Student_Doctor Posted September 14, 2011 Report Share Posted September 14, 2011 I recently did an elective in palliative care and was surprised at how much I enjoyed it. I am pretty set on family med as my future career, but if I wanted to do some palliative (likely at hospice) on the side what are the requirements? Are you required to do a fellowship, or can anyone do it? Link to comment Share on other sites More sharing options...
justletmein Posted September 14, 2011 Report Share Posted September 14, 2011 I recently did an elective in palliative care and was surprised at how much I enjoyed it. I am pretty set on family med as my future career, but if I wanted to do some palliative (likely at hospice) on the side what are the requirements? Are you required to do a fellowship, or can anyone do it? You are not required to do a formal fellowship if you want to do palliative care. Link to comment Share on other sites More sharing options...
rmorelan Posted September 14, 2011 Report Share Posted September 14, 2011 I recently did an elective in palliative care and was surprised at how much I enjoyed it. I am pretty set on family med as my future career, but if I wanted to do some palliative (likely at hospice) on the side what are the requirements? Are you required to do a fellowship, or can anyone do it? I am in clerkship now and my family medicine doctor I am with for the next 4 weeks has a substantial palliative care section to her practice at the local long term care hospital. She rounds there often and her residents work there as well. She has no additional training in that area, just a strong interest. Link to comment Share on other sites More sharing options...
moo Posted September 14, 2011 Report Share Posted September 14, 2011 If you are a family doc you can pretty much do anything you are comfortable with. A fellowship generally just gives you extra skills if you want it. It is not mandatory. I think most Palliative fellowships are six months long. Link to comment Share on other sites More sharing options...
justletmein Posted September 14, 2011 Report Share Posted September 14, 2011 I don't get these fellowships. Take a huge paycut just to get an unrecognized "interest". Screw it. If you plan on working in a major city, you will not be hired by an ED without a 2+1 fellowship. Although many people argue that a year of working in a remote, rural ER provides you with the same if not superior exposure than the fellowship year. As for the other fellowships, well don't you think you would rather have a few months of extra training if you plan on doing obstetrics? or geri? It is only one year, and you can surely pick up some walk-in shifts etc so the paycut won't be so bad. Link to comment Share on other sites More sharing options...
moo Posted September 14, 2011 Report Share Posted September 14, 2011 I don't get these fellowships. Take a huge paycut just to get an unrecognized "interest". Screw it. I dunno. Some fellowships are useful, like emerg and if you're rural and going to do some obstetrics or anesthesia. Others, I think, are just a way for family docs to pad their CV and be recognized as a "specialist" in something. Specifically, I'm thinking of sports med, chronic pain, care of elderly and palliative. I attended a geriatrics talk the other day, and the speaker put "Dip COE" behind his name. Took me forever to figure out what that meant lol. Link to comment Share on other sites More sharing options...
Student_Doctor Posted September 15, 2011 Author Report Share Posted September 15, 2011 I dunno. Some fellowships are useful, like emerg and if you're rural and going to do some obstetrics or anesthesia. Others, I think, are just a way for family docs to pad their CV and be recognized as a "specialist" in something. Specifically, I'm thinking of sports med, chronic pain, care of elderly and palliative. I attended a geriatrics talk the other day, and the speaker put "Dip COE" behind his name. Took me forever to figure out what that meant lol. Can't think of anything Dip COE could possibly mean... Also, thanks for the answers everyone! Link to comment Share on other sites More sharing options...
Wachaa Posted September 15, 2011 Report Share Posted September 15, 2011 Care of the Elderly (COE)... Link to comment Share on other sites More sharing options...
Jochi1543 Posted September 15, 2011 Report Share Posted September 15, 2011 My FM preceptor likes palliative care and his practice is weighted a little heavier in that direction. We actually had a lengthy discussion about that today and I asked him why he didn't do the 2+1. His exact words were that he doesn't think it's rocket science. I think if you actually see yourself working at an inpatient palliative care facility at least half the time, then it might be worthwhile. But it seems he felt that in order to do a couple of palliative house calls a week, all you need would be some past elective experience and access to good resources for things like cancer pain management, etc. Link to comment Share on other sites More sharing options...
Erk Posted September 15, 2011 Report Share Posted September 15, 2011 I don't get these fellowships. Take a huge paycut just to get an unrecognized "interest". Screw it. Call me crazy, but I think it is more about the professional development than the couple letters you could tack on your CV. If you don't feel you stand to gain from the fellowship, then there's clearly not that much reason to pursue one. Link to comment Share on other sites More sharing options...
