Quill said.

“A growing body of medical research has documented the benefits of high-quality palliative and hospice care for patients and families, for hospitals and payers, and for the health care system as a whole,” he said. “However, delivery of high-quality palliative and hospice care cannot take place without a sufficient number of health care professionals with appropriate training and skills.”

One major challenge is that medical students have little training in advance care planning and pain and symptom management during medical school, Dr. Quill said. Palliative care has been a specialty for only about 20 years, and medical education traditionally has focused on new technologies and treatments.

“There is a growing recognition that with the population aging and an exponential number of people who are living with chronic illness, there is going to be a tremendous need to integrate palliative care into usual care,” he said.

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