Surgeons’ perspectives on facilitators and barriers to fellowship training in hospice and palliative medicine (575)

Abstract

<b>Objectives:</b> While there is a national shortage of Hospice and Palliative Medicine Providers (HPM), surgeons comprise only 2% of the HPM workforce. The current study sought to explore facilitators and barriers to HPM fellowship training from the perspective of surgeons with training in HPM and a surgical specialty. <b>Methods:</b> We conducted a qualitative study utilizing semi-structured interviews with HPM fellowship-trained surgeons. Data were recorded, transcribed, and coded. Descriptive statistics were used to summarize demographic data, and thematic analysis was used to identify themes in participant responses. <b>Results:</b> There were 17 participants, including general surgeons (<i>n</i>=5), surgical specialists (<i>n</i>=5), general obstetrician/gynecologists (<i>n</i>=3), and obstetrics/gynecology specialists (<i>n</i>=4). All participants described having pivotal experiences that highlighted deficits in patient care, their clinical skillset, and/or their personal or professional development. Participants or their mentors recognized that practicing through a palliative care lens aligned with the participant's personal and professional identity and could fill self-identified deficits in their skillsets. These pivotal experiences and the participants' internal alignment with the HPM practice ultimately drove their decision to pursue an HPM fellowship. Many participants experienced bias when considering HPM, which was either internal bias and doubt or external bias or discouragement that they experienced during conversations with their mentors, faculty, and peers. Additionally, many participants had to overcome logistical barriers to pursue an HPM fellowship, including financial concerns, moving with spouses/families, coordinating an additional surgical fellowship, and navigating an uncertain job market post-fellowship. Ultimately, all participants found solutions to these barriers (JB1) and felt satisfied with their decision to pursue HPM training. <b>Conclusions:</b> Our participants emphasized the importance of mentorship and exposure to HPM as key facilitators to pursuing HPM training. While many participants had to navigate bias and logistical barriers, they felt HPM fellowship was feasible for surgeons and ultimately led to more satisfying careers in their current practice. Highlighting the experiences of HPM-trained surgeons who have navigated this underrepresented career path may empower other surgeons to consider HPM fellowship training and expand surgeon representation in the HPM workforce. HPM and surgical specialty organizations should work to mitigate the cultural and structural barriers to HPM surgical training identified by our participants to facilitate the growth of this critical healthcare resource, the HPM trained surgeon. This will add value to surgical and HPM care for patients, improve primary and specialty palliative care education in surgery and HPM, and foster HPM-oriented research within the surgical specialties while simultaneously addressing a critical HPM workforce shortage.