How Do I Get Training to Become A PHPM Physician?

How are hospice and palliative medicine fellowships structured?

Hospice and palliative medicine fellowships (HPM) are 12-month, clinical fellowships. The Accreditation Council for Graduate Medical Education (ACGME) Program Requirements include:

• Patient care in the following locations
  • Inpatient acute care site
    • Inpatient palliative care consultation service
    • Inpatient palliative care or hospice unit
  • Home visits for hospice
    • Long term care experience at a skilled nursing home facility, chronic care hospital, or children’s rehabilitation center
    • Ambulatory setting
• Scholarly activity or quality improvement project
• Electives – programs may offer:
  • Acute and chronic pain management service
  • Perinatal palliative care
  • Bioethics

How do I find out about fellowships?

The official list of all HPM fellowship programs can be found on the ACGME website, and the AAHPM supports a list of Pediatric Hospice and Palliative Medicine Fellowship Training Opportunities here.

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:

• Adult HPM fellowship with additional pediatric time possible
• Pediatric fellowships
• Free-standing pediatric fellowship programs
  • Pediatric track 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 palliative care or hospice rotations for 4-10 weeks or more during the academic year, the experience is otherwise pediatric focused.

Pediatric tracks within 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 pediatric time – 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 into that program. Be sure to look up details of the pediatric experience for each program individually.

Adult training programs

ACGME Hospice Palliative Medicine program requirements include 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 within adult programs, and adult programs) is not easily identified within the Electronic Residency Application Service (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 you general rank list?
• What is your experience in training pediatricians? Have you had other pediatric fellows?
• How many of your faculty or staff are pediatric-trained?

How do I apply for fellowship?

Applications are submitted via ERAS, which opens July for fellowships starting in July of the following year. Typically fellowship interviews run August through October, with rank lists due in November for the December match. These dates may vary based on the type of training program. Applicants must register with both ERAS and the National Residency Matching Program (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. 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 directors directly to see what options may be available at specific sites.

How do I find the right fellowship for me?

Contact program directors directly and ask questions about how the program will match your individual career interests and goals. You can even request to connect with their current or recently graduated fellows. The interview day will be very informative. Some questions to consider asking are:

• What is the program's history, current focus, and goals for growth?
• What current scholarly projects/quality improvement efforts is the program working on?
• How does the program support the job seeking process including interview preparation, contract negotiation, etc.?
• How does the program support fellows during an emotionally heavy year?

In addition, consider what factors are important to your individual goals:

• Potential for mentorship
• Program size
• Exposure to hospice (adult or pediatric)
• Geography
• Ability to moonlight in prior board certified or board eligible specialty

What makes a good applicant for PHPM?

Applicants for HPM fellowship come from diverse clinical backgrounds and all training and career stages. Applicants that are more competitive typically demonstrate:

• A longitudinal interest in PHPM: Use your cover letter to highlight what experiences formed and maintained your interest in the field
• Desire to incorporate PHPM into their post-fellowship career
• Application with a letter from HPM faculty
• Demonstrate the appreciation for and ability to work in multidisciplinary teams