Mid-Career Pathway

Osteopathic physicians may be eligible to sit for the HPM subspecialty certification examination without having to complete a fellowship program if they meet the practice pathway requirements for the American Osteopathic Association (AOA) through 2013. Visit your primary specialty board's website for these requirements.

AAHPM recommends that osteopathic physicians who wish to follow the practice pathway, develop a self-directed learning plan meeting high professional and educational standards.

Fellowship training is now mandatory for the field of hospice and palliative medicine for allopathic physicians.

If you sat for the exam in the fall of 2012 and did not pass, please contact your primary board about qualifying to sit again.

Historical Mid-Career Pathways

Many physicians have found themselves pulled toward providing hospice and palliative care services in mid-career. The input of physicians with a broad range of prior experience has provided the specialty with a welcome diversity of perspectives in caring for patients with life-limiting illnesses. Prior to the availability of fellowship programs and to the certification of hospice and palliative medicine by the American Board of Medical Specialties, many physicians would develop their own ad hoc education in the specialty.

Historical Path: Mid-career physicians would individually construct a program that included some combination of the following:

• On the job training as a hospice medical director with the support of an experienced hospice and palliative physician and the hospice interdisciplinary team
• On the job training as a member of a hospital-based palliative care team with support from an experienced hospice and palliative medicine physician
• Self-study programs in hospice and palliative medicine
• Attendance at AAHPM conferences and other educational offerings
• Formal mentorships with experienced colleagues

This informal self-education pathway is no longer an available path for board certification for allopathic physicians.

Current Practice Pathway to Board Certification: The 4 AOA cosponsoring boards permit physicians who have not completed a formal fellowship but do meet other practice and experience criteria, to sit for board certification until the end of the grandfathering period. AAHPM recommends that physicians pursing this practice pathway make a commitment to a self-designed learning program to achieve high levels of knowledge and competency in specialist level hospice & palliative medicine. Information provided below are recommendations for a comprehensive self-guided program to achieve high levels of competence in HPM.

Suggested path for a mid-career entrant 

Develop a self-directed learning plan for the practice pathway to board certification

AAHPM encourages mid-career physicians considering board certification to take charge of raising their skill levels.  An educational plan should go beyond simply acquiring the clinical and team hours required to meet board eligibility and address practice improvement within each of the main competency domains.

Step 1: Find a mentor. Seek the guidance of an experienced, preferably board-certified, specialist in hospice and palliative medicine.

Step 2: Review the competency statements and measurable outcomes documents. The Competency Statements outline what a fellow graduating from an ACGME accredited fellowship is expected to know and do. Mid-career physicians should strive for this level or higher in their educational plan. At present, no tool for self-assessment of progress on the competencies is available.  Physicians are encouraged to review the competencies and measurable outcomes, reflect on the areas in which they feel stronger, weaker, or unsure, and focus their learning plan accordingly. 

Step 3: Review recommendations for self-directed learning activities Information provided below suggests learning activities by competency domain. Review the domains and build at least one activity from each domain into the self-directed learning plan. No physician would be expected to do every activity listed, but every physician should address each competency domain in his or her personal learning plan.

Step 4: Develop a self-directed learning plan

• Identify gaps in competency and in clinical experience needed
• Decide on tools, resources, programs to use to address the gap. See the recommendations provided below   for resources.
• Identify an assessment plan to see whether desired improvement has been obtained (assessment can be something as simple as self-reflection, or more formal activity such as review of videotapes with a mentor)
• Set realistic time frame for learning and assessment activities.
• Review plan with mentor.
• Periodically review progress with mentor and adjust plan as needed.

AAHPM Recommendations for Self-Directed Learning Activities to Prepare for Board Certification During Grandfathering Period 

By Competency Domain

Patient and Family Care
Medical Knowledge
Practice-Based Learning and Improvement
Interpersonal and Communication Skills
Professionalism
System-Based Practice

Patient and Family Care
The recommended activities for this domain are:

• Participate in the AAHPM mentoring program
• Arrange for clinical supervision by experienced HPM specialist physician, preferably board-certified in HPM
• Acquire clinical experience sufficient to meet or exceed board requirement (800 hours of clinical involvement in subspecialty-level practice of hospice and palliative medicine), primarily in the context of work with a Medicare-certified hospice or a palliative care program meeting the NCP guidelines

Medical Knowledge
The recommended activities for this domain are:

1. Acquire foundational knowledge through study of one or more introductory texts or programs: Study a comprehensive palliative medicine textbook
   • Complete UNIPACS
   • Review Fast Facts
   • Participate in EPEC or Stanford End-of-Life Care Curriculum
2. Deepen knowledge to specialist level
   • Study a comprehensive palliative medicine textbook
   • Attend CME offerings such as the AAHPM Hospice Medical Director's course or Update in Current Concepts or comparable state or regional meetings with CME offerings in HPM
   • Attend AAHPM annual scientific meeting
3. Self assess knowledge and readiness for board examination using HPM PASS and HPM FAST modules
4. Remain up-to-date by studying PC-FACS, participating in journal club or following literature in journals.
   • Palliative Care JournalClub
   • Pallimed and Geri-pal blogs also comment on and provide highlights of current topics and articles.
   • Attend CME offerings such as the AAHPM Hospice Medical Director's course or Intensive Board Review Course or comparable state or regional meetings with CME offerings in hospice and palliative medicine.
   • Attend AAHPM/HPNA annual meeting.

Practice-Based Learning and Improvement
The recommended activities for this domain are:

• Develop own learning goals and practice improvement goals and plan for achieving practice improvement. Regularly review and update.
• Consider participation in intensive courses to bolster specific skills such as:
  • PCEP - ( Program in Palliative Care Education and Practice ) to gain education skills specific to palliative care
  • CAPC - ( Center to Advance Palliative Care ) workshops on developing and growing hospital-based palliative care

Interpersonal and Communication Skills
The recommended activities for this domain are:

Self-assess current skill level in these key competencies:

• Self-assess current skill level in these key competencies:
  • Competency 4.6 - Paradigmatic clinical situations (e.g. Discussing transitions in goals of care from a curative and/or life prolonging focus to palliative care and addressing patient/family emotional distress about talking about death and dying and end-of-life issues)
  • Competency 4.7 - Organizing and leading a family meeting
  • Competency 4.8 - Collaborates effectively with others as member or leader of IDT
• Acquire experience to meet or exceed the requirement for 100 hours of participation with a hospice or palliative care team by working with a Medicare-certified hospice or a palliative care program meeting the NCP guidelines.
• Participate in online learning about communication in palliative care, such as Stanford Cancer Palliative Education Network or Oncotalk.
• Develop educational plan for improvement in targeted interpersonal or communication skill areas.
• Consider participation in intensive courses in communication for physicians, such as:
  • Difficult Conversations in Healthcare: Pedagogy and Practice
  • Oncotalk 

Professionalism
The recommended activities for this domain are:

Actively participate as a member of:

• the American Academy of Hospice and Palliative Medicine or
• a regional or state hospice medical directors association or
• the palliative care special interest section of another specialty organization such as ACP

System-Based Practice
The recommended activities for this domain are:

• Lead or participate in at least two quality improvement projects in the clinical setting focused on improving elements of hospice and/or palliative care.

Additional Career Resources

AAHPM Job Mart

AAHPM Fellowship Directory

AAHPM Mentoring Programs

Board Certification Information: AOA

For more information, send an email to This e-mail address is being protected from spambots. You need JavaScript enabled to view it or call AAHPM 847/375-4712.