Palliative Care Need Grows, Specialists Dwindle

There is only one palliative care specialist for every 20,000 older adults living with a severe chronic illness.

Currently there’s a shortfall of up to 18,000 physicians focused on palliative care and hospice care. According to the American Academy of Hospice and Palliative Medicine there are 5,150 hospice programs and 1,635 hospital palliative care teams in the U.S. today.

That equates to one specialist for every 20,000 older adults living with a severe chronic illness.

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“There have to be more people for whom this is a specialty,” says Dr. Thomas Smith, director of palliative medicine at Johns Hopkins Hospital in Baltimore. “If you don’t have enough people to be out there practicing and showing people a better way to communicate, a better way to relieve pain, a better way to help people’s distress, it won’t happen.”

Patients turn to palliative care with a number of different illnesses, ranging from chronic to life-ending. The specialty also covers psychological counseling, help family conflicts and spiritual support.

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The American Board of Medical Specialties describes the subspecialty as “Hospice and Palliative Medicine.” While hospice tends to be a home-care service, palliative care is more common in hospitals or outpatient clinics.

“In Europe or Canada or Australia, hospice care and palliative care are the same thing,” says Dr. Porter Storey, executive vice president of the American Academy of Hospice and Palliative Medicine. “But in this country, the Medicare hospice benefit has defined hospice care as a wonderful set of services, but only for people in their last six months of life.”

Smith says that a combination of palliative care and usual care is now the accepted best practice.

“You can show that people live longer, people probably do live better, and their relatives — if they happen to die — do a lot better if you get palliative care involved,” he says. “If you have these conversations, people are less distressed and less depressed.”

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Nurses play a critical role on palliative care teams. And while there is limited data on the short supply of nurses in the area, Storey says that the National Board for Certification of Hospice and Palliative Nurses is “certifying lots more people than we are.”

Hoping to get more doctors and nurses into the field, Storey hopes Congress can lend a hand with the Palliative Care and Hospice Education and Training Act, which Senators Ron Wyden, D-Ore., and Jack Reed, D-R.I. introduced last month.

Advocates say the case for expanding palliative care is now clear. “We’re going have to pay attention to the most expensive patients and our previous structure has basically rewarded doctors for just doing more and more and more and more stuff,” Storey says. “We’ve now got very good research to show that just doing more procedures and tests on people in their final months of life isn’t better. They don’t live longer, they’re not more comfortable and often the opposite is true.”

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