On the job, Dr. Weissman says hospitalists should ask for consults for patients with complex needs. Also pay attention to how the service works and what it recommends. Taking a couple of days to round with the palliative care service could be very educational. It may be possible to take a part-time position with the team, providing weekend or vacation coverage. Hospitalists can participate on planning or advisory committees for palliative care in their hospitals or on quality improvement projects.
“If there isn’t a palliative care service, advocate for developing one,” he says.
Local hospice programs, especially those with inpatient hospice facilities that need daily physician coverage, might have part-time staff positions, which could be a great moonlighting opportunity for hospitalists and a way to learn a lot very quickly.
“I can tell the difference between physicians who have spent time working in a hospice, where you can learn about caring for people at the end of life because most of the patients are so sick, and those who have not,” says Porter Storey, MD, FACP, AAHPM’s executive vice president and a practicing palliative care physician in Colorado. “You can learn how to use the medications to get someone comfortable quickly and how to talk to families in crisis. It can be some of the most rewarding work you can possibly do—especially when you have the time and training to do it well for some of the most challenging of patients and families.”
Dr. Storey recommends that hospitalists join AAHPM, use its professional materials, attend its annual meetings, and, if they feel a calling, consider fellowship training as the next big step.
“Palliative care programs are growing in number and size but are chronically understaffed,” says Steven Pantilat, MD, SFHM, hospitalist and director of the Palliative Care Program at the University of California at San Francisco. “This creates a great opportunity for hospitalists. I have heard of places that were having trouble recruiting palliative care physicians but were willing to sponsor a hospitalist to go and do a fellowship, supplementing their salary as an incentive—and a reasonable one—for a hospitalist interested in making a career move.”
He says that palliative care, like hospital medicine, has been a significant value-add in many hospitals and health systems. More importantly, it correlates to positive patient outcomes (see “Research Highlights Palliative Care Contributions,”).
“What’s new is how it connects to current issues like improved care transitions and readmissions reduction,” Dr. Pantilat says.
Advocates say palliative care helps to match medical services to patient preferences, thereby improving patient satisfaction scores, especially for those who aren’t likely to achieve good outcomes. Dr. Pantilat says it puts plans in place for patients to get the right services for the post-discharge period and for responding to anticipated problems like chest pain.
“It’s not just how to get patients out of the hospital as quickly as possible,” he says, “but to do that with a plan that sets them up to succeed at home.”
Larry Beresford is a freelance writer in San Francisco.