Career Pathway

Hospice Physician based at VAMC
Jose Cariaga, MD

Institution: James A. Haley Veterans' Administration Health Systems in Tampa, FL

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/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?
1. 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

2. Be aware of the many different ways that patients can be helped in improving the quality of the remaining short time of their life--i.e., control of very many specific symptoms; be aware of the different aspects of pain (spiritual, psychosocial, physical)

3. Never underestimate the importance of "just being there" for the patients, ready to just listen and empathize

4. 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 non-professionals like the patients and their families and friends)

5. Realize that the dying also has certain specific stages of growth/development that can be realized and necessary for closure and subsequent "good death"