- Email: [email protected]
Workforce Shortage: A Staggering Need and a Call to Action
912
Journal of Pain and Symptom Management
Commentary
Workforce Shortage: A Staggering Need and a Call to Action Daniel Maison, MD, FAAHPM Spectrum Healthcare, Grand Rapids, Michigan; and National Council of Hospice and Palliative Professionals, National Hospice and Palliative Care Organization, Alexandria, Virginia, USA
The American Academy of Hospice and Palliative Medicine (AAHPM) Task Force article, ‘‘Estimate of Current Hospice and Palliative Medicine Physician Workforce Shortage,’’1 very clearly and thoroughly describes the disparity between the current hospice and palliative care physician supply and the projected future need. Anyone who has been engaged in hospice and palliative medicine will tell you that we are rarely limited by demand for our services but rather by the supply of health care providers with the right skills and training. In fact, a big part of every lead hospice physician’s job is physician recruitment. Recent changes in the Medicare conditions of participation and upcoming requirements for face-to-face visits with long-term patients will only compound the challenge of adequate staffing. In October 2009, hospice physicians had to begin writing a narrative for all new patients being admitted to hospice and a narrative every time patients are recertified as eligible for hospice services. This new regulatory requirement continues to pose a significant challenge to hospices nationwide in terms of physician staffing resource time. Any hospice where
Address correspondence to: Daniel Maison, MD, FAAHPM, Spectrum Healthcare, 145 Michigan Street NE, Suite 5120, Grand Rapids, MI 49503, USA. E-mail: [email protected] Accepted for publication: September 30, 2010. Ó 2010 U.S. Cancer Pain Relief Committee Published by Elsevier Inc. All rights reserved.
Vol. 40 No. 6 December 2010
physician resources were already scarce now has to find ways to spread their physician time even thinner. For the hospice physicians who are now required to complete these narratives, they have had to find a way to fit this mandated activity into already busy days. As a result, physicians are often left with the choice between completing these narratives and providing clinical care. In January 2011, the regulatory requirements for physicians will increase further. Every hospice patient will need to be seen by either a physician or a nurse practitioner within 30 days before the end of the second certification period (180 days after admission). Those patients also will need to be seen within 30 days before every subsequent recertification (every 60 days) for as long as the patient is on service for hospice. This new requirement will entail a large increase in the work responsibilities for many hospice physicians. Added to these increased requirements are the realities of an aging physician workforce and expectations of retirement. Additionally, hospice has undergone tremendous growth over the past 10 years and will likely continue to grow in the coming decade. The specter of additional staffing needs is ever present. Even before the changes in regulations outlined above, there often has been a tremendous untapped potential for further physician presence in hospice care. In 2008, the median length of stay (LOS) was just over 21 days, with approximately 35% of those served either dying or being discharged within seven days.2 These short LOS patients create additional pressures for a limited physician workforce that must see patients very soon after admission. Clearly, there is a tremendous need for more well-qualified hospice and palliative care physicians, and this need will only continue to increase in the future. This fact leaves all of us with one overriding question: How are we going to overcome this rapidly growing gap between what we have and what we need? In broad strokes, our choices seem to either increase fellowship training or continue to recruit practicing physicians to change careers and join our ever-growing ranks (or likely a combination of both). 0885-3924/$ - see front matter
Vol. 40 No. 6 December 2010
Commentary
