TAMPA — It's possible to start practicing palliative care medicine, while still learning how to provide it, according to two physicians who have made successful switches from other specialties.
Dr. Tina L. Smusz was once an emergency medicine specialist, but is now the medical codirector of Carilion Hospice of New River Valley Medical Center in Christiansburg, Va. She and Dr. Christopher W. Pile of Carilion Roanoke (Va.) Memorial Hospital described their experiences last month at the annual meeting of the American Academy of Hospice and Palliative Medicine and the Hospice and Palliative Nurses Association.
Retraining might be one way to help ease the growing need for palliative care specialists, according to Dr. Edward Vandenberg of the department of geriatrics at the University of Nebraska, Omaha. “The need for palliative care services in rural areas will rapidly outpace the need in urban areas on a per-person basis. Rural nursing homes will carry a significant share of the burden,” he said in an interview. The percentage of individuals over age 65 years who live in rural areas and need chronic care exceeds the percentage in urban areas. In 2004, the proportion of the population over age 65 years in the United States was 12.1%, while the proportion in rural Nebraska, for example, was 17%.
Both Dr. Smusz and Dr. Pile said that they were able to start practicing palliative medicine—while still learning how to provide it—by establishing relationships with several facilities in Southwestern Virginia simultaneously.
Dr. Pile was a practicing family physician when he started as the volunteer director of palliative care at Wythe County Community Hospital and its Hospice of Southwest Virginia. The area served by the hospice and the 104-bed acute and subacute care hospital includes four counties that have a total population of about 120,000.
Dr. Pile became the hospice's medical director and chairman of the hospital's ethics committee. After becoming certified in palliative medicine by the American Board of Hospice and Palliative Medicine, he gained consulting privileges in palliative care at Smyth County Community Hospital in Marion, Va., and Johnston Memorial Hospital in Abingdon, Va., where he also had contracts for delivering palliative care and ethics administration. Setting up the contracts was important because they allowed him to be paid for administrative time. Dr. Pile advised his audience to ensure that they are compensated for administrative time. “Don't shortchange yourself. [About] $100 an hour is reasonable,” he said.
He also became medical director of Valley Health Care Center, a 180-bed nursing facility in Chilhowie, Va., which offers skilled, intermediate, and assisted living care. He also became an associate professor at the Virginia College of Osteopathic Medicine in Blacksburg.
All of these entities supported his training and contribute to his current compensation. “Really it's just a matter of being creative,” said Dr. Pile. For instance, when he travels to palliative care training symposia, one facility pays for airfare, another facility covers registration, and a third reimburses his hotel costs. In return, Dr. Pile said he brings what he has learned back to each facility and gives in-service training to every staff member.
Dr. Pile's training has included a course based on the Education on Palliative and End-of-Life Care project, the American Academy of Hospice and Palliative Medicine's hospice medical director course and current concepts in palliative care course, and Harvard Medical School's program in palliative care education and practice. He also received palliative care leadership training under the auspices of the Center to Advance Palliative Care.
Dr. Smusz also works with several facilities in Virginia. Besides holding the post as medical codirector of Carilion Hospice of the New River Valley, she is a palliative medicine specialist there and does inpatient consultation for the larger network of facilities called Carilion Clinic. She also is on the faculty of Virginia College of Osteopathic Medicine. The area served by the Carilion Hospice includes four counties with a total population of more than 150,000.
Once Dr. Smusz realized that she had an interest in palliative medicine, she began volunteering with the hospice and doing home visits while continuing to work in emergency medicine. She became medical codirector of the hospice while she was still retraining. The following year she started to do palliative medicine consultations at Carilion New River Valley Medical Center.
Her training included a Center to Advance Palliative Care course on building a hospital-based palliative care program, training in one of the center's palliative care leadership programs, the same Education on Palliative and End-of-Life-Care course and Harvard program in palliative care education and practice that Dr. Pile attended. She also did extensive study on her own.