A Fellowship Does Matter

I entered my Palliative Care and Hospice Fellowship in July of 2014, having previously weighed the benefits and burdens of grandfathering in vs. fellowship training. Encouraged by colleagues and my employer I hoped to pursue an experience that would be richer than on the job training and book learning. I did my research before applying to programs. I asked a lot of hard questions to my potential programs. My program director questioned me about what I would want to accomplish since I was already a Hospice Medical Director and had years of physician experience. I laid out my goals and eagerly anticipated the start of my year of learning. Now I am confident that the value of my experience needs to be shared so that other contemplating such a move can be reassured.

I knew it was not going to be easy to move my established life. I resigned from my clinical and administrative positions. I said goodbye to many wonderful coworkers, and patients. I packed my bags and returned to life as a student. My medical career has always been about caring for populations at risk. I embraced the growth that comes from ongoing transitions in my medical career.

I quickly was amazed by the talent of my co-fellows and attendings. As palliative care and hospice providers, we learn amazing skills and invaluable tools for patients in need of care and compassion. Now I realize that I am past the eleven months mark and the time has flown. The experience of my fellowship year has far exceeded my expectations.

I now know how to manage patients and families who appear at the doorsteps of a busy inpatient unit in the worst of situations. I understand the dynamics of highly trained interdisciplinary teams when providing for the physical and emotional needs of patients with advanced suffering. I have learned to palliate the terrible suffering in bodies that cease to sustain themselves. I can feel the deep gratitude as families leave us through the same entrance that greeted them only hours or days earlier.

I have worked in multiple palliative care settings, from solo physicians to full interdisciplinary teams. I have gathered the wisdom of the physicians and other team members to maximize communication across the many levels of human despair. I have gained wisdom from hearing and contrasting multiple attendings’ approaches on symptom management. I know about triaging scarce team resources, the dance of consultant etiquette, and the need to enhance the primary physician’s relationship with the patient.

We care for more than just the patients and their families. We serve and care for the entire range of hospital staff: from medical students to attendings, from CNAs to directors of nursing. We support and coach the new social workers trying to grasp the nuances of hospice placement. We continue to define our role and our skills within hospital systems that barely have time to breathe and reflect. We respect and serve our patients and their families. We advance the science of palliative medicine as we gather data that shows our value to administrators eager to improve quality, satisfaction, and cost savings. All in all, we do great work.

I have grown personally and professionally in ways I never imagined. The need to be in a fellowship is reinforced every day. The year of intense experience is balanced by the beautiful and unwavering support of the attending faculty. The confusion of new places and new rotations is organized and simplified by amazing support staff. When we feel lost, we are given a path and encouragement. When we stress, we are given support and relief. When we look to the future, we are prepared for change and reminded that our mentors are always there for us.

This experience has transformed my initial goals, allowing me to envision the future of palliative care. I see myself able to work in all of the settings of hospice and palliative care. In our developing specialty I see myself returning not only to clinical work but also to a position of leadership and advocacy. I see a great opportunity for supporting teams during the explosion of need for palliative care across the continuum of health care. I hear the warnings about burnout in hospice teams and palliative care teams that need to stay strong now more than ever. I see the need for networking and support among our professions at all levels.

My program is supporting me in my quest to learn about business strategies for hospice and palliative programs. I am actively connecting with our national and international organizations. This amazing fellowship has given me and my co-fellows an environment, a model, and a vision of how to care for patients, families, coworkers, healthcare teams, and ourselves. I am excited because I now see vast opportunities in my life. I look forward to working with hospital systems and healthcare systems as our profession carries forward the recommendations from the Institute of Medicine’s recent report on Dying in America. It is clear to me that this transformation and world of opportunities would have been missed if I simply grandfathered in to board certification. I will forever be thankful that I chose this fellowship experience.

Whit Dunkle, MD, ABFP
Medstar Washington Hospital Center/Capital Caring Fellowship

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