Monday, July 11, 2022

Celebrating Hospice and Palliative Medicine as the Fifth Largest Medical Subspecialty

by Christian Sinclair (@ctsinclair)

We have entered a new age! Spread the word! Hospice and palliative medicine (HPM) is the fifth largest medical subspecialty!

You may have sensed we have been climbing the ranks, but I bet you are still surprised. A close look at the fellowship match data from Dec 2021, shows that HPM has the fifth highest number of matched applicants, behind the big 4: Cardiovascular, Pulmonary and Critical Care, Hematology and Oncology, and Gastroenterology.

When I share this good news with HPM colleagues, few put us anywhere near fifth. I did an informal poll on Twitter and less than half of respondents ranked HPM in the top 10. Of those that did rank HPM, the average rank was 7. Clearly, we are not telling our own story very well.

There are many possible reasons to feel skeptical, but yes, HPM is the fifth largest medical subspecialty! Yet, it still may not feel like that...why might that be? In general, I find HPM clinicians to be a humble, cordial bunch. We may be more introverted. We are not ones to generally boast about our accomplishments as a field. Most of that attention is often dedicated to some new technology or medicine anyway.

Also, maybe we percieve oursleves to be a smaller specialty because access to HPM physicians is still highly variable. Centered in metro areas and more likely to be found wandering the halls of academia, there may be local, regional or organizational reasons why HPM has a smaller footprint in one place, while being a driving force in another. A message can be muddled when telling a large audience to access HPM physicians yet there are none in their area.

Additionally, we are still quite a young specialty, with the birth of HPM as an official specialty being announced in 2005, and getting started in 2008. We have just entered our teenage years. Maybe it is OK to think about ourselves for a bit, and test the boundaries of our newfound confidence like any respectable teenager.

Lastly, many are working in health care organizations which still treat palliative medicine and hospice physicians as “nice to have” instead of “essential.” It is hard to feel like you are part of a larger group when there are not many colleagues around you. The teams we work with may still feel empty without all the key disciplines collaborating. A HPM physician is a good start, but when there are no resources, no infrastructure and not enough people to get the work done, HPM may be limited to being little more than a glossy brochure.

So why do we need to talk about this? Because this is a great opportunity to increase visibility which can help in a variety of ways. The message is simple, HPM is the fifth largest medical subspecialty! We are right behind cardiologists, oncologists, critical care and GI and this should be something (when shared) helps to cement our stature. When you are number five, we should not settle for being relegated to choosing ‘other’ on a list of medical subspecialties. If rheumatology is on there, so are we. If geriatrics is on there, so are we. If infectious disease is on there, so are we.

Sharing this message increases our visibility at our own organizations. We should be including this in our presentations on Hospice and Palliative Medicine 101, or frankly anytime we are asked to speak to outside audiences. We need to share this on social media and in conversations with our colleagues, friends and family. People should want to understand what hospice and palliative medicine doctors do, especially when HPM is the fifth largest medical subspecialty.

We are currently in fellowship application season, so this is a message to share when people come to your program. This increased national visibility will also help bring more people to our field with fresh ideas, diverse backgrounds, and new skills. We have important areas to grow with HPM physicians playing an important part including outpatient and community care, hospice care, pediatrics, and research. Right now, we are not filling all of our fellowship slots (85% filled) and we have a looming HPM physician shortage. What a great time to be popular and get the word out to pre-med students, med students and residents of all primary specialties to put HPM onto their short list. It will be hard to act surprised when learners declare an interest in palliative care, because after all, HPM is the fifth largest medical subspecialty.

I am still surprised this Tweet happened as recently as 2018!



I do not expect that to happen in the future. The more we share the growth of our field, that we are here, that we have numbers, that we are strong, and that we will make an impact, then we can reserve OUR seat at the table to make the important decisions shaping the future of health care. I hope you are thinking of the first person you need to tell that HPM is the fifth largest medical subspecialty. Let’s do it!

Original data here from NRMP. Summary of data for this post below.





For more Pallimed posts by Dr. Sinclair click here.
For more Pallimed posts about the profession click here.
For more Pallimed posts about hospice and palliative medince fellowship click here.


Christian Sinclair, MD, FAAHPM is a palliative care physician at the University of Kansas Health System, editor-in-chief of Pallimed, and trying to keep up a resolution to write more about palliative care in 2022.

Monday, July 11, 2022 by Christian Sinclair ·

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