Careers in Hospice and Palliative Medicine
See why a career in hospice and palliative medicine might be right for you.
Hospice and palliative medicine (HPM) is a medical specialty focused on enhancing quality of life for patients and their families who are facing serious conditions. HPM physicians develop particular expertise in
- complex symptom management
- psychosocial and spiritual support for the dying patient and the family
- assistance with end-of-life decisions and advance care planning
- continuity of care across settings
- home and hospice care
- bereavement care
- interdisciplinary teamwork.
"For the first time in my medical career I told a family their Dad was dying right in front of their eyes. But at the end of the meeting I was hugged and thanked (also for the first time in my medical career) for helping them navigate a dark and frightening path. I never realized my medical powers extended to helping people by having an actual conversation with them. I had really thought until this point it was about numbers and tests and medicine."
Because of a number of factors, including the field's rapid growth and a growing population of aging adults, great need exists for physicians and other healthcare professionals who specialize in hospice and palliative medicine, as well as nonspecialists trained in the core practice of hospice and palliative medicine. Many opportunities exist for recent graduates as well as established physicians seeking to expand or refocus their career.
A primary pathway to specializing in hospice and palliative medicine is subspecialty board certification, available to both allopathic and osteopathic physicians. Read more about board certification through the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA). ABMS and AOA certification requires candidates first complete a 12-month hospice and palliative medicine fellowship before sitting for the certification exam.
Physicians interested in providing care in hospice settings may also consider certification through the Hospice Medical Director Certification Board.
AAHPM Career Development Resources
AAHPM offers several resources to help physicians advance their careers in hospice and palliative medicine, such as leadership development opportunities and an active job board where physicians can seek available opportunities in hospice and palliative care.
You can connect with peers and colleagues new to the field by joining the Early Career Professionals special interest group (SIG) and read how hospice and palliative care affects the lives of patients and their families at AAHPM's patient website, PalliativeDoctors.org.
AAHPM offers scholarships to enable members to access educational events and resources that might otherwise be inaccessible to them.
Christian Sinclair, MD FAAHPM, assistant professor, Division of Palliative Medicine at the University of Kansas Medical Center, was the first fellow in a new hospice and palliative medicine fellowship program and is now co-editor of Pallimed and serves on the AAHPM Board of Directors.
In medicine I find discovering new questions and searching for answers to be the most satisfying part of my daily work. This curiosity led me to avoid fields where it felt like everything was already known and filled with guidelines, like cardiology. When I stumped my attendings in asking how they qualify someone as "poor prognosis" versus a "guarded prognosis," I knew I was on to something that would satisfy my desire to push the boundaries of current knowledge and understanding. In a hospice and palliative medicine practice the answers are never all there in front of you. By the very nature of its infancy, the field allows for creativity in prescribing, communicating, and problem-solving since the evidence base is still being formed. And once we do start to get some answers through the growing research, new questions and dilemmas emerge to challenge our current knowledge and expectations.
My training goals reflected a desire to pursue primary care or geriatrics because of the rewards received from whole person care and not an organ or disease based approach. You could say I was primed for palliative care. I began my palliative medicine career as a 2nd year internal medicine resident at Wake Forest University Baptist Medical Center in Winston-Salem, NC. During a week in which I drove home mired in self-doubt and fatigue about my chosen profession because I realized I had never been thanked, I had a spectacular encounter with a family which upended all my previous notions of what it meant to be a physician.
The patriarch of the family was dying in the Cardiac Care Unit, and I was on call when his condition really started to deteriorate. Until this time, the family had already adapted to the frequent hospitalizations spurred by his congestive heart failure, so they had not yet discussed what might happen if Dad did not rebound like he always had before. That evening during a meeting with the wife and three daughters, they demonstrated anger and sadness as I carefully communicated his current condition and actually for the first time in my medical career told a family their Dad was dying right in front of our eyes. But at the end of the meeting I was hugged and thanked (also for the first time in my medical career) for helping them navigate a dark and frightening path.
I never realized my medical powers extended to helping people by having an actual conversation with them. I had really thought until this point it was about numbers and tests and medicine. The staff pointed me in the right direction to the local hospice medical director, Dick Stephenson at the Hospice & Palliative CareCenter. He was looking for his first palliative medicine fellow and I was looking for guidance for my new inspiration.
Now as an associate hospice medical director and a hospital based palliative medicine consultant I am able to practice the full spectrum of palliative medicine. While working for Kansas City Hospice and Palliative Care, I am still able to have my foot in academia by being a site director for the University of Kansas Palliative Medicine Fellowship. It has also been a real pleasure being a co-editor of Pallimed, which has opened so many doors and connected me with so many wise and people.
Dorece Norris, MD, began as an infectious disease specialist during the HIV epidemic before becoming a hospice physician.
I began my medical career as an Infectious Disease specialist in Tampa in 1984, just as the HIV epidemic was evolving in our community. There were very few physicians willing to care for those in need, so my partner and I began providing primary care in addition to hospital-based infectious disease consultation work. Having lived in Tampa since childhood, many of my patients were personal friends, and my practice quickly became focused almost exclusively on primary care of those with HIV. The early years without therapy resulted in my approach being one of treating as many opportunistic infections as possible, delaying the inevitable, and providing palliative care for those at the end of life. I worked closely with Lifepath Hospice, remaining the attending and performing home visits.
