Development of Palliative Medicine as a Medical Subspecialty in the United States
Written by Norma Hirsch, M.D.
The rationale for the development of this new physician subspecialty is similar to the development of other subspecialties - to make new knowledge practically available to patients, families and their health care professionals. In short the rationale is to improve patient care. Formal recognition of a specialty by organized medicine sets standards upon which the public can rely.
Recognition also makes the field worthy of pursuit and encourages the “best and the brightest” to commit their careers to further developing the field.
Although the specialty of palliative medicine has been formally recognized in many countries1, it is still a developing specialty in the United States. Formal recognition by the American Board of Medical Specialties (ABMS) is anticipated in the next several years2.
Begun in the 1960’s, multi-focal efforts designed to extend the knowledge and skills inherent in the domain of palliative medicine continue to emphasize the precepts of pain and symptom management. Recently, curricula on palliative care have been developed and broadly disseminated. Certifying boards recognizing the subspecialties of hospice and palliative medicine have been established for both physicians2 and nurses3. Likewise, national organizations of physicians4 and nurses5 have been created to support health care professionals in their efforts to make hospice and palliative medicine services widely available.
Palliative care, like care provided by other subspecialties, is available to patients as primary, secondary, and tertiary care: (primary): acute management by the patient’s primary physician; (secondary): drugs, doses, and schedules prescribed by palliative medicine specialists that are outside the comfort level of the patient’s primary care physician. Psychosocial support may also be provided as part of the management plan; (tertiary): care provided where fellows and research based clinicians learn about and seek advanced approaches to pain and symptom management. Part of this search may include the enrollment of patients in clinical trials of new therapeutic agents.
Iowa currently has over twenty physicians certified by the American Board of Hospice and Palliative Medicine6. This number is certain to increase as the subspecialty of palliative medicine matures. This maturation can be expected to provide leadership for and support to health care professionals as they seek to provide comfort when cure is not possible. Among other things, the growth of hospice and palliative medicine as a subspecialty offers patients and families the potential to realize a more meaningful journey at end of life.
Footnotes
1 Great Britain, Ireland, Australia, and Canada
2 For more information about the American Board of Hospice and Palliative Medicine, see www.abhpm.org
3 For more information about the National Board for the Certification of Hospice and Palliative Nurses, see www.nbchpn.org.
4 For more information about the American Academy of Hospice and Palliative Medicine, see www.aahpm.org
5 For more information about the Hospice and Palliative Care Nurses Association, see www.hpna.org
6 To locate an Iowa physician certified by the American Board of Hospice and Palliative Medicine, see www.abhpm.org
7 For more information about the American Academy of Hospice and Palliative Medicine, see www.aahpm.org
8 For more information about the Hospice and Palliative Care Nurses Association, see www.hpna.org
9 To locate an Iowa physician certified by the American Board of Hospice and Palliative Medicine, see www.abhpm.org