So, what can each and every one of us do to help tackle this huge challenge? Clearly, no one of us can do it alone, but this problem is unlikely to be solved unless all of us do what we can. According to the AAHPM Task Force article,1 we as a profession are more than 4000 voices strong. The first thing we need to ensure is that we are all working together toward a solution. As an industry, we can work to continue to raise understanding of the value and necessity of our profession to health care as a whole. Whether it is making sure that we are at the table as the nation grapples with health care reform through political action or encouraging granting organizations to fund much needed research, solutions aimed at systemic change will be needed. In addition, we will need to ask for more resources to fund additional training opportunities for physicians who wish to enter specialized fellowship training. If we do not have more slots for aspiring fellows, how can we possibly hope to close the workforce gap? Individual hospices can help in working toward a solution as well. Hospices can work in partnership with existing training programs to supply clinical opportunities that can enhance training capacity. And even in those communities that do not have an existing fellowship program in their service area, hospices with a medical school or residency nearby can work to offer training experiences to physicians in training. It is impossible to overestimate the potential impact an experience at a hospice can have on someone who is in the midst of deciding on a career path. Who among us did not have someone during our training shape our career choices? By having students and residents rotate through hospice, we may plant the seed that sets a young person on the path to becoming a hospice or palliative care physician. Additionally, hospices can consider starting a fellowship training program in
913
collaboration with a local academic institution. In fact, it is likely that many hospices have some or all elements of a successful fellowship already in place. Funding this training is difficult, but not impossible. Much of hospices’ philanthropic support comes from those who have been either directly or indirectly served by hospice. Whether it is because of a family member who went through hospice, a close friend who received palliative care, or simply hearing of the care provided to someone unknown to them, many in our communities are very generous supporters of the work that we do. Among hospice donors, there are certain to be many who want to ensure that the care provided by hospice and palliative care is available for generations to come. There is a tremendous need already for more hospice and palliative medicine physicians. This need will only increase dramatically in the years to come. We all need to do whatever we can to help shrink the gap between what we need and what we have.
Disclosures and Acknowledgments The author declares no conflicts of interest and received no funding for this work. doi:10.1016/j.jpainsymman.2010.09.011
References 1. Lupu D. Estimate of current hospice and palliative medicine physician workforce shortage. Academy of Hospice and Palliative Medicine Workforce Task Force. J Pain Symptom Manage 2010;40(6): 899e911. 2. National Hospice and Palliative Care Organization. NHPCO facts and figures: Hospice care in America. Alexandria, VA: NHPCO, 2009:5. Available from http://www.nhpco.org/files/public/Statistics_ Research/NHPCO_facts_and_figures.pdf. Accessed September 29, 2010.
Journal of Pain and Symptom Management
Commentary
Workforce Shortage: A Staggering Need and a Call to Action Daniel Maison, MD, FAAHPM Spectrum Healthcare, Grand Rapids, Michigan; and National Council of Hospice and Palliative Professionals, National Hospice and Palliative Care Organization, Alexandria, Virginia, USA
The American Academy of Hospice and Palliative Medicine (AAHPM) Task Force article, ‘‘Estimate of Current Hospice and Palliative Medicine Physician Workforce Shortage,’’1 very clearly and thoroughly describes the disparity between the current hospice and palliative care physician supply and the projected future need. Anyone who has been engaged in hospice and palliative medicine will tell you that we are rarely limited by demand for our services but rather by the supply of health care providers with the right skills and training. In fact, a big part of every lead hospice physician’s job is physician recruitment. Recent changes in the Medicare conditions of participation and upcoming requirements for face-to-face visits with long-term patients will only compound the challenge of adequate staffing. In October 2009, hospice physicians had to begin writing a narrative for all new patients being admitted to hospice and a narrative every time patients are recertified as eligible for hospice services. This new regulatory requirement continues to pose a significant challenge to hospices nationwide in terms of physician staffing resource time. Any hospice where
Address correspondence to: Daniel Maison, MD, FAAHPM, Spectrum Healthcare, 145 Michigan Street NE, Suite 5120, Grand Rapids, MI 49503, USA. E-mail: [email protected] Accepted for publication: September 30, 2010. Ó 2010 U.S. Cancer Pain Relief Committee Published by Elsevier Inc. All rights reserved.
