Family physicians are filling the gap in providing palliative care to an aging population that continues to grow, according to a recent study.
Researchers at the Robert Graham Center for Policy Studies in Family Medicine and Primary Care analyzed survey data to identify the number and demographic characteristics of selected family physicians who offer palliative care. Of the 10,894 diplomates of the American Board of Family Medicine (ABFM) who recertified in 2013 and, thus, answered the 2013 ABFM Maintenance of Certification Demographic Survey, 33 percent said they provide palliative care.
The study(www.jabfm.org) was published in the March/April issue of the Journal of the American Board of Family Medicine.
Stark demographic differences were noted between those who do and do not provide this type of care, with researchers finding that physicians who provide palliative care are more likely to be white, male and practicing in a medical home, and to have been in practice longer than 20 years. Geographic trends also varied widely. Family physicians offering palliative care are more than twice as likely to be located in a rural area and are most likely to practice in the West.
Physicians who are certified in hospice care and palliative medicine were excluded from the study analysis so the focus would be solely on generalist family physicians.
"In rural areas, there is no one else to do palliative care, so for family physicians, it has to be part of their practice where they see their role as continuing from cradle to grave," Claire Ankuda, M.D., M.P.H., a former Graham Center fellow and a co-author of the study, told AAFP News.
Researchers also reviewed data regarding the site of care. Among all family physicians who report that they provide palliative care, 30 percent see patients in a nursing home, 45 percent in a patient's home and 17 percent in a hospice facility.
The need for palliative care will continue to grow, given that the elderly population is expected to increase from 46 million in 2015 to 69 million in 2030.
"We need all family physicians to provide palliative care because there will never be enough palliative care specialists to fill that role," Ankuda said.
Although medical schools are beginning to better address palliative care, the curriculum has not kept pace with demand, and physicians are not required to obtain training for symptom management.
"Medical schools are doing a better job than in the past, when it was barely covered," Ankuda said. "We spend weeks studying the Krebs cycle in biochemistry, but I have not thought about that once since I graduated. There is a great need for training in palliative care after graduation or residency."
Although younger physicians may acquire training in palliative care earlier, it is older physicians who are more likely to be providing it. Ankuda said this divergence might be the result of patients aging along with older physicians.
Besides limited training, Ankuda said the other major barrier to wider provision of palliative care is payment, which is still too low and restrictive. But because palliative care plays an important role in keeping people out of the hospital, physicians in medical homes who are paid based on improved health outcomes are able to manage that population more effectively.
"Having conversations and addressing symptoms takes time, sometimes over a period of months or years," Ankuda said. "As long as physicians are paid based on RVUs (relative value units) and there is pressure to see patients by volume, they won't be able to do that as well."
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