Fellow

Who Should Complete a Fellowship in Hospice and Palliative Medicine (HPM)?

Completing an HPM fellowship is required if you wish to obtain board certification in the field and be able to spend part or all of your career working clinically as a palliative care or hospice physician. Most HPM fellowships are one year in length.

What Will You Learn?

During fellowship, you can expect to see patients with a wide range of serious illnesses and in a variety of care settings. You will receive training in:

• Complex symptom management, including opioid and non-opioid pain management, patient-controlled analgesia, and management of distressing physical and psychological symptoms.
• Communication skills, such as strategies for breaking bad news, communicating with empathy, and leading family meetings.
• Indications, capabilities, and limitations for hospice services.
• Mechanics of working as a palliative care specialist, including documentation, billing, etiquette for working as a consultant, and the role of interdisciplinary teams.

Work Hours and Settings

ACGME standards require exposure to the practice of palliative care in the outpatient, long-term care, and inpatient settings, as well as provision of end-of-life care in home and inpatient hospice settings. In general, work hours are more regular and favorable than a typical emergency department (ED) schedule, with the bulk of your clinical times scheduled for weekdays. Many programs require limited night and weekend on-call responsibilities.

Salary and Moonlighting

Most fellowships offer salary and benefits according to the institution's standard PGY4 or PGY5 scale. Many fellows pursue moonlighting opportunities to maintain emergency medicine (EM) skills during the fellowship year and augment compensation. Discuss the moonlighting policy with your fellowship program director soon after the match and reach out to potential moonlighting sites in the spring before entering fellowship, as it can take several months to be credentialed to work as an attending.

Job Search and Negotiation

Given most fellowships are only one year, you will need to begin your search for an attending position soon after entering the fellowship.

• Summer/Fall: decide what balance of EM and palliative care you want to pursue for the beginning of your career. This can be highly individualized. Many graduates have been successful obtaining combined positions (e.g. 80% clinical EM, 20% clinical palliative care), while others choose to work entirely in one field or the other.
• Fall/Winter: use your mentorship network to identify potential hospitals or health systems where you would like to work. Begin contacting department chairs and medical directors to express interest in an attending physician role and set up interviews.
• Negotiation: many groups and academic institutions use standardized pay scales, so salary is often not directly negotiable, but other aspects of the job may be. These include the number of ED clinical hours or palliative care service weeks per year, protected time for academic work, or scheduling considerations for night and weekend shifts.