Vol. 40 No. 6 December 2010
physician resources were already scarce now has to find ways to spread their physician time even thinner. For the hospice physicians who are now required to complete these narratives, they have had to find a way to fit this mandated activity into already busy days. As a result, physicians are often left with the choice between completing these narratives and providing clinical care. In January 2011, the regulatory requirements for physicians will increase further. Every hospice patient will need to be seen by either a physician or a nurse practitioner within 30 days before the end of the second certification period (180 days after admission). Those patients also will need to be seen within 30 days before every subsequent recertification (every 60 days) for as long as the patient is on service for hospice. This new requirement will entail a large increase in the work responsibilities for many hospice physicians. Added to these increased requirements are the realities of an aging physician workforce and expectations of retirement. Additionally, hospice has undergone tremendous growth over the past 10 years and will likely continue to grow in the coming decade. The specter of additional staffing needs is ever present. Even before the changes in regulations outlined above, there often has been a tremendous untapped potential for further physician presence in hospice care. In 2008, the median length of stay (LOS) was just over 21 days, with approximately 35% of those served either dying or being discharged within seven days.2 These short LOS patients create additional pressures for a limited physician workforce that must see patients very soon after admission. Clearly, there is a tremendous need for more well-qualified hospice and palliative care physicians, and this need will only continue to increase in the future. This fact leaves all of us with one overriding question: How are we going to overcome this rapidly growing gap between what we have and what we need? In broad strokes, our choices seem to either increase fellowship training or continue to recruit practicing physicians to change careers and join our ever-growing ranks (or likely a combination of both). 0885-3924/$ - see front matter
Vol. 40 No. 6 December 2010
Commentary
So, what can each and every one of us do to help tackle this huge challenge? Clearly, no one of us can do it alone, but this problem is unlikely to be solved unless all of us do what we can. According to the AAHPM Task Force article,1 we as a profession are more than 4000 voices strong. The first thing we need to ensure is that we are all working together toward a solution. As an industry, we can work to continue to raise understanding of the value and necessity of our profession to health care as a whole. Whether it is making sure that we are at the table as the nation grapples with health care reform through political action or encouraging granting organizations to fund much needed research, solutions aimed at systemic change will be needed. In addition, we will need to ask for more resources to fund additional training opportunities for physicians who wish to enter specialized fellowship training. If we do not have more slots for aspiring fellows, how can we possibly hope to close the workforce gap? Individual hospices can help in working toward a solution as well. Hospices can work in partnership with existing training programs to supply clinical opportunities that can enhance training capacity. And even in those communities that do not have an existing fellowship program in their service area, hospices with a medical school or residency nearby can work to offer training experiences to physicians in training. It is impossible to overestimate the potential impact an experience at a hospice can have on someone who is in the midst of deciding on a career path. Who among us did not have someone during our training shape our career choices? By having students and residents rotate through hospice, we may plant the seed that sets a young person on the path to becoming a hospice or palliative care physician. Additionally, hospices can consider starting a fellowship training program in
913
collaboration with a local academic institution. In fact, it is likely that many hospices have some or all elements of a successful fellowship already in place. Funding this training is difficult, but not impossible. Much of hospices’ philanthropic support comes from those who have been either directly or indirectly served by hospice. Whether it is because of a family member who went through hospice, a close friend who received palliative care, or simply hearing of the care provided to someone unknown to them, many in our communities are very generous supporters of the work that we do. Among hospice donors, there are certain to be many who want to ensure that the care provided by hospice and palliative care is available for generations to come. There is a tremendous need already for more hospice and palliative medicine physicians. This need will only increase dramatically in the years to come. We all need to do whatever we can to help shrink the gap between what we need and what we have.
Disclosures and Acknowledgments The author declares no conflicts of interest and received no funding for this work. doi:10.1016/j.jpainsymman.2010.09.011
References 1. Lupu D. Estimate of current hospice and palliative medicine physician workforce shortage. Academy of Hospice and Palliative Medicine Workforce Task Force. J Pain Symptom Manage 2010;40(6): 899e911. 2. National Hospice and Palliative Care Organization. NHPCO facts and figures: Hospice care in America. Alexandria, VA: NHPCO, 2009:5. Available from http://www.nhpco.org/files/public/Statistics_ Research/NHPCO_facts_and_figures.pdf. Accessed September 29, 2010.