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 may will also learn more by joining the AAP Section on Hospice and Palliative Medicine (SOHPM). The SOHPM hosts a website and two LISTSERVs® that can connect you with others in the field of PHPM. The SOHPM welcomes pediatric trainee members, including medical students, residents, post residency training fellows, and early career physicians (among other member types). The SOHPM has a formal liaison relationship with the AAP Section on Pediatric Trainees and engages in various activities to support trainees and early career physicians interested in the field of PHPM. The AAP Mentorship Program offers opportunities for mentorship and peer support by matching trainees with mentors based on shared career interests. You may also consider joining the American Academy of Hospice and Palliative Medicine (AAHPM) and attending their 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 HPM fellowships structured?
HPM fellowships 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
- Inpatient acute care site
- Home visits with 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
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 website, and the AAHPM supports a list of Pediatric Hospice and Palliative Medicine Fellowship Training Opportunities at the following link: http://aahpm.org/career/clinical-training#fellowship-directory
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:
- Predominantly adult HPM fellowships
- Adult HPM fellowships with additional pediatric time possible
- Pediatric fellowships
- Free-standing pediatric fellowship programs
- Or 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 hospice rotations for 4-10 weeks or more during the academic year, the experience is otherwise pediatric focused.
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 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 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 which start July 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.
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.?
American Academy of Pediatrics