One of my preceptor's did hospice and she did not do a fellowship as far as I know. She worked in rural FP for 10 years, then moved to the city to do palliative care/medical director work for a nursing home for 10 years. She liked the nursing home gig because she was salaried and could spend as much time as needed with patients. Now she has been slitting some of her time in academics because she likes to teach.
For what it's worth, I have a friend who did rotations in a geriatric psych unit in a nursing home. He says that medical directors of these facilities can become shunned from the medical community for getting in over their head with too many pt's to care for and sending the surplus to the ER. He also said that some doctors view the medical directors and "going into it for the money" because it is not uncommon for them to make over 200K or even as much as 300K+ depending on their facility size. Ultimately some of these directors end up having more of an administrator than physician role. I have not heard this from an actual physician, so take it for what it's worth.
I think it would be a pretty good gig. I have been considering it since I enjoyed my hospice volunteer days from undergrad and my father-in-law has been accumulating/building several assisted living facilities.
Anyone else have anything to say about this route?