FamilyGuy Posted September 15, 2011 Report Share Posted September 15, 2011 I'm doing a PGY3 in Palliative Care at Queen's University after having completed a family medicine residency at UWO. I chose to do a PGY3 since I have an interest in the field and want to combine palliative care (both inpatient and outpatient) into my future family medicine practice (along with areas like nursing home and home visits). I would in essence be both a specialist in family medicine and be able to take consults for palliative care from fellow family physicians as well as patients in the hospital, depending on the setting in which I am working. Currently, most palliative care fellowships are run as conjoint programs between the Royal College and College of Family Physicians. The future of palliative care training in Canada is changing -- some palliative care consultants say that American board certification is coming to Canada in the next few years. Palliative care training may therefore branch off into two groups: a Royal College stream (2 year fellowship), accessible through internal med, anesthesia, pediatrics, etc.; and a College of Family Physicians stream (1 year fellowship), accessible after completing a residency in family medicine. In the future, having the training may improve your hirability depending on the centre in which you want to work, although right now palliative care is needed across Canada so it isn't as key to have the extra training. It has also been said that if one goes through the current stream (1-year conjoint program) and obtains a Certification of Palliative Medicine (Cert.Pall.Med.), this will be automatically be upgraded to a Diploma of Palliative Medicine (Dip.Pall.Med., which are the letter designations used in the U.S. and elsewhere) once palliative care becomes board-certified in Canada, without having to pay the board fee or sit a board exam. After the change occurs and the two streams exist, paying the board fee and completing the exam will be mandatory. Again, what these letters mean with respect to job prospects / hirability still is yet to be seen. I figured that I'm young and extra training never really hurts, especially down the road, so why not just get it now after finishing PGY2 in family med instead of working as a family doc and then going back to do extra training (which would involve taking time away from patients and likely a huge decrease in salary for the period of training). I had applied to the PGY3 programs in palliative care across Ontario, got into three of them and chose Queen's because of a few factors: -the best integration of community and inpatient palliative care I've seen across Ontario (community and hospital docs have Monday morning rounds where patients in both settings are discussed). The residency itself has very good continuity of care for residents (e.g. follow a patient from home coming into clinic -> admitted to hospital -> transferred to the PCU at St. Mary's) -fewer residents means more 1 on 1 teaching time with consultants, more independence, more hands-on experience -longitudinal palliative medicine clinic throughout the year helps you take on patients as "your own" as you follow them throughout the year -Kingston itself is beautiful, and if you live downtown you don't have to drive anywhere (save $$$ on gas) since grocery/gym/drug store/bank/restaurants/waterfront/trails etc. are at your doorstep. The only disadvantage I can think of for Queen's' program is a lack of exposure to paediatric palliative care. However, I have set up a one-month elective in Ottawa at CHEO to get exposure to this. In any case, in the future, should I encounter paediatric patients requiring palliative care, likely a paediatrician with experience in the area would be involved, but I wanted to get exposure to the field to see how best I can assist the patient and family as a family physician. I hope this helps! I have lots of positive things to say about my fellowship experience so far. Send me a message or reply here if you have additional questions. Link to comment Share on other sites More sharing options...
Student_Doctor Posted September 16, 2011 Author Report Share Posted September 16, 2011 Interesting, thanks FamilyGuy. I guess in the end it depends a little on how much palliative care I envision in the future whether I would want to pursue a fellowship or not. Although I think I would be more inclined to do something like one day a week or a couple afternoons a week at hospice rather than something more intense (ie working at a tertiary palliative center). Link to comment Share on other sites More sharing options...
FamilyGuy Posted September 16, 2011 Report Share Posted September 16, 2011 My advice would be to not completely rule out a fellowship at your stage and keep an open mind. As I said, extra training never hurts you. The skills I'm picking up during my fellowship year are applicable to pain management in general (I'm now MUCH more comfortable with assessing and managing someone's pain and working with different opioids) and symptom management in general (one learns good approaches to nausea, vomiting, constipation, dyspnea, etc.). These skills will be applicable in general family practice, in the hospitalist setting, in the nursing home, for home visits, and for hospice care. Plus, further down the road, if you decide to incorporate more palliative care into your practice, you'll already have the necessary skills and training, and if you apply for a position that requires a certification of some sort, you'll have that too. Link to comment Share on other sites More sharing options...
nephrolithiasis Posted September 18, 2011 Report Share Posted September 18, 2011 I have a few more questions I'm hoping some of you can answer (this thread seems the most appropriate). How many 2 + 1 programs are there? I've only heard of O & G, anesthesia, ER, palliative care, care of elderly and sports medicine. Or can I do a +1 in anything I'm interested in? Is there an advantage to doing a +1 rather than some extra training? Thanks in advance. Link to comment Share on other sites More sharing options...
