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CLINICAL PAIN MEDICINE

ISSUE: 3/2010 | VOLUME: 8:03

Palliative Practice Pathway Window Soon May Be Shut

Larry Beresford

Anesthesiologists with an affinity for palliative cares focus on relieving the pain and suffering of serious illness should know that the opportunity to achieve professional recognition for those skills based on field experience soon may be gone. Hospice and palliative medicine (HPM) is recognized as a medical subspecialty by the American Board of Anesthesiology (ABA) and nine other medical specialty boards, with board exams given every two years. (See http://www.theaba.org/Home/examinations_certifications.) After the October 2012 exam, it will become necessary to first complete a full-year fellowship in HPM in order to sit for HPM boards, and those wishing to pursue the practice pathway alternative for certification must complete requirements by 2012. But because those requirements include 800 hours of clinical involvement in the subspecialty-level practice of HPM and two years of participation on an interdisciplinary hospice or palliative care team, they need to find such a team to work with and quickly get started on the two-year commitment. ABA generally requires completing practice pathway requirements before applying to sit for boards, and the application deadline for the 2012 HPM boards is in December 2011, explained Maria Moffa Graham, the ABAs director of credentialing services. However, ABA decided in January to adopt a continuous application cycle for its subspecialty boards (which also include critical care medicine and pain medicine). In the case of HPM, applicants will have until June 30, 2012, to complete their two years of subspecialty practice in HPM in order to sit for the boards later that year, she said. Thus, they would need to start their clinical experience by June 30, 2010. A Good Fit for Anesthesiologists Catherine Powers, MD, of Anesthesia Associates of Kansas City, Mo., presently is pursuing this practice pathway to HPM certification, working part time in an unpaid position with Kansas City Hospice & Palliative Care. A clinical anesthesiologist for more than two decades, she appreciates the opportunity to address the symptoms of serious and advanced illness, such as pain, nausea, delirium and anxiety, as well as other end-of-life care issues. Ive been doing this for 18 months and I hope to sit for the HPM exam in 2010, said Dr. Powers, who plans to take a 10-week leave of absence from her anesthesiology position early in 2010 in order to accumulate sufficient hospice clinical hours to apply. Dr. Powers approached Kansas City Hospice, which employs a half-dozen HPM-certified physicians, about sponsoring her practice pathway experience. I started out shadowing the other physicians for six months, partly to make sure I really wanted to continue, she said. My medical group allowed it, and Kansas City Hospice was excited to have the free labor. Theyve been so welcoming to me, because they are so confident in what they do. Working alongside these people has been a revelation to me.

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Palliative Practice Pathway Wind...

Mostly she sees terminally ill patients at the agencys Hospice House, a freestanding acute end-of-life care facility, but also does palliative care consultations at area hospitals and with the agencys pediatric team. Dr. Powers has not done home hospice visits yet but expects to during her upcoming leave. In 2008, the first year it offered the exam, the ABA issued 19 subspecialty certifications in HPM. One of them was to Diane Portman, MD, who has worked full time for Tidewell Hospice in Sarasota, Fla., since 2006. Anesthesiologists are positioned to do hospice and palliative medicine very well, given their experience with pain management, respiratory care and critical care, said Dr. Portman. She also found that her professional experience of doing pain medicine full time for seven years, and personal experiences of an extended convalescence after a life-threatening auto accident and full-time caregiving for her husbands devastating postsurgical complications (both have recovered) gave her a different viewpoint on what the health care system is like for patients with advanced illness and their caregivers. I wanted to share that with my patients, but that was harder to do in other settings. The psychological, social and spiritual aspects of hospice and palliative care are the biggest challenges for most anesthesiologists to learn, added Dr. Powers. That was OK for me personally, she said. Its documentation thats been hard for me. I never had to dictate a history and physical in my entire career up to now.

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