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Professional Certification of Palliative Medicine Charles F. von Gunten, MD, PhD Past Chairman.

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Presentation on theme: "Professional Certification of Palliative Medicine Charles F. von Gunten, MD, PhD Past Chairman."— Presentation transcript:

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2 Professional Certification of Palliative Medicine Charles F. von Gunten, MD, PhD Past Chairman

3 Setting the Standard of Excellence in Hospice and Palliative Medicine Professional certification is important for the field

4 Palliative Care IIIInterdisciplinary care focused on relieving suffering and improving quality of life. MMMMay be combined with therapies aimed at reducing or curing the illness, or it may be the total focus of care.

5 Standard Model of Care PresentationDeath Therapy with Curative Intent Bereavement Care 6m Medicare Hospice Benefit Field & Cassel (eds) IOM Report, 1997

6 Palliative Care Model PresentationDeath Therapy with Curative Intent Bereavement Care Symptom Rx Relieve Suffering Palliative Care 6m Medicare Hospice Benefit

7 Who does palliative care?  Primary  Secondary  Tertiary JAMA 2002;287:

8 Example: Interface of Palliative Care and Nephrology Primary Palliative Care Secondary Palliative Care Tertiary Palliative Care Pt with ESRD, nausea & abdominal pain Nephrologist successfully uses antiemetics, analgesics & coanalgesics Asks for consult for refractory sx and for time- consuming family dynamics Admitted to pc unit for refractory Sx. Rx. PM fellow

9 Palliative Medicine  The term palliative medicine refers to the physician discipline as part of interdisciplinary palliative care at secondary and tertiary levels

10 Why a Palliative Medicine Subspecialty?  Improve patient care  Create and disseminate new knowledge  Credibility and recognition  Recognized in UK, Ireland, Canada, Australia, New Zealand Field & Cassel (eds) IOM Report, 1997

11 The case for palliative medicine subspecialty  Board certification  Scholarly research  Fellowship training  Professional Association  Professional Role

12 Board Certification  Founded 1995  First examination 1996  1800 diplomates  Exam by NBME –230 items in 4 hour exam –688 items in bank  > 500 applicants for 2005  20% growth per year  MOC initiated in 2004 J Palliat Med 2000; 3:

13 New ABHPM Diplomates

14 ABMS Boards J Palliat Med 2000; 3: n = 1535

15 Scholarly Research  > 7 Medline-listed peer- reviewed specialty journals –Listed on Fact Sheet  Also published in major journals (NEJM, JAMA)  Many Textbooks

16 Fellowship Training  47 programs in 2004 –3 NCI-funded –6 VA programs –97 slots total annually Accessed May 4, 2004

17 Fellowship Training  1.9 slots per program (median 2, range 1 – 8)  8.5 applicants per program (median 6, range 0 – 40)  4.5 applicants per slot February survey 86% response rate 86% response rate

18 Fellowship Training  Voluntary Guidelines modeled after ACGME model  Palliative Medicine Review Committee accredits after ACGME RRC model  ACGME application initiated J Palliat Med 2002; 5:23-33

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20 Professional Association  American Academy of Hospice and Palliative Medicine  1900 members

21 Professional Role  Hospital-based consultants –Ambulatory outpatient component  Hospice medical directors Cohen B, Salsberg, E. SUNY Albany,

22 Professional Role  30% US hospitals (26% of teaching hospitals) have palliative care consult teams  20% increase annually  6,021 hospitals listed by AHA J Palliat Med 2001;4: J Palliat Med 2001;4:309-14

23 Professional Role  3,200 hospice programs  care for 25% of US deaths  Each must have at least one physician medical director

24 Volume of Need  Rapid growth in serious, chronic illness  Consequence of effective technologies  2.3 million deaths –10% sudden –Of remaining 90% 40-60% with unrelieved suffering40-60% with unrelieved suffering

25 The case for palliative medicine subspecialty  Board certification  Scholarly research  Fellowship training  Professional Association  Professional Role

26 Setting the Standard of Excellence in Hospice and Palliative Medicine Professional certification is important for the field


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