palliative care without fellowship

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nexus73

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Can psychiatrists do palliative care without fellowship? Does residency training cover the typical work like this. or is it reasonably learnable on the job? Seems like several local hospice jobs have been filled by family med or IM docs without palliative board cert.

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You can certainly do psychiatry for hospice etc without a fellowship but it is highly unlikely anyone would hire a psychiatrist without additional training to do general palliative care and I think most psychiatrists would be quite rusty with doing physical exams and managing other medical problems etc. Though in the past you certainly could learn this under supervision without fellowship (one of the attendings at my residency program attended on the palliative care service and didnt have a fellowship in it but those days are probably over). A lot of these jobs are about supervising NPs as well. From what I understand, palliative care jobs are becoming more competitive and there is an increasingly strong preference/requirement for palliative care trained/boarded physicians in many areas of the country. There is also the question of what your malpractice will cover (mine wouldn't cover this).
 
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I have no idea if you could get hired for this but I know even coming from CL with probably the most overlap with palliative in terms of psych subspecialties, I would in no way feel prepared to take a palliative care job. I know the basics, and am def better at basic palliative work than your average surgeon/hospitalist/etc given the skill (listen to the patient!) and philosophy overlaps but the training and experience is wildly different. They know much more about pain meds and other physical symptom management than we do.
 
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Can psychiatrists do palliative care without fellowship? Does residency training cover the typical work like this. or is it reasonably learnable on the job? Seems like several local hospice jobs have been filled by family med or IM docs without palliative board cert.
I don't think so since a big part of their job includes recommendations on titration of pain medications and such. I think that psychiatrists can really contribute to these situations in a CL capacity but unless its a really large hospital the volume of work is probably too unpredictable. I did know psych NP's that were integrated into palliative care teams and would spend days on individual cases but if you are relying on billing its not a super sustainable model. The work is important but also super draining and lots of risk issues can come up which increases the amount of time spent.
 
I have no idea if you could get hired for this but I know even coming from CL with probably the most overlap with palliative in terms of psych subspecialties, I would in no way feel prepared to take a palliative care job. I know the basics, and am def better at basic palliative work than your average surgeon/hospitalist/etc given the skill (listen to the patient!) and philosophy overlaps but the training and experience is wildly different. They know much more about pain meds and other physical symptom management than we do.
Agree with this, I do think that a psychiatrist who has trained in a pain fellowship with a strong C/L background could potentially do this, but even then there are aspects of the medical care that would be better addressed by other physicians.
 
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There are at least a few politically minded hospices that want patients to die even if there is no terminal disease. They just pump them with Haldol, let the patient get so dehydrated after they are sedated that they die. That kind of "skill" doesn't require a fellowship. The difficulty is 1. do you want to practice (or malpractice) this kind of medicine and 2. can you identify those types of hospices.
 
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