The American Board of Medical Specialties (ABMS) has recently approved the establishment of an ABMS recognized certification in Hospice and Palliative Medicine. Previously radiation oncologists, oncologists, internists, anesthesiologists and other specialists may have been involved in the American Board of Hospice and Palliative Medicine (www.abhpm.org), which has worked for over 10 years in promoting excellence in the delivery of medical care for advanced progressive illnesses and developing standards for training and practice in palliative medicine. This board will no longer be providing certification examinations, as the transition to the official ABMS certification begins.

The official ABMS certification in Hospice and Palliative Medicine will be administered through the American Board of Internal Medicine. Recognizing that a wide range of specialists will be involved in this discipline, 10 boards of the ABMS, including the American Board of Radiology, are co-sponsors of this new ABMS recognized discipline. Other cosponsoring boards include the American Board of Anesthesiology, The American Board of Emergency Medicine, The American Board of Family Medicine, the American Board of Pediatrics, the American Board of Physical Medicine and Rehabilitation, The American Board of Psychiatry and Neurology, and the American Board of Surgery.

Although the program will primarily be administered through the American Board of Internal Medicine, diplomates of any of the co-sponsoring boards are eligible to obtain certification, if they meet essential eligibility requirements and pass a certifying examination. During a 5-year grandfathering period, those interested who meet specified eligibility criteria will be able to obtain certification by applying to their respective primary board (ABR) and taking a certifying examination (written exam only). During this five-year grandfathering period, additional formal training will not be required. Currently, in addition to certification by the respective board (ABR certification) and an unrestricted state license to practice medicine, it is expected that the candidate should have at least two years of subspecialty level practice of hospice and palliative medicine (averaging at least 20% of the applicant’s time), including at least 2 years and 100 hours of participation with a hospice or palliative care team and active care of at least 50 terminally ill patients.

For those interested in this certification, registration and application will be available through the American Board of Radiology early in 2008, for the first examination currently scheduled for October 29, 2008. Specific details for registration and examination will be provided early in 2008.

The following definition has been developed by the prior board of hospice and palliative medicine and adopted by the sponsoring boards:

An ____(internist, family medicine practitioner, etc) with special knowledge and skills to prevent and relieve the suffering experienced by patients with life-limiting illnesses. This specialist works with an interdisciplinary hospice or palliative care team to maximize quality of life while addressing physical, psychological, social and spiritual needs of both patient and family throughout the course of the disease, through the dying process, and beyond for the family. This specialist has expertise in the assessment of patients with advanced disease; the relief of distressing symptoms; the coordination of interdisciplinary patient and family-centered care in diverse venues; the use of specialized care systems including hospice; the management of the imminently dying patient; and legal and ethical decision making in end-of-life care.

If you are practicing in this area of hospice and palliative care and are ABR certified, you will be eligible to apply for the ABMS certification in Hospice and Palliative Care. The application will be made available through the American Board of Radiology in early 2008, with the first exam offered October 29, 2008. The examination for all candidates, regardless of their primary specialty will be the same, but will be administered through the American Board of Internal Medicine at multiple locations yet to be determined. There is radiation oncology representation on the examination writing committee.

Are all Board Certified Radiation Oncologists Eligible?

As an ABR certified radiation oncologist you meet the basic eligibility requirements. However, as a subspecialist, it is anticipated that you will be spending a significant portion of time dedicated to Hospice and Palliative Care. The current guidelines state that during this grandfathering period, the candidate should demonstrate at least two years of subspecialty level practice in hospice and palliative medicine (averaging at least 20% of the applicant's time), including at least 2 years and 100 hours of participation with a hospice or palliative care team and active care of at least 50 terminally ill patients.

Do I need to take the examination to get certified?

Yes. You will need to take the examination that will be administered through the ABIM. However, the first examination will not be offered until October 2008. Application materials and registration will be available through the ABR early in 2008.

How long will the grandfathering period be open?

Currently the grandfathering period will be open for 5 years (through approximately 2011). During this time ABR certified diplomates may apply for certification without additional training, but must meet the basic eligibility criteria outlined above, and pass the certifying examination.

Who will issue the certification?

The primary specialty board of the candidate will issue the subspecialty certificate in Hospice and Palliative Medicine. In the case of radiation oncologists, diagnostic radiologists and general radiologists the ABR will issue the certificate after obtaining the examination results from the ABIM.

What happens after the grandfathering period?

Following the grandfathering phase, which is set for the next 5 years, candidates will need to do an approved year of training in an ACGME training program in Hospice and Palliative Care following their primary certification in their respective specialty. Radiation oncologists, diagnostic radiologists, and general radiologists in addition to specialists from any of the co-sponsoring boards listed above, will be eligible to apply for these training fellowships.

What will the fee for certification be?

The fee has not yet been worked out. The fee will primarily reflect the cost of the written examination. It is anticipated that a proportion of the examination costs being incurred by the ABIM will be passed on to the ABR for diplomates taking the examination and that the ABR will then pass these costs on to the candidate. These details will be worked out over the next year.

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