Considered it...... nah

[med99]

Problem is that it is not available as a primary residency. You have to go through at least 3 years FP, internal med, neurology, PM&R.....in order to do the fellowship.

If it was a primary residency, I would have done it without a second thought, but I cannot imagine spending 3 more years of my life doing stuff that I don't enjoy and still end up earning less money.

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[drwatson]

You would be surprised how many boards are going to sponsor the Hospice fellowship (FM, Peds, IM, Surgery, ER, Psych, Anes...I think). It doesn't matter what you go into you are eligible for the hospice fellowship. Don't count it out if you are interested! And the fellowship is only 1 year (I could be wrong, but I'm certain it isn't 3)

And, unlike every other specialities, even though hospice docs may make less, I *never* hear them complain about it. Which is a stark contrast to the other "underpaid" specialities. I think this is due to the remarkably high level of job satisfaction those guys get.

I think the main question you have to ask is: how do you want to practice medicine?

 

[ForamenMagnumPI]

I'm doing a family medicine residency, and I plan to do hospice/palliative care. It is a long road, but I think the more broad residency that I do first gives me the exposure and learning opportunities I need to be a better hospice physician in the future. Just a thought.

 

[TommyGunn04]

...And the fellowship is only 1 year (I could be wrong, but I'm certain it isn't 3)...

There ARE actually a few 3-year fellowships, but they're generally 1 year of clinical work and 2 years of research. Most of the others are indeed just 1 year fellowships. Check out the AAHPM fellowship directory here: http://www.aahpm.org/fellowship/directory.html

 

[signomi]

I interviewed at one and two year programs this year. With acceptances in hand, there was no way I was going to commit to an extra year of poverty, so I eliminated the two year ones right off. I think you have to be deeply invested in an academic/research position to commit that extra year.

 

[rpkall]

Is Psych really going to be one path to a palliative care fellowship? This sounds like a great idea (keep training focused on your personal interests/strengths) but also a not-so-good one (how many procedures and management decisions in clinical medicine are psychiatrists making in their training?)...

Do you think the fellowship is enough training as far as procedures and med managment for psychiatrists to come out of it knowing as much as FM docs about palliative care and being as comfortable in the role of hospice doc?

I'm asking because it sounds like a fascinating route to hospice medicine, but I worry about short-changing myself out of getting experience with procedures and decisionmaking.

I know, I know, there are few procedures in hospice (debridement of ulcers, I&D maybe, etc)... But I wonder about clinical decisions. Or is it that the only decisions you're making are comfort-based, and that one year of fellowship is fine for that?

 

[signomi]

As a practicing hospital doc who is going back for a year of fellowship, I must say having procedure skills is pretty nice. It makes me much more self-confident. I run the rapid response and code teams during my shifts, so I intubate 3-6 times a month (truuuuust me, hospice patients and their families change their minds about intubation sometimes). I also place sutures frequently (one of the hospice patients fell last week and needed them) enough to feel comfortable.
Let me put it this way: it is very nice to already have those skills under your belt. And I learned them on the fly while working, not as an Internal Medicine resident. Can you learn these skills during your fellowship? Probably. Could you do an elective at the end of Psych residency that would allow you to get these skills? Probably. I guess it goes to when you want to learn them and how much practice you want to get.
IMHO, to go palliative medicine after psych residency, I would hope it would be a residency that has a good amount of medicine time. In some places, it seems like the psych residents only do 1-2 months in their entire residency and some of them seem soooo uncomfortable during those ward months. That said, they are probably much better at the psych stuff!

 

[maranatha]

Although still not a lot of medicine, many psych residencies actually require 4 months of medicine and 2 months of neurology plus ER rotations during the first year. In addition, there are required rotations on C&L, which has a heavy medicine component. Some of the programs I've interviewed at also have elective time on oncology and/or hospice units--i.e Mich., OSU, IOL, and Hopkins. I'm not arguing that this is sufficient (I'm still a med. student and I don't have the experience or knowledge to make this judgement), but it must be enough for a few of the pain and palliative care fellowships to accept applications from psych residents....?

 

[rpkall]

Thanks for responding! I'm quite interested in the physiology/psychology of death and dying, but if possible, I'd rather spend 4-5 years of residency training in psychiatry (it may just be less painful for me than having to work 15 hrs a day studying pure medicine). At the same time, I *do* want to be proficient in minor surgical/procedural skills, but this may not be possible without going to a good IM/FM residency (maybe even just an unopposed FM, where the residents get a lot of exposure with office surgical procedures, ward coverage, etc).

In any case, thanks again.

