University of Nebraska Creates Hospice, Palliative Care Fellowship

The University of Nebraska Medical Center (UNMC) has received approval to create a fellowship program in hospice and palliative medicine, creating that state’s first formal training program to alleviate the ongoing shortage of hospice and palliative care clinicians. The Omaha-based Children’s Hospital and Medical Center and Nebraska-Iowa Veterans Affairs Healthcare System will partner with the university to develop and administer the fellowship.

The United States has 13.35 hospice and palliative care specialists for every 100,000 adults 65 and older, according to an April 2018 study. The research estimated that by 2040 the patient population will need 10,640 to 24,000 specialists; supply is expected to range between 8,100 and 19,000.

Research published earlier this month found that the hospice and palliative care workforce will likely be depleted during the next two decades due to retirement and burnout. Inadequate access to hospice and palliative care specialty training is a major barrier to alleviating these shortages.

“There are many hospices across the country that are having very serious challenges recruiting and retaining physicians, nurses, and other staff,” said Stacie Levine, M.D., section chief of Geriatrics and Palliative Medicine at the University of Chicago Medical Center, told Hospice News. “We have the baby boomers reaching their twilight years, and I am not sure what we are going to be able to do with what we have in front of us.”

Levine leads a fellowship program at the University of Chicago similar to the one begin launched in Nebraska.

The fellowship, which will begin in July 2020, will include one focused on pediatrics and two specializing in adult care. The stakeholders will select three new fellows each year who will receive training in home-based hospice care, pain management, and oncology. The fellowship also will expand educational capacity for additional learning including medical students, nursing students, and resident physicians in end-of-life care.

“We need to dramatically expand the number of physicians trained in this area to meet the needs of patients in hospitals as well as in the outpatient clinics,” said Al Fisher, M.D, Ph.D., associate professor and chief of the UNMC Department of Internal Medicine’s Division of Geriatrics, Gerontology and Palliative Medicine. “We know from clinical studies that palliative care can improve outcomes and quality of life. We’re really underutilizing a great resource for both patients and their families.”

Specialty training is necessary to effectively provide the necessary support and care to hospice and palliative care patients and their families according to Lu Lukas, M.D., medical director of hospice and palliative medicine at the Nebraska-Western Iowa VA Healthcare System.

“They offer a more nuanced approach to complex decision-making and meticulous attention to symptoms, so that people feel heard, get treatment that matches their goals and values, and maximize quality of life, even in the advanced stages of illness,” said Lukas. “So many people come to UNMC from across the state to get treatment for advanced illness. We need more doctors who can work with them during acute treatment and when they return to their communities.”