What to look for?

[JeremiahJohnson]

Hey folks, recently decided to pursue HPM - but what should I be looking for in a program, what makes a *good* HPM program? Or is it something that really isn't distinguished much between programs and I should just focus on geography >>

Thank you! <3

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[WilcoWorld]

It depends on your goals.

If you want to pursue a career in academics, then you'll be better suited to train somewhere that produces academicians.
If you are wedded to a specific geographic area after graduation, then training in that area will help you by availing you to a network of connections.

On the other hand, if what you want is to become boarded in HPM so that you can practice good HPM, I think it's going to be mostly about "fit", which is an admittedly ambiguous term. I do think a good mix of clinical experience is important - you want to treat not just patients with advanced cancer, but also heart failure, stroke, dementia, COPD, etc. So asking about case mix is worthwhile. But if I had only 2 questions to ask of a program, they would be:
1 - What are your recent fellows doing now?
2 - To the current fellows, are you happy?

 

[throway134]

Hey folks, recently decided to pursue HPM - but what should I be looking for in a program, what makes a *good* HPM program? Or is it something that really isn't distinguished much between programs and I should just focus on geography >>

Thank you! <3

Wilco gave an excellent response.

Especially If you’re already an attending I would also ask the fellows about how much autonomy they get. I practiced a few years before returning for fellowship, and fortunately went to a program where I was allowed a lot of leeway (within safe margins on drugs I wasn’t familiar with like methadone).

I heard of some programs where they were basically having fellows shadow goals of care discussions until 2-3 months in, and I would likely have responded extremely poorly to this.

Case mix can vary a lot, especially in the clinics depending on whether you have a dedicated cancer/chf/liver clinic or whatever attached to the mother ship. Our cancer center had a dedicated np so we probably got less of most oncology outpatient than I would have liked if I were going to do outpt, which I fortunately had no interest in.

3 other things with a lot of variation:
1. How strong is the hospice exposure and what kind of exposure is it
2. Is there a dedicated palliative unit where you are primary? This tends to be a good place to learn more symptom/gip hospice management
3. What is palliative usually consulted for in their hospital (e.g. pain vs goc). In some hospitals you will be all goc, in others like where I trained you kind of get turned into an acute pain service. Was good for training but would be miserable for attending life