Physician Assistants Pursue Larger Roles in Hospice and Palliative Care

The role of physician assistants (PAs) in hospice and palliative care has been advancing over the past several years and is poised to keep growing, an encouraging step toward expanding access to palliative care for the increasing number of people living with serious illnesses.

Key to that growth has been a change in federal law that took effect in January 2019 authorizing PAs to serve as designated attending medical providers for patients in hospice care. Though some barriers remain that cloud reimbursement, advocacy groups like the National Hospice and Palliative Care Organization (NHPCO) and Physician Assistants in Hospice and Palliative Medicine (PAHPM) are actively exploring solutions.

More recently, the CSU Shiley Institute for Palliative Care launched a palliative care certificate program for PAs – the first of its kind in the country. The online Physician Assistant Certificate in Palliative and Serious Illness Care will welcome its first cohort of students on May 6.

“It’s an exciting time to be working in the field,” said Kathy Kemle, MS, PA, who helps direct the Family Medicine Residency Program at Atrium Health Navicent in Macon, Ga., and will serve as a guest instructor for the Institute’s course.

“To me, all the stars are aligned,” said Kemle, who also serves as President of PAHPM, an education and advocacy group affiliated with the American Academy of Physician Assistants (AAPA), the national professional organization for PAs in the United States.

The 12-week PA certificate course was developed by palliative care experts including Nadya Dimitrov, DPM, PAC, Assistant Director of the PA post-professional master’s program at Stony Brook University in New York, and Executive Director of PAHPM.

Dimitrov said the course is designed for PAs with experience in all medical and surgical specialties.

“A broad spectrum of PAs is already doing this (palliative care),” said Dimitrov. “Now is the time for refining and enhancing what’s already out there. It’s like being at the tip of the wave.”

Philosophy of Patient-Centered Care

In many ways, PAs are a natural fit for providing hospice and palliative care, a whole-person, patient-centered approach to managing the symptoms of serious illness. PA program accreditation standards include required education in palliative and end-of-life care, said Kemle.

“The basic tenets of PA training include excellent skills in communication and patient-centered care, which also means addressing the psychological and spiritual aspects of care, along with public health perspectives,” she said.

“We’re grounded in taking a good history and listening to our patients,” Kemle said. “We translate medicine for our patients.”

The new PA certificate course will build on those skills to prepare and enhance the participation of graduate PAs in all specialties on interdisciplinary teams to deliver high-quality supportive palliative care.

Dimitrov said it will feature online didactic material that students complete on their own schedule, along with weekly 90-minute Zoom sessions led by a guest PA who specializes in palliative care. Those sessions will center on a case scenario developed by a student and presented in an interactive Grand Rounds-style discussion.

Theoretical background, clinical tools, skill building exercises, and interactive support are also included, with coursework covering the domains of hospice and palliative care detailed in the Palliative Care Guidelines of the National Consensus Project for Quality Palliative Care.

PAs who complete the course will earn 72 continuing education hours and a certificate recognizing they’ve acquired specialized knowledge and skills in palliative care, valued by employers including hospice programs.

Successes and Challenges

The PA certificate program is just one example of growing interest in highlighting optimal team practice of PAs. Another is a new Oxford University Press textbook, “Palliative and Serious Illness Patient Management for PAs,” co-edited by Dimitrov and Kemle, that’s set to be released in August 2021.

In mid-2020, AAPA produced an issue brief on PAs in palliative care, highlighting the current landscape, opportunities for growth, and success stories including:

• An inpatient acute palliative care unit at Montefiore Medical Center in the Bronx
• PAs providing palliative medicine and end-of-life care at the Veterans Affairs Medical Centers in Phoenix, AZ, and Fargo, ND
• A variety of community-based services at Four Seasons Compassion for Life in Flat Rock, N.C.

Still, challenges lie ahead. Even if every PA in practice in the U.S. – greater than 185,000, at last count – were to specialize in palliative care, it would still be insufficient to meet the growing need, Kemle says.

And despite the advances of telehealth/telemedicine in palliative care, access problems persist, especially in rural and underserved areas where PAs may be the main medical resource for their community.

Experts say it’s more important than ever that generalist and sub-specialty frontline clinicians, including PAs, are trained to provide primary palliative care to their patients and families living with serious illnesses.

Editor’s note: For more information about palliative care training opportunities for PAs, please contact the CSU Shiley Institute for Palliative Care at palliativecare@csusm.edu or 760-750-4006.