 

[maranatha]

Thanks for responding! I'm quite interested in the physiology/psychology of death and dying, but if possible, I'd rather spend 4-5 years of residency training in psychiatry (it may just be less painful for me than having to work 15 hrs a day studying pure medicine). At the same time, I *do* want to be proficient in minor surgical/procedural skills, but this may not be possible without going to a good IM/FM residency (maybe even just an unopposed FM, where the residents get a lot of exposure with office surgical procedures, ward coverage, etc).

In any case, thanks again.

Have you considered doing a combined Psych/FM residency? I would think this would be an awsome background for this area. Also, keep in mind that there are a lot of FM programs that have a heavy psycho-social component where you could get some counseling skills. Off the top of my head, U. of Rochester is very strong in this area. I'm certain there are many, many more.

(I seriously considered FM, but have always been more drawn to the psych/neuroscience and also want "in depth" psychotherapy. Palliative care is also not the only subspeciality that I'm interested in. )

 

[i61164]

I know of a Neurologist that is doing this fellowship. I have heard people say that Neurology is certainly not the easiest path to this career, but a Neurologist definitely brings a nice skill set to the field and will pick up the rest during fellowship training. I imagine the same is true of Psychiatrists. If you know you want to do this from the start then it would seem logical to me to do the FM residency. You will end up with a really broad knowledge base and you are only doing 4 total years of training.

Med99 - I mean, what is the alternative? If years of training is the issue, the only way to do less is IM, Peds, FM, or EM. From your post I can guess that you don't like FM and IM, so unless you are thinking about going for Peds or EM, then you will do at least 4 years of training anyway.

If you are looking for the highest income per years of training, you might want to look at EM and Gas.

 

[KUVaulter]

Fellowships, with the exception of several combined with Heme/Onc or Geriatrics, are only 1-2 years, with the second year focused on Research. most programs like to see residents from Medicine, FCM with some accepting Anesthesia. I haven't seen any looking for Psych residents yet. I can't imagine that Psych docs would have enough medicine to be a good Palliative Care doc- there is still lots of medicine involved.

 

[peduncle]

what is hospice and palliative medicine and why would anyone be attracted to it?

 

[maranatha]

Fellowships, with the exception of several combined with Heme/Onc or Geriatrics, are only 1-2 years, with the second year focused on Research. most programs like to see residents from Medicine, FCM with some accepting Anesthesia. I haven't seen any looking for Psych residents yet. I can't imagine that Psych docs would have enough medicine to be a good Palliative Care doc- there is still lots of medicine involved.

Given that I'm just about to start a psych residency and my experience is limited, take this with a grain-of-salt. My understanding is that a psychiatrist’s role in palliative care is to work along side IM/FM Doc's in more of a supportive/consult role. Thus, they would be better served in a group setting to help with the co-morbid psychiatric issue that inevitably arise in the context of chronic disease and the dying process. One way to get trained in this is to do a Psychosomatic Fellowship in a program that has psychiatrists working in palliative care and hospice.

 

[maranatha]

what is hospice and palliative medicine and why would anyone be attracted to it?

Here is a good way to start:

http://www.aahpm.org/

 

[dodoc07]

As a practicing hospital doc who is going back for a year of fellowship, I must say having procedure skills is pretty nice. It makes me much more self-confident. I run the rapid response and code teams during my shifts, so I intubate 3-6 times a month (truuuuust me, hospice patients and their families change their minds about intubation sometimes). I also place sutures frequently (one of the hospice patients fell last week and needed them) enough to feel comfortable....

Actually, these skills are not really necessary if you want to become a practicing hospice doc. I've done a rotation as a fellow at one of the largest inpatient hospice units on the east coast, and there was no code cart nor mechanical vents on the premises. On the rare occasion there was a "full code" patient admitted, the staff was prepared to dial 911 should the patient arrest. For procedures such as paracenteses or thoracenteses, the hospice contracted with a local physician group to perform them, if it was ever considered necessary. Again, it was extremely rare that a person's symptoms could not be controlled by simpler medical measures (i.e., medication); I do not believe I ever witnessed such procedures done in inpatient hospice.

As far as a background in psych goes, this would be extremely valuable in hospice and palliative medicine, as the majority of these docs have a background in IM and FP, and as such, generally have a very poor understanding of the pharmacodynamics of psych meds. Anxiety, agitation, and depression are very common at the end of life, and are considered some of the important symptoms that hospice and palliative medicine can help with.

Just my two cents.

 

[maranatha]

As far as a background in psych goes, this would be extremely valuable in hospice and palliative medicine, as the majority of these docs have a background in IM and FP, and as such, generally have a very poor understanding of the pharmacodynamics of psych meds. Anxiety, agitation, and depression are very common at the end of life, and are considered some of the important symptoms that hospice and palliative medicine can help with.

As someone who's about to start a psych resideny with an interest in palliative care, that is good to hear...