2+1 in palliative care

[1fuzzy2dino3]

Can any one here tell me about what practice in palliative care with a 2+1 looks like?

 

can you split your time between clinic and hospital palliative care? or do ppl just do full time palliative care only ... kinda like CCFP EM - where most docs just end up doing full time EM work.

 

thank you all for your input.

[frozenarbitor]

Can any one here tell me about what practice in palliative care with a 2+1 looks like?

 

can you split your time between clinic and hospital palliative care? or do ppl just do full time palliative care only ... kinda like CCFP EM - where most docs just end up doing full time EM work.

 

thank you all for your input.

 

I was told by my program director that R3 in EM and palliative (and anethesia which is mostly rural) are the R3s that tend to make people focus exclusively on R3 specialty and leave little or no time for clinical family medicine.

[Jochi1543]

I don't think you need an R3 in this field to practice it well. I just finished my palliative care rotation and I enjoyed it a lot, but the knowledge base just isn't that big. If you have great emotional intelligence and do a few weeks of electives in palliative during med school and residency, you should be adequately prepared for it. Both my palliative care preceptors felt that way, and both were regular GPs with no extra training.

 

In general, as the poster above me alluded, R3 training means furthering your specialized knowledge at the expense of everything else.

[Satsuma]

I think you would have the flexibility to tailor your career however you want.

There is such a shortage of palliative care docs that you would work full-time for sure, but if you didn't want to people would be happy if you were doing part-time.

 

I know a fam doc +1 who does all palliative and loves it. There is an in patient palliative unit at the hospital where she works. So she does in-patient palliative as well as community palliative - so alot of home visits etc. There is quite a large number of docs in the area it seems so call is not too frequent. Although, all you need is one patient apparently to take up most of the night, as these patients can be very time consuming.

 

I know of another internist +1 palliative. She does a mix.

 

The US now has an exam to sit for the specialty of palliative care. I suspect that Canada will eventually follow. But who knows how long that would take.

[FamilyGuy]

Thanks for directing me to this thread, ploughboy.

 

I completed a +1 in palliative medicine and currently practice a 60/40 mix of family medicine/palliative care in the community. If the family practice you are part of is willing to let you dedicate time away to do palliative care, it is very possible to do this mix. I am lucky in that I am part of an academic family practice, and thus I could schedule my week like this. I choose to do community palliative care rather than inpatient as it made more sense for this type of practice and I have coverage over other days of the week from my colleagues.

 

From your original question, you wish to do a combination of clinic (I assume family medicine?) and hospital palliative care. This may be doable if you round on your hospital patients before/after clinic. Typically for hospital coverage, you'd be there for a week or two, depending on the rotation schedule. I would think this combination would be harder to swing than community palliative care (or dedicated palliative care clinics) alongside family medicine clinics.

 

I hope this helps.

[1fuzzy2dino3]

Thanks all for your informative responses!

 

Family Guy: what do you mean when you say 'community palliative care'? what does that entail?

 

I'm strongly considering a 2+1 in palliative care, but sadly, i have not as yet come across information that explains what the different practice options within palliative care are. so your input would be appreciated

 

and yes, i do envision a split... much like your 60:40, but didn't know that i could do something 'palliative' outside of the hospital!

 

many thanks!

and thanks to PB for directing FG!

[JewelLeigh]

I have three colleagues who did a 2+1 in palliative. Their respective practices are as follows:

 

- Fulltime palliative care - about 30% in-hospital, 30% hospice, 40% non-hospice home care

- Fulltime palliative care - 100% hospital - consulting and admissions

- 40-50% family practice/50-60% palliative care - palliative component is about 60% hospice and 40% outpatient consults and home care

 

In my experience, "community" palliative care involves consulting on outpatients, including follow-up visits - these can be in office or home based on the patient's functional status. Often patients seen in the office will eventually be seen at home as their illness progresses. Community palliative care will often involve hospice care as well, which somewhat resembles in-patient care, but within a much nicer environment, a bigger focus on quality of life and a totally different way of billing (at least in Ontario).

[1fuzzy2dino3]

I have three colleagues who did a 2+1 in palliative. Their respective practices are as follows:

 

- Fulltime palliative care - about 30% in-hospital, 30% hospice, 40% non-hospice home care

- Fulltime palliative care - 100% hospital - consulting and admissions

- 40-50% family practice/50-60% palliative care - palliative component is about 60% hospice and 40% outpatient consults and home care

 

In my experience, "community" palliative care involves consulting on outpatients, including follow-up visits - these can be in office or home based on the patient's functional status. Often patients seen in the office will eventually be seen at home as their illness progresses. Community palliative care will often involve hospice care as well, which somewhat resembles in-patient care, but within a much nicer environment, a bigger focus on quality of life and a totally different way of billing (at least in Ontario).

 

 

thanks for the above info!

[FamilyGuy]

For me, my community palliative care group takes referrals from family doctors who wish us to see their patients at home. In some centres, this is done for shared care (which I prefer) vs. "take over care" (i.e. an MRP model of palliative care). We will then see the patient at home until death, or facilitate admission to a palliative care unit if the family feels unable to cope despite maximal CCAC supports.

 

We take referrals only from family doctors (not internal medicine in hospital, for example) as some family doctors want to continue to see their patients at home until death, and we don't want to step on these doctors' toes. Indeed, I would much rather more family doctors see their own patients, and utilize palliative care services for only the more challenging cases, or for phone advice only. I feel that that is a more sustainable model as our population ages.

[1fuzzy2dino3]

For me, my community palliative care group takes referrals from family doctors who wish us to see their patients at home. In some centres, this is done for shared care (which I prefer) vs. "take over care" (i.e. an MRP model of palliative care). We will then see the patient at home until death, or facilitate admission to a palliative care unit if the family feels unable to cope despite maximal CCAC supports.

 

We take referrals only from family doctors (not internal medicine in hospital, for example) as some family doctors want to continue to see their patients at home until death, and we don't want to step on these doctors' toes. Indeed, I would much rather more family doctors see their own patients, and utilize palliative care services for only the more challenging cases, or for phone advice only. I feel that that is a more sustainable model as our population ages.

 

thanks for the info!