I have completed my application, paid my fee, scheduled my exam, and now I am beginning to study! So why am I doing this?

I have been in Hospice and Palliative Medicine for almost 30 years. I am a fellow and past president of the AAHPM. I am a founding member of the Academy, and I have my own palliative care company employing over 25 physicians, with two new contracts. How could I possibly benefit from getting this certification? I have talked with many people over the last two years who may have different credentials but do have the same question.

Hospice and Palliative Medicine is a very young field. Its entire existence fits within my career, and I am nowhere near ready to retire. In its short history, HPM has become a subspecialty of medicine and has a seat with the big boys of medicine. One of the consequences of this is that the board certification now requires a fellowship. There are only about 250 training positions in the country, and as a general rule, the only people that do fellowships are young physicians fresh out of training. Many of us who do hospice medicine are neither young nor fresh out of training, and are unlikely to stop our current activities to do a fellowship even if there were adequate physicians.

As of last count, there are over 5800 hospice programs in the country, and I believe a similar number of declared palliative medicine programs. Many physicians don’t consider this, but there are more board certified HPM physicians now than there are likely to ever be in the future. This is due to the fact that the large majority of physicians who are board certified, qualified for that certification based on practice experience, not fellowship training.

In addition to these workforce considerations, the regulatory and administrative demands on hospice physicians are constantly growing. Gone are the days where hospices could have their medical directors “sit down, shut up, and sign”. The hospices need physicians that are competent not only in good palliative medicine, but that also know how to provide for these regulatory and administrative needs.

Here enters the need for a certification that a physician can deliver these goods. This certification never intends to be an ABMS/AOA board specialty, and therefore will never require a fellowship. A physician can qualify to take the exam if they have had a fellowship, but they can also qualify now and forever, by practice experience. This certification also focuses very heavily on hospice and not the broader world of non-hospice palliative medicine. We fully anticipate that this will be the credential of value to the hospice industry as we go forward.

I don’t believe that getting this certification will change or enhance my professional life at this point in my career. I do believe that this certification is very important to the world of hospice medicine. This young profession needs all of us to step up to provide this very important credentialing foundation to the work that we do. If you, like me, see what you do as something more than a job, then I would like to extend a personal challenge for you to look beyond the personal gains, and assist in getting the momentum behind this certification.

Submitted by: David M. McGrew, MD FAAHPM