A Word from the President: Embracing the Value of Palliative Medicine
AAMC Reporter: June 2011
Two experiences recently brought home the challenge of caring for seriously ill patients who, many times, have one or more chronic conditions. The first was my visit with members of the American Academy of Hospice and Palliative Medicine, which highlighted for me the importance of palliative care and its relevance to a wide variety of patients. The second was a meeting with former American Association of Retired Persons President Bill Novelli (whose Viewpoint appears in this issue), during which we discussed ways the AAMC can support the goals of the Coalition to Transform Advanced Care and how academic medicine has an important role to play in caring for our most critically and chronically ill patients.
Patients with multiple chronic conditions often require the highly specialized and individualized care academic medical centers provide, including an interdisciplinary team of health care and social service providers, pain management, and increased communication with at-home caregivers. All these elements are aspects of palliative care, a subspecialty aimed at improving the quality of life for patients with one or more chronic conditions. Contrary to the perceptions of many, palliative care is often administered alongside curative treatments and has been shown to extend the lives of some patients. Interestingly, multiple studies have shown that this is exactly the kind of care patients want, even if they are not familiar with the term “palliative care.”
In the last decade, the nation’s medical schools have significantly increased their emphasis on palliative care education. In 2006, the American Board of Medical Specialties approved palliative medicine as a subspecialty. Shortly thereafter, the Accreditation Council for Graduate Medical Education certified the first postgraduate fellowship training programs in palliative care. To ready physicians for this shift, AAMC-member institutions have gone beyond offering static courses in palliative care, pain management, and geriatrics (where older patients often require complex case management). Today, increasing numbers of medical schools are weaving such concepts throughout the four years of medical education and, in many cases, are requiring the demonstration of competency in these areas before students graduate. A look through the 2010 supplement to Academic Medicine, A Snapshot of Medical Student Education in the United States and Canada, will show the many ways in which medical schools are incorporating palliative care and pain management in the curriculum and preparing future physicians to care for an aging population with unique needs.
Medical schools and teaching hospitals also are furthering palliative care on the research front. Mount Sinai School of Medicine houses the Center to Advance Palliative Care (CAPC) and the National Palliative Care Research Center (NPCRC), which, under the leadership of Diane E. Meier, M.D., and R. Sean Morrison, M.D., respectively, increase the knowledge and evidence base about best practices in palliative care through research that is rapidly translated into improved clinical practice. The CAPC has established palliative care leadership centers across the country to enable interdisciplinary teams to visit peer institutions where health practitioners study palliative care programs currently in place and utilize long-term mentorships to improve quality at their own institutions. The NPCRC, which collaborates closely with CAPC, works to establish priorities for palliative care research, foster the development of future palliative care researchers, and facilitate research to improve care for the seriously ill.
In clinical care, research shows that teaching hospitals, which treat the sickest and most vulnerable patients, are more likely than other hospitals to offer palliative care. According to a CAPC survey, 100 percent of responding AAMC-member teaching hospitals reported having a palliative care program for patients in place. Among U.S. hospitals with 50 beds or more, the number of palliative care programs increased over 125 percent between 2000 and 2008, and in 2008 over 81 percent of U.S. hospitals with greater than 300 beds offered palliative care programs, with this growth continuing.
The importance of palliative care was recently recognized by the Joint Commission, which will soon offer advanced certification in the subspecialty to those hospitals that exhibit interdisciplinary teamwork, patient and family engagement, and coordination of care among providers. We expect many AAMC-member institutions to seek and qualify for this certification.
The increased national focus on palliative care could not come at a better time. According to the Centers for Disease Control and Prevention, chronic conditions, such as heart disease, cancer, and diabetes, are the leading causes of death and disability in the United States, accounting for 70 percent of all deaths in the country. The U.S. population also is aging, with nearly one in five Americans expected to be age 65 or older by 2030. With both chronic disease and higher rates of health care utilization associated with aging, and more Americans having access to regular health care through the Affordable Care Act, the need for palliative care is only likely to increase. But this increased demand also comes at a time of decreasing supply of physicians overall and of those who specialize in palliative care. According to a December 2010 study published in the Journal of Pain and Symptom Management, the current shortage of palliative and hospice medicine physicians is anywhere between 6,000 and 18,000 physicians.
Perhaps more important than the many ways academic medicine is improving palliative care management are the lessons the most ill can teach us. Palliative care and related fields, like geriatrics, are a microcosm of the larger health care system. Everything is amplified when the patient in front of us is managing multiple chronic conditions, from the need for us to work seamlessly with other health professions to placing the patient and their family’s needs truly at the center of our efforts. For all these reasons, palliative care is a high-impact specialty that will see increased demand moving forward and will require some of medicine’s brightest minds to choose it as their career path.
Darrell G. Kirch, M.D.
AAMC President and CEO