As effective therapy became available, many of my patients stabilized, living into maturity and developing the expected illnesses of diabetes, heart disease, COPD, hypercholesterolemia, etc. While delighted that my patients and friends were living much longer and healthier, I found that an office-based, general internal medicine practice did not provide the same professional satisfaction for me. At the time, I did not understand my restlessness, until a dear friend asked me to be the attending for her son, whom I had known since early youth. Now he was in his 40s and had developed Amyotropic Lateral Sclerosis (known as Lou Gerhig's Disease), a progressive, untreatable illness that usually results in death within 2-3 years. Tobi was progressing rapidly, and the decision had been made to focus on comfort care at home. Once again I found myself working with LifePath and making home visits. Providing palliative care and a comfortable death for Tobi and his family in an interdisciplinary team environment was the experience that enlightened me to my dissatisfaction with my current practice. I understood then that I needed to transition my career to that of a hospice and palliative care physician. Fortunately, LifePath Hospice had an opening for medical staff at that time and, with the mentoring of Dr. Deidre Woods and the support of the entire staff, I have had no second thoughts regarding paths not taken. I now have tremendous professional satisfaction providing the quality of life and palliative care through the end of life for our patients and intend to continue this career path in California.
Drew Rosielle, MD, hospital-based palliative care consultant and Fellowship Director, entered a hospice and palliative medicine fellowship immediately after residency.
How did you get in to HPM?
I went straight into HPM after residency training. In medical school I had very little exposure to palliative care. In fact I had none outside of hospice settings—it just wasn't part of the curriculum, and the hospitals at my medical school had no clinical programs then. Some part of me knew that caring for patients and their families as they approached death was particularly compelling and meaningful to me, so I cobbled together a hospice rotation and really liked it. During residency I contemplated oncology, geriatrics, and critical care but realized all of those career paths drew me towards them because I wanted to care for patients at life's end. I wasn't exposed to palliative medicine much, and, still early in my residency, wasn't sure that it was a viable career path, other than something that was tacked onto another specialty/practice (primary care, geriatrics, oncology, etc.). I finally had a mentor reassure me that it was a very viable option (and boy was he right—we still have a major physician shortage), so I decided to go straight into fellowship and have been doing HPM full time ever since.
What do you enjoy most about your work?
The patient care and collaborative nature of consultation. Patients and their families are so grateful for what we offer—symptom relief, real options, recognition of the emotional impact of illness and mortality. In some ways I think palliative docs do it for the instant gratification: no one ever thanked me for my skilled, evidence-based secondary prevention of cardiovascular events or getting their HbA1c less than 7. But plenty of people thank me and my palliative care team members on a daily basis. Palliative care is a way to help people in an immediate, tangible way. The other aspect is the collaborative and consultative aspect of it. Other doctors and clinicians, who are struggling to figure out the best way to help their sickest patients or patients that they feel like they are not helping, look to us for help. Being able to actually do that is very gratifying.
What advice would you give to someone interested in entering the field?
- Do a fellowship
- Prior to starting your fellowship, spend your energies on becoming the best physician you can outside of palliative care (whether it's internal medicine, pediatrics, family medicine, neurology, etc.). Don't take that second HPM elective rotation (unless you need it to decide what you want to do) - take a PM&R rotation, or a hepatology rotation, or something else instead. To do HPM well, you have to have solid general medicine chops - you'll get all the HPM training you'll need in your fellowship.
- Join AAHPM and go to conferences.
Jose Cariaga, MD, had 16 years of geriatric experience in private practice before transitioning to the role of hospice physician based at the Veterans Administration.
How did you get in to HPM?
I started practicing Internal Medicine/Geriatrics in Pittsburgh in 1989. We then moved to Tampa in 1990 and I was in private practice. While in private practice, my practice partner and I experienced the difficulties of maneuvering through the paperwork required to run a practice and dealing with the accompanying diminishing reimbursements. There were difficulties in maintaining a competent office staff. The overhead expenses were continuing to grow at an unreasonable rate. All these concerns were taking a significant amount of time away from patient care. Having been raised by my grandparents until I was 6 years old, I developed a lot of fondness, admiration, and respect for the elderly, hence I pursued geriatric medicine. The opportunity to take care of mostly elderly frail patients came in 2005 when I joined Lifepath Hospice.
What do you enjoy most about your work?
There came the excitement of working with multidisciplinary teams, compassionate/competent colleagues, fellows, researchers, and medical students, and patients' families. The variety of responsibilities offered by hospice and palliative medicine practice was very professionally and personally rewarding. Most of all, the opportunity to take part in the treatment of patients during their end-of-earthly life stage by the alleviation of their physical, psychosocial, and spiritual suffering, although very challenging, was very satisfying and invigorating.
What advice would you give to someone interested in entering the field?
- Learn to appreciate the wealth of wisdom/knowledge that patients have accumulated in the end-stage of life and that they can also be wonderful teachers to the caregivers/their own families.
- Be aware of the many different ways that patients can be helped in improving the quality of the remaining short time of their life, that is, control of very many specific symptoms; be aware of the different aspects of pain (spiritual, psychosocial, physical).
- Never underestimate the importance of "just being there" for the patients, ready to just listen and empathize.
- Anticipate challenges in working with interdisciplinary teams, but look forward to rewarding aspects of collegial interdependence on the other professionals on the team (which, by the way, include nonprofessionals like the patients and their families and friends).
- Realize that the dying also has certain specific stages of growth/development that can be realized and necessary for closure and subsequent "good death."