Staff shortages currently squeezing hospice and palliative care providers are likely to get worse before they get better. A forthcoming study to be published this week in Health Affairs found that the number of palliative care physicians will decline during the next 25 years even as demand rises, the study’s authors said.
Contributing factors driving the decline include higher rates of retirement as baby boomer clinicians retire, as well as significant rates of clinician burnout. More than 40% of physicians are aged 56 or older, and the intake level for new palliative care and hospice physicians will not be able to match the number who are leaving the field, the study, titled “Policy Changes Key To Promoting Sustainability And Growth Of The Specialty Palliative Care Workforce,” found.
“There are two perfect storms going on, where the number of physicians will go down and the number of patients will go up,” lead author and physician Arif Kamal of Duke University told Hospice News. “We start to see a ratio as bad as 24 patient visits-per-day for one physician. That volume of visits in one day is potentially prohibitive of high quality, high touch care. What we do that is different from other medical fields; we need in-depth conversations that include time to allow patients and their family members to process and think and reflect. You can’t be out of the room in 15 minutes.”
Palliative care, formerly on the outskirts of medicine, is increasingly becoming the standard of care for some serious illnesses, particularly cancer, advanced heart disease, and neurological conditions such as dementia. Coupled with rising awareness and acceptance of hospice and palliative care, the depleting workforce will have exponentially more patients to care for during the next two decades.
More than 2,000 clinicians responded to a survey that Kamal and co-authors sent to the membership of nine professional organizations that included a range of disciplines from physicians, physician assistants, and nurses to pharmacists, social workers, and chaplains. Much of the soon-to-be published study focuses on physicians because more data were available for that population, according to Kamal.
However, the staffing shortages will likely affect every type of clinician who comprise interdisciplinary hospice and palliative care teams. The researchers concluded that changes to public policy, clinical education, payment models, and stepped up efforts to combat burnout are likely needed to reduce attrition and attract new clinicians to the field. Burnout is a major reason that many clinicians leave the field early in their careers, according to Kamal.
“Physicians alone cannot do this important work. That wouldn’t be practical, and it wouldn’t align with the spirit of what palliative care and hospice are,” Kamal said. “We cannot do this work without the important contributions of all the members of the team.To sustain the workforce across all disciplines payment models need to recognize the role and value of all clinicians on the team and provide a mechanism for recognizing those efforts through payment. I think hospice figured that out early on with a per diem payment model with the understanding that you need to have a multidisciplinary approach.”
Kamal told Hospice News that the system for training new palliative care physicians needs to be redesigned to allow for faster and more extensive on-boarding, as well as alternative processes for training existing physicians to enter the specialty workforce. Currently to become a palliative care specialist a candidate must participate in a fellowship, spaces for which are very limited nationwide.
“What we are seeing now are the consequences of a policy that has been in place for seven years that limits who can sit for board examinations,” Kamal said. “Now it’s catching up with us.”
The study will appear in the June issue of the journal Health Affairs.