With demographic pressures pushing end-of-life care toward the front of medical, legal and political agendas, the physicians who provide much of that care in Canada are finally eligible for specialty status.
Dr. Doris Barwich, president of the Canadian Society of Palliative Care Physicians (CSPCP), says palliative medicine now has official recognition as a two-year subspecialty from the Royal College of Physicians and Surgeons of Canada. This in turn will mean broader training opportunities for existing and future physicians who focus on palliative treatment.
Under the Royal College program, internal medicine, anesthesia, neurology and pediatrics will be the base specialties, but doctors from other specialties, including family medicine, will “be allowed access to the subspecialty if they can demonstrate the necessary prerequisite competencies.”
“Establishment of [these] credentials also ensures that Canada joins other Western nations in recognizing the important skill sets of palliative care physicians,” Barwich explained in a December letter to CSPCP members. The society, formed in 1993, has more than 300 members.
Dr. Susan MacDonald, the medical director of palliative care for Eastern Health in St. John’s, said that until now physicians could complete an accredited year of “added competency” in palliative care through either the Royal College or College of Family Physicians of Canada. That training earned a certificate, but did not grant designation as a specialist.
MacDonald said the new two-year training program, which is still under development, will broaden medicine’s ability to meet the needs of an aging society and enhance palliative care training for non-cancer diseases. “This new subspecialty will increase the visibility of palliative medicine and provide a boost when it comes to advocacy issues,” she says.
CMA President Louis Hugo Francescutti, a past president of the Royal College, welcomed the announcement. “Given the way our demographics are heading, this is a timely move,” he said. “In 20 years a quarter of us will be 65 or older, a proportion that is almost twice as high as it is today. We have to get ready for this shift, and expanding our expertise in palliation is another step in that direction.”
He said the CMA also hopes this “is another step toward developing a truly national strategy for dealing with all the issues headed our way” because of Canada’s aging society.
But now that palliative medicine is recognized as a subspecialty, how attractive will it be to physicians?
MacDonald, president-elect of the CSPCP, hopes the specialty designation will help attract new recruits. However, she acknowledges that this will not be an easy task.
“Fields like geriatrics, family medicine and palliative medicine aren’t considered as ‘sexy’ as cardiology and trauma surgery,” she said, adding, only partly in jest: “If only someone like George Clooney would play a palliative care MD in a major movie.”
She says education will have a major role to play in changing attitudes. “I think we will have to work at getting people to understand the joys and tremendous benefits that can be found working in palliative medicine. If we educate and tap into the emotional resonance MDs have toward those who are suffering, we can make some headway.”
And she does think attitudes are changing. “At Memorial University, we changed the entire course from being lecture based to experiential through the use of case studies, films, interviews and large-group discussions of students’ attitudes toward failure, fear and death,” she said. “The students love it — it’s one of the highest marked experiences in second year, and now we are inundated with students doing electives with us. I suppose I subscribe to the theory that you get them while they’re young.”
She thinks most palliative care will be provided by generalists such as FPs and internists. “I don’t try and convince students to become palliative care doctors. I try and get them to realize that whatever field they end up in, they will be palliative care providers.
“And I also tell them that I didn’t choose palliative care — it chose me. I am very satisfied with the result, and go home every night satisfied that I made things better for patients who would otherwise be suffering more had I not seen them. In other words, I’m doing what I love and I see value in it. What more do you want?”