by Larry Beresford

The most comprehensive assessment of the hospice and palliative medicine (HPM) workforce shortage, conducted by Dale Lupu for AAHPM’s Workforce Task Force in 2010, estimated a gap of between 2,787 and 7,510 FTEs just to satisfy the current need for HPM physicians.[1] And that doesn’t count the coming tsunami of aging Baby Boomers with multiple chronic conditions—or the looming retirements of many of the field’s leaders and pioneers.

The current pipeline of new fellowship-trained HPM physicians adds fewer than 200 new specialists to the workforce each year—with structural constraints on its growth. After this year’s HPM board certification exam in October, the experiential pathway to board certification for mid-career physicians will come to an end. And that is why the Mid-Career Training Task Force convened 43 experts and leaders of the field at the Westin O’Hare Hotel in Chicago August 9 and 10 for a summit designed to grapple with the workforce dilemmas and consider possible future scenarios for this field.

Where is the field of HPM going? Will it continue to experience growth? What will be the impact of an anticipated 4,000 new board-certified HPM doctors following this year’s exam? How does HPM fit into the reforming health care system of medical homes and accountable care organizations? How might the field evolve, revise its focus or even change its name to keep up with those larger changes? Should the focus of AAHPM be narrowed or broadened? If there is a limited resource of HPM specialists, can primary care physicians be taught to play larger roles in providing primary-level palliative care to their patients? What about nurse practitioners and physician assistants? What are best practices in a world where there will never be enough HPM practitioners? What kinds of mid-career alternatives might be envisioned to the full-year, full-time fellowship that will be required for new HPM physicians starting in 2013?

These are the kinds of questions that were explored at the Workforce Summit. National leaders like Norman Kahn, MD, executive vice president, Council of Medical Specialty Societies; Clese Erikson, MPAff, director, AAMC Center for Workforce Studies; and William Iobst, MD, vice president of academic affairs, American Board of Internal Medicine, offered insights, hope and useful suggestions and believed that a mid-career solution was at least theoretically possible, working with ABMS and other specialty societies. But first, it is essential for AAHPM to clarify the need — both currently and in anticipation of future need — and craft a proposal.

Clement Bezold, PhD, founder and chairman of the Institute for Alternative Futures, served as a facilitator, helping participants to engage in future scenario planning, which he acknowledged is an uncertain process. “It’s not about prediction but preparation,” he explained. “Success is the degree to which your current thinking changes.” Participants in small groups explored four possible future scenarios for the field, with his charge: “If this is your future, step into it.”

Congratulations to Academy leaders including Workforce Summit co-chairs Amy Abernethy, MD FACP FAAHPM, David Weissman, MD, and Mid-Career Task Force Chair John Mulder, MD FAAHPM for organizing and framing such an important discussion.


[1]Lupu D. Estimate of current hospice and palliative medicine workforce shortage. Journal of Pain and Symptom Management 2010 Dec.; 40(6): 899-911.

Larry Beresford is a freelance medical writer from Oakland, CA, who specializes in hospice and palliative care issues.