Hospice jobs

[visceral0775]

I am in the early phases of fellowship, but starting to think seriously about the job market since HPM is only a 1-year training program. I honestly don’t know if I envision myself doing inpatient palliative care if at all. I dread most of GOC conversations in the hospital. I have an interest in hospice and am wondering how common it is to be a FT hospice doc? I definitely never went into this field with the intention of making a ton of money, but I also want to be able to live and pay bills. I am open to ideas about other potential career paths.

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[baileyfal]

FT Hospice jobs are definitely available. Examples: hospice director, home based hospice/palliative doc, IPU.

I will caution you that GOC conversations still occur with pt’s/families in hospice care

 

[visceral0775]

FT Hospice jobs are definitely available. Examples: hospice director, home based hospice/palliative doc, IPU.

I will caution you that GOC conversations still occur with pt’s/families in hospice care

Thank you

 

[visceral0775]

FT Hospice jobs are definitely available. Examples: hospice director, home based hospice/palliative doc, IPU.

I will caution you that GOC conversations still occur with pt’s/families in hospice care

I haven't done my hospice rotation yet. I imagine that the GOC are slightly different in Hospice than they are in the inpatient Palliative world. What are some of the main differences?

 

[Frazier]

Yes, there are fulltime hospice jobs. Look for medical director positions with large hospice organizations (Vitas, etc). Alternatively look for admin positions with a midsized hospice organization (regional medical director, CMO, etc).

GOC talks continue to some degree with hospice given that patients are not required to be DNR/DNI for hospice enrollment. So there are those instances, also decisions and shared decision making in regard to prescribing, deprescribing, also some occasional procedural discussions...should we get that catheter put in for malignant ascites? Etc.

I suppose depending on the staffing of your hospice this could be deferred to NP.

But yes, the overall flavor of GOC discussions is different than inpatient palliative (ICU has difficult family, consult palliative for GOC.... Patient having trouble weaning from vent and family doesnt want to extubate, consult palliative for GOC.... frail 85 year old with a weight less than her age and end-stage-every-organ wants to continue pushing for aggressive chemotherapy, consult palliative for GOC.)

We have a role and a service we offer. You will do GOC convos in nearly all settings, but find a flavor that you don't dread. Or if you dread them for a particular reason, assess why and try to address accordingly.

You will need to be very flexible geographically to start with your first job... then keep an eye on the market to find a similar job to your liking in a region of your liking. If you find a job you like now (Sept), go ahead and apply. The credentialing process can sometimes take forever, just tell them you will be available to start in July.

 

[visceral0775]

Yes, there are fulltime hospice jobs. Look for medical director positions with large hospice organizations (Vitas, etc). Alternatively look for admin positions with a midsized hospice organization (regional medical director, CMO, etc).

GOC talks continue to some degree with hospice given that patients are not required to be DNR/DNI for hospice enrollment. So there are those instances, also decisions and shared decision making in regard to prescribing, deprescribing, also some occasional procedural discussions...should we get that catheter put in for malignant ascites? Etc.

I suppose depending on the staffing of your hospice this could be deferred to NP.

But yes, the overall flavor of GOC discussions is different than inpatient palliative (ICU has difficult family, consult palliative for GOC.... Patient having trouble weaning from vent and family doesnt want to extubate, consult palliative for GOC.... frail 85 year old with a weight less than her age and end-stage-every-organ wants to continue pushing for aggressive chemotherapy, consult palliative for GOC.)

We have a role and a service we offer. You will do GOC convos in nearly all settings, but find a flavor that you don't dread. Or if you dread them for a particular reason, assess why and try to address accordingly.

You will need to be very flexible geographically to start with your first job... then keep an eye on the market to find a similar job to your liking in a region of your liking. If you find a job you like now (Sept), go ahead and apply. The credentialing process can sometimes take forever, just tell them you will be available to start in July.

Thank you for the advice

 

[visceral0775]

Yes, there are fulltime hospice jobs. Look for medical director positions with large hospice organizations (Vitas, etc). Alternatively look for admin positions with a midsized hospice organization (regional medical director, CMO, etc).

GOC talks continue to some degree with hospice given that patients are not required to be DNR/DNI for hospice enrollment. So there are those instances, also decisions and shared decision making in regard to prescribing, deprescribing, also some occasional procedural discussions...should we get that catheter put in for malignant ascites? Etc.

I suppose depending on the staffing of your hospice this could be deferred to NP.

But yes, the overall flavor of GOC discussions is different than inpatient palliative (ICU has difficult family, consult palliative for GOC.... Patient having trouble weaning from vent and family doesnt want to extubate, consult palliative for GOC.... frail 85 year old with a weight less than her age and end-stage-every-organ wants to continue pushing for aggressive chemotherapy, consult palliative for GOC.)

We have a role and a service we offer. You will do GOC convos in nearly all settings, but find a flavor that you don't dread. Or if you dread them for a particular reason, assess why and try to address accordingly.

You will need to be very flexible geographically to start with your first job... then keep an eye on the market to find a similar job to your liking in a region of your liking. If you find a job you like now (Sept), go ahead and apply. The credentialing process can sometimes take forever, just tell them you will be available to start in July.

How common is it to do medical director right out of fellowship? A few people have cautioned against doing this as a first job right out of training

 

[Frazier]

It is not common for it to be full-time gig in general -- let alone for new graduated fellow. The reasons are likely multifaceted: there are more palliative jobs available than FT hospice med director jobs, many med director jobs want some years experience practicing prior to hire, most graduates say they actually want to practice palliative medicine after finishing fellowship (vs hospice medicine), geography is tough with job markets currently, hospice medical director can be continued into very old age (not to say palliative is necessarily strenuous, but the inpatient side tends to be just different than being in your med director office and doing IDT's/certifications/etc) so many times folks stick around.

I don't think I'd have some great hesitation to pursue it right out of fellowship. I'd want more robust education prior to diving in -- most fellowships do not go into the real nitty gritty of hospice regulations when you will need to know being med director. Read one the AAHPM HMD manual.

If hospice was my passion and there was a hospice job in region I loved and wanted to stay longterm -- I would take that job.