Lactic Folly Posted September 18, 2011 Report Share Posted September 18, 2011 I've also known people who did a +1 in pediatrics and academic family medicine. Individualized programs are available as well. Not sure what you mean by "some extra training" - the +1 allows you to be paid as a PGY3 during that year. Link to comment Share on other sites More sharing options...
cardiomegaly Posted September 18, 2011 Report Share Posted September 18, 2011 This is a little specific to Alberta, but check out these two websites: U of A Family med: http://www.familymed.med.ualberta.ca/Home/Education/ThirdYear/ U of C Family med: http://www.ucalgary.ca/familymedicine/R3 Category 1 R3 years have nationally standardized curriculum - that includes palliative, anesthesia, care of the elderly and the EM program (EM you have to match through CaRMs) Lots of Category 2 programs are available and flexible for your own design - each school may offer different types of these. Link to comment Share on other sites More sharing options...
FamilyGuy Posted September 18, 2011 Report Share Posted September 18, 2011 Options in Ontario for PGY3 (sometimes known as Enhanced Skills): McMaster University http://fammedmcmaster.ca/postgraduate/enhanced-skills-program-pgy3 NOSM http://www.nosm.ca/education/pgme/general.aspx?id=490 University of Ottawa (this is a PowerPoint file) http://www.familymedicine.uottawa.ca/assets/documents/postgrad/PGY3/PGY-3%20Program%20-%202011-2012%20Academic%20Year%20Version%202.ppt Queen's University http://www.dfmqueens.ca/education/enhanced_skills.php University of Toronto http://www.dfcm.utoronto.ca/prospectivelearners/prosres/pgy3.htm University of Western Ontario http://familymedicineuwo.ca/PGY3programs.aspx As Lactic Folly said, most of these are 12-month programs in which you get treated as a PGY3 resident under PAIRO and get a PGY3 salary. You can also self-design a program at most schools, and if it's 12 months, you get the PGY3 designation and salary. Some people choose to do "extra training" of 3 or 6 months in something self-designed instead of a formal PGY3 program; I don't know how funding works for this. It is best to contact the school in which you are interested for more information. In terms of the application, as Cardiomegaly mentioned, EM is run through CaRMS while the other PGY3 programs are individual applications to the specific schools. Link to comment Share on other sites More sharing options...
FamilyGuy Posted November 16, 2011 Report Share Posted November 16, 2011 As an update, Queen's University residency programs recently went through accreditation. Regarding our Palliative Care Medicine Program (PGY3), the accreditors found no disadvantages whatsoever to our program and went so far as saying that we should be a "model of how palliative care residency programs should run across the country". Just wanted to put that out there for those thinking of applying for one of the PGY3 programs. As always, if you have any questions about the PGY3 in Palliative Medicine, post here or PM me! Link to comment Share on other sites More sharing options...
Renin Posted November 16, 2011 Report Share Posted November 16, 2011 As an update, Queen's University residency programs recently went through accreditation. Regarding our Palliative Care Medicine Program (PGY3), the accreditors found no disadvantages whatsoever to our program and went so far as saying that we should be a "model of how palliative care residency programs should run across the country". Just wanted to put that out there for those thinking of applying for one of the PGY3 programs. As always, if you have any questions about the PGY3 in Palliative Medicine, post here or PM me! Do you think they will ever open up the +1 to anyone? Like if I am a 5-yr psychiatrist, would I be able to do palliative with an additional PGY3 year (ie: year 6)? Link to comment Share on other sites More sharing options...
FamilyGuy Posted November 16, 2011 Report Share Posted November 16, 2011 The +1 is currently a conjoint program. Anyone from the Royal College or College of Family Physicians can apply. I've not heard about someone from psych applying before; that's an interesting combination. We certainly get a lot of people with existential crises, depression and anxiety, so having a psych background would certainly be handy in those instances. For your specific question about doing a PGY6 after psych, perhaps I will direct you to my program director. I'll PM you her email address. Link to comment Share on other sites More sharing options...
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