Severe shortage of palliative care clinicians looms, researchers say

A shortage of specialty palliative care clinicians is imminent and won't recover until 2045 without action from Congress, according to a study published in Health Affairs.

The study — led by Arif Kamal, MD, an associate professor of medicine at Duke Cancer Institute in Durham, N.C. — surveyed more than 2,000 specialty hospice and palliative care clinicians in 2018, and then projected physician clinicians from 2019–59, using data from the American Board of Medical Specialties and the American Osteopathic Association to the American Academy of Hospice and Palliative Medicine.  

Researchers found that about one-third of physicians, nurses, social workers and other survey respondents reported burnout, and nearly half of the 826 physician respondents were age 56 or older. Respondents who reported burnout were 1.4 times more likely to leave the field early compared to those who didn't.

These findings indicate significant challenges to retaining the specialty palliative care workforce, as well as a projected rise in retirements in the next decade, the researchers said.

In 2019, 7,618 physicians were board-certified in hospice and palliative medicine. But the researchers projected the number of physicians would slowly decline to 6,660 in 2033 and won't recover to the 2019 level without policy change.

"Our modeling revealed an impending 'workforce valley,' with declining physician numbers that will not recover to the current level until 2045, absent policy change. However, sustained growth in the number of fellowship positions over 10 years could reverse the worsening workforce shortage," Dr. Kamal and the other researchers concluded.

"There is an immediate need for policies that support high-value, team-based palliative care through expansion in all segments of the specialty palliative care workforce, combined with payment reform to encourage the deployment of sustainable teams," they added.

The researchers recommended passage of the Palliative Care and Hospice Education and Training Act, which was reintroduced in Congress earlier this year. They also recommended more research into the workforce capacity and growth of nonphysician palliative care specialist clinicians.


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