Training to Become a PHPM Physician

How Do I Get Training to Become A PHPM Physician?

The first step is to know that PHPM is the right field for you. This is why we recommend spending time with a PHPM team on an elective rotation, especially if you are considering a PHPM fellowship immediately after a general pediatrics residency.

You can also learn more by joining the AAP Section on Hospice and Palliative Medicine (SOHPM). The SOHPM hosts a Web site and a listserv that can connect you with others in the field of PHPM. You may also consider joining the American Academy of Hospice and Palliative Medicine (AAHPM) and attending its annual assembly, if you are able, to make contacts in PHPM and to appreciate the breadth and depth of the field.

Once you are more certain that PHPM is the career for you, the next step to becoming board-eligible is to complete a fellowship in hospice and palliative medicine. Prior to 2012, practicing physicians who met certain patient care criteria could be “grandfathered” into sitting for the hospice and palliative medicine board exam. Since then, only those physicians who have completed a fellowship are considered board-eligible.

How are typical hospice and palliative medicine fellowships structured?
Hospice and palliative medicine fellowships (HPM) are 12-month, clinical fellowships. The ACGME Program Requirements include:

  1. Patient care in the following locations:
    • Inpatient acute care site
    • Inpatient palliative care consultation service
    • Inpatient palliative care or hospice unit
  2. Home visits with hospice
    • Long-term care experience at a skilled nursing home facility, chronic care hospital, or children’s rehabilitation center
    • Ambulatory setting
  3. Scholarly activity or quality improvement project
  4. Electives

Fellowships may also offer some combination of the following:

  • Acute and chronic pain management rotations
  • Perinatal palliative care exposure

How do I find out about fellowships?
The official list of all HPM fellowship programs can be found on the ACGME Web site, and the AAHPM supports a list of pediatric palliative care fellowships and available pediatric tracks at the following link: http://aahpm.org/career/clinical-training

For those who are interested in pediatric-adult combined fellowships or pediatric-specific fellowships, it is important to note that HPM fellowships come in a number of different forms:

  1. Predominately adult HPM fellowships
  2. Adult HPM fellowships with additional pediatric time possible
  3. Pediatric Fellowships
    • Free-standing pediatric fellowship programs; or
    • Embedded within an adult HPM fellowship program

Stand-alone pediatric HPM training programs – These programs are at Children’s Hospitals and are run entirely by pediatric HPM faculty and staff. Some may include adult hospice rotations for 4-10 weeks or more during the academic year, the experience is otherwise wholly pediatric.

Pediatric tracks in conjunction with adult HPM training programs – These programs vary significantly in the amount of pediatric training offered, from as little as 4-15 weeks of pediatric time to as much as 9-10 months or more of time pediatric – equivalent to what is offered in the stand-alone pediatric HPM training programs. Some pediatric tracks have positions reserved for pediatricians and a rank list that is separate from the adult programs. Other pediatric tracks have a single rank list for all candidates and the pediatric track is utilized if a pediatrician matches in to that program. Be sure to look up details of the pediatric experience for each program individually.

Pediatricians welcome in adult training programs – ACGME Hospice Palliative Medicine program requirements includes two weeks of pediatrics minimum for all trainees. Some adult HPM training programs are willing to train pedestrians and may be willing to develop or have developed additional pediatric training experience (beyond the required 2 weeks). Each program will be different and should be contacted directly for details.

The difference between these three types of programs (stand-alone pediatric programs, pediatric tracks and pediatricians welcome in adult programs) is not easily identified within ERAS. Be sure to view the program website or reach out to program directors if you have specific questions. Questions to ask may include:

“How much time do your pediatric fellows spend in pediatrics vs. adult medicine?”
“Do you rank your pediatric applicants separately or are they part of your general rank list?”
“What is your experience in training pediatricians? Have you had other pediatric fellows?”
“How many of your faculty are pediatric-trained?”

How do I apply for fellowship?
Applications are submitted via ERAS, which opens July 15 for fellowships starting July 1 of the following year. Typically fellowship interviews run August – October, with rank lists due in November for the December match. Applicants must register with both ERAS and NRMP/MSMP for the fellowship match.

Combined Fellowship Options:
Experts have recently suggested an alternative pathway for combined HPM training with fields such as Hematology/Oncology, Critical Care and Neonatology. 5 However, at this time, the majority of programs require the completion of one fellowship training program before beginning another. If you are interested in a combined fellowship option, we recommend you contact program directors directly to see what options may be available at specific sites.

Mid-Career Pathways:
At this time, no fellowships offer specific mid-career pathways. However programs may be willing to work with candidates to design a program that allows mid-career physicians to spread their fellowship training over two years in order to allow continued clinical practice during training. We recommend that you contact program.

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References

  1. National Consensus Project Guidelines for Quality Palliative Care. Clinical Practice Guidelines for Quality Palliative Care, 3rd Ed. . 2013. (Accessed August 19, 2015, at http://www.nationalconsensusproject.org.)
  2. National Hospice and Palliative Care Organization. NHPCO Facts and Figures: Hospice Care in America. 2013. .
  3. NHPCO's Facts and Figures: Pediatric Palliative and Hospice Care in America 2015 Edition. National Hospice and Palliative Care Organization, 2015. (Accessed August 11, 2015., 2015, at http://www.nhpco.org/sites/default//files/public/quality/Pediatric_Facts-Figures.pdf.)
  4. American Academy of Pediatrics SoHaPMaCoHC. Pediatric Palliative Care and Hospice Care Commitments, Guidelines and Recommendations. Pediatrics 2013;132:966-72.
  5. Snaman JM, Kaye EC, Levine DR, et al. Pediatric Palliative Oncology: A New Training Model for an Emerging Field. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 2016;34:288-9.